Cardiac surgery at high altitude

Area of Science:

• Cardiology
• Pediatric Surgery
• High-Altitude Medicine

Background:

• Patent ductus arteriosus (PDA) is a common congenital heart defect in children.
• High-altitude environments present unique physiological challenges, including reduced oxygen availability.
• Surgical interventions for congenital heart defects at high altitudes require careful consideration of patient acclimatization and anesthetic management.

Purpose of the Study:

• To evaluate the safety and feasibility of surgical ligation of patent ductus arteriosus (PDA) in children residing at high altitudes.
• To assess the outcomes of pediatric cardiac surgery performed during medical camps in remote high-altitude regions.

Main Methods:

• Retrospective review of 11 pediatric patients (ages 4-17) who underwent PDA ligation.
• Procedures performed at Sonam Norboo Memorial District Hospital in Leh, Ladakh (11,400 feet).
• Surgery conducted under general anesthesia with endotracheal intubation, with same-day extubation.

Main Results:

• All 11 children survived the PDA ligation procedure.
• No surgical or anesthetic complications were reported.
• Patients were discharged within 5-6 days post-surgery.
• Children had low mean arterial oxygen saturation at room air but were acclimatized to high altitude.

Conclusions:

• Simple cardiac surgical procedures, like PDA ligation, can be performed safely and effectively at high altitudes.
• High-altitude medical camps can successfully provide essential pediatric cardiac surgical care.
• The study supports the feasibility of managing congenital heart defects in pediatric populations in remote, high-altitude settings.