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Paediatric heart care 15 6-2012 -7 pm


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Paediatric heart care 15 6-2012 -7 pm

  1. 1. History of Pediatric Cardiology & Surgery in India and AP Prof. P. Krishnam Raju CARE Hospital Hyderabad
  2. 2. “Fortunately the diagnosis of the exact lesion is not of greatimportance in either prognosis or treatment, there is nocurative treatment and nothing , which will either diminishthe deformities or favour the closure of abnormal openings.The treatment must therefore be hygienic and symptomatic” (Dr. John Morse, 1926)(His textbook 0f pediatrics contained just five pages oncongenital cardiac anomalies)
  3. 3. My Early Exposure to Congenital Heart DiseaseProf. P. Laxman Rao GMCDr. Peraiah GMCDr. Helen TaussigAutopsy of Ebstein’s Anomaly PatientCongenital MethemoglobinemiaPt with - (As MD Post graduate) VSD + AR ( 1972) DSS Operated (1986) As Prof of CARDIOLOGY SMC VIJAYAWADA
  4. 4. Paediatric Cardiology in India Beginnings• Dr. S. Padmavathi First trained ( Late fifties)• Dr. Vythilingam 1961 CMC , Vellore• Dr. R. Tandon 1963 AIIMS• Dr. P. Laxman Rao 1964 GMC, AP• Dr. Vishnu Jain Mid Sixties, Patna• Dr. Bachu Edibam Master Jamshedpur• Dr. S.K. Sanyal Safdarjung Hospital, N.Delhi• Dr. I P Sukumar 1974 CMC / Vellore• Dr. P S. Bidwai• Dr. S. Srivastava 1976, AIIMS, New Delhi
  5. 5. Paediatric Cardiac Catheter Interventions INDIA• Rashkind Balloon Septostomy in d-TGA Early 70s – CMCH, Vellore.• Balloon Pulmonary Valvotomy 1985 - Dr. M. Khalilullah N DELHI• Ballon Aortoplasty of CO-AO 1985 – Dr. M. Khalilullah N DELHI• Balloon Aortic Valvuloplasty 1986 – Dr. M. Khalilullah, New Delhi• Device Closure of PDA 1988 – Dr. R. Arora, New Delhi
  6. 6. Dr. S. PadmavatiNational Heart Institute49, Community CentreEast of KailashNew Delhi – 65Ph: 26414156,26414157,26414075,26414251Fax:91-11-26225733E-mail:
  7. 7. Prof. R. Tandon Consultant CardiologistSitaram Bhartia Institute of Science and Research Centre New Delhi
  8. 8. Dr. I P Sukumar, Paediatric Cardiologist Christian Medical College, Vellore
  9. 9. Christian Medical College Hospital Cardiology• First department of Cardiology 1957• First department of CTVS 1949 (DR REEVE BETTS)• First department of Paediatric Cardiology 1974• First exam for Certification in CTVS ( Vellore) 1960 (Dr. N. Gopinath, First Graduate)
  10. 10. Paediatric Cardiology Academics• Paediatric Cardiac Society of India - Late 1990’s• Journal of PCSI Y 2008 (ON LINE)• Annual Conferences and workshops of PCSI• Case volumes of > 500 / Yrs Paediatric Cardiac Surgery, - Six centers• Dedicated Paed Cardiologists mid 90’s = < 12• No dedicated Training Programme in Paediatric Cardiac Surgery• DM (Card) 1962 AIIMS 1964 CMC, Vellore• Fellowship in Paediatric Cardiology – NBE 4 centers
  11. 11. Pediatric Cardiac Surgery I. First Heart Operation in INDIA 1946 Suturing of bleeding LV wound INDIA by Dr. J.Shah , KEM Hospital, Bombay• PDA Ligation - 1949 Dr. B.R.Billimoria, Masina Hospital, Bombay• Potts – Smith Shunt - 1953 TOF Dr. Reeve H Betts, CMC Hospital, Vellore.• CO – AO Repair - 1953 Dr. P. K. Sen, KEMH; Bombay• ASD Closure - 1956 (Surface Hypothermia) Dr. P.K. Sen, KEMH, Bombay• Open Aortic Valvotomy - 1959 (Inflow occlusion surface Dr. AK Basu, SSKMH, Calcutta. Hypothermia)
  12. 12. Pediatric Cardiac Surgery 2. ASD Closure - 16- 2-1961 (OHS / CPB ) Disc Oxygenator Dr. K.N.Dastur INDIA BYL Nair Hospital, Bombay• VSD Closure - May 1961 (OHS / CPB Dr. N. Gopinath, Pump oxygenator) CMCH, Vellore• Pulmonary Valvotomy 1963 Dr. Nemish A. Shah Bombay Hospital, Bombay• TOF (Total Correction) 1963 Dr. Radhakant Padhi Wanless Chest Hospital (TB Sanatorium), MIRAJ MH
  13. 13. Pediatric Cardiac Surgery 3. Ebstein’s Anomaly Repair 1968 -1970 RSOV, DORV Repair Dr. Stanley John INDIA CMCH, Vellore• Infant Cardiac Surgery February 1976 Dr. K M Cherian, Chennai.• Senning for d-TGA July 1979 Dr. K M Cherian, Chennai.• d-TGA ASO 1984 Dr. K M Cherian, Chennai• Fontan Surgery 1977 Dr. I M Rao, AIIMS• Blood less OHS ASD Closure 1978 Dr. P. Shatapathy, Manipal
  14. 14. KEM Hospital, Mumbai
  15. 15. Christian Medical College and Hospital, Vellore
  16. 16. Southern Railway Hospital, Perambur
  17. 17. MadrasMedicalMission
  18. 18. Frontier Lifeline Hospital, Chennai
  19. 19. Fortis Escorts Heart Institute New Delhi
  20. 20. AIMS , Kerala
  21. 21. Sri Sathya SaiSuper Speciality Hospital, Puttaparthi
  22. 22. Narayana Hrudayalaya, Bangalore
  23. 23. Sri Jayadeva Hospital, Bangalore
  24. 24. S S K M Hospital , Kolkata
  25. 25. SVIMS, Tirupati
  26. 26. CARE Hospital, Banjara Hills
  27. 27. Innova Children HospitalSecunderabad
  28. 28. STAR Hospital, Hyderabad
  29. 29. Care Hospital, Vizag
  30. 30. Prof. N. Gopinath
  31. 31. Prof. N. Gopinath
  32. 32. Dr. Stanley John, MSCardiac SurgeonDepartment of Thoracic & Cardiovascular SurgeryYellamma Dasappa HospitalNo.25, Andree Road, Shanthinagar, Bangalore – 27Ph: 2225642,2225643, Grams: “YELDAS”Telex: 0845-2696 PCO IN ATTEN - ICTP 618
  33. 33. Dr. K.M. CherianCMDFrontier LifelineMogappair,Chennai
  34. 34. Pediatric Cardiology / Surgery Andhra PradeshProf P. Laxman Rao GMC 1965Dr. Dasaradha Ram Reddy Niloufer hospital 1970s (mid)Cardiology / Gandhi Hospital 1976 onwardsPaed. Cardiology Unit Niloufer Hospital 1982Dr. Baaji OGH 1960s-70s ASD / PS (Inflow Obstruction Technique)Dr. Viswanatham GMC PDA/ COAODr. Jaffar Khan KGH, Vizag 60s-70s (PDA)Dr. KV Naidu Chest hospital B-T Shunt ( First)Dr. CR Rajagopalan / Team First OHS (ASD) VSD / TOF - 7th July 1976 GANDHI HOSPITAL SECUNDERABADDr. B V Rama Rao First ASO (dTGA) 1996
  35. 35. Pediatric Cardiology / Surgery Now in Andhra PradeshINNOVA HospitalsCARE HospitalsSTAR HospitalAPOLLO Hospital HyderabadNIMS HospitalLOTUS HospitalCARE Hospital VizagSVIMS Hospital TirupathiSri Satyasai Institute of Medical Sciences, Puttaparthi
  36. 36. Pediatric Cardiology / Surgery Andhra Pradesh Gandhi Hospital• First Cardiac Cathlab in AP 1976• First Echo Machine ( M-Mode) 1980• First DM (Card) Training Programme 1980• First Open Heart Surgery 1976• First ASD / VSD / TOF / Valve Replacement Surgeries.
  37. 37. Gandhi Hospital, Secunderabad
  38. 38. The team which performed the first Open Heart Surgery in A.P. on 7th July 1976 The first cath lab was setup in Andhra at Gandhi
  39. 39. Old Gandhi HospitalAbandoned & Vandalised 2012
  40. 40. NIMS, Hyderabad
  41. 41. Pediatric Cardiology / Surgery Andhra Pradesh Societal InitiativesPrivate Initiatives LITTLE HEARTS FOUNDATION - CARE FOUNDATION Y2002 HRIDAY - STAR HOSPITALS NIMMAGADDA FOUNDATON -C ARE HOSPITAL APOLLO HOSPITALS Rajeev Arogyasri Govt. of AP
  42. 42. 1944 – The first Chest Hospital was established at 8 Indian Base General Hospital in Aundh, near Pune by Defence Services to treat defence personnel with chest injuries and pulmonary diseases.
  43. 43. 1948• Dr.Reeve Hawkins Betts started first Cardiovascular and thoracic unit at Christian Medical College and Hospital, Vellore, Tamil Nadu.• Pulmonary and Esophageal surgeries were performed initially at Vellore.
  44. 44. 1954• Founding of Association of Cardiovascular and Thoracic Surgeons in August 1954, at the Association of Surgeons of India at Vellore under presidentship of Dr. AV Baliga, Mumbai.• ASI subseciality took place with Dr. Reeve H Betts as President, Dr. AK Basu as Secretary.• The five members are Dr. SS Anand, Dr. Yudvir Sachdev, Dr. SK Sen, and Dr. PK Sen.
  45. 45. Academic Aspect• First specialty examination – Master of Surgery in Cardiothoracic and Vascular Surgery held on 1st April 1960.• Dr.Gopinath graduated in the 1st examination along with Geoffrey Allen.• 1964 – the designation to MCh was done.• Five year MCh course at AIIMS.
  46. 46. Training of the Personnel• MCh candidates – about 50 per year.• Diplomate of National Board conducted by Corporate Hospitals has received wide spread recognition• Man power from nursing, physiotherapists and perfusionists has grown enormously.
  47. 47. The Journal - IJTCVS• Dr. Solomon Victor brought out the first issue in 1981.• Dr. A. Sampath Kumar has done an excellent job as Editor of Indian Journal of Thoracic Cardiovascular Surgery (which is in 31st
  48. 48. Pediatric Cardiology – Specialty 1 (Not subspeciality)Foetal Cardiology / SurgeryNeonatal CardiologyAdolescent CardiologyPediatric Cardiac ImagingPediatric Interventional CardiologyPediatric EPPediatric Preventive CardiologyPediatric Molecular CardiologyPediatric Intensivest
  49. 49. Pediatric Cardiology – Specialty 2 (Not subspeciality)Adult Congenital CardiologyPaediatric Heart TX ServicesPaediatric Cardiology / Surgery Nursing Services Technicians Perfusionist Nutritionists Rehab Team.
  50. 50. Cardiac Paediatric Anaesthes Perfusion Other Non-invasive supportOthers Electrophysiology catheterisation and Cardiac -iologists technologists Imaging personnel interventions surgeons Paediatric Paediatric Cardiology Cardiac Surgery Early diagnosis and timely referral Pediatrician neonatologist Comprehensive obstetrician pediatric cardiac care Intensive care Infection Nursing Respiratory Intensivists control therapy Chart showing the human resources associated with comprehensive Paediatric heart care
  51. 51. Differences encountered between patient populations with congenital heart disease (CHD) from India and those from developed nations. Specific differences• Pulmonary hypertension from late presentation.• Neurological insults: hypoxic insults to the developing brain, brain abscess, stroke.• Malnutrition and anaemia because of both delayed correction and high prevalence in population.• Lung infections are associated with shunt lesions.• High prevalence of neonatal sepsis.• High prevalence of low birth weight.• Pregnancy in the presence of significant heart lesion.
  52. 52. Cost-effective strategies for pediatric catheter-based interventions Problems• Cost of dedicated catheterisation laboratories for pediatric catheterisation.• Cost of disposable hardware.• Cost of dedicated anesthesiology support for pediatric procedures• Cost of imported occlusive devices.
  53. 53. Cost-effective strategies for pediatric cardiac surgery Problems• Limited availability of conduits• Cost of imported bypass disposables• Cost of suture materials• Human resources for intensive care unit care• Complex heart defects requiring single/ multistage corrections.• Prosthetic materials
  54. 54. Shortcomings in pediatric heart care in India Broad Category• Detection of CHD• Diagnosis• Referral• Treatment• Prevention• Healthcare planning
  55. 55. Role of Institutions• Training• Developing specific strategies for Indian patients• Cost effective practices• Indigenous Technology
  56. 56. Pediatric Cardiology: Summary• 1938-Essentially no Rx for CHD – Pioneers-pathologists, cardiologists, surgeons, imaging experts, intensivists, interventionalists• 2002-Rx for virtually all CHD, BUT mort./morb.: – ventricular function – arrhythmia – cns – valves/conduits – pulm hypertension• New frontiers-causation, gene-based Rx, CHF Rx, Arrhythmia Rx, imaging, safety of CPB, PVR• An incredibly exciting run--much for the future
  57. 57. “ Change comes because some one some where has the courage of conviction- no matter how foolish”
  58. 58. Some see things as theyare and ask why Change ?Others dream of thingsthat never were and askwhy not ? Walton LiLLEHEI
  59. 59. “The real measure of your wealth is how much you would be worth if you lost all your money” Anon