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A new innovative technique for treating blue babies

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A long time ago, in November 1944, Dr. Alfred Blalock, Mr. Vivien Thomas and Dr. Helen Taussig performed a new operation for the time at Johns Hopkins University Hospital in the United States. This operation, later known as the Blalock-Taussig shunt, was the first operation described for the treatment of patients with cyanotic congenital heart disease, commonly known as “blue babies or blue baby syndrome”.

Blue babies are born with a variety of critical heart conditions and have low blood oxygen levels, leading to a condition in which the baby’s skin and lips turn blue. The most extreme form of this defect is called pulmonary atresia, in which there is no natural connection between the heart and the pulmonary arteries. Therefore, emergency life-saving surgery is required in the first few days of life to save these patients and maintain their oxygen levels.

Since the first Blalock-Taussig shunt operation (BT shunt) almost 80 years ago, pediatric cardiology and cardiac surgery have developed in many ways.

A minimally invasive, nonsurgical alternative to the BT shunt is a relatively new procedure called PDA stenting that is performed by pediatric cardiologists in the Cath cardiac laboratory. This procedure was first performed around 20 years ago as an alternative to the BT shunt and since then many children’s heart centers have gained a lot of experience with this technique. At SRCC Children’s Hospital, we also routinely prefer PDA stenting to BT shunt to restore pulmonary blood flow in critical blue babies. Last year we introduced a new innovative technique for PDA stenting that has made this complex and challenging procedure in newborns safer and faster.

This technique, “Hybrid PDA Stenting with Flip Technique”, which we recently published in an international journal, is an innovation in which the cardiac surgeons open small surgical accesses to the patient’s cervical vessels and we then assume they approach. From a small 2 cm incision in the baby’s neck, with the help of special catheters and wires, we can cross a small natural connection between the body artery and the pulmonary artery, known as a PDA, and place a stent in it to place a stent that keeps its patency. The procedure takes about 1 hour, and babies typically spend an additional 7 days in the hospital before they are discharged. Then, about a year after their first procedure, they return to their full corrective surgery, after which they lead a near-normal life.

This innovative hybrid approach has helped us overcome some of the challenges and limitations of the PDA stent over the routine old approach from the baby’s femoral vessels and enabled us to successfully treat complex cases that would previously have been referred for high risk surgery instead. Our team has now completed around 25 such PDA stents using this approach. An experienced full-time team of pediatric cardiologists and pediatric cardiac surgeons is required to establish such a hybrid PDA stenting program and similar complex pediatric cardiac intervention programs. Such programs help to further improve the treatment outcomes of critically ill patients with congenital heart defects and to make complex procedures safer.

Photo of PDA, which is the only blood supply to the baby’s pulmonary vessels

Photo of the stent successfully placed in the PDA at the end of the procedure

Dr. Supratim Sen | Senior Consultant – Cardiology – Pediatrics | SRCC Children’s Hospital, Mumbai

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