A new and joyous beginning in the New Year of 2019 for a humble fishing family in Negombo’s Kuda Paduwa and a first for Sri Lanka, making medical history in the country. Bypass heart surgery for a child under 12. Even though everyone knows about coronary artery bypass grafting (CABG) in adults who have blocked [...]


Francia and her family can look forward to a happy new year

The seven-year-old diagnosed with three blocks in the vessels supplying blood to her heart, undergoes bypass surgery, marking a milestone in the state health sector

A new and joyous beginning in the New Year of 2019 for a humble fishing family in Negombo’s Kuda Paduwa and a first for Sri Lanka, making medical history in the country.

Bypass heart surgery for a child under 12.

Back home: Bright-eyed Francia. Pic by M.A. Pushpa Kumara

Even though everyone knows about coronary artery bypass grafting (CABG) in adults who have blocked vessels which supply blood to the heart, never before has it been performed on a child below 12.

However, the other day, sitting before us is seven-year-old W. Francia Vidushi Fernando, a slip of a girl smiling shyly at us behind her face mask.

Back home from the Kandy Teaching Hospital, having undergone open heart surgery under the skilled hands of Consultant Cardiothoracic Surgeon Dr. Anil Abeywickrama and his able team, Francia along with her family await the year with hope.

Just like most in Sri Lanka, this family whose ‘breadwinner’ is into a deevara rassawa, was content with their lot. W. Dickson Fernando would go out to sea, while Sriyanie tended home and hearth. They were blessed with three children – a daughter and a son followed by another daughter.

It was when Francia, the youngest, was a babe in arms, just nine months old that a fever hit her. Rushed to the Negombo District General Hospital, the cause of the fever was elusive and she was transferred to the Lady Ridgeway Hospital (LRH) for Children in Colombo.

Asamanya unak,” murmurs Sriyanie, explaining that it was an unusual fever which would not go down even with medication.

It was caused by the hereditary Kawasaki Disease, also known as Mucocutaneous Lymph Node Syndrome. Affecting mainly children under the age of five, its symptoms include a high temperature that lasts for 5 days or more, a rash and swollen glands in the neck. The heart may be affected in as many as 1 in 4 children, with damage sometimes occurring to blood vessels (coronary arteries) that supply the heart muscle and also the heart muscle itself.

Unfortunately, Francia’s little heart was affected and Sriyanie says that echocardiograms indicated that there was an asamanya idimumak (unnatural swelling) of the heart.

The family was devastated. “Godak duka hithuna,” says Sriyanie, reliving those early days when they were gripped by sadness and in the depths of despair.

Treatment began under Consultant Paediatric Cardiologist Dr. Shehan Perera of the LRH. Once discharged from the LRH, the family was advised to take Francia for check-ups every six months to the Negombo Hospital, as it was close to home. INR reports were a must. [This is the International Normalized Ratio or Prothrombin Time (PT), a standardized measurement of the time it takes for blood to clot.]

Thereafter, Francia “hondatama hitiya” (was well), says Sriyanie, adding that she was like any other child. When she reached school age, she began attending St. Peter’s Madhya Maha Vidyalaya, while the clinic visits continued.

Everything was fine until November 2 – the malavunge mangalya dine (All Souls’ Day). As Sriyanie got her three children ready for church, Francia complained of a chest pain, closer to the neck. Sriyanie assumed it was due to sema (phlegm) and it did wane in about five minutes.

But the next day too while Francia was playing with her friends, she was assailed by chest pain. Lasting just a short while, it went off again, only to return in the evening. Sriyanie, however, was not unduly worried as they had done the INR test two days before.

As the pain intensified, they rushed Francia to the Negombo Hospital. But the pain subsided soon and she was her usual self.

With the paper work being done to discharge her the next day, Sriyanie sees divine intervention……it was 8.30 in the night and Consultant Paediatrician Dr. LakKumar Fernando was on a ward round as he was wont to do many times, even though not expected of a senior doctor at that time of the night. The pain struck again and Francia was wracked by loud sobs before his eyes.

Immediately, Dr. Fernando had ordered an electrocardiogram (ECG) and blood tests and on seeing the reports transferred the child to the LRH.

With echocardiograms and an angiogram being performed by Consultant Paediatric Cardiologist Dr. Shehan Perera, came the disturbing find that Francia had three blocks in the vessels supplying blood to the heart.

Having diagnosed this serious condition, the doctors were frank that no bypasses had been performed in small children.

They, however, held out a tiny ray of hope – armed with more tests including a CT-angiogram, she was gently put into an ambulance and transferred to the Kandy Hospital into the care of Dr. Anil Abeywickrama.

Straight into the High Dependency Unit Francia was sent with instructions that she should not be allowed to walk, with bed-rest being strictly adhered to.  Many were the discussions that Dr. Abeywickrama had with the parents – how bypasses had not been attempted on a child before. Numerous tests followed and a wait of two weeks as Francia got a cough.

Friday, November 23, Francia was taken into the operating theatre for open heart surgery and unceasing were the prayers of the parents in Kandy while kannalaw (pleading) went forth from relatives and friends back home at the Kuda Paduwa church.

Aluthma ipadumak (a new birth) through deviyange haskamak (a miracle),” says Sriyanie, adding that there is nothing they can do for Dr. Abeywickrama and his team except thank them from the bottom of their hearts.

They also light candles before the Perpetual Succour (Mary, mother of Jesus Christ) to shower blessings on them for the loku sevaya (major service) they are performing for humble folk.

Doctors make tough decision 
It was a stressful decision for the heart team of the Kandy Teaching Hospital headed by Consultant Cardiothoracic Surgeon Dr. Anil Abeywickrama.No bypass (CABG — coronary artery bypass grafting) had been performed on such a small child.But there was no option — death was staring seven-year-old Francia who was suffering from unstable angina (poor blood flow to the heart) in the face.

If the bypass was not attempted Francia would die anyway and if the bypass was attempted she could die on the operating table. All three of the main arteries supplying blood to Francia’s heart were more than 90% blocked.

Urgent discussions ensued between the LRH heart team which included Consultant Paediatric Cardiothoracic Surgeon Dr. Kanchana Singappuli and Consultant Paediatric Cardiologist Dr. Shehan Perera and Dr. Abeywickrama who had earlier done a stint at the LRH.

Even though the odds seemed to be stacked against Francia, they decided to go ahead and attempt the bypass as it was known that Dr. Abeywickrama was heavily into using arterial grafts rather than veins for such procedures.

“Usually about 70% of the grafted veins used in bypasses get occluded or blocked within 10 years,” says Dr. Abeywickrama, reiterating that unlike veins, there is 90% patency (remaining open and unobstructed) in arterial grafts.

The bypass surgery on this child began around 9.30 in the morning, lasting five hours, with two arteries which were used for the bypass being harvested from under her breastbone and the other from her left hand.

“There was much tension and worry,” concedes Dr. Abeywickrama for unlike in adults, Francia’s arteries were tiny.

He commends his skilful team including Consultant Cardiothoracic Surgeon Dr. M. N. Jazeel who came from the National Hospital in Colombo; Consultant Cardiao thoracic Anaesthetist Dr. Aruni Jayasekara; and Medical Officers (Cardiothoracic Surgery) Dr. Samitha Vithanage and Dr. Suranga Wijesinghe for all the efforts to save this little girl.

For the country, it is proof of how the excellent state health system works in tandem (Negombo to LRH to Kandy) for the poorest of the poor.

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