A Halocline in Human Heart

The purpose of a cardiac surgery can be broadly classified as curative and palliative. Some surgeries are curative, the defect or derangement is addressed and completely normalised .Whereas when its technically impossible to correct or if correcting the defect is going to be deleterious to life , then surgeries are done to improve the quality of life ,which is said to be palliative surgeries. Though these patients’ life expectancy is below average sometimes they live for reasonable number of years with good quality life.

One such case worth sharing is about a 20 year old adult who was diagnosed with major congenital heart defect at 4 months of age.

This particular patient had consulted multiple hospitals across the country and everywhere he was advised Heart and Lung Transplantation. Heart and Lungs are like ‘Twin Brothers’ , if one gets hurt the other will cry. If one fails the other organ also will fail eventually. Heart has 4 chambers – 2 upper collecting chambers called as Right and Left atrium and the wall separating it called as inter atrial septal wall ; 2 lower pumping chambers ,right and left ventricle and the wall separating it called as inter ventricular septum. This particular patient had multiple large gaps in the inter-ventricular septum.

The two pumping chambers have different role, the right pumps into the low pressure system, the lungs, for oxygenating the impure blood and the left pumps the oxygenated blood received from lungs to the whole body , a high pressure system. God has created heart in such a way that Blood don’t mix with each other normally as it is physically separated by the walls.The muscle power of each ventricles are also designed in such a way to push blood against the corresponding resistance . So, the right ventricle is always weaker than the left ventricle in amount of work done.

In this patient the large gaps in the ventricle wall from birth allowed the left ventricle to push blood very forcibly into the Lungs. As this continuous damage prolongs in the lungs the blood vessels in the lungs hardened and eventually closes.If no blood flow to the lungs, no oxygenation happens. And after the lungs the heart also slowly fails.

These patients have dark lips, dark nail beds , palm and soles, severe breathlessness , mostly they are bed bound. And our patient was referred to us primarily for Heart and Lung transplantation as we have good track record of Heart and Lung Transplantation.

And now the real challenges starts…

The patient was well aware of his clinical situation, he can hardly walk within his house. He knew he was dying . He innocently asked us about reasons for his dark lips ,deformed and discoloured nails and whether that could be corrected at the least.

And we started working on the patient , his oxygen in blood was 65 %, which is very low (normal -more than 95%). Echo cardiogram showed large gaps in the ventricular septum. It appeared that the de-oxygenated blood was flowing from the right to left ventricle through these gaps ,as the lung blood vessels are damaged since his birth. And we felt that this might be reason for his low oxygen levels however the level is too low to explain this. As both the oxygen rich and de-oxygenated blood should mix within the Heart chambers. Based on our previous experiences we were expecting oxygen level between 85 to 90% after mixing .

Also from the Echo cardiogram we found out his heart though had multiple defects the pumping power is near normal.