Thursday, March 26, 2009

Smiling Child.. Finally

You could never see a smile on her face. Lagmavva, a cute little 8 year old from North Karnataka hardly ever sported a grin on her face for all the 15 days that she was under our care. She was one of the bluest 'tets' that has been operated on in MSR-NH so far. Surgery was uneventful but for some confusion regarding the exact RV/LV pressure ratio post CPB( we all agreed finally that it was less that 0.75..). Nevertheless, child was successfully weaned off the CPB with stable hemodynamics with minimal inotropic supports and normal sinus rhythm. We extubated her on first POD, since all the necessary parameters were within acceptable limits. All of us, members of the surgical team, rejoiced secretly for this favorable outcome. But our joy was to be only shortlived since, much to our disappointment and dismay, the cardiologist found  residual VSD with'sizeable' shunt on post op echo. How ever, she also suggested that, since all the pieces are not really fitting approriately in the jigsaw puzzle it would be prudent to do a catheterisation study to grade the VSD and measure Qp/Qs. Cath was done and fortunately proved that VSD wasn't all that significant and Qp/Qs is 1. So, with her cardiac problem sorted out, we heaved a sigh of relief and proceeded with her futher management  so that she can be discharged from the ICU. But then, she had different plans for us !
She refused to take anything orally except coffee( a lots of coffee.. sometimes 6 cups straight!). If forcibly fed, she used to vomit everything with in few minutes. Her past history revealed similar problem since almost 2 months along with history of intermittent abdominal pain. We sought evaluation by pediatrician, pediatric surgeon and pediatric cardiologist. They didn't find anything grossly abnormal with her and one of them even suggested that it could be because of some psychiatric problem. The latter opinion looked more plausible to us also, since the child hardly used to smile, always used to be withdrawn from her surroundings and used to be hyper irritable. This repeated vomiting episodes soon after food intake continued for almost a week after discharge from our post op ICU. So. we decided to get an endoscopy done for the child. We had the dubious honour of anesthetising the child for the fourth time( Cath study, surgery, cathstudy again and finally for the endoscopy !). This turned out to be a very wise move.. it was found on endoscopy that the child had a stricture oesophagus because of reflux oesophagitis due to hiatus hernia! The stricture was dilated with balloon and child was shifted to ward. After a really long time she could eat a meal and retain it too.  
She started smiling after that. And it was a wonderful sight !  I wanted to share it with you all and hence this post..


arun said...

looks like the way through a woman's heart is through the mouth too. good one anil

Dr.Rutledge said...

Hi Anil,

What a wonderful story. Great post.

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thejas said...

good story and very well done. that smile is the ultimate satisfaction.

Shaktiman said...

All credit goes to doctor he done it very well.
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