A premature Iraqi Baby with complete heart block and heart failure was given a new lease of life at Fortis, Gurugram, Haryana.

Doctors at Fortis Memorial Research Institute, Gurugram were presented with a rare case of 32 weeks pregnant Iraqi Patient Tara Yosuf (24) whose fetus showed major heart complications.

The ultrasound done in Iraq showed huge abnormalities in the fetus. The mother underwent a fetal echocardiogram which revealed that the fetus had a complete heart block with signs of congestive heart failure. Ms Yousuf flew to India in an emergency and sought treatment at Fortis Gurugram. The case was presented before Dr Preeti Rastogi, Additional Director, Obstetrics and Gynecology, Dr. Antony Joseph Thekkinedath, Head of Neonatal Intensive Care Unit and Dr Udgeath Dhir, Director and Head, Cardiovascular Thoracic Surgery, FMRI who along with their teams, successfully treated the premature baby.

An emergency C – section was done, and a baby boy was delivered with a heartbeat of only 40 beats a minute (the ideal heartbeat is 130 or 140 beats a minute) in April 2019. The baby also had immature lungs and was immediately put on ventilator support. As the baby’s heart rate was very low, it led to fluid accumulation and swelling in the body. The patient was given medicines on day 1 to increase the heart rate followed by a temporary pacemaker on the next day. This was done to stabilize the baby's heart rate, a statement from the Hospital said.

The procedure was complicated as the baby was premature in cardiac failure and had to be anaesthetized for the procedure. The challenge was of the baby coming off the ventilator without any complications. The baby responded positively to the temporary pacemaker with improvement in heart rate, cardiac functions and reduction in the generalized swelling. The baby underwent another surgery after 24 days for a permanent pacemaker implantation.

According to Dr Antony Joseph Thekkinedath, Head of Neonatal Intensive Care Unit at FMRI, “When the baby was delivered the chances of its survival were very bleak. As the heartbeat of the patient was very low and the body had a lot of swelling our focus was to immediately stabilize the child with medicines. The baby was immediately ventilated. It is very rare to install a pacemaker in a 32 week-old baby, who is not only premature but also needs special attention for this complex problem, specially because the permanent pacemaker is inserted in small chest cavity of the premature and has to fight for space with the heart and lungs.”

Dr Udgeath Dhir, Director & Head, Cardiovascular Thoracic Surgery at FMRI said, “The baby’s heart rate was worrisome. We had to wait for 24 hours before making any decisions regarding the surgical intervention. In view of poor heart rate, the baby was initially given medicines to increase the heart rate and to reduce the swelling.''
Within 24 hours of delivery, temporary ventricular pacing was done to stabilize the baby and get the heart rate to normal.

The baby was taken off the ventilator after three days and was monitored with a temporary pacemaker. Once completely normal, apermanent pacemaker was installed with surgical intervention.

Ms Yosuf said, “I came here with almost no hope of seeing my baby alive or healthy.In Iraq, the doctors were not positive that my child would live. When I met Dr. Antony and Dr Dhir, they assured me that they would do their best to make sure my baby would survive.It has been a difficult journey for us. My baby underwent multiple surgeries and the isolation, the dread and the anxiety that has accompanied this entire ordeal has made this terribly difficult for me. ”