KUALA LUMPUR, June 10 — The National Heart Institute (IJN) achieved another major landmark when it successfully operated on a three-month old separated conjoined twin.
The baby had a congenital heart defect called ‘Transposition of the Great Vessels’ (TGV), where the valve and the artery is inverted.
Aleesa Hana Moh Saiful Riduan was born in Kota Kinabalu, Sabah on February 19 with a conjoined twin at 37 weeks of gestation via an elective caesarean section.
While her other sibling was perfectly healthy, Aleesa looked abnormally blue at birth with poor respiratory effort.
An echocardiography later confirmed the diagnosis of TGV with intact ventricular septum and restrictive patent foramen ovale.
Upon diagnosis, Aleesa was treated with an emergency balloon atrial septostomy — a procedure to increase oxygen saturation in patients with cyanotic congenital heart defects — and stabilised for twin separation surgery that took place in Hospital Likas in Sabah.
Aleesa’s mother, who did not want to be named, said she only discovered about her twins condition at the 22nd week of her pregnancy.
“A Fetal MRI made the diagnosis of conjoined twins antenatally,” she added.
She said they were joint at the bottom of the chest to the centre of navel.
After the twins were separated, Aleesa underwent a stenting of the patent ductus arteriosus as the left ventricular size was regressing.
The stent’s duty was to improve the blood flow to the left ventricular to keep it well-functioning until the child is fit enough to undergo a heart surgery.
She was then transferred to IJN for surgical correction of her heart defect.
However, the heart problem was not the only challenge the medical team at IJN had to face.
On admission, Aleesa had severe lung complication and sepsis, which made the doctors’ task even more difficult for post-operative management.
Additionally, the child was very swollen and edematous due to prior infection.
After stabilising her, Aleesa successfully underwent arterial switch operation led by consultant cardiothoracic surgeon Dr Sivakumar Sivalingam on May 16 to switch back the heart’s abnormal blood vessels to the normal circulation.
Describing Aleesa’s condition, Dr Sivakumar admitted that the patient’s case was unique and complicated as she had several complex heart problems along with lung infection.
According to him, a normal heart comes with two coronary arteries, one to pump blood into the lung, where it is oxygenated, and the other to supply blood to the rest of the body.
But as for Aleesa’s case, her heart came with only one artery.
On top of that, Dr Sivakumar said another problem they faced was Aleesa’s abnormal heart positioning as it was on the right side of her chest.
Considering the complexity of her condition, a strong medical team comprising two surgeons, two anesthetists, a perfusionist (the person who operates the cardiopulmonary bypass machine), two operation theatre (OT) staff nurses and one OT technologist spent over four hours at the operation room to give Aleesa a new lease of life.
Although the operation was declared a success, Dr Sivakumar said the patient experienced a relatively stormy post-operative period with poor lung compliance that required keeping the chest open for three days before successfully closing it back.
“The intensive care team did a fantastic job at monitoring the patient round-the-clock to get the lung function better, and we eventually succeeded after 24 hours.”
Dr Sivakumar also highlighted that the success of the surgery was mostly due to the excellent collaborative efforts between the medical teams in Kota Kinabalu and Kuala Lumpur to rightfully separate the twins, diagnose Aleesa’s heart defects and treat her with care.
Aleesa was recently weaned off the ventilator and is only on nasal oxygen support until her lung tissues are fully recovered.
She is scheduled to be discharged and transferred back to her hometown in Kota Kinabalu tomorrow to be placed in Likas Hospital pediatric ward until her condition stabilises.
