Patient’s family was not eager for surgical closureSurgical procedure could have ended up with associated scar and morbidity
Challenge was to find an effective alternative way out for the closure
Kolkata, March 28, 2018: A 24-year old lady, mother of two young kids, hailing from a middle class family in Jharkhand had symptoms of easy fatigability and palpitation for the last few years. A year back, Selva Mohan (name changed on request), recalls that she started dragging herself to household work but after sometime, she could not even hold her 4-months baby and carry other household chores. In such a scenario, her husband, who is into a decent job, got her evaluated locally. It was detected that Selva had a very large hole between the two upper chambers of the heart (in between the right and left atrium of the heart), known as atrial septal defect (ASD) in medical terminology. Incidentally Selva had no such complication before five years ago but slowly she could understand that she got tired easily experiencing the symptoms.
She was referred to a private hospital in Kolkata for further diagnosis and necessary treatment. Selva was very lean and weighed only 32 kgs. On detailed evaluation including trans-esophageal echocardiogram (TEE), it was diagnosed that she had a very large ASD. There were thin and deficient margins along with dilatation of right sided chambers of the heart which was unarguably due to the volume overload. The large hole in the heart required early closure without any delay.On detailed evaluation including trans-esophageal echocardiogram (TEE), it was diagnosed that she had a very large ASD. There were thin and deficient margins along with dilatation of right sided chambers of the heart which was unarguably due to the volume overload. The large hole in the heart required early closure without any delay.
Generally, such large holes with deficient rims in the heart are closed by open heart surgery which requires prolonged hospital stay and large scar on the chest.
“The young lady and family members were not eager for surgical closure in view of possible difficulty in breast feeding of the young kid in post-operative period, associated scar and morbidity,” recall Dr. Anil Kumar Singhi, Senior Consultant Interventional Paediatric Cardiologist and Dr. Rana Rathor Roy, Senior Consultant Interventional Cardiologist at Medica Superspecialty Hospital.
The whole task of closure with the device was more challenging with deficient rims of the hole. The Government of Jharkhand supported the procedure cost as Medica Superspecialty Hospital has tie-up with the Government of Jharkhand.
The procedure was done with a special technique of balloon support of device deployment under fluoroscopic and trans esophageal echocardiogram guidance in cardiac catheterization laboratory. The procedure was done in around 90 minutes time. The device was successfully placed and she was extubated on table.
Selva was shifted to the ward within few hours on the same day of the procedure. On second day the doctors after re-examining, confirmed that the hole was closed completely. On doctors’ recommendations, the lady was discharged on the second day of the procedure itself. “It was extremely difficult for the family to believe that the major cardiac intervention was done without any particular scar and on top of that, the patient was discharged on the next day of the procedure,” further elaborated the doctors.
Nowadays large holes with deficient rims can be closed without cut and scar in the chest with better results, fewer complications, faster patient recovery and lower healthcare costs. Regarding risks with this method, the doctors said: “Any invasive procedure has associated risk. We do the procedure in beating heart. The risks and complications are much less than surgical intervention.”
Selva is indeed ‘eternally grateful’ to Medica for such an intervention without any surgery and early release from the hospital. Recently she came for a check-up and was visibly very satisfied and said that now she can perform all her little household chores quite comfortably.
“This particular approach to ASD closure is indeed very unique. We at Medica are definitely looking to innovate with such low risk surgical techniques in curing such serious defects and ailments. Selva’s recovery is indeed a huge boost to the Medica team,” said Dr. Alok Roy, Chairman, Medica Group of Hospitals.