Ozaki technique saves 4-yr-old heart patient in city hosp

Coimbatore: In a cost-effective way, cardiothoracic surgeons of a city hospital recreated a four-year-old child’s pulmonary artery with her own heart tissues or pericardium without the need to use a bovine graft which costs several lakhs or a homo graft costing Rs 55,000, which is not easily available. The surgeons also used a technique called the Ozaki technique to recreate the pulmonary valve, which is usually used only to recreate the aortic valve.
Four-year-old Navinasri was wheeled into city-based G Kuppusamy Naidu Hospital in mid- June with severe breathing difficulty. She was referred from Thanjavur Medical College. The child, who was diagnosed with a complex congenital heart defect called Tetralogy of Fallot with Pulmonary Atresia type 2, had a history of heart problems since she was five-month-old. Tetralogy of Fallot with pulmonary atresia is a condition where the baby has a hole in between the lower chambers of the heart and the main blood vessel (the pulmonary artery, connecting the right side of the heart to the lungs was absent.)
In August 2019, Navinasri was noticed by GKNM while conducting a screening camp in Thanjavur Medical College. Pediatric cardiac surgeon Dr Vijaykumar Raju noticed that her branch pulmonary arteries, which supply deoxygenated blood to the lungs, were small. “We told her parents that she needs to undergo two surgeries to cure the defect and save her life,” he said.
In November, the child underwent an open-heart surgery, covered by the state comprehensive health insurance scheme, where the surgeons placed a tube between a branch of the aorta, main artery carrying blood away from the heart, and the right pulmonary artery, so that more blood flows to the lungs for purification.
However, in June she again developed breathing problems and doctors realized that a clot had formed in the tube. “We also realized the presence of a large abnormal blood vessel supplying blood to the right lung,” said Dr Vijaykumar. She underwent another open-heart surgery on June 12, in the city. “We disconnected the abnormal blood vessel from the right pulmonary artery, the clot in the artery was also removed, we closed the hold in the lower chambers of the heart, we placed a conduit from the right ventricle to the right pulmonary and left pulmonary artery and the pulmonary artery was recreated,” he said.
The doctor said the pulmonary and the valve was made using the pericardium, or tissue covering the heart, using Ozaki technique. “This saved them at least Rs 2 lakh,” he said.
Cardio thoracic surgeons said that this could be a good example to pursue in low-income countries. “While there is a chance of the child outgrowing the valve, it is still a good cost-effective way to recreate the pulmonary valve. The challenge is to recreate the valve while keeping the child's heart open,” said Dr Anto Sahayaraj, cardiothoracic surgeon at Chennai-based Gleneagles Global health city.