Saving Shanaya with surgical skill, innovation and faith
Pretty as a princess: Shanaya on her first birthday
She was not only home for Christmas and New Year but also to celebrate her first birthday, which even many medical specialists doubted she would do.
Little Shanaya is the trailblazer of an innovative but risky surgery not done before in Sri Lanka and also on one so small!
Now just 13 months, having marked the milestone birthday on December 6, last year, Shanaya is “doing awesome” is how Dad, Tryon Hamer describes her, “bossing her older brother, six-plus Kyle” and showing her displeasure to Mum Sajitha if her milk feed is late even by a few minutes.
The odds had, however, been heavily stacked up against tiny baby Shanaya, and even as medical colleagues were advising Consultant Cardiothoracic Surgeon, Dr. M.S. Mugunthan, not to take up the scalpel, Tryon and Sajitha had been adamant.
“We have faith in God and absolute trust in you and the team,” they had said, without hesitation. They believe that God performed a miracle through the skilled hands of Dr. Mugunthan.
The tale of joy, heartbreak, nail-biting agony over the touch-and-go situation and finally the triumph we hear from Tryon last weekend, as he laughs, jokes and breaks down during its narration.
The pregnancy and birth through a caesarian of Shanaya were normal, with the first signs of trouble being detected by Consultant Neonatal Paediatrician Dr. Nalin Gamaathige, who felt there were heart rhythm issues, at two weeks when her vaccination was due.
Advising Tryon and Sajitha to get it checked immediately, he had put them onto Consultant Paediatric Cardiologist Dr. Shehan Perera whose echocardiogram (ultrasound) detected multiple defects in the tiny heart.
All smiles: The happy family enjoying Christmas
His encouraging assurance was: “There are things that can be repaired and others that cannot be repaired. This can be repaired.”
Advised to scrupulously attend the clinic at the Lady Ridgeway Hospital (LRH) for Children in Colombo, the distraught couple was also told of the danger signs of their newborn turning blue especially the lips.
“Shanaya was strong and normal,” says Tryon.
The open-heart surgery could be carried out when she was between four to six months, but she had not met the weight requirement of a minimum of 7kg.
The hospital saga began for Tryon and Sajitha when they admitted her on October 7, last year. She was 10 months and an echo had indicated the need for immediate surgery.
The first eight-hour surgery a routine one, had been performed on October 9. It was a success. There followed a five-day stay in the Cardiothoracic Intensive Care Unit (ICU) with the transfer to the ward on October 13. Serious trouble struck again with the repaired heart valves getting infected and ruptured, with an echo suggesting infective endocarditis. It was a serious bacterial infection leading to a severe leakage in the valves.
Reliving the terrible fears, Tryon says that Shanaya swelled up and had to be rushed back into the ICU and treated with strong antibiotics on October 24, where she was until October 27. Back in the ward, the ordeal was not over.
“Going into cardiac arrest, while in the arms of Sajitha, Shanaya’s eyes had gone up and she had turned blue. She had been clinically dead for three minutes,” says Tryon, describing how all the doctors had rushed in and resuscitated her. “Transferred to the ICU once again, she was all tubed up.”
Dr. M.S. Mugunthan: Trailblazing heart surgery
It had been on October 31, that Dr. Mugunthan told them that medically they were doing everything possible for the little one but surgically there was nothing much that could be done.
The couple’s ardent prayers though had been answered when on November 3, the doctors told them of a surgery to save Shanaya’s life, not done in Sri Lanka on such a small baby as it was very risky.
“Go ahead,” the couple had assured the doctors.
Taken into the Operating Theatre on November 4, the surgery had lasted a marathon 10 hours, with a tired but all smiles Dr. Mugunthan, who had not even had a sip of water, walking out telling them the surgery was successful.
Shanaya was once again in the ICU, this time with her chest open to prevent any bleeding, with all types of tubes snaking out from around her. Once her chest was closed and she was transferred to the ward on November 18, the next challenge was building up her strength from being gaunt and skeletal.
While Shanaya’s parents shower praise on Dr. Mugunthan and the LRH cardiac team for their valiant efforts, Victory Day had come on December 4, when their little one was home to celebrate her first birthday on the 6th.
| The technically challenging procedure | |
| Shanaya had a “mix” of problems right at the centre of the heart, explains Consultant Cardiothoracic Surgeon Dr. M. S. Mugunthan.She was diagnosed with congenital endocardial cushion defect (ECD) also known as an atrioventricular canal defect (AVCD). In ECD, the walls separating all four chambers of the heart are poorly formed or absent. There are also defects in the valves separating the upper and lower chambers of the heart, hindering the proper flow of blood.Delving into medical technicalities, Dr. Mugunthan says: “AVCD may involve defects in the inferior portion of the atrial septum (the stout wall separating the heart’s upper chambers); the inflow portion of the ventricular septum (the thick muscular wall of the lower chambers) and the tissue forming the left and right AV valves.“Surgical repair, therefore, requires correction of the atrial septal defect (ASD), the ventricular septal defect (VSD) and the repair of both the left and right AV valves. This procedure is routinely performed in Sri Lanka,” says Dr. Mugunthan. If left untreated, the defect leads to mixing of oxygen-rich and oxygen-poor blood, increased blood flow to the lungs, elevated (higher) lung pressure and heart failure, he says, explaining that surgery is usually performed between six months and one to two years of age, depending on the severity of symptoms. In Shanaya’s case, according to Dr. Mugunthan, the initial corrective surgery was successful. However, a subsequent severe infection of both the left and right AV valves placed the surgical team in a dilemma. The left AV valve was extensively damaged, resulting in severe leakage and progressive heart failure. “While the less-damaged right AV valve could be repaired, the left valve was irreparable. The only option to eliminate the infection and ensure the baby’s survival was to remove the infected valve and implant a mechanical prosthetic valve,” he says. Then arose a major technical challenge – the small size of the left AV or mitral valve (size 12) needed for Shanaya and also the absence of a well-defined annulus (the fibrous ring that anchors the valve). It was significantly smaller than the available mechanical valves, making conventional implantation impossible. Explaining that among mechanical valves, the aortic valve has the smallest available size, Dr. Mugunthan says that he selected the smallest aortic mechanical valve (size 16) and implanted it obliquely in a reversed position so that it could function as Shanaya’s mitral valve. The successful suturing of a larger mechanical valve into a much smaller opening where there was no well-defined annulus was a technical feat not done in Sri Lanka before. Shanaya is alive and passed her first birthday due to this exceptional innovation and surgical skill of Dr. Mugunthan. |
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