💐 Paediatric & Neonatal Heart Surgery

Transposition of Great Arteries (TGA) — Neonatal Emergency

In TGA, the two great vessels arise from the wrong chambers. Oxygen-depleted blood recirculates through the body while oxygenated blood loops back to the lungs — a parallel circulation incompatible with life beyond the first days. The newborn appears grey, then blue, with rapidly worsening oxygen levels.

Dr. Agarwal performs the Arterial Switch Operation (ASO) — the gold-standard correction where both vessels are detached, the coronary arteries are carefully replanted, and the vessels are re-attached to their correct chambers. Surgery is ideally performed within 7–14 days of birth, before the left ventricle loses systemic conditioning. The result: a fully biventricular, anatomically correct circulation and a normal life expectancy.

Tetralogy of Fallot (TOF) — 'Blue Baby Syndrome'

TOF causes chronic low oxygen saturation, producing the characteristic blue tinge (cyanosis) in the skin, lips, and fingernails. Children may experience hypercyanotic spells — sudden episodes of intense blueness, irritability, and breathlessness triggered by exertion or crying.

Dr. Agarwal performs total intracardiac correction — VSD closure with a patch, relief of right ventricular outflow obstruction, and reconstruction of the pulmonary valve / annulus. For very small or haemodynamically unstable neonates, a staged approach beginning with a Blalock-Taussig-Thomas shunt is chosen. Post-correction, children achieve near-normal exercise capacity and growth.

ASD — Hole in the Heart (Upper Chambers, Atrial Septal Defect)

Many small ASDs close on their own in infancy. Significant defects allow left-to-right shunting: over time, excess blood flow into the right heart causes it to enlarge, and pulmonary hypertension can develop. Symptoms include recurrent chest infections, easy fatigue, and poor weight gain.

Dr. Agarwal closes ASDs surgically with a pericardial or Dacron patch, or using a catheter-delivered occlusion device when anatomy permits. Surgery is elective in childhood but urgent if symptoms demand earlier intervention.

VSD — Hole in the Heart (Lower Chambers, Ventricular Septal Defect)

VSD is the most common congenital heart defect. Large VSDs cause significant left-to-right shunting, heart failure, failure to thrive, and risk of Eisenmenger syndrome (irreversible pulmonary hypertension) if left unrepaired. A loud systolic heart murmur is often the first clue.

Dr. Agarwal closes VSDs with primary suture or patch repair on cardiopulmonary bypass. Timing is guided by the child's weight, symptom burden, and degree of pulmonary hypertension. Children post-VSD closure achieve normal cardiac function and growth.

TAPVC — Total Anomalous Pulmonary Venous Connection

In TAPVC, the oxygenated blood returning from the lungs cannot enter the left side of the heart directly — it drains into a vein or right chamber. Obstructed TAPVC causes severe cyanosis and pulmonary oedema within hours of birth, and is a true surgical emergency. Even unobstructed TAPVC leads to progressive right heart dilation.

Dr. Agarwal performs pulmonary vein reconnection surgery — creating a wide anastomosis between the pulmonary venous confluence and the left atrium, ligating the anomalous drainage, and closing the ASD. Surgery in the neonatal period is technically demanding and requires expert post-operative PICU management.

Single Ventricle Defects — Fontan Completion

When a child has only one effective ventricle, a full correction is not anatomically possible. Instead, a staged palliative strategy separates the pulmonary and systemic circulations entirely — allowing the single ventricle to pump oxygenated blood to the body while venous blood flows passively to the lungs. This is achieved through a three-stage sequence: Norwood / Modified BT shunt → Bidirectional Glenn → Fontan Completion.

The Fontan completion — the final stage — connects the inferior vena cava directly to the pulmonary artery, bypassing the heart entirely. Dr. Agarwal has extensive Fontan experience, including total cavopulmonary connection (TCPC) with lateral tunnel and extracardiac conduit techniques.

🏆 Paediatric Heart Transplantation

Dr. Vijay Agarwal performed the first paediatric heart transplant in Maharashtra — a landmark that signalled India's arrival in high-complexity paediatric cardiac care. Paediatric heart transplantation is considered for children with end-stage dilated cardiomyopathy, failed Fontan circulations, or inoperable congenital heart disease where quality of life is severely compromised.