Super Specialists in the cardiac sciences department at Narayana Multispeciality Hospital, Jaipur successfully diagnosed and treated a ‘two day’ old newborn born with Coarctation of Aorta (CoA). CoA is a critical cardiac defect in which a portion of the aorta (main blood vessel supplying oxygen-rich blood to the body) is very narrow, and blocks blood flow to the lower half of the body. In this case, the aorta was severely constricted, needing immediate corrective surgery otherwise the newborn would not have survived.
The congenital anomaly came to light when the newborn’s mother underwent a routine foetal echo during her pregnancy. Results of the echo suspected Coarctation of Aorta (CoA) in the foetus (unborn child). Being a high-risk pregnancy, the parents were counseled to plan the delivery of the baby at a tertiary center having a full-fledged cardiac program as well as having the capability to manage the high-risk pregnancy. It was important that the hospital should have neonatal cardiac surgeons, neonatologists, pediatric cardiologists, gynecologists and cardiac anesthetists & intensivists. The parents-to-be came to Narayana Multispeciality Hospital, Jaipur where under the close monitoring of Dr. Richa Choudhary, Consultant – Obstetrics & Gynecology & actively supported by a team of multi-disciplinary experts, the delivery was successful.
The newborn weighing 2.7 kgs was kept under close observation in the hospital’s Neonatal ICU, and an ECHO was done within 24 hours of birth to check all vitals. The ECHO diagnosed and confirmed Co-arctation of Aorta with associated PDA. The narrowing of the Aorta was blocking blood flow to the lower half of the body resulting in deficient blood supply to vital organs such as liver, kidneys etc.
At birth, the lower half of the body also gets blood through an additional source known as ductus arteriosus, which naturally closes within a few minutes after birth. Under the guidance of Dr. Prashant Mahawar, Consultant – Pediatric Cardiology, special drugs were administered which helped keep the ductus arteriosus open to maintain the blood supply, which is a mandatory step to keep the newborn alive until surgery is performed. Within 48 hours post-delivery, a team of doctors headed by Dr. CP Srivastava, HOD & Chief Consultant – Cardiac Surgery and Dr. Pradeep Goyal, HOD & Sr. Consultant – Anesthesia & Critical Care operated upon the newborn. The narrowed portion of the aorta was surgically removed, and the aorta was re-constructed to allow blood to flow normally through it.
Incidentally, the mother had undergone corrective heart surgery for Tetralogy of Fallot, 14 years back by Dr. CP Srivastava when he was in SMS Hospital, Jaipur.
“Operating newborns with congenital heart defects are challenging as the size of a baby’s heart is very small and there are risks involved like internal bleeding during or post-surgery, breathing problems etc. Post-operative management of a newborn is also very critical since all the organs, especially lungs, are in the initial developing stage and require skilled critical care doctors for management” said Dr. CP Srivastava. Commenting on the complexity of the surgery Dr. Pradeep Goyal said “ The real challenge was the age and size of the newborn wherein any intervention would require manipulation in very tiny vessels”
Commenting on the surgery Mr. Karthik Ramakrishnan, Facility Director at Narayana Multispeciality Hospital, Jaipur said, “While Narayana Multispecialty Hospital performs more than 40 pediatric cardiac surgeries in a month, successfully operating on a two-day-old neonate requires special expertise and skills and is made possible only by our extensive experience in operating on high risk cardiac patients. Our infrastructure & team is well equipped to handle such high-risk cases and we are happy we could make a difference to the baby and the parents.”