The baby with an over-sized heart

A baby in Tripura suffering from recurring lung infections was found to have an over-sized heart by doctors in Bengaluru.

The parents, who had dizygotic twins, became concerned with the male child, aged one-and-a-half, when he began to suffer frequent lung infections, abnormal sweating and had trouble putting on weight, requiring hospitalisation on two separate occasions.

During the child’s second admission at a hospital in Tripura, the pediatrician suspected the boy had a congenital heart condition. When the boy was rushed to Manipal Hospitals in Bengaluru, the attending pediatrician-cardiologist, Dr Kavya Mallikarjun, was surprised to discover the boy had a fast heart rate. A stereoscopic examination discovered an unusual murmur over his chest and back.

Dr Mallikarjun said she prescribed an echocardiogram test. What she found initially stumped her.

“It was something I had never seen before. The aorta, which is the main blood vessel which supplies oxygenated (good) blood to the entire body, normally arises from the left ventricle and carries blood to all the organs. But in this baby’s case the aorta was leading somewhere else,” she said.

The echocardiogram also showed the boy’s left heart chambers were bigger in size than normal and the valve on the left side (mitral valve) had a significant leak, caused by an abnormal flow of blood from the aorta.

Although a CT scan is a last measure, Dr Mallikarjun asked the parents to authorise the test as it would reveal the problem in detail. The parents agreed.

The scan showed an abnormal communication from the descending aorta to the pulmonary vein on the left side. Pulmonary veins carry oxygen-rich blood from the lung to the left side of the heart from where it is supplied to the body through the aorta. “The result was baffling,” Dr Mallikarjun said, adding that she had to consult medical journals in order to find what the condition was.

She eventually discovered the baby had a congenital descending aorta to pulmonary vein fistula. Only 10-15 such case studies had been compiled worldwide.

Following a successful device closure of the fistulous communication in a cardiac catheterisation laboratory, the child was released from the hospital in June.