The heart is normally a well-guarded organ, wrapped in several linings of tissue, held deep inside the body in the middle of a cavity, protectively cupped between the rib cage and the spine.Now imagine a newborn baby, whose heart lay outside his tiny bird-like chest, pumping furious and naked in the germ-laden air. On Thursday, surgeons at the All India Institute of Medical Sciences spent three and a half hours to put the 10-day-old boy's heart inside his body.
The team of seven doctors was headed by cardiac surgeon A K Bisoi and they were taking on an unprecedented enterprise. This yet to be named infant, born in Bihar to daily-wage earner parents, is by far the only surviving example in India of a person born with complete thoracic Ectopia Cordis, a malfunction where the child is born with his heart in an abnormal position.
In this case, the baby was born with his heart 100 per cent protruding outside his chest, with zero immunity and no protective lining.
What is more, the baby did not have a heart cavity inside his body. So, the surgery involved not just returning the tiny heart to its home, but first pushing aside lungs and blood vessels to make its nest.
"As there was no space in his body to accommodate the heart, we literally created a home for it in his body. We mobilized the diaphragm by almost 60 degrees anterior and to the left. Then we gently pushed other organs like the lungs and liver to create space and nearby structures to create space," said Dr Bisoi, additional professor, cardiac surgery.
"Then we gently placed the heart partly in the heart cavity and partly in the stomach cavity without twisting, kinking or rotating any thing."
The baby was suffering from septicemia or bacterial infection in the blood, due to his heart being exposed to the atmosphere during his perilous journey from Muzaffarpur in Bihar to Delhi.
Then AIIMS doctors performed the procedure while the boy's heart was beating. They did not suspend his body functions, like his brain and heart, which they had earlier decided. See graphic
This is the first time in India, and perhaps the second time in the world, that somebody in such a critical condition has survived the operation.
In August 1975, US citizen Christopher Wall was operated for this condition in a hospital in Philadelphia and is still surviving.
"It is the first time in the world that someone has survived the operation and has also lived after it. The baby is awake and responding," said Bisoi, who still has his fingers crossed, as he believes that there are still many odds against the infant in his journey to recovery.
The baby has been shifted to Cardiac Care Unit and doctors say that every hour now is critical for the baby. "We have to closely monitor the baby as every hour is crucial."