A detailed cardiac evaluation revealed not only a significant VSD—an abnormal opening in the heart’s ventricular septum—but also raised suspicions of a rare condition involving the coronary arteries
Narayana Health SRCC Children's Hospital
A Mumbai hospital has successfully performed a rare and intricate heart surgery on an 18-month-old child diagnosed with a large ventricular septal defect (VSD) along with an exceptionally uncommon coronary artery anomaly.
The child was brought to Dr Supratim Sen, senior consultant paediatric cardiologist at Narayana Health SRCC Children's Hospital, Mumbai - OPD, with symptoms including poor weight gain, frequent respiratory infections, and delayed developmental milestones. A detailed cardiac evaluation revealed not only a significant VSD—an abnormal opening in the heart’s ventricular septum—but also raised suspicions of a rare condition involving the coronary arteries.
Normally, the coronary arteries originate from the aorta and supply oxygen-rich blood to the heart. In this case, however, one of the coronary arteries – the left anterior descending (LAD) artery – was suspected to be originating from the pulmonary artery on the patient’s echocardiogram. This rare anomaly, known as Anomalous Left Anterior Descending Coronary Artery Arising from Pulmonary Artery (ALADAPA), was confirmed through a CT coronary angiogram.
Only about 10 such cases have been documented worldwide in medical literature.
The case was reviewed in a multidisciplinary cardiac team meeting. Given the complexity, the surgical team led by Dr Pradeep Kaushik decided to proceed with a dual procedure: the re-implantation of the anomalous LAD into the aorta and closure of the VSD.
The surgery posed significant technical challenges. The LAD, being a delicate vessel of just about one millimetre in diameter, had to be carefully mobilised and reconnected to the aorta without any distortion to ensure long-term blood flow. This step was critical to restoring the heart’s normal pumping function. Both the VSD closure and LAD re-implantation were completed in a single surgery that lasted nearly 10 hours.
Post-surgery, the child was closely monitored in the cardiac ICU for 10 days. Follow-up echocardiograms confirmed successful revascularisation, showing that oxygenated blood was now reaching the heart efficiently- an essential indicator of a positive outcome. The child is currently recovering well.
Dr Sen explained, “This was an exceptionally rare and challenging case, both in terms of diagnosis and surgical planning. The ALADAPA is a condition so uncommon that it can easily be missed unless we look closely at every detail during the echocardiogram. The fact that we were able to identify this condition and successfully address both the VSD and the anomalous coronary artery during the complex surgery is a testament to the expertise available at Narayana Health SRCC.
This case underscores the importance of high-quality paediatric cardiac care and the need to remain vigilant for even the rarest conditions.
Dr Kaushik, senior consultant pediatric cardiac surgeon at the hospital added, “I am proud of the entire cardiac team—from the cardiologists who confirmed our suspicion, to the surgical team that carried out a technically demanding operation with great precision, to the anesthesia and ICU teams who ensured that the patient recovered well from this complex surgery.”
Dr. Zubin Pereira, facility director at the city hospital further added, “Timely diagnosis, detailed planning, and seamless teamwork were the keys to saving this child’s life. This achievement reinforces our commitment to providing advanced, high-quality paediatric cardiac care. The expertise and dedication of our team ensure that rare and complex conditions can also be managed successfully.”
The child will continue to receive regular cardiac follow-ups to monitor long-term outcomes.
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