Plugging

a hole in the heart

WHEN 13-year-old Parmendra Singh shuffled into the cardiac clinic at Col onial War Memorial Hospital in Suva, his mother’s eyes brimmed with tears but his own were glazed and listless. An examination on the echogram revealed why a gaping hole in the atrium of his heart.

From the day of his birth, Parmendra’s chances of living a long and healthy life were not good. His mother, Savita Devi, says he did not seem unhealthy until the chest pains started when he was aged 11.

But even before then, Parmendra’s heart had had to work overtime to pump the blood to his listless limbs, past the hole in his heart.

Normally, the hole between the atrial cavities close at birth to prevent mixing of blood low in oxygen from the right atrium to the left atrium thus bypassing the lungs. But Parmendra was born with an atrial septum defect, or “hole in the heart”, which often has made him too tired and weak to join in the activities which most children take for granted.

Now, 13 years later, he is to be given the chance for a healthy, fulfilled life.

This is how it went: October 4, 7.30 am: Parmendra is semi conscious but restless as Dr Judy Lynch and her assistants connect him to a drip and insert a tube into his chest to supply drugs and monitor pressure. Different drugs kill the pain, paralyse the patient

Parmendra and Mum: as good as new

and ensure he forgets what is happening. 8.30: Parmendra has been transferred to the adjacent surgery and the theatre nurse arranges the sheeting over him. A second sheet is suspended to protect his face.

His chest is painted with iodine. 9.15: The team are assembled. Dr Terry Mau cuts the skin with a scalpel, then uses the electrical cautery to cut through the flesh (the heat of this electrical drill also stops the bleeding).

Once at the bone level, he uses a saw with

a guard on it and splits the sternum.

A big metal brace called a self-retaining retractor holds the wound apart, doing what the human hands of the surgeon’s assistant would have done in operations years ago.

Dr Mau cuts through the pericardium a thin skin covering the heart. He stitches this open so the inside of the heart is laid bare.

9.45: Tubes from the bypass machine are inserted to take out blood and put in drugs. It is time to clamp the aorta and divert the blood from Parmendra’s heart to the heart/ lung machine. The machine will take over the functions of his heart and lungs.

The tubes of the machine slowly begin to run crimson with blood and

perfusionist James Picken (specially

trained to use the machine and admin ister the Cardioplegia drug which para lyses the heart) is hard at work. The

heart bypass machine controls the flow of blood and regulates the temperature of the blood. 9.52: Dr Mau has exposed the gaping two-by-five centimentre hole in Parmendra’s heart. “This must be the biggest one we’ve seen so far,” Dr Mau comments.

But it is a simple matter to just take a patch off the pericardium and stitch it over the hole. Within a year the body will have fused the patch over the area and the stitches will hardly be visible, says

theatre nurse Pat Saar. 10.17: The patching has been done and it is time to retreat back through the steps. The machine has been by

passing Parmendra’s

heart and lungs for 32 minutes, and it is now time to give them back their momentum. The flow of blood will wash away the drug which deadened its natural beat.

There is not much left to do except tidy up.

Even tying Parmendra’s ribcage back together with wire ties and pliers is considered a lesser step, although it seems to be one of the roughest aspects of the operation. By the time the last layer has been stitched together, everything is neady in place. Everything has gone to plan and the signs are that Parmendra’s body will do the rest and heal itself. The smile on his mother’s face is also one of the rewards of the operation. She has five children. Parmendra is the youngest and still alive. D

Scarred: Parmendra after