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Past events at MIOT

Ten years ago when we started MIOT Hospital, the dream that we would one day have high precision multi speciality hospital was always there and it is wonderful today to realise that dreams do come true – larger than life, all in a span of ten years.

Our profile today is all over the world – people from different parts of the world come with faith and hope of getting well and walking out of our portals with well being and cheer and keep visiting more often thereafter as friends which is our joy.

MIOT Centre for Children’s Cardiac Care

In March 2007 we decided, with our special team headed by Dr. Robert Coelho, and for interventional cardiology headed by Dr. K. Sivakumar to start an exclusive department for children – The MIOT Centre for Children’s Cardiac Care, the first of its kind in the south with an exclusive theatre for paediatric cardiac surgeries, an ICU with state of art facilities. The need to start an exclusive unit for paediatric cardiac care seemed our priority as we realised through census reports that were more than 2 million children affected by heart disease in India alone.

Path breaking procedures in Paediatric Cardiology in MIOT Hospitals

MIOT Centre of Children’s Cardiac Care has successfully completed more than 1000 surgical and catheter based interventions. The department celebrated the Children’s day with all the children operated at MIOT Hospitals in this period on 13th November 2009.

Congenital heart defects

Congenital heart defects refer to birth defects in the heart, affect around 0.8% of the babies born universally. They range from simple lesions like valvar narrowing, narrowing of blood vessels, and shunts across the septum separating the right and left sided chambers of the heart. Some of the lesions are too complex like blue baby syndromes; hypoplastic left heart syndromes, and other univentricular situations. The prognosis of most of these illnesses have markedly improved in the recent years due to advances in the technology, expertise, understanding of the human physiology in these small infants. Conditions which were considered inoperable about 10-15 years ago have found solutions to palliate these children who suffer from the ravages of these deadly diseases.

Hybrid procedures for treating congenital heart diseases at MIOT

MIOT Hospitals was the first to introduce the concept of hybrid interventions in paediatric cardiology on a regular basis in many complex cardiac anatomies in India. Hybrid procedures may be defined as a combined intervention partially done surgically through open surgical techniques and partially completed by catheter based interventions in the catheterisation laboratory or in operating suites. Surgical techniques have the advantages of being applicable even in the smallest of the babies, weighing as low as even under 2 kg. It also gives excellent visibility to the cardiac external structures. Catheter interventions done on the birth defects in heart have the merits of being less invasive and avoid connecting the heart to extracorporeal circulation through heart lung machine. When the heart lung machine utilisation is avoided in the smallest and sickest of these babies, the recovery of the patients after cardiac surgery is very quick and most infants can come out of the mechanical ventilation in less than 1 day and be out of the intensive care unit in 2-3 days. These babies are also protected from infections and other problems since the procedures are completed swiftly in short operating times.

Infrastructure at MIOT Hospitals for treating congenital heart diseases

The infrastructure needed for accurate performance of these hybrid interventions is extremely crucial for the success of these procedures. These interventions combine various imaging tools. A cardiac catheterisation laboratory with sterile environment provided by laminar airflow, a broad table to aid performance of all surgical procedures, flat panel sensor with image retrieval software are very important to get accurate visualisation of the small arteries and veins in the hearts of infants. The procedures also need heavy backup support from other imaging tools like high resolution 2 dimensional and 4 dimensional echocardiography, and images obtained from the food pipes through transesophageal studies. The cardiac operating suites should be provided with facilities for acquisition of fluoroscopic images and should have adequate space for accommodating all the imaging tools.

Types of Hybrid Procedure

Hybrid procedures are classified into two types. Procedures that are done concomitantly together by surgeon and paediatric interventional cardiologists on the same sitting include perventricular device closures, intraoperative stenting, and hybrid management of hypoplastic left heart syndromes. There are a group of another set of procedures that are done sequentially by the paediatric interventional cardiologist in cardiac cath lab followed by the surgeon in operating room within few hours to days. This includes arch vessel stenting prior to corrective intracardiac surgeries, atrial septal stenting prior to pulmonary artery banding procedures or univentricular repairs, ductal stenting to retrain ventricles before arterial switch operations for blue baby syndromes. These procedures require close cooperation and synchrony between the interventional cardiologist and cardiac surgeon, discussions and coordination among all team members including intensivists and anesthetists. When performed on appropriate situations, they offer solutions to various types of cardiac illnesses that may be condemned inoperable.

MIOT centre of Children’s cardiac care started more than two years ago, had a prime motive of putting patients first, in providing the best of these above said imaging and operating room infrastructure for all the needy people, of either ends of the socio-economic spectrum. It caters for many foreigners coming to India for medical tourism as well as a large number of economically impoverished infants and children referred from the various government rural hospitals with the same high standards of infrastructure and equipments. This has aided in very high success rates and performance of certain unique procedures for the first time in the country. The MIOT centre also takes pride in having the best manpower who are principally motivated to team effort in bringing the best solutions for various cardiac problems considered to be unsuited for correction.

Picture of hybrid intervention

This baby is born with aortic atresia, where there is no blood supply to the entire body and may prove fatal if untreated in the first few hours of life. In a hybrid intervention, after opening the sternum, through a small pinhole through the blood vessel, shown with an arrow, a large stent is placed in the ductus to maintain the blood supply for the entire body.

Another picture of hybrid intervention: A large apical muscular ventricular septal defect, hole measuring around 14 mm in a 2 kg baby treated by a large occluder device inserted through a small pinhole (shown in arrow) through the right ventricle of heart.

The MIOT Centre for Children’s Cardiac Care has completed over 1000 successful heart surgeries out of which 630 open heart surgeries and 480 interventional surgeries. Of these around 200 are children from abroad.

Working with the government

Working with the government on the scheme, “Illam Seerar Iruthaya Pathukappu Thittam” has been a great eye opener for us to realise how government and private or corporate enterprises can come together and coordinate to reach out towards community well being and a better quality of life for the people, at the same time creating development and awareness. We are one of the largest participants having taken up over 200 surgeries under the scheme in the last two years.

The Tamil Nadu Governments unique program for children has indeed been a great boon to many families and we are happy we could be a part of having worked with the government and the children of the state.

CHIME

A special trust called CHIME started in September 2007 in the same year to aid children with heart disease. CHIME has come to the aid of around 300 children in these two years – aided fully most often and sometimes partially to overcome the cost of complex surgeries.

Valarmathi from Kanchipuram who came with severe heart failure because of a leaking mitral valve, afflicted with rheumatic heart disease was in need of an urgent surgery. Her valve was repaired instead of replacement. She is one of the children who participated in our program today.

Sivarangan was another critical case with two valves affected who dropped out of school because of his health, underwent correction and now back in school. He is one of the participants, very enthusiastic to participate at the children’s day function at MIOT Hospital.

Anbarasan who was born a blue baby, had a serious condition called pulmonary atrasia, where the heart defect is combined with the abnormalities of lung arteries. He underwent a series of repair surgeries and leading a normal life today.

10 year old Stephen Gitao from Kenya had a rare variant of a complex condition called anomalous pulmonary venus connection (APVC) – who underwent a complicated repair.

In the last year MIOT Centre for Children’s Cardiac Care and CHIME have also forged ahead with camps in districts to identify children requiring heart surgeries and also creating awareness among people for the need for early detection, treatment.

As we had done last year, so also this year MIOT Hospitals conducted a free consultation camp for children from November 16 to November 21 at our Hospital. More than 100 children’s were screened and benefited during this free consultation camp.