Lady Ridgeway Hospital takes giant leap:
How teamwork saves a life
“It’s a mine field” says Dr. Mahendra Munasinghe in the midst of an
open heart surgery to save the life of one and a half year old Anura
from Badulla, who is undergoing heart surgery at the Lady Ridgeway
Hospital Cardiac operating theatre to correct a congenital defect in his
It springs to my mind that it is no wonder that they say “Heart
surgery is not for the faint hearted,” as the world renowned Cardiac
surgeon from USA DR. Jeremy R Torstveit who is standing beside me
whispers in my ear “if you feel light headed please sit on the floor
immediately. For God’s sake don’t fall on the patient”.
Open heart surgery in progress Pictures by Rukmal Gamage
In the case of little Anura, it is a life threatening hole and an
abnormally located major vessel, which hampers the blood circulation and
increases the blood pressure in the lungs of the two year old and if
left untreated would ultimately claim his life.
Due to the ailment his heart has become congested and as twice as
large and is almost touching the ribs. Little Anura is one in a
thousands who seek treatment for congenital heart defects at the LRH and
if untreated in time his young life would be terminated before it
reaches it’s prime.
Fortunately for him the intervention has been a timely one, but for
more than 1,000 others who are in the waiting list at the LRH in
expectation of complex heart surgery to save their lives, may not be
that fortunate. Cardiac Surgeon Dr. Munasinghe, in this operation is
assisted by a team numbering around 8, who are thoroughly trained
professionals in their chosen fields of expertise.
At the beginning of the operation Anaesthetist Dr (Mrs) Mahalekama
gives little Aruna a sleep-inducing medication through the IV, he
continues to breathe a mixture of oxygen and anaesthetic gas (general
anaesthesia) to make sure that he remains asleep throughout the entire
Then a tiny tube is inserted to an artery in the arm to measure the
blood pressure accurately.
A device called the CVP catheter is inserted into the jugular vein
(in the neck) to measure heart function, heart and lung pressure and
also to give medication. A breathing tube (endotracheal tube) too is
inserted into the mouth and down the windpipe (trachea) to maintain an
airway. Probes have to be inserted into the rectum and into the nostril
to measure the exact core temperature of the body.
A urinary catheter too comes in to play which is inserted and
connected to a collection bag to measure the patient’s urine output.
All this is done with utmost care as one wrong move could either
damage tissue or a major vessel.
When all measures are in place opening a cavity to expose the heart
begins, with Dr. Munasinghe splitting the breast bone with an electric
saw. Then the breast bone and ribs are retracted to open up the chest.
Tubes are inserted to the main blood vessels to keep the heart going,
including blood flow and oxygenation are rerouted through the heart-lung
Body temperature is lowered down to 32`C so that the heart can be
safely stopped during the procedure by the injection of a drug.
Later the heart is stopped and is opened with an incision.
Blood inside the heart is sucked out to be recycled via the heart
lung machine. The large hole in the middle of the interior of the heart
gets exposed and later the surgeon fills the gap with a patch which is
sewed in to place very carefully.
When the procedure is completed, the incision in the heart is closed
and the heart is being restarted. When the surgical team was satisfied
that the heart beats strongly again, Aruna’s heart is being slowly
weaned off the heart-lung machine. The breast bone is wired together and
the chest incisions is closed.
This all might sound a bit simple, but remember the surgeon works on
a vigorously beating heart initially and in an area where a lot of vital
structures are concentrated. One wrong move could see the end of a young
life, which is aspiring to reach adulthood like any other.
Everybody in the team the Surgeons, Anaesthetists, Nurses, helpers
all play their part during the operation. But at times the calming voice
of Dr. Munasinghe is necessary when nerves play a trick or two.
The crucial moment is when the patient is weaned from the machine
which supports him throughout the operation.
The Doctor proudly says to me “look at the heart now, its’ size has
already been reduced” as Dr. Torsveit whispers in my ear again take one
final look before he closes the cavity, because you might not get the
opportunity again. “Isn’t it beautiful ?”.
Though a life has been saved, it has a cost. According to Dr.
Munasinghe this particular operation would have cost more than
Rs.400,000 in a private institution, which is way beyond the reach of
Even before you read this article, one week since the life saving
surgery, we hear that little Anura has already left the LRH with his
happy mother, to lead a normal life just like his many friends, a luxury
which he did not enjoy earlier.