MADURAI
For R. Vijayakumari from Markanathapuram in Virudhunagar district, a daily wager in a cracker unit and the sole breadwinner of her family comprising her husband and four daughters, life came to a standstill when her youngest daughter was identified with a rare and complex heart ailment mid last year.
As the cough, fever and breathlessness failed to recede despite medication from local hospitals, the girl, aged 13 and studying Class 9 in a government school, was brought to a private hospital in Madurai, where she was diagnosed with ‘Submitral left ventricular aneurysm (SLVA)’ - a life-threatening and rare heart ailment.
“The literature about the condition is sparse. Though the first case was reported in 1812, not more than a few hundred cases have been reported widely since,” A. Rathinavel, Head, Department of Cardiothoracic Surgery, GRH, who headed the team of surgeons that operated the child, said.
Explaining the condition, S. Shanmugasundaram, Dean (in-charge), GRH, said that while aneurysm generally meant the weakening and outward bulging (like a bubble) of the wall of a blood vessel, SLVA meant weakening and bulging on the posterior wall of the left ventricle, one of the four chambers of the heart.
“To complicate the condition, for this child the aneurysm was affecting the closely located mitral valve through which blood flows from left atrium to left ventricle,” he added.
On why the effect of this congenital condition was not felt by the child earlier, Dr. Rathinavel said that the bulging at birth must have been smaller in the size of few millimetre. “Over the years it had grown and when we operated, it was 6 x 5 cm, the size of a small orange,” he said.
He said that the weakening and bulging of the wall resulted in reduced efficiency in pumping of blood. “Importantly, the wall may suddenly burst, resulting in immediate death,” he said. “In fact, in many cases, the condition is identified only after the death due to rupture,” he added.
After diagnosing the condition, two major private hospitals in Madurai, while agreeing to operate, told Ms. Vijayakumari that there was high possibility that the child could die during the procedure or develop renal failure.
“They said it will cost at least ₹ 3 lakh apart from the coverage under Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS). I was hoping to arrange the money somehow, but there was no guarantee that my child will survive,” she said.
That is when her elder daughter, studying nursing, suggested approaching GRH. “When the child was brought to us, she was not in a condition to undergo surgery. Hence, we performed it after a month on December 19, 2018,” Dr. Rathinavel said.
In an open heart surgery, the bulged portion of the left article’s wall was removed and replaced with an artificial Polytetrafluoroethylene (PTFE) patch. The mitral valve was replaced with an artificial valve.
Profusely thanking the doctors, Ms. Vijayakumari pointed that the surgery and more than one month of hospitalisation was done free of cost.
“Unless there is an abnormal and unpredicted infection, for which the chances are remote, the girl can now lead a normal life,” Dr. Shanmugasundaram said.
He appreciated the team of doctors, which included M. Kalyanasundaram, Director (in-charge), Institute of Anesthesiology, S. Balasubramanian and G.S. Sivakumar from Department of Cardiology, and R. Muthukumar and R. Meenakshi Sundaram from Department of Cardiothoracic Surgery.
