Re; Mantoo, Mohsin Raj; Ramakrishnan, Sivasubramanian – Pediatric cardiac interventions: Innovations from India

Dear Sir, This is with reference to the review article on “Pediatric cardiac interventions: Innovations from India,” published in the previous issues of the Annals.[1] First, the authors are congratulated for spotlighting our national contributions to pediatric interventional cardiology. Many of these innovations were made by the pioneers, keeping in mind the resource constraints of a developing economy. There’s a persistent, significant discrepancy between the number of children born in India annually with congenital heart disease (9/1000 live births) and the availability of healthcare resources.[2] Added to this is the burden of acquired cardiac illnesses led by rheumatic heart disease. Percutaneous adult cardiac interventions were extrapolated and reapplied after customization to pediatric demographics. Table 1 of the article[1] groups the innovations into five major categories: (1) new devices from India (or by Indians), (2) new techniques, (3) interventions standardized/consolidated by India, (4) existing techniques/devices used for newer indications, and (5) innovative emergency bailouts. The authors thus chronicle and classify the spectrum of pediatric cardiac interventions fueled by the team’s necessity, novelty, and ingenuity. The importance of the “heart team” approach and teaming up with the industry has been duly emphasized.[1] It would be appropriate here to mention that the world’s first successful nonsurgical septal reduction in pediatric hypertrophic obstructive cardiomyopathy (HOCM) was performed in a 3-year-old critical child in India.[3] This life-saving bailout was performed by Subash Chandra V, Jayaranganath M, and Shenoy A when high-risk surgical intervention for severe HOCM without extracorporeal membrane oxygenator, internal cardiac defibrillator, and transplant backups, all of which were not available way back in 2006. The article was published as a case report in the International Journal of Cardiology in 2006.[3] A similar strategy was utilized later, as Sivakumar and Jain reported in 2024.[4] These are examples of procedures under Category 5, as in Table 1. To summarize, the uniqueness of the Indian socioeconomic–medical environment paradoxically developed it as a laboratory of “out-of-the-box” pediatric cardiac interventions. The review article and the contributions from these stalwarts reinforced the same message. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.