The Hindu : Despite her ailment, Noor was lucky

Online edition of India's National Newspaper
Thursday, Jul 17, 2003

Southern States

Southern States - Karnataka-Bangalore

Despite her ailment, Noor was lucky

By Harichandan A. A.

BANGALORE July 16. A surgeon often faces a situation that is not explained in textbooks. The case of two-and-a-half year-old Noor Fatima too presented doctors with more than one problem.

Surprisingly, a connection that is normally severed within a few hours of the baby's birth was intact and keeping Fatima in better condition than expected.

Ventricular Septal Defect (VSD) is a hole in the wall that separates the two lower chambers of the heart, the right and the left ventricles. There are two upper chambers called right atrium and left atrium.

All that is known is that VSD has its roots during the time the heart is formed in the foetus, some eight weeks into pregnancy. The exact cause is not known yet.

Fatima had two holes that made the doctors decide on opening up her heart to sew them up, while she was on a heart-lung machine.

In a normal heart, oxygen-poor (blue) blood from the body enters the right atrium and then goes to the right ventricle from where it is pumped to the lungs.

Oxygen-rich (red) blood from the lungs enters the left atrium and goes to the left ventricle from where it is pumped out into the body.

The holes in the septum of Fatima's heart (wall separating the lower chambers) were allowing pure and impure blood to go back and forth across the chambers. What made matters worse was that the duct (pulmonary artery) carrying impure blood from the heart to the lungs was constricted (a condition called stenosis).

If this was not corrected, the most obvious problem would have been heart failure. It could also have caused lung disease by building up pressure in the pulmonary artery and in the blood vessels in the lungs itself.

A dangerous infection of the inner surface of the heart called bacterial endocarditis could also have occurred from bacteria that could enter the bloodstream from other parts of the body.

One connection that in normal hearts closes a few hours after a baby is born remained open in Fatima which doctors said actually helped in keeping her in better shape.

The condition called Pulmonary Ductus Arteriosus is a connection between the pulmonary artery and the aorta, the main duct that takes purified blood from the heart to the rest of the body.

Since the connection was still there, despite the stenosis of the pulmonary artery, some blood was still reaching the lungs.

Fatima now rests in the intensive care unit. In the long term, most children who have had their VSD surgically repaired will live healthy lives. Activity levels, appetite, and growth will be normal in most children.

Each year, over 1.5 lakh children in India are born with congenital heart disease, be it defective heart valves or holes in the heart as in Fatima's case.

Poverty makes only 20 per cent of them seek medical treatment. Surgery is expensive and, in most cases, a patient will have to pay on his own. Until inexpensive ways of treating hearts are found, awareness will be the key to keeping costs down and ensuring that when there is surgery, it is successful.

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