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Sunday, June 25, 2017
"When it was time for Arjun to go with the anesthesiologist, I couldn't [let him go]," Nidhi Kohli tearfully recalled of the moments before her 5-month-old's heart surgery in March. "I had to give Arjun to my husband so he could do it."
Born with ventricular septal defect (VSD), Arjun's congenital heart condition was not diagnosed until he was nearly three months old when he began crying a lot, experiencing feeding difficulties and failing to gain weight. After consulting with Arjun's doctor, his parents, Pratik and Nidhi, sought a second opinion from a pediatrician at CHoR. That doctor referred Arjun to one of CHoR's gastrointestinal specialists who heard a heart murmur and referred the family to a pediatric cardiologist. Following an echocardiogram, Arjun was diagnosed with VSD, the most common congenital heart defect in children, which is characterized by a hole in the wall between the heart's two major pumping chambers. Because the heart wastes energy as a result of the hole, patients with VSD often tire easily and have rapid breathing and difficulties eating and growing.
Since some cases of VSD will spontaneously close, doctors advised the Kohlis to wait a couple of months before having surgery. In January, Arjun was admitted to CHoR, where he received a feeding tube and began gaining weight. He had echocardiograms every two to three weeks, and by late winter, it became clear that Arjun's VSD was too large to close on its own. His physicians recommended surgical closure by the Children's Hospital Foundation Heart Center team.
Wanting to be sure their son received the best care, the Kohlis sought additional opinions from doctors at the country's top two pediatric heart centers and were prepared to temporarily move their family, including their 2-year-old daughter and Nidhi's parents, if necessary. After meeting Thomas Yeh Jr., MD, PhD, FACS, Director of the CHF Heart Center and Chief of Cardiac Surgery, CHoR, they said they knew Arjun would receive the best care in Richmond.
"We felt confident after talking with Dr. Yeh," recalled Nidhi. "He was very straight forward and confident."
Pratik said Dr. Yeh's strong surgical record and personal attention were additional factors in the family's decision—"he said he would take care of Arjun personally and be his father for two days." The couple was also impressed that the CHF Heart Center provides specialized neuromonitoring of brain activity during surgery, a service that would not have been provided at the other two hospitals.
"We are one of the few centers in the country that does comprehensive neuromonitoring of patients' brains during surgery,"said Dr. Yeh of the procedure that measures oxygen levels in the brain, blood flow, and brain and spinal cord activity. "We believe neuromonitoring provides an important safety net for children. Because surgical survival is so good these days, it's no longer just about getting the child through the operation but also making sure the child has the best life they can have, and brain function is a big part of that."
On March 20, Arjun had surgery to repair his VSD as well as a minor second hole that was discovered between his heart's upper chambers during the procedure. He spent three days in CHoR's pediatric intensive care unit with at least one of his parents by his side round-the-clock. Pratik said Arjun's breathing improved within three days and within two weeks, his condition was "much improved."
Nearly three months after surgery, Arjun continued to rely on the feeding tube for nutrition, but he was learning to eat small bites and was scheduled to enroll in the Children's Feeding Program at CHoR so he could be weaned off the feeding tube. He also was meeting regular developmental milestones including rolling over. His parents describe Arjun as a happy baby who giggles, smiles and rarely cries. Although he will continue to be followed by Dr. Yeh, Arjun is not expected to need additional surgeries as he grows. His only limitation is that he can't play football — a restriction Pratik said he doesn't mind.
"Children's Hospital was the total package," said Pratik. "The PICU was great, the post-op care was absolutely brilliant, and the nurses were awesome. Dr. Yeh came through with flying colors."