An 18-month-old girl with a single ventricle heart defect, a rare congenital condition in which only one chamber of the heart performs the pumping function that two chambers would normally share, was treated at BM Birla Heart Hospital. Her oxygen saturation was between 60 and 65 percent, significantly below the normal range, and her body weight was 7.5 kg, well below what would be expected for her age. Both factors placed her in a high-risk surgical category before any consideration of the procedural complexity itself.The primary clinical challenge in this case was surgical access. In adult minimally invasive cardiac surgery, one lung is routinely deflated to create the working space the surgical team requires. In an infant with oxygen saturation already compromised, that approach is not viable. Even a brief reduction in respiratory function at these saturation levels carries the risk of irreversible harm. The team at BM Birla Heart Hospital, led by Kuntal Roy Chowdhury, Consultant Paediatric Cardiac Surgeon, was required to perform the procedure with both lungs remaining functional throughout.Maintaining bilateral lung function during surgery of this kind requires precise coordination across the entire operating team. Surgeons, anaesthetists, and perfusionists need to work within carefully timed intervals, with each stage of the procedure calibrated against the child’s physiological tolerance rather than against a standard surgical sequence. The child’s low body weight added further complexity: anaesthetic tolerance and post-operative recovery potential are both reduced in underweight cyanotic patients, compressing the margin within which the team could operate.Dr Kuntal Roy Chowdhury said, “In infants with this level of oxygen compromise, the constraints are different from anything we encounter in adult cardiac surgery. The procedure has to be structured around what the child’s physiology can absorb at each stage. Keeping both lungs functional throughout required the entire team to maintain a level of synchronisation that leaves very little room for variation.”The child came through the procedure and is currently in recovery. This intervention represents the first stage of a planned treatment sequence that will continue as she grows. Single ventricle defects are managed through a series of staged surgeries over several years, with each procedure building on the haemodynamic changes established by the previous one.
