A 13 year old girl was suffering from breathlessness while playing. She was diagnosed to have heart murmur in school. She was referred to a cardiologist Dr. Nandhakumar. ECG, Echocardiogram revealed severe leak in her mitral valve in the left side of the heart. Not only that, her heart was also enlarged. This was a grave situation, if not treated will lead to fatality. She was advised mitral valve replacement. Parents are daily wage workers and cannot afford heart valve replacement surgery. Since she is a 13 year old girl child there was a lot of apprehension from the parents that the heart operation will produce unsightly scar in the front of the chest. This will produce a lot of peer pressure in school and lead to inferiority complex in the child in her growing years.
She did not undergo surgery due to these reasons and was being referred to various hospitals. Finally, she was referred to Dr. Thiagarajamurthy and his team in Ramakrishna hospital cardiac surgery department. Mitral Valve replacement can be done in two methods. Conventionally it is done by opening the front of the chest by sternotomy. However a latest method of doing mitral valve replacement is by making a small 4 inch incision in the right side of the chest under the breast tissue. By doing surgery by this method the scar will be totally invisible once the child grows up. Patients are from a poor socioeconomic status.
Ramakrishna hospital management decided to do this patient under government CM scheme. Team led by Dr Thiagarajamurthy along with Dr. Vijay Sadasivam, Dr. Krishnan, Dr. Ashok Hariharan, Dr. Menon, Dr. Arunkumar, Dr Sujith performed MICS Mitral Valve replacement successfully by a small 3inch right side chest incision using unique set of instruments and special heart lung bypass technique. Her valve was found to be damaged beyond repair hence replaced.
Patient recovered very well and was off the ventilator within 2 hours after surgery. Patient was walking the following day. She was fit for discharge on 4th post-operative day.
This is the first time in the state of Tamilnadu that such a MICS valve replacement was done in Pediatric age group. Thanks to Ramakrishna management and TN CM scheme, patient had this world class treatment totally free of cost.
MICS (minimally invasive cardiac surgery) is one of the latest techniques in heart surgery where the front of the chest is not cut open. Operation is done through a mini incision either through right or left of the chest. This leads to a faster recovery and a scar that is very small and cosmetically acceptable in women.
Minimally invasive cardiac surgery is very cost effective. It is not prohibitively time and cost consuming like robotic heart surgery. Surgery time is comparable to open surgery. Initial investment is very less hence it can be offered to even poor patients. In our country where heart surgery is a big burden on people in poor socio economic background, MICS is a good alternative. Patients can be discharged on 5th day to home.
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