A team of doctors at Bai Jerbai Wadia Hospital for Children performed a high risk balloon aortic valvotomy procedure on a newborn boy from Ahmednagar with blocked valve, 15 per cent ejection fraction, breathing problem, and murmuring of heart.
The infant, who is off the ventilator and is recovering well, showed immediate, significant improvement in the heart pumping capacity after the opening of valve.
The baby was born amidst the paranoia unleashed by the pandemic, and weighed 2.5kg at birth. Eight days later, the mother realized that the baby’s breathing was rapid, and worsened after breastfeeding. They took the baby to a local paediatrician who also detected a heart murmur—an abnormal sound that is heard as blood moves through the heart, confirming some sort of a birth defect. The echocardiography test carried out in Loni, Ahmednagar, revealed that his aortic valve (major heart valve) was blocked by birth and the ejection fraction was 15 per cent (55 percent or higher is considered normal). Later, the baby was referred to Wadia Hospital, and was brought by ambulance from Ahmednagar to Mumbai.
"The baby came in an emergency condition and his health worsened. The cardiac team, including the paediatric cardiac anesthetist, interventional cardiologist, nursing, and the technical team took precautions by wearing four layers of covering (including lead aprons and PPE kit) in view of baby’s unknown COVID-19 status. Bedside echocardiography was performed which confirmed severely obstructed aortic valve and heart pump failure. The baby was immediately admitted to the isolation unit and put on a ventilator in view of severe breathing difficulty," said Dr Shreepal Jain, consultant interventional paediatric and fetal cardiologist at the hospital.
This congenital condition is seen in 2 per cent of the overall population; among this, 15-20 per cent will have blocked valve, and 25 per cent will have this condition after one month of birth. Medicines were started to help improve the heart pumping and blood circulation to vital organs. The baby and mother’s nasal swab was sent for the COVID-19 test.
In view of the overall health condition of the baby, it was decided to perform emergency surgery for opening the heart valve.
Dr Shakuntala Prabhu, medical director, said, “The baby underwent balloon aortic valvotomy or balloon aortic valvuloplasty which is a minimally-invasive surgery performed using cardiac catheter with a deflated balloon in the tip. The catheter is inserted into a blood vessel. It is moved to the narrowed valve, and the balloon is inflated to open the heart valve. The challenging procedure lasted for two hours, and his echocardiography showed immediate significant improvement in the heart pumping capacity after the opening of the valve. The baby was shifted back to the isolation unit for further management.”
The baby’s COVID test was negative. However, the mother tested positive and had to be shifted to Kasturba Hospital for isolation. The baby was then shifted to the cardiac ICU and is off ventilator now, and will be discharged soon. The father, who requested anonymity for himself and the family said, “We were fretting due to the COVID infection. We would have lost our baby if he wouldn’t have received timely and prompt treatment.”