Dr. Smita Mishra

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss the prevalence of heart defects in babies. Around 7-8 babies born out of 1000 children, might have some kind of heart defect for which certain intervention is necessary such as surgery or a cath procedure.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk on the topic when should surgery be done in single ventricle, in this video. If single ventricular heart is presenting with symptoms of hypoxia, cyanosis, then these babies should be put on beta blockers and iron. If these babies are having frequent attacks of cyanotic and hypoxic spells then a BT shunt surgery is advised.

The video talks about the treatment of aortic stenosis in children by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. The aortic stenosis might respond well to valvotomy procedures which is ballooning of the aortic valve. Later in life, these infants might need a repeat intervention such as valve replacement surgery in adolescent age group.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain about pulmonary stenosis. Pulmonary stenosis is the valvular obstruction at the level of pulmonary valve. It can present immediately after birth or later in age. If pulmonary stenosis is severe at birth, then baby will be blue. These patients are treated with the ballooning procedure but if valve is not involved or the obstruction is below or above the valve then in such cases surgery is advised. Once it is corrected, the baby doesn’t need any other intervention.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk about aortic stenosis in this video. Aortic stenosis can happen in a newly born baby presenting with sudden circulatory failure. These babies are palliated with prostaglandins. In future, these children should be sent to tertiary health care center and can be treated with ballooning procedure. She further tells that rarely these children needs surgery.

The video talks about the follow up patient who were treated for coarctation of aorta by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. Coarctation of aorta might be an etiological factor for hypertension. These babies should be assessed for blood pressure rise and should be diagnosed early and treated with proper medication. Also, echocardiography is done along with other investigations such as CT angiogram etc., if hypertension persists in these babies.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about the management of children with coarctation of aorta. If the baby is very sick and has femoral pulses, should be started on prostaglandin and transferred to tertiary care center. Ballooning procedure or surgery is done below six months and after that the baby should be treated with ballooning procedure which can be required more often. She will further explain that after the age of 10 years, a stent is placed in the narrow portion of the aorta so that recurrence of coarctation is avoided.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, with explain about coarctation of aorta in this video. In coarctation of aorta, the aorta has some kind of stenosis. These babies present themselves when ductus arteriosus is closed which is generally very late. The lower limb pulses of these babies are very weak or absent. Hence, it is recommended that any new born baby suddenly becoming symptomatic should check the femoral artery.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss the precautions for patients with prosthesis. Infection is prevalent in patients with prosthesis. They are prone of cardiac infections so need to be very careful. Infective endocarditis prophylaxis along with dental hygiene is very important.  Six month dental checkup should be done to avoid any caries of tooth. Any infection in the body should be promptly treated. Patient with artificial valve should be careful with antibiotics and avoid self prescription.

The video talks about the postoperative monitoring following a surgery by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. After surgery, postoperative monitoring is similar after 7 days, 3 months or six months and after that a six monthly follow up is necessary for these patients. In few patients, things are stable for a year or two, then yearly monitoring is advised.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about mechanical prosthesis and when it is required in this video. Mechanical prosthesis is preferred as the life of tissue valves is very less. In mechanical prosthesis, it is expected to be 20 years of longevity and re-intervention is not frequently needed. Life-long blood thinner is given and certain blood tests are advised such as INR which has to be between 2-3. INR should be monitored every 3 weeks. When the INR value stabilizes then can be repeated every three months and the drugs needed to be adjusted. She will further explain what to do if an INR value is less or more than normal value.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain postoperative management after valve replacement. If the valve is leaking, then ballooning is not a good option. In such cases, mostly valve replacement is advised. The valve replaced can be mechanical or tissue made. In case of tissue made valve, blood thinners are required for three months and in mechanical prosthesis, lifelong blood thinners are required.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain about rheumatic heart disease. It is the throat infection by streptococcal bacteria which might lead to heart disease known as valvular heart disease. The valves become regurgitant or stenotic or both. A close follow-up is maintained for these patients. She will further talk on balloon mitral valvotomy. Penicillin prophylaxis is also checked in these patients.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk about valvular heart disease in this video. Rheumatic heart disease is the major cause of valvular heart disease. In this the valves don not function properly. The valves are present in between the chambers of heart and they open in one direction to avoid backflow of the blood. She will further explain the importance of the valves.

The video talks about congestive heart failure by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. Congestive heart failure is seen in babies born with large hole in heart due to which there is large amount of blood flow to the heart. These babies have large liver and can have cardiomegaly. They can’t breastfeed properly and take more time to feed. Echocardiography is done and early intervention is advised.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain about the cyanotic spell. Cyanotic spell is intermittent increase in cyanosis in children who are born with blue lips and fingers known as blue baby. These babies cry excessively and have deep breathing and sometimes can become unconscious too. Dr. Mishra will further discuss the negative effects of cyanotic spells in these babies. The brain can become hypoxic and have convulsions too. Medical management or early surgical intervention should be considered in these babies with cyanotic spell.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about fenestration in Fontan surgery in this video. Many a times when the lung pressure is not appropriate, then there is a hole between right and left side of heart which is known as fenestration. The saturation of the baby can fall around 90% and the hole in these kids is closed by a device through CAT procedure.

The video talks about the postoperative medical management plan following Fontan surgery by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. These patients need warfarin which is a blood thinner for the rest of life. Rhythm disturbances has to be taken care in these patients. They need a regular checkup at least yearly after the first year of life. They might need a conduit replacement when they are of 14-15 years of age.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss the outcome of a Fontan surgery. Children who are undergoing Fontan repair, most of the time they have 20% complication rate and 80% they might have a better life. They can’t be an athlete but can perform day to day activities and lead a normal routine life and can also do exercises in a symptom restricted manner.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain about Fontan surgery in this video. When a single ventricle patient reaches 5 years of age, both his veins which comes from the upper part of the body and the lower part of body are connected to the pulmonary artery and in the lower part of body, blood comes from IVC, hence a channed is been put between IVC and pulmonary artery and a conduit is been placed. This is known as a Fontan completion of a single ventricular heart.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain about Glenn surgery. When right ventricle is not formed properly, the superior vena cava, the venous channel brings blood from upper part of body is directly connected to the right pulmonary artery. Hence, the ventricle is bypassed in this case so one ventricle is present and it needs to support the system and systemic artery.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss the management of an asymptomatic baby with left ventricle in this video. If a baby with a single ventricle remains asymptomatic up to age of 5-6 months then they do not need PA banding known as palliative surgery. After six months of age, can undergo Glenn surgery which is a step towards the single ventricular repair known as Fontan surgery.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss the management for single ventricle. Many a times when babies with single ventricle have congestive heart failure at birth and have little cyanosis, feeding difficulty and high lung pressure then these babies should go for first stage of surgery known as pulmonary arterial banding. PA banding is a procedure which reduces blood supply to lungs protecting it.

The video talks about single ventricle by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. A serious heart defect where the chamber of the heart is not formed in babies is known as single ventricle. She will give example of the abnormal heart valve and explain in details about this condition.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk on the postoperative outcome of a baby with TAPVC. An obstructed TAPVC is a disease where post-operative outcome maybe negative and baby can be very sick. In non-obstructive TAPVC, the risk is low and the baby can have a normal life. Dr. Mishra will further explain the complications regarding this condition.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about the obstructed TAPVC in this video. Babies born with obstructed TAPVC are very sick from birth and many times they are taken as case of lung infection rather than a cardiac problem. In these babies, an early surgery is advised. A bluish baby with tachypnea and not having fever should be considered of obstructed TAPVC. She will further discuss the management if the baby is born with non-obstructive TAPVC.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain about TAPVC. TAPVC is the total anomalous pulmonary venous return. It is a disease where pulmonary veins don’t give their pure blood to left side of heart rather are connected to right side of heart. If the baby presents with a high lung pressure, then baby becomes very sick within 72 hours of life and needs a very early surgery.

The video talks about the follow-up of TGA babies by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. After surgery, the follow-up period remains the same such as one month, three months, six months and one year. They should also undergo echocardiography to check the growth of the pulmonary artery and the aorta which can be seen properly. There might be a rare possibility of narrowing of the pulmonary artery. These children generally do well and no intervention is needed later in life.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about the surgery for a TGA baby can be delayed in this video. A baby who is born with the ventricular septal defect and has patent ductus arteriosus, these kids can wait till four weeks and a surgery can be performed between four to eight weeks successfully.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about when to operate a TGA baby. TGA baby should be operated at the first opportunity available. Ideally they should be operated within 15 days so that the normal arterial switch operation is done. She will also explain when the baby can undergo operation if presented after 15 days or one month.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk on what can be done if a TGA baby is born in a remote area in this video. In such situations, prostaglandins are the best treatment option. A new born center should be provided with prostaglandin injection. They should be given in an infusion form and should be transferred to tertiary care center after the injection has been started. These injections are life saving for these babies.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain about balloon arterial septostomy. The balloon arterial septostomy done for TGA babies to create an ASD and systemic and pulmonary blood can be mixed and a saturation in the body can be achieved up to 60 – 70 %.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about the transposition of great arteries (TGA) in this video. The pulmonary artery which comes from left ventricle where pure blood is present and the aorta is connected to right ventricle. She will explain about the series of sequences of the blood circulation and the saturation level in the babies. She will also discuss the management of this condition.

The video talks about the medical management of TOF by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. After the diagnosis of TOF, the hemoglobin level should be 13-14 mg/dl. Hemoglobin below 12mg/dl is anemia for a cyanotic baby. Beta blockers are given regularly to control the heart rate and cyanotic spell. After the surgery, beta blockers are given and the child might need some additional medical management. These babies should have regular follow-up with pediatric cardiologist.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk on the complete repair be done in TOF baby. If the patient has undergone some kind of palliation in first 2-3 months of life then surgery is usually delayed for one or two years depending upon the saturation of the baby. If the saturation is low around one year, then complete repair should be done around one year.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about the outcome of TOF repair in this video. These babies can become completely cyanotic. They might have dilatation of heart after 10-12 years. In case the heart dilatation is present, they undergo certain tests and if required a valve replacement surgery is done.

The video talks about the complete repair of TOF baby by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. Complete repair of TOF is usually done after five months of age and the ventricular septal defect should be closed. The right ventricular outflow should be reconstructed. She will further explain how the reconstruction is general done in these babies.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk on the early surgery of TOF baby be done. A baby who is having saturation level less than 70% have 2-3 options below six months of age. A total correction should be done at a younger age or a BT shunt surgery is conducted. Sometimes a cath procedure is also done known as RVOT stenting.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk about the treatment of tetralogy of Fallot in this video. If these kids are not very symptomatic in first 5-6 months of age then they are allowed to grow and keep monitoring their saturation level. If saturation is above 70% then they are allowed to grow up to 6-7 kg of weight. If the baby is blue and gets cyanotic spells, an early surgery can be planned.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain tetralogy of Fallot. It means that there is a large hole in the heart and blood flow to lungs is restricted either due to absence of pulmonale valve. It this case the right side of blood directly enters the left side of the heart.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about blue baby in this video. In babies born blue, the right sided blood flows in the left sided heart and this connection is because of abnormal pulmonary valve where blood is not flowing into lungs. Pulmonary arteries should be connected to the right side of heart. She will further explain the cause of the blue baby.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, talks about the precautions required in those children with hole in heart. A child who presents very late and has high lung pressure has to undergo cath procedure. She will further explain how which surgery is done along with medical management. These children should be followed up regularly. She will also explain the precautions to be taken in these kids.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss the precautions needed in patients who come late for treatment in this video. When children comes late, they might be having very high lung pressure and can go for surgery and closure of the hole in the heart. In these children, echocardiography is done more frequently and are started with pulmonary vasodilators. She will further explain how long the medications are to be continued.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss the postoperative management of a child with hole in heart. For these kids, medical management is given for 3 – 6 months. As per the institute guidelines, aspirin might be required post-surgery. Aspirin is given for ASD closure. She will further explain the other medical management given in ASD closure device. Warfarin is prescribed for old patients and the device is large.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss the medical management for babies with hole in heart in this video. Mostly a decongestive therapy is given such as digoxin, diuretics and enalopril are prescribed for medical management.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk about the follow-up of the children with hole in heart. In general, children having hole in heart needs follow-up at one month, three months, six months and after that yearly follow-up and after 2-3 years can be followed up at 5 years. She will also talk about the medical management in these patients.

The video talks about the other kinds of hole in the heart by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. Aortopulmonary window or AP window and atrial septal defect (ASD) are other kind of holes which should be addressed as early as possible. These are operated after six weeks of life and can be complicated than simple ASD or VSD. She will further explain the details of different kinds of heart defects.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain about patent ductus arteriosus (PAD) in this video. It is common in foetal life. Once the baby is born, PAD closes within 72 hours or within three months. If the baby is born before 40 weeks, the ductus remains open and is troublesome and requires medical management. Sometimes even surgical ligation is required as early as 2 weeks of life. If the baby is responding to medical management, then can undergo device closure.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk about the heart defects in babies managed. A hole in the heart is a simpler defect and all the holes can be managed very effectively with normal functional capacity. A hole in heart generally represents within 3 to 6 months of life with a feeding difficulty with irritable babies and not gaining weight. These babies should undergo echocardiography and be operated within 3 to 6 months. They might need medical management for some time after surgery.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain about ventricular septal defect (VSD) in this video. VSD is little more complicated than ASD. Dr. Mishra will explain the physiology of ventricular septal defect. The lung pressure should not increase or they will become stiff and thick and in these children lung changes might develop.

The video talks about the frequency of follow-up in these babies by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. Any intervention done in these babies have to be followed up at one month, three months, six months and one year. After one year, a yearly follow-up is recommended.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss different types of ASD. ASD can be of many types and can be associated with other defects such as leak in valve. Many a times it is related to acute ventricular septal defect (AVSD). It should be operated early in the first year only.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain atrial septal defect (ASD) in this video. In this defect, the baby usually remains asymptomatic in first year of life. If the ASD is more than 8mm in size, then it needs to be operated. She will further explain which type of surgery is done.

The video will explain about the hole in heart by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. Blood comes to right side of heart and then goes to lungs and then left side of heart. There is no connection between right and left side of heart. If there is any defect in the heart valve, blood directly passes between them. It can affect lungs and baby can have lot of respiratory problems.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will explain the normal blood circulation. There are two systems in the body: pulmonary related to lungs and body. Body utilizes oxygen and lung gives oxygen. Once the body accepts oxygen, blood reaches to right side of heart and then lungs and comes to left side of heart and again circulated to the whole body.

Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will discuss about the normal oxygen saturation of a baby in this video. All adults and children have oxygen saturation of about 98-100 %. It should not be below 95%.

The video talks about the babies with heart defect need surgery by Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital. All babies who are born with the birth defect might need surgery. 40 – 60% of the babies might need some kind of cardiac intervention and the others might heal on its own.

In this video, Dr. Smita Mishra, Pediatric Cardiology, Associate Director - Jaypee Hospital, will talk about babies in India are born with heart defects. Around 80,000 babies per year in India are born with the heart defect.