A New Milestone in Cardiac Care for Children

By Swati Amar

Chennai is once again in the limelight, snaring the attention of the medical fraternity as well as innumerable little cardiac patients and their anxious parents across the world. Not surprisingly, the Apollo Group did an encore creating world-first milestone , with Apollo Children’s Hospital Chennai, performing 50 percutaneous Fontan procedures without prior surgical preparation. This achievement stands testimony to the increasing expertise and clinical experience in the advanced and minimally invasive care for children with congenital heart diseases. The procedure involves a catheter-based approach that offers an alternative to conventional open-heart Fontan surgery, in carefully selected children with complex single-ventricle heart disease.

Percutaneous Fontan Procedure

A Fontan procedure is an operation for children born with one working heart ventricle. Following the Fontan procedure, the oxygen-poor blood in the child’s body goes straight to their pulmonary artery instead of through their heart chambers . A Fontan procedure creates a new path for blood to reach the child’s lungs. It sends oxygen-poor blood from their lower body straight to their lungs via the pulmonary artery. This blood doesn’t pass through their heart . So, the one single functioning ventricle can pump oxygen-rich blood into the body.

While this standard Fontan operation is an open-heart surgery requiring cardiopulmonary bypass and a sternotomy, the percutaneous approach uses catheters, wires and covered stents inserted through blood vessels to establish the extracardiac connection. This catheter-based method helps avert repeated open-heart surgeries , shortens hospital recovery times and reduces surgical trauma for the selected paediatric patients.

Apollo Advantage

The technique has been developed and refined by Apollo’s Paediatric Cardiology and Paediatric Cardiothoracic Surgery teams.

According to Dr C.S. Muthukumaran, Senior Consultant and Head, Department of Paediatric Cardiology, Apollo Children’s Hospitals, Chennai, children with single-ventricle heart disease often have to undergo many major heart operations before the Fontan stage. This is the final stage of treatment for many of these children that redirects blood from the lower-half of the body directly to the lungs. If the anatomy and haemodynamics are suitable , a catheter-based approach can help establish the Fontan pathway without another major open-heart surgery.

Patient Selection

Not every child is suited to the percutaneous procedure. Patient selection is elaborate, requiring detailed evaluation of cardiac anatomy, haemodynamics including pulmonary artery anatomy and pressures, ventricular function and venous pathways. The assessment may also include echocardiography, CT imaging and cardiac catheterisation.

Dr Neville A G Solomon, Director, Paediatric Cardiothoracic Services, Apollo Children’s Hospitals says, “ This is not about replacing surgery with a newer technique. It is about bringing paediatric cardiology and cardiac surgery together to decide the best way forward for each child. ” For some children, surgery still remains the best option while in carefully selected patients, a catheter-based Fontan may offer another pathway.

Apollo Children’s Hospital has performed more than 14,000 catheter-based cardiac interventions in children, contributing to their immense experience in complex paediatric cardiac care.

This milestone underscores the growing role of catheter-based interventions in the management of complex congenital heart disease, emphasizing the strategic significance of careful patient selection, multidisciplinary decision-making and ongoing long-term clinical follow-up. Reaching 50 percutaneous Fontan procedures reflects Apollo’s commitment to continuously widen the possibilities of exemplary treatment and outcomes for little cardiac patients and their families.