October 31, 2020

The smallest baby in the world with a cardiac ablation | Society

The smallest baby in the world with a cardiac ablation | Society

The Head of the Arrhythmia Unit of the Sant Joan de Déu Hospital, Georgina Sarquella, reviews Maria before her parents and older brother. In video, statements from parents. Photo: EFE | Video: Atlas

Maria's heart was beating a lot and very hard from before she was born. In the 20th week of pregnancy, the doctors confirmed to their parents, Raquel and Alfonso, that the little girl suffered an incessant tachycardia: her heart was beating at 300 beats per minute, when there were normally 150. The antiarrhythmic drugs had no effect and the small He was born premature, with 1,310 kilos of weight and 200 beats per minute. His heart was beginning to suffer. An accessory pathway in the organ was causing a kind of short circuit in electrical wiring that allows blood to be pumped and it had to be neutralized. Despite its tiny size, a team of the hospital Sant Joan de Deu in Barcelona intervened to the girl and subjected her, successfully, to a cardiac ablation to burn that path that was out of control of the electric circuit of the hospital. heart. It was the first time in the world that this intervention was performed on such a small baby.

"She was extremely premature and small, her heart was less than two centimeters, the veins were one millimeter in diameter," she recalls. Dr. Josep Brugada, cardiologist and director of the Arrhythmia Unit of Sant Joan de Déu, I am a reference in the State for pediatric arrhythmias. Since 2014, that the Ministry of Health authorized the hospital as a reference for cardiac ablations, 620 interventions of this type were carried out. About 380 of them were in children under 10 years and 36 in children under 10 kilos, like Maria.

The doctors knew that in Maria's heart there was an anomaly, a kind of electrical pathway attached to the normal electrical circuit of the heart, which caused an imbalance in the functioning of the organ. At the Miguel Servet hospital in Zaragoza, where the family originates, they tried to fight the tachycardia by dispensing antiarrhythmic drugs to the mother so that the fetus could receive them through the placenta, but it was of little use. The medication allowed delaying delivery until week 30 but did not cure the disease. "Despite using all available therapeutic arsenal, Maria resisted," recalls Geòrgia Sarquella, cardiologist at the arrhythmia unit of Sant Joan de Déu.

10 days after birth, María was taken to the Sant Joan de Déu hospital to undergo a cardiac ablation never performed on a baby of her size – the youngest child operated until then weighed 1.5 kilos and had been operated on in that same hospital in 2003-. "The objective was to locate the accessory pathway through a catheter, locate that electrical cable and eliminate it," says Brugada.

The intervention was not long, just 20 minutes. But it was complex because of the size of the baby and the risks of "burning structures that do not touch or damage the valves" of the heart, explains Sarquella. Nor was it easy to insert the catheter through a femoral vein that was barely a millimeter.

However, they did it. On January 4, cardiologists managed to insert the catheter by the tiny femoral of the girl and bring it to the heart. There, they located the path that misadjusted the electrical circuit and burned it with radiofrequency. "We destroyed the accessory pathway with heat and, immediately, the tachycardia stopped, we had normalized the electrical network in his heart," says Brugada. A month and a half later, the little one has healed and his heart, impeccable, keeps beating.


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