Girl, 2, in Abuja’s first successful PDA surgery

  {video here} At 2, Joanna Enahoro, faced a daily risk of heart failure and imminent death until surgeons at Garki Hospital, Abuja successfully closed an open blood vessel at the top of her heart last Saturday.She had patent ductus arterosus, PDA, a condition commonly affecting up to 20% of babies born prematurely.Joanna weighed 770g, […]

 

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At 2, Joanna Enahoro, faced a daily risk of heart failure and imminent death until surgeons at Garki Hospital, Abuja successfully closed an open blood vessel at the top of her heart last Saturday.
She had patent ductus arterosus, PDA, a condition commonly affecting up to 20% of babies born prematurely.
Joanna weighed 770g, much smaller than her twin Comfort who weighed 1.5kilos.
Her growth stalled due to her condition, said Dr Tolutope Utele, consultant paediatrician at GHA who saw Joanna’s birth there and sat in on her surgery last week. “She went through a lot, was always in and out of hospital.”
With level of care for newborns, “we tend to have more preterm—babies less than 1kg—now than before, so we have quite a number of children with PDA.”
In foetuses, the blood is the major medium for breathing, because the lungs don’t work at full capacity, and nutrition. A major open vessel at the top of the heart is crucial to this task.
That task ends at birth when the lungs kick in and the baby begins breathing on its own. At this point, the blood vessel should close between a day and a week.

In children with PDA, like Joanna, that vessel stays open, though blood doesn’t flow out of it. The increased volume strains the heart, causing shortness of breath and increased risk of cardiac arrest.
Joanna couldn’t have undergone the surgery as a newborn, but without treatment, death was only a matter of time.
Her mother, Linda Enahoro, nervously watched in uncertainty as Joanna was wheeled into theatre.

 

Excitement and learning

Joanna’s surgery is the first procedure to correct PDA done by GHA, the country’s first public-private partnership (PPP) and it whipped interest and medical excitement.
Up to 30 surgeons, anaesthesiologist, nurses and journalists were in the theatre as Joanna’s surgeon Dr Sanusi and assistant Dr Elijah Miner declared first knife on skin at 10:02 am.
Tablets and mobile phones recorded the moments. Unsure how the surgery would reveal, surgeons stayed calm on their feet—an anticlimactic version of a medical drama.
Joanna was hooked onto respirators to help her breathe. In minutes, surgeons cut through the left side of her back with diathermy—instruments that use heat to cut and immediately seal blood vessels under the skin to prevent excess bleeding.
They opened her up using retractors and, nearly an hour later, reached her heart. The PDA site was ready for ligation—essentially tying off the vessel before cutting it.
Two hours later, Joanna was closed up, wheeled out the theatre and into an intensive care unit to recuperate.

Proud brains
That her doctors succeeded is a major coup for GHA to beat its chest. “The surgery shows PPP is surely the way for the country to go,” said Dr Ibrahim Wada, group medical advisor for GHA.
“Not only does it normalise the situation, it allows allow our experts to prove themselves—that we may be men of colour but our brains work like any other in the world. I think the time has come for Nigeria to put her foot down, go beyond our limitations and be a strong leader
in the world community.”
The surgery didn’t come cheap. Joanna’s parents were concluding arrangements by January to fly her abroad for surgery before GHA began talking got its experimental juices flowing.
High-tech instruments in the theatre and personnel to man such surgeries set GHA back a fortune. Joanna was kept under by US-based cardiac anaesthesist, Dr Adetola Talabi. GHA’s consolation for its huge capital outlay is that it can become a referral centre for cardiac
surgeries in the country.

Losing and leaping
“It is a loss financially, but a major leap for us,” said GHA chief medical director, Dr Elijah Miner, who assisted on Joanna’s surgery. “The hospital will suffer, but we are prepared to make the sacrifice first.”
The initial sacrifice is to ensure the country knows such surgeries can be done at home, and helping families cut the cost of transport and lodging at some hospital in India, Germany or the UK—costs that 99% of families who can afford it will plunge into.
“If we get our acts rights, we will be serving a huge population,” said Miner. “What we need is for organisations and individuals to sponsor people for such surgeries. In the long term, it is going to be a lot cheaper than flying people abroad. We want to make it affordable and available. We started with availability first, and then work down the cost.”
Number of people with heart conditions that could benefit is growing, Dr Talabi explained, insisting, “Heart diseases have shot up to among the top killer diseases in Nigeria, and they don’t distinguish between rich and poor.”
When people suddenly and inexplicably drop dead, autopsies and follow-ups are hardly done, but those caring for these people know they died from heart problems, Talabi said.
“What is said is that there are opportunities that doctors can look at you and notice heart problems or damaged vessels. Unfortunately for us, the best they can do is ‘please go back home, hope for the best, take it easy.’ Up to 90% of those people might die. This is what Garki is not going to let happen again.”
The hours Joanna spent under the knife, her  mother was shed tears and waited in anxiety and prayers. Joanna and her sister are the Enahoro’s only children after more than a decade of marriage, and after a lot of challenges since birth, how Joanna would come through the surgery was uncertain.
“I never knew the outcome of all this,” her mother said later. “God used the doctors to do what we have been praying for all this time for our daughter.”