1. History of PediatricCardiology & Surgery in India and AP Prof. P. Krishnam Raju CARE Hospital Hyderabad

2. Fortunately the diagnosis of the exact lesion is not of greatimportance in either prognosis or treatment, there is nocurative treatment and nothing , which will either diminishthe deformities or favour the closure of abnormal openings.The treatment must therefore be hygienic and symptomatic(Dr. John Morse, 1926)(His textbook 0f pediatrics contained just five pages oncongenital cardiac anomalies) 3. My Early Exposure to Congenital Heart DiseaseProf. P. Laxman RaoGMCDr. PeraiahGMCDr. Helen TaussigAutopsy of Ebsteins Anomaly PatientCongenital MethemoglobinemiaPt with - (As MD Post graduate) VSD + AR ( 1972)DSS Operated (1986)As Prof of CARDIOLOGY SMC VIJAYAWADA 4. Paediatric Cardiology in IndiaBeginnings Dr. S. Padmavathi First trained ( Late fifties) Dr. Vythilingam 1961 CMC , Vellore Dr. R. Tandon 1963 AIIMS Dr. P. Laxman Rao 1964 GMC, AP Dr. Vishnu Jain Mid Sixties, Patna Dr. Bachu Edibam Master Jamshedpur Dr. S.K. Sanyal Safdarjung Hospital, N.Delhi Dr. I P Sukumar 1974 CMC / Vellore Dr. P S. Bidwai Dr. S. Srivastava 1976, AIIMS, New Delhi 5. Paediatric Cardiac Catheter Interventions INDIA Rashkind Balloon Septostomy in d-TGAEarly 70s CMCH, Vellore. Balloon Pulmonary Valvotomy1985 - Dr. M. Khalilullah N DELHI Ballon Aortoplasty of CO-AO1985 Dr. M. Khalilullah N DELHI Balloon Aortic Valvuloplasty1986 Dr. M. Khalilullah, New Delhi Device Closure of PDA1988 Dr. R. Arora, New Delhi 6. Dr. S. PadmavatiNational Heart Institute49, Community CentreEast of KailashNew Delhi 65Ph: 26414156,26414157,26414075,26414251Fax:91-11-26225733E-mail: padmavat@del12.vsnl.net.in 7. Prof. R. Tandon Consultant CardiologistSitaram Bhartia Institute of Science and Research CentreNew Delhi 8. Dr. I P Sukumar, Paediatric CardiologistChristian Medical College, Vellore 9. Christian Medical College HospitalCardiology First department of Cardiology 1957 First department of CTVS 1949 (DR REEVE BETTS) First department of Paediatric Cardiology 1974 First exam for Certification in CTVS ( Vellore) 1960(Dr. N. Gopinath, First Graduate) 10. Paediatric Cardiology Academics Paediatric Cardiac Society of India - Late 1990s Journal of PCSI Y 2008 (ON LINE) Annual Conferences and workshops of PCSI Case volumes of > 500 / Yrs Paediatric Cardiac Surgery, - Six centers Dedicated Paed Cardiologists mid 90s = < 12 No dedicated Training Programme in PaediatricCardiac Surgery DM (Card) 1962 AIIMS1964 CMC, Vellore Fellowship in Paediatric Cardiology NBE 4 centers 11. Pediatric Cardiac Surgery I. First Heart Operation in INDIA 1946Suturing of bleeding LV wound INDIAby Dr. J.Shah , KEM Hospital, Bombay PDA Ligation - 1949Dr. B.R.Billimoria, Masina Hospital, Bombay Potts Smith Shunt - 1953TOF Dr. Reeve H Betts, CMC Hospital, Vellore. CO AO Repair - 1953Dr. P. K. Sen, KEMH; Bombay ASD Closure - 1956 (Surface Hypothermia) Dr. P.K. Sen, KEMH, Bombay Open Aortic Valvotomy - 1959 (Inflow occlusion surface Dr. AK Basu, SSKMH, Calcutta. Hypothermia) 12. Pediatric Cardiac Surgery 2. ASD Closure- 16- 2-1961(OHS / CPB ) Disc OxygenatorDr. K.N.Dastur INDIA BYL Nair Hospital, Bombay VSD Closure- May 1961(OHS / CPB Dr. N. Gopinath,Pump oxygenator) CMCH, Vellore Pulmonary Valvotomy1963 Dr. Nemish A. Shah Bombay Hospital, Bombay TOF (Total Correction) 1963 Dr. Radhakant Padhi Wanless Chest Hospital(TB Sanatorium), MIRAJ MH 13. Pediatric Cardiac Surgery3. Ebsteins Anomaly Repair1968 -1970 RSOV, DORV RepairDr. Stanley JohnINDIACMCH, Vellore Infant Cardiac SurgeryFebruary 1976 Dr. K M Cherian, Chennai. Senning for d-TGA July 1979 Dr. K M Cherian, Chennai. d-TGA ASO 1984 Dr. K M Cherian, Chennai Fontan Surgery1977Dr. I M Rao, AIIMS Blood less OHS ASD Closure1978Dr. P. Shatapathy, Manipal 14. KEM Hospital, Mumbai 15. Christian Medical College and Hospital, Vellore 16. Southern Railway Hospital, Perambur 17. MadrasMedicalMission 18. Frontier Lifeline Hospital, Chennai 19. Fortis Escorts Heart InstituteNew Delhi 20. AIMS , Kerala 21. Sri Sathya SaiSuper Speciality Hospital,Puttaparthi 22. Narayana Hrudayalaya, Bangalore 23. Sri Jayadeva Hospital, Bangalore 24. S S K M Hospital , Kolkata 25. SVIMS, Tirupati 26. CARE Hospital, Banjara Hills 27. Innova Children HospitalSecunderabad 28. STAR Hospital, Hyderabad 29. Care Hospital, Vizag 30. Prof. N. Gopinath 31. Prof. N. Gopinath 32. Dr. Stanley John, MSCardiac SurgeonDepartment of Thoracic & Cardiovascular SurgeryYellamma Dasappa HospitalNo.25, Andree Road, Shanthinagar, Bangalore 27Ph: 2225642,2225643, Grams: YELDASTelex: 0845-2696 PCO IN ATTEN - ICTP 618 33. Dr. K.M. CherianCMDFrontier LifelineMogappair,Chennai 34. Pediatric Cardiology / SurgeryAndhra PradeshProf P. Laxman Rao GMC1965Dr. Dasaradha Ram ReddyNiloufer hospital1970s (mid)Cardiology / Gandhi Hospital 1976 onwardsPaed. Cardiology UnitNiloufer Hospital1982Dr. BaajiOGH1960s-70s ASD / PS (Inflow Obstruction Technique)Dr. ViswanathamGMC PDA/ COAODr. Jaffar KhanKGH, Vizag 60s-70s (PDA)Dr. KV Naidu Chest hospital B-T Shunt ( First)Dr. CR Rajagopalan / TeamFirst OHS (ASD) VSD / TOF - 7th July 1976GANDHI HOSPITAL SECUNDERABADDr. B V Rama Rao First ASO (dTGA) 1996 35. Pediatric Cardiology / Surgery Now in Andhra PradeshINNOVAHospitalsCAREHospitalsSTARHospitalAPOLLOHospitalHyderabadNIMSHospitalLOTUS HospitalCAREHospitalVizagSVIMS HospitalTirupathiSri Satyasai Institute of Medical Sciences, Puttaparthi 36. Pediatric Cardiology / Surgery Andhra Pradesh Gandhi Hospital First Cardiac Cathlab in AP1976 First Echo Machine ( M-Mode) 1980 First DM (Card) Training Programme 1980 First Open Heart Surgery 1976 First ASD / VSD / TOF / Valve Replacement Surgeries. 37. Gandhi Hospital, Secunderabad 38. The team which performed the first Open Heart Surgery in A.P. on 7th July 1976The first cath lab was setup in Andhra at Gandhi 39. Old Gandhi HospitalAbandoned & Vandalised 2012 40. NIMS, Hyderabad 41. Pediatric Cardiology / Surgery Andhra PradeshSocietal InitiativesPrivate Initiatives LITTLE HEARTS FOUNDATION - CARE FOUNDATION Y2002 HRIDAY - STAR HOSPITALS NIMMAGADDA FOUNDATON-C ARE HOSPITAL APOLLO HOSPITALS Rajeev ArogyasriGovt. of AP 42. 1944 The first Chest Hospital was established at 8 Indian Base General Hospital in Aundh, near Pune by Defence Services to treat defence personnel with chest injuries and pulmonary diseases. 43. 1948 Dr.Reeve Hawkins Betts started firstCardiovascular and thoracic unit at ChristianMedical College and Hospital, Vellore, TamilNadu. Pulmonary and Esophageal surgeries wereperformed initially at Vellore. 44. 1954 Founding of Association of Cardiovascular andThoracic Surgeons in August 1954, at theAssociation of Surgeons of India at Vellore underpresidentship of Dr. AV Baliga, Mumbai. ASI subseciality took place with Dr. Reeve H Bettsas President, Dr. AK Basu as Secretary. The five members are Dr. SS Anand,Dr. Yudvir Sachdev, Dr. SK Sen, and Dr. PK Sen. 45. Academic Aspect First specialty examination Master of Surgeryin Cardiothoracic and Vascular Surgery held on1st April 1960. Dr.Gopinath graduated in the 1st examinationalong with Geoffrey Allen. 1964 the designation to MCh was done. Five year MCh course at AIIMS. 46. Training of the Personnel MCh candidates about 50 per year. Diplomate of National Board conducted byCorporate Hospitals has received wide spreadrecognition Man power from nursing, physiotherapists andperfusionists has grown enormously. 47. The Journal - IJTCVS Dr. Solomon Victor brought out the first issue in1981. Dr. A. Sampath Kumar has done an excellent jobas Editor of Indian Journal of ThoracicCardiovascular Surgery (which is in 31stYear.now) 48. Pediatric Cardiology Specialty 1 (Not subspeciality)Foetal Cardiology / SurgeryNeonatal CardiologyAdolescent CardiologyPediatric Cardiac ImagingPediatric Interventional CardiologyPediatric EPPediatric Preventive CardiologyPediatric Molecular CardiologyPediatric Intensivest 49. Pediatric Cardiology Specialty2 (Not subspeciality)Adult Congenital CardiologyPaediatric Heart TX ServicesPaediatric Cardiology / SurgeryNursing ServicesTechnicians Perfusionist Nutritionists Rehab Team. 50. CardiacPaediatricAnaesthesPerfusionOtherNon-invasivesupportOthers Electrophysiology catheterisation andCardiac -iologists technologistsImaging personnel interventionssurgeons PaediatricPaediatric Cardiology Cardiac Surgery Early diagnosis and timely referralPediatrician neonatologist Comprehensiveobstetrician pediatric cardiac care Intensive care Infection NursingRespiratoryIntensivistscontroltherapyChart showing the human resources associated withcomprehensive Paediatric heart care 51. Differences encountered between patient populations withcongenital heart disease (CHD) from India and thosefrom developed nations. Specific differences Pulmonary hypertension from late presentation. Neurological insults: hypoxic insults to the developing brain, brain abscess, stroke.Malnutrition and anaemia because of both delayed correction and high prevalence in population.Lung infections are associated with shunt lesions.High prevalence of neonatal sepsis.High prevalence of low birth weight.Pregnancy in the presence of significant heart lesion. 52. Cost-effective strategies for pediatric catheter-based interventions Problems Cost of dedicated catheterisation laboratories forpediatric catheterisation. Cost of disposable hardware. Cost of dedicated anesthesiology support for pediatricprocedures Cost of imported occlusive devices. 53. Cost-effective strategies for pediatriccardiac surgery Problems Limited availability of conduits Cost of imported bypass disposables Cost of suture materials Human resources for intensive care unit careComplex heart defects requiring single/ multistagecorrections. Prosthetic materials 54. Shortcomings in pediatric heart care in India Broad Category Detection of CHD Diagnosis Referral Treatment Prevention Healthcare planning 55. Role of Institutions Training Developing specific strategies for Indian patients Cost effective practices Indigenous Technology 56. Pediatric Cardiology: Summary 1938-Essentially no Rx for CHD Pioneers-pathologists, cardiologists, surgeons, imaging experts, intensivists, interventionalists 2002-Rx for virtually all CHD, BUT mort./morb.: ventricular function arrhythmia cns valves/conduits pulm hypertension New frontiers-causation, gene-based Rx, CHF Rx,Arrhythmia Rx, imaging, safety of CPB, PVR An incredibly exciting run--much for the future 57. Change comes because some one some where has the courage of conviction- no matter how foolish 58. Some see things as theyare and ask why Change ?Others dream of thingsthat never were and askwhy not ?Walton LiLLEHEI 59. The real measure of your wealth is how much you would be worth if you lost all your money Anon 60. I SALUTE ALL THOSECARDIOLOGISTS,SURGEONS,TECHNICIANS,NURSES,RESEARCHERS,BASICSCIENTISTS,INDUSTRY AND ABOVE ALL OURNICE LITTLE ANGELS AND PARENTS,PHILANTHROPHISTS---------- WHOCONTRIBUTED ENORMOUSLY FOR THEGROWTH OF PAEDIATRIC CARDIOLOGY ANDSURGERY ALL OVER THE WORLD AND INDIA