Highly complex cardiac surgery on a 15-month-old girl at the Policlinico San Donato

The little one - followed in utero at Vittore Buzzi Hospital, with which Policlinico San Donato has a longstanding collaboration - had already undergone, at only 20 days old, first operation to bandage the pulmonary artery to protect the lungs and second operation, in 2 months, for further reduction.

"It is a preparatory procedure for cardiac correction surgery," explains Dr. Alessandro Varrica, surgeon of the Pediatric and Adult Congenital Cardiac Surgery Department at Policlinico San Donato.

The child was only hospitalized once she reached a suitable weight (between 8 and 10 kg) at 15 months of age to endure the operation. The surgery, called a modified double switch, is among the few ever performed in the world. The following was performed simultaneously: 

• atrial-arterial switch;
• Hemi-Mustard and Glenn (BDG) with interventricular defect (IVD) closure. 

This not only restored the connection of the pulmonary artery with the right ventricle and the aorta with the left ventricle, thus restoring the connection between the systemic and pulmonary circulation, but also closed the hole in the wall separating the 2 lower chambers of the heart. 

The surgery was performed with extraordinary success, so much so that the child remained hospitalized after the operation for only 15 days, including 5 days in intensive care and 10 days in the ward.

Throughout the journey, the child was followed by Dr. Antonio Saracino, Head of the Clinical Pediatric Cardiology Unit at Policlinico San Donato.

Pediatric heart surgery area of Policlinico San Donato is the first center in Italy and one of the most active centers in Europe in the diagnosis and treatment of congenital heart disease. Approximately 500 cardiac surgeries are performed each year to treat congenital heart disease, in addition to more than 600 patients treated with interventional cardiology procedures. 

In addition, the surgery was the first in the world, of such high complexity, to be performed with a new, state-of-the-art advanced perfusion system that Policlinico San Donato had recently tested first in the pediatric setting, which is particularly good at containing the risk of exposure to long extracorporeal circulation times, as Dr. Mauro Cotza, Head of the Perfusion Service and ECMO Unit at the hospital, told us.

"We had 2 options: anatomical correction, of very high complexity, completely resolving the child's pathological picture, or physiological correction, a less risky surgery that would not have completely resolved the anatomical problem, then with the prospect for the child to have to undergo, after a few years, other surgeries that were never definitive.

We bravely chose the first path, strengthened by the expertise for high-complexity surgeries of pediatric cardiac surgeons and strengthened by the trust of the little girl's parents, who trusted us completely," concludes Dr. Alessandro Varrica, surgeon of Pediatric and Adult Congenital Cardiac Surgery Department, directed by Dr. Alessandro Giamberti.