SERVICES

Care that follows a child from the womb into adulthood, under one roof.

Three departments work as a single unit: Paediatric Cardiology, Paediatric Cardiac Surgery, and Paediatric Cardiac Intensive Care and Anaesthesiology. Where a child needs a neonatologist, geneticist, neurologist, nephrologist or airway surgeon, that specialist joins the same team rather than receiving a referral.

BEFORE BIRTH

Fetal cardiac services

India’s first comprehensive fetal cardiac programme, and still the only one of its kind in the country. Defects can be identified from twelve weeks of pregnancy, which changes what is possible afterwards: the mother delivers in-house, and a newborn with a critical defect reaches intervention within hours instead of being transported across states in the days after birth.

The International Quality Improvement Collaborative for Congenital Heart Disease was established in 2008 to benchmark congenital heart surgery outside high-income countries. Data is submitted continuously and independently audited, which means a partner does not have to build a measurement framework. One exists, it is external, and it predates the partnership. IQIC Site

Why this matters to the outcome. Late arrival is the single largest reason children in India do badly after heart surgery. Diagnosis before birth removes the delay entirely.

NEWBORN

Neonatal and infant heart surgery

The clearest measure of a paediatric cardiac programme is what it can do for a newborn. Complex defects such as double outlet right ventricle and multiple ventricular septal defects are corrected here routinely.

  • Arterial switch operation — for transposition of the great arteries. Over 1,000 performed.
  • Norwood operation — for hypoplastic left heart syndrome. One of few centres in India performing this regularly.
  • Tetralogy of Fallot — total correction
  • Endocardial cushion defect repair
  • ALCAPA repair — anomalous left coronary artery from the pulmonary artery
  • TAPVC repair — total anomalous pulmonary venous connection. Around 1,000 performed in newborns.
  • Single-stage arch repair with correction of intracardiac defects
  • Double outlet right ventricle — total correction
  • Senning and double switch procedures
  • Systemic-pulmonary shunts and PA banding

PRETERM

The preterm cardiac surgical programme

Kerala’s first comprehensive preterm cardiac surgery programme. Babies weighing as little as 1.3 kg, and as young as 34 weeks’ gestational age, have undergone open-heart surgery here and gone home.

The programme runs as a continuum rather than an operation: tracked transport from remote centres using the Neoport app, stabilisation in the neonatal ICU, surgery scheduled by clinical need rather than by weight or age, then team-managed post-operative care. Procedures in this group include VSD closure, TAPVC repair, aortopulmonary window correction, arch repair with VSD closure, and arterial switch — including arch repair and VSD closure performed simultaneously with the switch.

COMPLEX

Complex congenital and valve surgery

High-end reconstructive work performed routinely rather than occasionally, much of it planned in advance on 3D and virtual reality models of the child’s own heart.

  • Complex DORV rerouting using 3D and VR models
  • Rastelli and Ross operations
  • Aortic valve bicuspidisation and Ozaki repair
  • AV valve repair in univentricular hearts
  • Conduit replacement and redo operations
  • Biventricular conversion of previously palliated univentricular pathways
  • Cone repair for Ebstein’s anomaly
  • Congenital mitral stenosis and regurgitation repair
  • Combined tracheal and cardiac surgery — resection, slide tracheoplasty, aortopexy
  • Surgery for endocarditis

Single ventricle physiology. Staged repair through PA banding, systemic-pulmonary shunts, cavopulmonary (Glenn) shunts and the Fontan operation, including the extra-cardiac Fontan.

COSMETIC

Surgery that does not leave a mark

A child cured of a heart defect can still carry the scar, and the questions that come with it, for the rest of her life. Where the anatomy allows, surgeons here take a harder route to avoid that.

  • Trans-axillary approach — nearly 300 operations. The incision sits under the arm.
  • Ministernotomy (key-hole) — approximately 300 infants and children, offered since 2015
  • Kerala’s first minimally invasive cardiac surgery in children
  • Limited posterolateral thoracotomy — over 1,500 open-heart procedures
  • Minimally invasive pulmonary valve implantation after primary tetralogy repair
  • Performed this way: tetralogy repair, septal defect closure, anomalous venous connection correction, endocardial cushion defect repair
A young girl lifted up by her father after surgery, arms raised, no visible scar.

The trans-axillary incision is slower and more difficult to perform, and benefits nobody except the child.

WITHOUT SURGERY

Catheter interventions

Many defects can now be closed without opening the chest. Amrita holds leadership status in catheter intervention in India, and several techniques in use here were developed in-house specifically to bring the cost down.

  • PDA closure — over 2,500 performed using cost-effective techniques developed at Amrita. One of the largest such experiences in the world.
  • ASD device closure — among the largest experiences in India. South India’s first, in 1999.
  • Percutaneous pulmonary valve implantation — India’s first in a child
  • Stenting of coarctation, pulmonary artery and PDA
  • Hybrid procedures for complex defects, surgeon and cardiologist operating together
  • PDA closure in preterm infants — the world’s first published series
  • VSD closure — technique modified here to reduce cost to the family
  • Balloon dilation for valve obstruction at all ages
  • Coronary artery fistula and pulmonary AV malformation closure
  • Pacemaker and ICD implantation, and a comprehensive paediatric electrophysiology service

IMAGING

Seeing the defect before deciding what to do about it

India’s first and only dedicated cardiac MRI programme for congenital heart disease, established in 2010, sits alongside South Asia’s first point-of-care 3D printing lab (2015) and Extended Reality Lab (2021).

  • Echocardiography — 2D, 3D, 4D, transoesophageal and fetal, on a dedicated paediatric lab
  • 256-slice CT for cardiovascular scanning
  • 3D reconstruction and printing of the child’s own heart
  • Two digital flat-panel catheterisation laboratories
  • Cardiac MRI — 1.5T and 3T scanners
  • Nuclear medicine — myocardial perfusion, viability and lung perfusion studies
  • Virtual reality planning meetings before complex repairs and catheter procedures
  • Exercise and arrhythmia evaluation — paediatric CPX, treadmill, head-up tilt, Holter

AFTER SURGERY

Intensive care

A 34-bed paediatric cardiac intensive care unit, with twelve beds sited immediately next to the operating theatre. Equipped with ECMO, inhalational nitric oxide, LV assist and advanced life-support ventilation.

Post-operative care is run by a multidisciplinary team rather than the surgical unit alone: clinical pharmacist, infection control, specialist nursing, nutritionists and respiratory therapists. A dedicated non-cardiac ECMO team also supports children with viral myocarditis, ARDS, septic shock and poisoning. Intensive care and nursing practice here has developed through a standing collaboration with Stanford and Lucile Packard Children’s Hospital.

Around the clinical care. Medical social workers and patient educators help families cope with the diagnosis and assemble the resources to pay for treatment. Translators are available around the clock for out-of-state and international families, including help with accommodation and food.

LIFELONG

Specialty clinics and life after childhood

Congenital heart disease is a condition, not an event. A child whose heart is repaired at six months needs surveillance through school, through adolescence, through pregnancy and into middle age. The common failure, in every country, is that she vanishes from care in her twenties because nobody was set up to keep her. This department opened India’s first dedicated Adult Congenital Heart Disease clinic for that reason. It has now been running long enough that children operated on in its early years are adults in its clinics today, which is the only proof of continuity any programme can honestly offer.

  • Adult Congenital Heart Disease Clinic: India’s first dedicated clinic of its kind. A child treated here at six months is still a patient at thirty.
  • Pulmonary Hypertension Clinic: Running since 2012, with more than 500 patients on its registry. A nodal centre for the Pulmonary Vascular Research Institute.
  • Cardiovascular genetics: Novel BMPR2 mutations identified in the South Indian population, and a lethal genetic cardiovascular disorder in North Kerala first described by this department.
  • Outreach clinics: Regular clinics run in Kozhikode, Palakkad and Kollam, so follow-up does not require a journey to Kochi.

TRAINING

Making more of the people who do this work

India has roughly 120 paediatric cardiac surgeons for a country where 240,000 children are born with a heart defect every year. Treating children one at a time cannot close that gap. Training the people who treat them can.

  • DM Paediatric Cardiology — three-year structured course, the first in India recognised by the Medical Council of India
  • Dedicated programmes in cardiac anaesthesiology and intensive care
  • Sri Lanka’s first three paediatric cardiologists trained here
  • Children’s HeartLink global training site — the first among several international sites given that status
  • International Pediatric Cardiac Surgery Fellowship
  • Six of India’s leading paediatric heart surgeons trained here
  • Japan, China and Portugal have sent surgeons here for advanced training

Funding a fellowship is one of the three partnership pathways