In Lviv, doctors saved baby Karolina, who had a rare and extremely complex heart defect that occurs in only 0.5% of cases. After a series of highly complex operations, including a 10-hour radical correction on an ECMO machine during coronavirus pneumonia, the child is now home with a normal heartbeat and saturation. This was reported by the Lviv City Council, writes UNN.
Details
Little Karolina from Lviv was born with a rare and extremely complex heart defect – transposition of the great arteries. This is when the main arterial vessels are swapped, and the two circulatory systems work disconnectedly.
Her mother, Maria, learned about her baby's diagnosis when she was 24 weeks pregnant. And later, doctors discovered another complication: a stenosed, or narrowed, pulmonary artery valve. Such a combination of defects is extremely rare and occurs in only 0.5% of all cases of transposition of the great arteries.
Since St. Nicholas Children's Hospital has its own maternity ward and the only Children's Cardiac Surgery Center in the western regions, Maria decided to give birth here. And immediately after birth, little Karolina was taken to the cardiac surgery department.
In the first days of her life, a vascular shunt was implanted – a replacement for the Botallo's duct, and a balloon atrial septostomy was performed for better blood mixing and stabilization of her condition. This first stage was meant to buy the baby time so that she could grow a little before radical correction.
At 6 months, the baby underwent the next operation. Since the left ventricle of the heart was not sufficiently trained, it had to be prepared for a heavy load. So, cardiac surgeons reduced the opening between the atria. This intervention predictably led to a more severe condition for the child, but it was a conscious and weighed decision by the doctors.
This was done so that the left ventricle of the heart could cope with the necessary blood volume in the future. But on the other hand, there were "trade-offs": if you make this opening smaller, the saturation will be lower and will drop from 80% to, say, 60-70%, and it will be even harder for the body to "breathe." But there was no other way to prepare for full correction.
The operation was successful, and oxygen saturation levels predictably dropped. And in this particularly vulnerable period, on the 6th day after the intervention, Karolina contracted coronavirus. Pneumonia developed. For a child with chronic hypoxia, this was a very severe blow. Saturation critically dropped to 30%. Doctors barely managed to connect the little patient to ECMO – a device that replaces the work of the heart and lungs. Karolina was on it for 2 weeks, and she was transported directly to the operating room on ECMO for the decisive operation.
The highly complex intervention for radical correction of transposition of the great arteries, called the "Nikaidoh operation," lasted 10 hours. Oleksandr Yachnik completely "reconstructed" the baby's heart so that it would work as nature intended.
This was an extremely complex clinical case. To successfully perform ECMO on a child with uncorrected transposition, and even with coronavirus pneumonia, is a fundamental success in the world of cardiac surgery.
Doctors add that Karolina is already home today. Her saturation is normal, and her heart is working properly. Although the valve will still need to be changed as the child grows, she will not have significant life limitations.