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She's
whole again Normal as she seems, Achini has had a rough week, having been released from hospital only last Sunday. The surgery that closed the two holes in her heart could have left her scarred and bedridden. Instead a different approach on the part of the doctors meant that she came home two days after the operation, and is already feeling on top of the world. "Achini hardly ever got sick," says her mother, Nirmala Jayathilaka, explaining how they had taken the 13-year-old to the doctor in Nawagamuwa when she complained of pain in her legs. As their doctor checked her pulse and heartbeat, he quickly realised it was something far more serious than leg pain. She had an abnormal murmur in the heart. He advised Achini's parents to take her to the National Hospital in Colombo immediately. After several tests at the hospital, Achini's parents were told that heart surgery was their only option and that it would cost them two and a half lakhs. M. L. Leelarathna, Achini's father, knew he would never be able to afford it on his driver's salary. The distraught parents turned to the President's Fund and Ceylinco Insurance for financial assistance, and were relieved when both responded with donations of Rs. 175,000 and Rs. 75,000 respectively. To undergo the operation, Achini had to be mentally and physically fit. Hence the doctors suggested that she not be told of the impending surgery. "She did not know till she was asked to stay in the hospital," said her mother, adding that she was not permitted to stay with Achini. "From the day the doctor told me that it was something more than a pain in her legs, there hasn't been a single night when I have not cried myself to sleep," sighs Mrs. Jayathilaka, adding that she has had to be strong for her daughter. Achini had been quite accustomed to the hospital having undergone a battery of tests. So when on October 6, she was getting ready to enter hospital again, she was not afraid. In fact she was looking forward to moving around the ward and observing the doctors and nurses at work. "I want to be a doctor one day, and I loved to watch them," says Achini. Recalling being taken into the theatre on October 7, she says, "I did not feel any pain, and I was not scared." But the 45 minute surgery seemed to take forever for her anxious parents who waited outside the theatre, praying. Back home two days after the surgery Achini is her usual jaunty self. Although the doctors have recommended she return to school almost immediately, her parents feel she must have a few more days of rest. A student at Bomiliya National School, Achini is now looking forward to doing her favourite gymnastics again and enjoying her friends' company. As normalcy slowly returns to the Leelarathna family they hope to go to the temple, where they had previously asked for healing, to give thanks for Achini's recovery.
Pioneering procedure "Although we have had thirty such operations, this was the first patient with two holes in the heart," revealed Dr. S. Mithrakumar, Consultant Cardiologist and Interventional Cardiologist at the National Hospital going on to add that state hospitals in Sri Lanka began using this advanced procedure only in the last six months. Like in Achini's case, in most children ASD causes no symptoms. "Symptoms tend to appear only once the individuals cross into their 30s," said Dr. Mithrakumar. “Normally we wait until the child is about 5 years old as more delay could adversely affect her development," he cautioned, going on to stress the importance of dealing with the defect as soon as it is discovered. Only a very large defect may allow so much blood flow through it to cause congestive heart failure symptoms such as shortness of breath, easy fatigability or poor growth. When an atrial septal defect is present, blood flows through the hole primarily from the left atrium to the right atrium. This shunting increases the blood volume in the right atrium, which in turn means more blood flows through the lungs than would normally occur, leading to high blood pressure in the lungs. If left untreated, atrial septal defect may cause problems in adulthood. These problems may include pulmonary hypertension (which is high blood pressure in the lungs), congestive heart failure (weakening of the heart muscle), atrial arrhythmias (which are abnormal rhythms or beating of the heart) and an increased risk of stroke. Previously doctors would opt for open-heart surgery when faced with septal defects. This required the heart to be opened and the defect closed. In the case of a small hole, stitches would suffice but if it was large a patch would be employed. This resulted in large scars on the chest and prolonged bed rest. The newer method, however, allows for the Septal Occluder to be inserted into the heart through a catheter, which in turn is inserted through the femoral vein in the upper part of the right thigh. "The Amplatzer septal occluder is a self-expanding, double saucer shaped device, with a central stent-like connecting cylinder," said Dr. Mithrakumar. Made of nitinol wire mesh filled with polyester fabric, it self inflates only once the doctors have begun to pull back the sheath as they withdraw the catheter. If all goes well, and the size of the hole has been judged correctly the septal occluder, fits perfectly into place and blocks the hole. "Most of the first world has been using this device for over a decade now, but it is still not widely used in Sri Lanka," explained Dr. Mithrakumar Dr. Mithrakumar recommended that Achini go back to living an active lifestyle. According to him "the point of the whole exercise is to enable patients to live normal, fulfilled lives”. He went on to explain how the tissues would grow back around the device, while the device itself shrinks, thereby ensuring high recovery rates. The main draw- back is the cost of the device, with a price tag of Rs. 240,000. |
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