Lady Ridgeway Hospital takes giant leap:

How teamwork saves a life

Rasika SOMARATNE

“It’s a mine field” says Dr. Mahendra Munasinghe in the midst of an open heart surgery to save the life of one and a half year old Anura from Badulla, who is undergoing heart surgery at the Lady Ridgeway Hospital Cardiac operating theatre to correct a congenital defect in his heart.

It springs to my mind that it is no wonder that they say “Heart surgery is not for the faint hearted,” as the world renowned Cardiac surgeon from USA DR. Jeremy R Torstveit who is standing beside me whispers in my ear “if you feel light headed please sit on the floor immediately. For God’s sake don’t fall on the patient”.

In the case of little Anura, it is a life threatening hole and an abnormally located major vessel, which hampers the blood circulation and increases the blood pressure in the lungs of the two year old and if left untreated would ultimately claim his life.

Due to the ailment his heart has become congested and as twice as large and is almost touching the ribs. Little Anura is one in a thousands who seek treatment for congenital heart defects at the LRH and if untreated in time his young life would be terminated before it reaches it’s prime.

Fortunately for him the intervention has been a timely one, but for more than 1,000 others who are in the waiting list at the LRH in expectation of complex heart surgery to save their lives, may not be that fortunate. Cardiac Surgeon Dr. Munasinghe, in this operation is assisted by a team numbering around 8, who are thoroughly trained professionals in their chosen fields of expertise.

Asleep

At the beginning of the operation Anaesthetist Dr (Mrs) Mahalekama gives little Aruna a sleep-inducing medication through the IV, he continues to breathe a mixture of oxygen and anaesthetic gas (general anaesthesia) to make sure that he remains asleep throughout the entire surgery.

Then a tiny tube is inserted to an artery in the arm to measure the blood pressure accurately.

A device called the CVP catheter is inserted into the jugular vein (in the neck) to measure heart function, heart and lung pressure and also to give medication. A breathing tube (endotracheal tube) too is inserted into the mouth and down the windpipe (trachea) to maintain an airway. Probes have to be inserted into the rectum and into the nostril to measure the exact core temperature of the body.

A urinary catheter too comes in to play which is inserted and connected to a collection bag to measure the patient’s urine output.

All this is done with utmost care as one wrong move could either damage tissue or a major vessel.

When all measures are in place opening a cavity to expose the heart begins, with Dr. Munasinghe splitting the breast bone with an electric saw. Then the breast bone and ribs are retracted to open up the chest.

Inserted

Tubes are inserted to the main blood vessels to keep the heart going, including blood flow and oxygenation are rerouted through the heart-lung machine.

Body temperature is lowered down to 32`C so that the heart can be safely stopped during the procedure by the injection of a drug.

Later the heart is stopped and is opened with an incision.

Blood inside the heart is sucked out to be recycled via the heart lung machine. The large hole in the middle of the interior of the heart gets exposed and later the surgeon fills the gap with a patch which is sewed in to place very carefully.

When the procedure is completed, the incision in the heart is closed and the heart is being restarted. When the surgical team was satisfied that the heart beats strongly again, Aruna’s heart is being slowly weaned off the heart-lung machine. The breast bone is wired together and the chest incisions is closed.

This all might sound a bit simple, but remember the surgeon works on a vigorously beating heart initially and in an area where a lot of vital structures are concentrated. One wrong move could see the end of a young life, which is aspiring to reach adulthood like any other.

Everybody in the team the Surgeons, Anaesthetists, Nurses, helpers all play their part during the operation. But at times the calming voice of Dr. Munasinghe is necessary when nerves play a trick or two.

The crucial moment is when the patient is weaned from the machine which supports him throughout the operation.

Beautiful

The Doctor proudly says to me “look at the heart now, its’ size has already been reduced” as Dr. Torsveit whispers in my ear again take one final look before he closes the cavity, because you might not get the opportunity again. “Isn’t it beautiful ?”.

Though a life has been saved, it has a cost. According to Dr. Munasinghe this particular operation would have cost more than Rs.400,000 in a private institution, which is way beyond the reach of Anura’s parents.

Even before you read this article, one week since the life saving surgery, we hear that little Anura has already left the LRH with his happy mother, to lead a normal life just like his many friends, a luxury which he did not enjoy earlier.