Girl with hole in the heart is now whole, after a medical first
By George.Kebaso, August 19, 2022Heart specialists at a private hospital in Nairobi have pulled a first in Kenya after successfully closing a hole in the heart of a two-year-old girl. They used a catheterization laboratory (Cathlab) procedure without resorting to open surgery.
On August 10, 2022, the parents of Ann Waithera Chege admitted her to the hospital after a referral from Thika Level 5 Hospital. And just the next day they returned home with their fully operated-on daughter in stable condition.
Baby Waithera had undergone a trans-jugular closure of the large patent ductus arteriosus (PDA), a persistent opening between the two major blood vessels leading from the heart, after experiencing repeated lung and respiratory infections. This had caused her parents sleepless nights, according to Lucy, the mother.
“Two years ago, I was blessed with a healthy baby. I named her Waithera and we were happy as a family,” Lucy Wanjiku told ‘People Daily’ through telephone from Gatundu in Kiambu county.
Initially, her daughter had no signs of ill health, she said. But in June this year, she noticed that the girl could not stand up and walk, or even talk, and had breathing difficulties. She sought medical help at a number of health facilities, from faith-based to Level 4 and 5, and was even referred by a doctor at Kasarani, Nairobi, to India.
But she did not have the money needed to travel outside the country. Wanjiku even mobilised relatives and villagers for a funds drive, though what was raised was not enough. While almost giving up, a well-wisher directed her to Mediheal Hospital.
Abnormal condition
“I took her for a check-up at a nearby Catholic-based health facility. The scans turned out that Waithera had an abnormal condition in her heart. We were referred to Gatundu Level 4 Hospital, and later to Thika Level 5. Lastly, I met someone who referred me to Mediheal Hospital,” she said.
Today, Wanjiku is happy. Her daughter started walking, barely a week after the surgery. “She is also talking. I have confidence that we have good specialists in Kenya. I would like to advise fellow Kenyans to look around before embarking on medical journeys abroad,” she said yesterday.
Dr Vijaysinh Patil, a cardiologist at Mediheal who led a team of eight Cathlab staff, termed the surgery a success. The surgery makes it six such complex procedures in the world … and the first in Kenya.
“The parents said their daughter was symptomatic, getting repeated lung infections and other respiratory illnesses due to the holes in her heart. Also, the baby was not gaining weight, according to the parents,” he told ‘People Daily’ yesterday. He said the child’s parents looked very scared when they brought her to the hospital.
“They were so emotional and didn’t want to seek medication abroad because of the associated costs and social disintegration occasioned by culture shock. They only wanted their baby treated here,” he said.
He described the surgery as complicated, being a procedure for a small baby. The baby weighed 11 kilos instead of the normal weight of between 13 and 18 kilos.
The surgery saved the couple slightly above Sh1 million — besides the time, language and cultural barriers anticipated abroad for such a procedure.
“We made the admission to the Cath lab on a Monday morning. In one hour, we had completed the surgery. On Tuesday morning, we discharged the baby,” he narrated, noting that this suppressed the financial costs, infection rate, and length of stay in the hospital. It was a genetic kind of condition, which would have resulted in several other associated effects in the long run.
“It increases lung pressure and, if not addressed early in life, the patient will continue experiencing acute lung pressure, difficulty in breathing and complicated surgeries. Some patients become totally inoperable,” Dr Patil said.
To avoid these complications, cardiologists usually close such holes in time when the lung pressures are reversible, he said.
Syndromic babies
Trans-jugular closure of the large PDA in small syndromic babies, Dr Patil said, involves a trans-catheter device closure of the PDA through a femoral artery, preferred as a safe, effective and well-tolerated route. The femoral artery is a major vessel which carries blood from the bottom of the abdomen, through the lower limbs, to the heart, other organs in the body, and back.
“We report a case of successful closure of PDA using Cera Lifetech PDA Occluder via trans-jugular approach in interrupted inferior vena cava (IVC),” added the cardiologist who — with his team — has done 15 cardio-surgeries in Kenya since the Cath Lab was inaugurated early this year.
The IVC is a major vein that brings oxygen-poor blood from the lower body back to the heart, said Dr Patil,.
He then narrated the admission history of baby Waithera: “A two-year-old female syndromic baby, weighing 11kg, was admitted for percutaneous device closure of PDA. An echocardiogram showed a 4.5 mm tubular type duct and large ventricular septal defect (VSD, a transcatheter repair described as a type of heart procedure. The femoral venous access was not possible in view of interrupted IVC; therefore, we decided to use a trans-jugular approach,” he narrated during an interview.
Systolic murmur
“Clinically, there was a continuous murmur in the left upper sternal border and pan systolic murmur on the left lower sternal border. A chest x-ray showed an enlarged heart with increased pulmonary blood flow”. We would like to highlight that trans-catheter closure of PDA using jugular venous access is safe and effective even among infants, he noted.
According to Dr Patil, the syndromic child presented with repeated respiratory tract infections, poor weight gain and failure to thrive. “Clinically, there was a continuous murmur in the left upper sternal border and pan systolic murmur on the left lower sternal border. Chest x-ray showed an enlarged heart with increased pulmonary blood flow.