CHENNAI: It all began with a `murmur'. The sound that Dhruv Mistry's paediatrician heard when he placed his stethoscope on the boy's chest made him suspect that some infection came hand in hand with fever and cough and he ordered an echocardiogram. He little suspected that his seven-year old patient had suffered a silent heart attack.

Dhruv had suffered a heart attack due to a blocked coronary artery. Doctors who examined him in Ahmedabad decided that surgery would be very risky and recommended that he be put on drugs. However, when a doctor decided the boy needed better intervention, he referred him to M.R. Girinath, Chief Cardio-Vascular Surgeon, Apollo Hospital, Chennai.

While the Apollo team is familiar with performing beating heart coronary bypass surgeries on adults, it took some courage and technique to handle a child's heart, whose artery measured just above one mm in diameter. The team performed a beating heart bypass surgery on the boy, using the left internal mammary artery that runs close to the breastbone to create a graft artery to the heart, Jacob Jamesraj, cardiac surgeon, explained. The mammary artery was chosen because it does not develop fatty blocks and grows as the child does, Dr. Girinath said. "We did not really think we could do the procedure on a beating heart," he said, since the usual instruments used on adults were too big for the small chest.

When the blood came rushing back into the heart, the team knew that they had indeed pulled it off and that little Mistry would live a long and normal life. As the Mistrys belong to a middle-income family, financial assistance was provided from Apollo's Save A Child's Heart programme.