Child patients with complicated congenital heart disease saved

Thursday, 2017-06-15 04:55:23
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Truong Ngoc Linh C., a child patient who received successful heart disease surgery, was discharged from hospital on June 14.
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NDO – Born prematurely at 37 weeks, weighing only 1.7 kg and having a rare combination of congenital heart diseases, infant Nguyen Trong P. has been saved by doctors at the Children's Cardiology Centre (under the Vietnam National Hospital of Pediatrics).

P.’s mother, Nguyen Thi Th. got pregnant at the age of 40 after two miscarriages, however, right from the fetal stage the child was malnourished, which led to P. being born with a combination of five complex heart defects.

Immediately after C-section, P. only had an oxygen saturation level at 15-20% (normally at 90-95%) and went into cardiac shock. The mortality rate was up to 80-90%. P. was immediately transmitted to the centre for mechanical ventilation. Despite being actively resuscitated, P.’s condition remained critical, with oxygen saturation levels only up to 25%.

Dr. Nguyen Ly Thinh Truong, the centre’s deputy director, said that the centre had successfully operated on nearly 400 cases of congenital heart diseases but P. was the youngest, most lightweight infant, with the combination of five cardiac defects, making it extremely difficult for doctors to make the decision for treatment.

Identifying the case as one of the most complicated ever performed at the center, doctors decided to operate on two aortic and pulmonary arteries; to try to release all blockages on the ventricle escape path by removing the entire organism blocking the left ventricular outflow. At the same time, the septum was enlarged and the pulmonary artery was tightened temporarily to limit the risk of heart failure, ensuring adequate blood supply to the baby's body and avoiding pulmonary edema and postoperative heart failure.

"The hardest thing in this surgery is to get the coronary artery in its correct position. We have to magnify four times than normal to carry out the surgery. At the same time, we must calculate how to turn the coronary artery at 180 degrees, without twisting its roots," said Dr. Truong.

After ten hours on the operating table, P.’s condition was relatively stable and P. was transferred to the resuscitation phase. The operation took place a week ago, and within two days, P. was extubated. Now the patient is able to breathe and eat in small quantities.

Dr. Truong continued, sharing his account of another successful surgery on Truong Ngoc Linh C. (born on May 31, 2017), an infant with complicated congenital heart disease with a large ventricular septal defect and pulmonary artery atrophy. L. was promptly treated and was discharged from hospital yesterday.

Dr. Nguyen Ly Thinh Truong, deputy director of the Children's Cardiology Centre under the Vietnam National Hospital of Pediatrics, shares his account of the two successful surgeries at his centre.

C. was hospitalised at 20 days old, weighing just 2.2kg, with life-threatening conditions, having no pulmonary arteries and the ductus arteriosus were diminished which could lead to sudden death at any time.

Doctors had to use arterial duct retention medicine and increase blood flow to the lung to make oxygen saturation levels high enough to maintain C.’s health and try to nourish the child so that the patient would gain enough weight for surgery (normally from 3-6 months).

When C. was over a month old, despite weighing just 3.2 kg, the lack of oxygen gradually became severe. With no choice, doctors decided to undergo the surgery to repair all of the cardiac injuries in a single operation, as in Vietnam there is currently no small diameter (3mm) tube available to connect blood vessels, which can extend the waiting time for full repaired surgery when the patient’s weight is higher.

After seven hours of continuous operation, Dr. Truong said that as the patient’s tissues were still easily broken during surgery, doctors had to carefully open the right ventricle to put in the small tube and connect the blood vessels from the right ventricle to pulmonary artery. After the surgery, the baby's heart is basically functioning normally and can develop normally.

However, two days after the surgery, the baby developed pulmonary edema and blood spilled into the breathing passages. Every survival indicator dropped very quickly; oxygen saturation lowered, blood pressure dropped and the lungs almost did not operate. Doctors decided to use the extracorporeal membrane oxygenation (ECMO) method to support both of C.’s heart and lung.

C. luckily survived and on the third day after the operation, the lung of the child has improved. On the seventh day after the surgery, the lung had recovered completely and the heart was functioning as normal, so the doctor decided to withdraw ECMO. Echocardiographic findings suggested that cardiac function was relatively good. However, in the long run, the baby will need surgery to replace the pulmonary artery, to use artificial materials suitable for C.’s development.

“Fixing all the damage in the heart of a baby less than a month old is a very stressful strategy for us. However, compared to other large heart centres in the world such as the Republic of Korea, Japan or the US, our strategy in managing this case is quite similar and has been successfully applied," Dr. Truong said.

Over the past few years, Truong’s center has successfully operated on many complex heart diseases with multiple congenital heart injuries. The last two cases again confirm the professionalism, ethics and whole-hearted manner of the doctors at the centre.

Incidents of congenital heart disease in Vietnam currently stand at around 0.8-1% among newborns, of which, 1-2% with repositioned artery root.

This disease can be screened from within the fetus. However, not all doctors can detect the defects, even in countries with advanced medicine. If there are no other lesions, the detection of repositioned artery root is very difficult, added Dr. Truong.

He recommended that in the first month of baby’s life, parents should observe if their child has any abnormal signals or rapid breathing (even when there is no breastfeeding or physical activity) and sweating a lot, and if so, they need to take the child to medical facilities for heart screening. Children’s weight gain slowing down after two or three months or no weight gain at all can also be a sign of heart failure.