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KARACHI: Doctors at the Indus Hospital (IH) hit a milestone in heart surgery developments in Pakistan when they “successfully” performed a specialised surgery for a congenital heart disease for the first time in the country.

Known as percutaneous pulmonary valve implantation, the minimally invasive catheter-based intervention was performed on a 15-year-old girl Fatima born with multiple heart defects; a hole in the heart, absence of a pulmonary valve and an improperly formed main pulmonary artery.

Her diagnosis was quick as parts of her body had bluish tinge at the time of birth. She had a stent implant at two-and-a-half years’ age and then an angiography before having an open heart surgery in 2014 during which she received a tissue valve implant, the hole in her heart was repaired and a conduit was formed to relieve right ventricular outflow obstruction.

However, over time, the valve and conduit had contracted and developed deposits of calcium, resulting in increased pressure on the heart.

“Given the fact that Fatima already had an open heart surgery and a similar procedure again might harm her, the best option was to go for percutaneous pulmonary valve implantation,” Dr Arjamand Shauq, a cardiac surgeon at Alder Hey Children’s Hospital in Liverpool, UK, who led the doctors’ team at the IH, said.

Explaining the procedure, Dr Shauq said that a catheter (thin plastic tube) was passed through the vein in the groin up to the heart, through which the valve was inserted. The whole procedure was monitored on the screen.

“The advantage of this approach is that it’s safer, less painful and has a shorter recovery period, though it’s costly,” he said, adding that it was done free of cost.

According to him, the patient might need more surgeries in future depending on how long the conduit properly functioned. However, he said, the patient would have a normal healthy life and no specific precautions would be advised.

“This technique, introduced in early 2000 in the world, helps reduce the number of surgeries a patient with such condition might have. In Pakistan, we have an issue of both cost and expertise. But, I believe a beginning has been made and now we need to build upon it,” he said, adding that he had planned to train IH doctors on the technique in future.

According to Dr Shauq, the girl suffered from a severe form of Tetralogy of Fallot, a rare condition caused by a combination of four heart defects that are present at birth, which affect the structure of the heart, cause oxygen-poor blood to flow out of the heart and to the rest of the body.

Also part of the team was Dr Mohammad Riaz, senior anaesthetist at the IH and Dr Mehnaz Atiq, a senior professor at the Aga Khan University Hospital. Asked about the prevalence of congenital heart disease, she said: “One in 100 children is at risk and half of those who are at risk are vulnerable to have the kind of complications Fatima had.”

She urged the government to help reduce the valve cost, which was around Rs2 million to Rs2.5m today.

Recalling how the family struggled to get the best treatment for Fatima, Junaid Hasan, Fatima’s brother and an engineering university student, said that it was both emotionally and financially challenging.

“My father is a rickshaw driver and the family ran deep in debt after Fatima had her open heart surgery at a private hospital. There was no possibility for us to bear another huge amount on her treatment this time. It was all Allah’s work. We are greatly indebted to all doctors and the hospital,” he said.

Published in Dawn, December 3rd, 2017

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