Escorts gives new lease of life to IVF Baby

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A baby girl, weighing 1.9 Kg was born to parents after 16 long years of marriage through in-vitro fertilization technique on August 17, 2009 at her home town Ludhiana. During her DPT vaccination, doctor suspected a murmur in the heart and she was referred to undergo ECHO test at her local hospital. ECHO established that she was suffering from some complex heart problem, and then she was brought to Fortis Escorts Heart Institute in Delhi.

She was rushed into Fortis Escorts Heart Institute in emergency suffering from cyanosis (blue coloration of skin) and tachypnoea (rapid breathing) on April 20, 2009 (Time?). After the initial stabilization, baby underwent ECHO that revealed that she had a case of Aortic Artesia (The rare congenital absence of the normal valvular opening in the aorta) which was supplied by a large patent ductus arteriosus (PDA), the blood vessel which connected the two major arteries – aorta and pulmonary in the baby’s body. PDA was arising from the main pulmonary artery which also gave origin to both branch pulmonary arteries supplying the lungs.

The baby had very severe pulmonary hypertension and she was also predisposed to PDA closure (like all new borns) an event which if left untreated, could have been fatal as her body was getting blood circulation only via PDA. Baby had normal ventricles with a normal mitral valve. She was one of the rare neonates with “Aortic Atresia with normal left ventricle”.

The doctor at Escorts, Dr. Rajesh Sharma, decided to go for Norwood procedure for her first surgery and complete repair was scheduled for 6 months to one year later. During the Norwood procedure, the doctor connected the right ventricle of her heart to the aorta to restore blood supply to other parts of the body. A tube was implanted in the ventricle to function as the pulmonary artery supplying blood to his lungs.

Baby is responding well to the operation and will be discharged in a few days.

CASE ASEESSMENT

• Aortic atresia usually occurs in combination with other heart defects (usually hypoplastic left heart syndrome in which the chambers, valves and related blood vessels on the left side of the heart are so malformed that they can’t pump the blood into the body).
• Ductus arteriosus is supposed to close within few minutes or in some cases few days after birth as part of the normal blood circulation in babies. However in some cases the ductus arteriosus remains open (patent). This opening results in abnormal blood flow in the body allowing oxygen–rich blood from aorta to mix with oxygen–poor blood from the pulmonary artery.
• Only 4-7% of aortic atresias may have a normal left ventricle and mitral valve making then candidate for a biventricular repair akin to the circulation in normal humans.
• Hypoplastic left heart syndrome (HLHS) is a rare abnormality with a low incidence of 0.016 per cent to 0.036 per cent live births.
• Some recent studies suggest that IVF babies are 30 % more likely to suffer from higher rates of heart valve defect and other health problems.
• In view of high operative risks, most of the hospitals in India do not offer any surgical treatment in HLHS and aortic artresias.

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