Saving a newborn baby with severe heart disease: transposition of the great arteries
The University of Medicine and Pharmacy Hospital in Ho Chi Minh City (BV ĐHYD TPHCM) has just saved a newborn baby with a complex congenital heart disease. The baby's cardiac abnormality was detected when the fetus was over 20 weeks old and was diagnosed with transposition of the great arteries. This is a dangerous heart defect for newborns because it directly affects the blood circulation supplying the brain and organs. Additionally, the baby also suffered from severe neonatal infection. Thanks to timely treatment and close collaboration of the multidisciplinary team of doctors at BV ĐHYD TPHCM, the newborn has been saved and has now recovered normal heart function.
Early detection of fetal abnormalities thanks to prenatal cardiac ultrasound screening
Previously, most cases of transposition of the great arteries were detected later, after the baby was born. Today, thanks to advances in prenatal diagnosis and screening for severe fetal conditions, doctors at BV ĐHYD TPHCM can accurately diagnose many complex diseases early, as in the case of this baby, whose heart disease, transposition of the great arteries, was detected at about 20–22 weeks of gestation.
The 36-year-old mother of this newborn patient has updated information, knowing how to screen during the pregnancy stage. After a fetal heart ultrasound for the baby at around 20 weeks of gestation, as recommended for fetal heart screening, doctors detected and accurately diagnosed and gave comprehensive counseling to the family. Specifically, the baby was found to be diagnosed with transposition of the great arteries, this is a severe congenital heart disease. In this condition, the two major arteries that function to transport blood from the heart to the lungs and to the body's organs are not connected as normal, they are reversed in position, thus called transposition.
That means when this disease occurs the baby's aorta is connected to the right ventricle, whereas normally it should be connected to the left ventricle. The danger here is that the two arteries carry two different sources of blood to supply the body. Oxygen-poor blood (blue) is supplied to the body's organs instead of going to the lungs. Oxygen-rich blood (red) returns to the lungs instead of supplying the body's organs.
In the prenatal period, the newborn primarily receives circulatory support from the mother's heart, so the fetus in the mother's womb will not be greatly affected when this disease occurs. However, when the baby is born, this defect alters the body's blood circulation, and it is dangerous because if not intervened early, the baby will certainly die. Therefore, as soon as an abnormal heart issue is detected in the baby, obstetric doctors advise the mother and family to consult a pediatric cardiologist for evaluation and a treatment plan for the baby immediately after birth.
Multidisciplinary cooperation and difficulties due to the epidemic situation
It is known that when receiving this case, doctors at Ho Chi Minh City Hospital of Tropical Diseases were under great pressure because the time needed to focus treatment for the baby coincided with the peak of the Covid-19 pandemic.
Assoc. Prof. Dr. Cao Đằng Khang - Head of Pediatric Cardiac Surgery Department, Ho Chi Minh City Children’s Hospital shares: “The first pressure in treating this case is that the baby is too small and the interventional procedures must be performed immediately after birth; this baby also has severe neonatal infection. Under normal conditions there were many risks, and unfortunately that time coincided with the peak of the Covid-19 pandemic. Therefore, many obstacles were expected, especially the shortage of personnel as the doctors of Ho Chi Minh City Children’s Hospital were largely mobilized for epidemic control. Identifying this as an urgent situation to save a life, we tried every possible way.”
Although Ho Chi Minh City Children’s Hospital has previously successfully treated
To ensure the pediatric treatment proceeds as smoothly as possible, Ho Chi Minh City Children's Hospital (BV ĐHYD TPHCM) coordinated an interdisciplinary team between the Cardiology Center and the Neonatology Department, with a highly specialized Cardiac Anesthesia and Intensive Care team. From the baby's birth to the time of surgery and the severe post-operative period, all occurred during the intense Covid-19 outbreak, and the hospital flexibly deployed staff from the Covid treatment hospital to help save this newborn.
The interdisciplinary team at Ho Chi Minh City Children's Hospital coordinated harmoniously, dividing tasks according to expertise in a reasonable way so that each step proceeded smoothly: the obstetrician understood the progression of the pregnancy and labor process, the neonatologist cared for the baby immediately after birth, the congenital heart interventionist performed interventional procedures right after birth, the congenital heart surgeon planned surgery immediately after birth together with the cardiac anesthesia and intensive care physician, and the post-operative nursing team for the baby was also very important.
Immediately after birth, the baby must have blood mixing to have enough blood to nourish the body. Therefore, the doctors decided to rupture the atrial septum to create a mixed blood flow in the heart in order to increase the amount of red blood (oxygen‑rich blood) circulating to nourish the body, ensuring oxygen levels are not too low, while using medication to maintain the arterial duct. These procedures help sustain the body during the newborn period while awaiting surgery for the baby.
The first major surgery performed when the newborn was just 10 days old
After being intervened and resuscitated immediately after birth, the baby also developed a severe neonatal infection that required aggressive antimicrobial treatment to ensure the surgery could proceed. The baby underwent surgery to repair all cardiac lesions at 10 days of age. This was an extremely close collaboration among congenital heart surgeons, anesthesiologists, intensive care specialists, and pediatric cardiac nurses to achieve a successful operation. The operation repaired the congenital transposition defect of the two great arteries, restoring the heart’s structure and physiology to normal.
Although the surgery proceeded smoothly as planned, the neonatal infection and postoperative infection required treatment for more than a month, the baby fortunately recovered, cleared the infection, and was discharged with a normally functioning heart.
According to Associate Professor Dr. Cao Đằng Khang - Head of Pediatric Cardiac Surgery Department, Ho Chi Minh City Children's Hospital, effective treatment of complex congenital heart disease requires a multidisciplinary team collaboration. In this baby's case, a comprehensive treatment plan was prepared from before birth, with specific assignments when coordinating multiple specialty teams. Ho Chi Minh City Children's Hospital has this strength, organizing a comprehensive treatment group at the same Center, delivering maximum effectiveness for children with complex congenital heart disease. More importantly, even during the Covid-19 pandemic, Ho Chi Minh City Children's Hospital still ensures high professional standards, appropriately mobilizing personnel to guarantee quality care for complex conditions.
