2-year-old successfully undergoes Tetralogy of Fallot repair & Complete chest wall reconstruction at Narayana Superspeciality hospital, Howrah
Kolkata, August 18, 2017: Narayana Superspeciality Hospital, Howrah, gives a 2-year-old girl a second lease of life by successfully performing an intra-cardiac repair for Tetralogy of Fallot (an inborn structural defect of the heart) and complete chest wall reconstruction. When baby Afreen Praveen, a 2-year-old girl, was brought to the emergency of NSH, she was barely able to breathe. In the 2 years, her parents had always found her to be blue and struggling to breathe.
Afreen’s condition was unique. In addition to having a major inborn structural defect of the heart called Tetralogy of Fallot, she had an absent breast bone or sternum. Her heart was covered only by skin. How she grew up to be two years with that is a miracle.
The Narayana team had no time to waste as the child was very blue and had to be put on ventilator support immediately. The cardiac diagnosis was established by the pediatric cardiology team led by Dr Amitabh Chattopadhay. The cardiac surgical team led by Dr Debasis Das took up the challenge of performing a hi-risk surgery after consulting Dr Adhish Basu, plastic surgeon.
Dr. Debasis Das, Consultant Cardiothoracic Surgeon, Narayana Superspeciality Hospital, said, “The child was transferred in a critical state to Narayana Superspeciality Hospital and had to be put on ventilator straightaway. On diagnosis, we found out that the child had an inborn structural defect of the heart called Tetralogy of Fallot. What made this case extremely rare that her breast bone was completely absent and the heart was covered by only skin. One could see it throbbing beneath the skin. “
“The successful hi-risk surgery is a testament to our endearing team effort to continually go against the odds and make a difference” added, Dr. Das.
Afreen was taken up for surgery and the heart operation, although difficult, went smoothly. On that day, the skin was closed over the heart after covering it with artificial material.
Next day when she was a bit more stable, a joint cardiac and plastic surgery team led by Dr Debasis Das and Dr Adhish Basu did an extensive chest wall reconstruction using the patient’s own ribs to a put a cover over the heart. The surgery was successful.
Dr. Adhish Basu, Consultant Plastic Surgeon, Narayana Superspeciality Hospital, said “On investigating we found the baby’s entire breast bone was split into two parts and she had a deformed heart. She needed a complicated heart surgery and an even more complicated plastic surgery to reconstruct her breast bone. With support from our anesthesia and cardiac teams, we successfully completed both the surgeries. This kind of double reconstruction of heart and breast bone is extremely rare.”
Complete sternal cleft (Absent breast bone) is a very rare anomaly and accounts for 0.15% of chest wall malformations (Thoracic Surgical Clinics, 2010). A combination of structural heart defect like Tetralogy of Fallot and complete absence of breast bone is even rarer, occurring in less than 1 per 100,000 population (Annals of Thoracic Surgery 1997).