Paediatric & Congenital Surgery

Paediatric & Congenital Surgery

Fortis Escorts Heart Institute has 2 Paediatric Cardiac Surgical Units headed by Dr. K.S. Iyer and Dr. Rajesh Sharma and has one of the busiest and most successful cardiac surgical programs in the India comparable to the best in the world.

Dr. K.S. Iyer’s Unit

The Paediatric program has grown greatly since1995 and is one of the larger Paediatric surgical programs in India. Today this surgical unit provides both a regional as well as a supraregional service for complex heart surgeries for small children from many parts of the world.

Busy and high volume Paediatric cardiac surgical program : More than 600 cases per year
Currently the Paediatric surgical unit headed by Dr K.S.Iyer performs more than 600 surgeries on babies and small children every year. The unit today is an internationally recognized unit and is a major regional referral unit for repair of complex heart defects in babies and small children both in India as well as neighbouring countries ( Afghanistan, Iraq, Pakistan, Bangla Desh, Nepal). More recently, the unit has also been operating on small children from many far-off countries – Uganda, Tanzania, Nigeria, Khazaghistan).

Integrated Team Approach :

The unit is committed to providing both quality and cost effective Paediatric cardiac surgical care to as many children with heart defects from all parts of the world as is possible. This has been achieved by a highly integrated Paediatric cardiac service involving a closely knit team consisting of Paediatric cardiologists, Paediatric intensive care specialists, anesthetists, perfusionist, skilled nursing staff and a caring social worker.

Internationally acceptable surgical results : Overall surgical survival > 97%

The surgical results of both simple and complex cases are internationally acceptable and are comparable to the results of leading units in North America, England and Europe. An audit is done regularly and the surgical results are compared with the surgical results of the European Association of Cardiothoracic Surgeons data base.

The overall survival rate has been consistently more than 97 % for the last seven years. The survival rates for simpler cases has been more than 99% and for more complex cases between 89-95%.

Profile of surgeries performed:

The profile of surgeries performed ranges from operations on 1 day old babies to adults with late presenting congenital heart disease. Surgeries performed range from surgery for atrial septal defects , ventricular septal defects, tetralogy of Fallot ( survival outcomes > 99%) to arterial switches, surgeries for total anomalous pulmonary venous connection, surgeries for single ventricle situation ( bi-directional Glenn, extra-cardiac Fontan operation), and other complex surgeries and surgeries for serious heart conditions – conduit repairs, re-operations, double switch procedures etc. ( survival outcomes > 95%). The unit specializes.in patients presenting with late complications such as pulmonary hypertension, ventricular dysfunction and polycythemia.

Improving immediate and long term outcomes by continuing education

The unit is focused on developing newer and innovative methods to steadily improve both immediate and long term results of Paediatric heart surgery. There is tremendous emphasis on teaching, continuing medical education, in-service training and partnerships with many international and overseas units to ensure that all members of the team are up to date with the latest and most recent developments in the specialty.

The unit is a world-renowned unit and many of the team members are faculty members at International meetings and are invited to contribute actively at these scientific meetings.

Health Facts

Helping Parents to cope

The unit is also actively involved in helping parents cope with rearing a child with heart disease. The unit offers compassionate and caring support to these children and assists them in improving their quality of life, encouraging them to integrate effectively into the mainstream.

Today parents of babies and children with congenital or acquired heart disease need not despair as the majority of defects have some surgical option and many children can lead near normal lives subsequently.

If your child is suspected to have heart disease and you wish to contact us :

Dr. Rajesh Sharma’s Unit

All congenital cardiac lesions are corrected / palliated. List includes simple lesion like PDA, ASD, VSD, TOF, TGA complex lesion like single ventricle (including HLHS) TGA VSD, TGA VSD PS, DORV, DOLV, aortic arch abnormalities (Coarctation, aortic arch interruption).

Dr. Rajesh Sharma’s unit has the experience of being referred the largest number of arterial switch operations ever to be performed in the whole country & one of the largest experiences in the whole world.

Challenging operation being performed at Escorts Heart Institute & Research Centre:

1. Multistage palliation for HLHS (hypoplastic left heart syndrome) has recently been started with a high success rate for the challenging stage I Norwood procedure. Stage 1 repair of Hypoplastic left Heart syndrome a uniformly lethal anomaly for which the Sano modification has been successfully incorporated.

2. Anatomical repair of Congenitally Corrected Transposition of the Great arteries. CCTGA is a rare anomaly is which the Right ventricle is the systemic ventricle and the Tricuspid valve the systemic AV valve. This lesion results in time linked systemic ventricular failure. This can be prevented by timely execution of the double switch operation. It was first performed the world over in 1993, it corrects the atrioventricular & ventriculo arterial discordance there by normalizing the connections, thus bringing the left ventricle to bear the systemic after load and thereby preventing fatal heart failure. The surgeons at Fortis Escorts Heart Institute have one of the World’s largest experiences with this operations which is performed only in a very limited number of centers the world over. Arterial Switch operation (ASO) is the procedure of choice for TGA. While neonatal presentation is an accepted indication for the ASO, we have been performing this operation ever in late presenters. Up to 5month of age a primary arterial switch is performed with postoperative LV support with extra corporeal membrane oxygenation (ECMO), on which the LV is prepared. Beyond this age the Senning operation or the 2 stage ASO is done.

3. VSD, PA, MAPCAS is a complex lesion in which all or parts of the lung drive blood supply directly from the aorta. Fortis Escorts Heart Institute offers primary one stage unifocalization of the MAPCAS with VSD closure & RV to PA conduit in suitable case while, in those cases not suitable for one stage correction, a palliative systemic to pulmonary artery shunt with collateral unifocalization is performed.

4. Ross operation for aortic valve disease is being performed routinely. Here, instead of a prosthetic heart valve, the patients own pulmonary valve is transferred to the aortic position while a Valved conduit is placed in the pulmonary position. Advantages of the Ross operation are zero need for anti coagulation with all its attendant draw backs & preservation growth of potential of the aortic valve in children.

5. In addition over the last 1 ½ years Fortis Escorts Heart Institute has started a Paediatric ECMO programme where in any patient who suffers a sudden cardiac arrest that is refectory to resuscitation is put an extra corporal membrane oxygenation (ECMO) & thereby has a 70% chance of salvage in our experience. Thus patients, who have had a satisfactory surgical heart repair but for some reason sustained a refectory cardiac arrest, still have a good chance of survival & successful discharge from hospital as normal & intact children.