| From your Guide Dr.MANI |  | |
Hypoplastic Left Heart Syndrome | ||
| From your Guide Dr.MANI | | |
Hypoplastic Left Heart Syndrome | ||
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What then are Nature's compensatory methods in HLHS ?
HLHS is caused by altered blood flow patterns even as the child is developing within the mother's
body. At birth, the left sided heart structures are severely under-developed and are very small. So
they are not able to pump blood to the remaining parts of the body.
If such a condition continues, life is not possible. To help correct it, the right ventricle assists the left
ventricle in its work. The situation becomes a functional type of SINGLE VENTRICLE - that is,
there is only one working ventricle - the right.
Also, the ductus arteriosus remains patent after birth for some time, and this helps blood flow as
well. The blood pumped by the right ventricle first enters the pulmonary artery. Here, it is divided
into two portions. One portion of this blood crosses the patent ductus arteriosus and flows into the
aorta. From here it is distributed to all the other parts of the body, just as in a normal person.
The remaining portion of blood in the pulmonary artery enters the lungs for purification. In this way,
the right ventricle supports blood flow into the lungs as well as the aorta.
However, when the ductus arteriosus closes - as it normally does soon after birth - there is a
sudden worsening. With the left heart being too small, all of a sudden there is no blood flow into the
aorta. If left untreated, survival is impossible.
Should HLHS be surgically treated ?
This is, in my opinion, the most difficult question to answer about HLHS. Various issues -
emotional, scientific, economic and ethical - arise, confusing the whole affair and making it very
complex. Rather than stating my personal opinions, I will attempt to discuss the options available.
When detected early enough in pregnancy, Medical Termination of Pregnancy (MTP) - also called
"therapeutic abortion" - may be offered to the family. The argument in favor of MTP is that the
outcome of surgery for HLHS is still uncertain, particularly in the long run. Also, the surgical
process is emotionally traumatic to the entire family, and the expense is considerable. Another
theoretic reason to prefer MTP is that it does not pass on the genetic defect of HLHS patients to
future generations.
Against this choice stand witness the increasingly large number of survivors of surgery for HLHS.
Support groups made up of parents of these "tough kids" are living evidence that it is possible to
face and overcome the difficulties in caring for such children. And the results of surgery are rapidly
improving. Very soon, these may be good enough to make MTP an ethically unacceptable option
for HLHS. Also, many people have religious and moral objections to MTP.
A sympathetic approach to discussing these problems with the parents is essential. No parent
should be made to feel guilty about choosing MTP after a diagnosis of HLHS is made. At the same
time, a easily understandable and considerate explanation of all the surgical options, the
"state-of-the-art" results, the potential risks and problems, and long term outcome should be given
to all parents who wish to consider surgery for their children.
What can the surgeon actually do ?
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