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First Time in the World - Fourth Time Operation for Leaking Thoracic Aortic Aneurysm (after failure of two stenting operations) - Bursting into the Lung in a 5 Year Old Child - Press Meet - 30 September 2011.
A 5-year-old girl from Bangladesh was referred to us from another hospital with history of coughing out large amount of blood and she was advised emergency surgery. When this child was 3 years, she underwent open surgery for patent ductus arteriosus, which is a heart disease present from birth. In this condition blood from the aorta passes directly into the lung through a connection which normally closes at the time of birth.
After this operation she was alright for about 1½ years. Then she started coughing out blood in small amounts which slowly increased. Then she consulted a local doctor who told them that blood is leaking from the aorta and she requires a surgery which is highly risky and could not be done there. So she was brought to India and was admitted in another hospital where they had put 3 stents. Even after this, the leak could not be closed and she was referred to us for surgery as an emergency. After admitting her we found that her blood group is ‘AB’ Negative, which is extremely difficult to get in an emergency. We required atleast about 4-5 bottles of blood to do the operation.
To tide over the emergency, we tried another stent surgery and put 2 more stents. Because of the technical difficulty caused by the complex aneurysm, this was also not successful. Then we had no other alternate other than subjecting her to a high risk emergency surgery, which involves high cost and about 5-6 bottles of blood. They were coming from a very poor socio-economic family and did not have any money for the operation. So, CHIME (CHILDRENS HEART INTERNATIONALE MIOT – a Charitable Trust established by MIOT Hospitals to provide funds for Free Heart Surgeries for Needy Children suffering from Congenital and Rheumatic Heart Diseases) agreed to bear the expenses and we decided to do the operation. ‘AB’ negative blood was managed with great difficulty and we got about 4 units of blood. She underwent corrective surgery on 15.09.2011.
Procedure: We opened the front of the chest and connected her to heart-lung machine and then the blood was cooled to about 18°C. Since the aneurysm was extending into the left lung, it was very difficult to visualize the aneurysm from the midline. So, we have to make another incision on the side of the chest to separate it from the lung. When the temperature reached 18°C, we stopped circulation to the lower part of the body and continued circulation to the brain. After this, we opened the aneurysm. Since there were metal stents inside, it was very difficult, but somehow we managed to remove all the stents. Then we stitched a synthetic graft to repair the aneurysm and the injury in the lung was also repaired. After this, she was brought to normal body temperature and disconnected from heart-lung machine. She had an uneventful postoperative recovery getting discharged in 2 days. To our knowledge this is the first of its kind in a small child who had undergone stenting at such a young age for aortic aneurysm followed by complex surgery. We referred literatures and found that that there was no such case reported before.
The surgical team was headed by Dr. V. V. Bashi, assisted by Dr. Harilal, Dr. Kannan R. Nair and Dr. Dilipkumar. Anaesthesia team was headed by Dr. Aju Jacob, assisted by Dr. Jyotsna and Dr. Shankar. Besides this, a team of dedicated perfusionists, and highly skilled nurses, and technicians assisted the operation which lasted for 6 hours.
Even though the total cost would have been around 4.5 lakhs, the surgery and treatment was provided at free of cost taking into account the health and socio-economic status of the child.