New DelhiFortis Escorts Heart Institute (FEHI) recently conducted a successful bypass on the youngest Indian ever with a ten year old boy undergoing surgery for Homozygous Familial Hypercholesterolemia (HoFH).  The surgical team of doctors was led by Dr Ramji Mehrotra, Director – Cardio-Thoracic Vascular Surgery at FEHI and he conducted the Coronary Artery Bypass Grafting (CABG) using total arterial grafts.

 The patient, a resident of Mathura, was born with a rare genetic disorder called Homozygous Familial Hypercholesterolemia (HoFH). He was presented to Dr Peeyush Jain, Director, Non-Invasive Cardiology and Head-Preventive Cardiology, Fortis-Escorts Heart Institute with chest pain and breathlessness over three days. Investigations revealed that he already had suffered a massive myocardial infarction (heart attack) and he was in a condition of heart failure. The patient was immediately shifted to ICU for further investigations and treatment under Dr Viney Jetley, Associate Director, Invasive Cardiology, FEHI. An angiography conducted showed severe coronary artery blockages compromising blood flow to heart muscle necessitating a surgical intervention of urgent Coronary Artery Bypass Grafting (CABG). His heart was functioning at 50% capacity. The CABG was performed by Dr Ramji Mehrotra, Director – Cardio-Thoracic Vascular Surgery, FEHI.

Dr Ramji Mehrotra said, “The bypass operation at this age itself is a challenge as it mandates joining small caliber vessels to his heart arteries which are also very minute. The second challenge was imposed by very poor function of his heart (EF 22%). For adults with poor heart function there are support machines available to support the heart while conducting the surgery but these are not available for such young patients. The third consideration was to select the grafts, which will last for long period of time. The arterial grafting was therefore planned with these challenges. The surgery was smooth and uneventful and the boy was discharged within one week”.

Dr Ashok Seth, Chairman-Fortis Escorts Heart Institute, said, “The cause of the young boy developing life threatening blockages was Familial Hypercholesterolemia. Familial hypercholesterolemia is a rare genetic disorder that is passed down through families. It is a condition where the LDL or the bad cholesterol level remains very high in the circulation. The liver is unable to remove the bad cholesterol from the blood leading to artery blockage starting.

At an early age resulting in heart attack. Homozygous Familial Hypercholesterolemia occurs one in a million in general population and it is a highly unusual case where a child had to undergo bypass surgery at a tender age of barely 10 yrs. There is no effective treatment other than surgery in this medical condition because it is genetic. This also sends an alarm that early lipid screening is highly desirable for children and adolescents.’’ “All children should be screened for cholesterol abnormalities at least once between ages 9 and 11 years and children >2 years age should have a fasting lipid profile if a family member (<55 y males, <65 y females) had documented cardiovascular disease or if a parent had total cholesterol level >240 mg/dL,” he added, highlighting further that “screening is not yet widely practiced, but the need for routine screening in children and adolescents is being recognized increasingly.  There is also an urgent need to provide facilities for management of lipid abnormalities in children to prevent premature heart attacks. Fortis Escorts Heart Institute is looking in the direction of providing pediatric cholesterol screening facility”.

The father of the patient thanked the doctors and said, ‘’When I was told about my son’s medical condition and saw him suffering, I lost all hope that he will ever be normal again. After the surgery when I saw him smiling for the first time I did not have adequate words to thank Fortis Escorts Heart Institute and the team of doctors who worked tirelessly to grant him a new life. Now his future is looking bright.’’

Dr. Peeyush Jain further commented that a Cholesterol Screening and Management Clinic for children and adolescents shall soon be launched at Fortis-Escorts Heart Institute, a first of its kind in the Indian subcontinent. Dilating upon this, he mentioned that while in past, the main reason for cholesterol testing during childhood was to identify and treat children with genetically inherited high levels of cholesterol, the focus is rapidly expanding to screening of overweight or obese children and adolescents for cardiovascular risk factors.  This is important because both genetic and acquired risk factors are associated with accelerated atherosclerosis, leading to premature heart attacks. While this boy is an extreme case, there are no doubt millions of other children who in the absence of screening in childhood stand the risk of heart attacks when they are in their 30s and 40s.

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