A team of doctors at Apollo Hospitals, Hyderabad, accomplished a near miracle by saving a mother and child, from a highly critical health condition. The mother, into her 7th month of pregnancy, developed COVID and had to be treated on ventilator. To save the baby, a pre-term delivery was performed on her despite the mother’s condition. Both mother and baby were discharged hail and healthy. This was a first-of-its-kind care in this part of the world, where a 7-month preterm baby was delivered from a mother undergoing infertility care, while being ventilated for COVID. he 34-year-old patient, was undergoing infertility treatment and was into the seventh month of pregnancy. Being a precious delivery for the couple , they were seeking the guidance of Dr Sharmila, Senior Consultant Pediatrician at Apollo Hospitals, to avoid later stage medical complications. However, recently along with the other members of her family, the mother got infected with COVID-19 and was brought to the hospital on July 15th in a very critical condition. On admission, her condition deteriorated rapidly, and saturation levels were dismally low necessitating ventilator management. There was little hope of her survival medically, as nearly 90% of pregnant women needing ventilation, breath their last or end up delivering still born preterm babies. The medical team too had its set of challenges specific to this case: Complex hemodynamics of pregnancy and severe COVID infection with high viral load Difficulty in ventilation and the inability to make patient sleep on her belly, which is a necessity for COVID patients and is done for non-pregnant patients Difficulty in performing surgery with the protective (PPE) gear. Difficulty in assessing and reviving the baby at birth and the PPE not allowing proper assessment and delicate care babies’ need. The Doctors took these challenges in their stride and were keen to save both the mother and baby, but on a priority wanted to save the mother. During the course of the treatment the mother stopped responding and chances of her survival seemed slim, the team decided to retrieve at least the baby before the mother succumbs. The baby was delivered on July 17th by operating on the mother, while sustaining her on ventilator. But the baby too was found to be ill and not responding to resuscitation. The team revived baby’s heart function with medication, but the risk of it not surviving continued to be high. The baby later developed a blood stream infection and was treated. The baby gradually recovered, she started responding to the treatment and got better by the day. The fully recovered baby was discharged today. In the meantime, the mother saw a phenomenal recovery and was discharged on August 10th, 2020. The team of Doctors at Apollo Hospitals, who made this near miracle possible were Dr Deepak, Dr Nagaraj and Dr Sidharth, Critical care specialists: Dr Suneetha Nareddy, Dr Ravi Kiran and the team of Infectious disease specialists, Dr Vimee Bindra, Gynecologist; Dr Sanath Reddy, Anesthetist; Dr Sharmila, Neonatologist; Dr Chandrakant, Pulmonologist and Dr Prasad, Radiologist. During this period one of the Doctors from the Critical Care Team ended up getting infected with COVID, but the entire team risked their life to see this miracle happen despite several odds.

Doctors at Indraprastha Apollo Hospital, operated a 52-year-old woman for removal of the largest ovarian tumour ever to be operated in the world. Patient was a resident of New Delhi who had been gaining weight for the last few months and weighed a total of 106 kgs. She recently started experiencing difficulty in breathing, acute pain in her lower abdomen and consequently difficulty in walking and sleeping. With rapid weight gain and increasing complications, the family consulted a local surgeon, who then referred the patient to Indraprastha Apollo Hospitals. Upon investigation at Indraprastha Apollo Hospitals it was revealed that the lady had a giant, progressively expanding tumour in her ovary and this was putting pressure on her intestine (intestinal adhesions) causing acute stomach pain and inability to digest food. Additionally, the haemoglobin of the patient had dropped to 6, causing severe anemia. A team of surgeons led by Dr Arun Prasad, Senior Consultant, Surgical Gastroenterology & Bariatric Surgery including Dr Abhishek Tiwari, Consultant, Surgical Gastroenterology, Dr Geeta Chadha, Senior Consultant, Gynaecology & Obstetrics and Dr Jaya George, Senior Consultant, Anaesthesiology at Indraprastha Apollo Hospitals, Delhi conducted a three -and-a-half-hour successful surgery for extraction of this 50 kg tumour on 18th August, 2020. Elaborating on the case, Dr Arun Prasad, said, “In over 30 years of my experience as a surgeon I have never come across a case where the tumor weighed almost half the person’s body weight. There was a case reported in 2017 as the largest from Coimbatore where a lady was operated for a 34 kg tumour in her ovary.” “Extraction of a 50 kg tumour was a challenge for the team. More so because the patient had exceptionally low haemoglobin and had to undergo 6 units of blood transfusion (in total) before, during and after the procedure. This procedure was a perfect example of how important it is to understand the traditional methods of surgery while evolving with new minimal access procedures. Here, there was no space in the abdomen for insertion of equipment via laparoscopy or robot assisted methods, hence we had to resort to traditional methods of surgery. With the combined effort of experts from the Gastroenterology, Gynaecology and Anaesthesiology teams, the extraction was done successfully.” A key surgeon on this case, Dr Abhishek Tewari, said, “The patient was admitted with complaints of stomach pain, breathing stress and obvious weight gain. She was advised immediate surgery else the tumour would have grown exponentially and caused pressure on other organs leading to possible organ failure. Fortunately, the tumour was benign and the patient had no co-morbidities, which enabled a faster recovery. Post-surgery her weight dropped to 56 kgs.” Dr Geeta Chadha, Senior Consultant, Gynaecology and Obstetrics at Indraprastha Apollo Hospitals, said, “There is no proven reason for emergence of a tumour in the ovary, but it can happen during the formation of the cells in a human body. As a first ever case of a 50 kg tumour in the ovary, this was a challenging procedure. Due to the giant tumour, the intestinal tract throughout was compressed and flattened which was putting pressure on the gut leading to risk of rupture in the ovary. The surgery was done with utmost precision while keeping in mind seamless extraction of the tumour and simultaneously ensuring no harm is caused to the ovary or the gut. Post-surgery the patient showed tremendous recovery and was discharged on 22nd August.”

While the world grapples with the fear of contracting Coronavirus, authorities worldwide are entirely focused on tackling Covid-19 spread and have issued guidelines for the management of other diseases and health conditions. However, amidst the nationwide lockdown, some patients suffering from serious health conditions could not get specialized medical attention. In a continuous effort to save lives, Apollo Hospital recently flew 7 children from Manila and Philippines, to Indraprastha Apollo Hospital as these children required immediate liver transplant and postponing the treatment any further posed a serious threat to their lives. These kids were brought to the hospital on a special flight, with a medical team on board to tackle any emergencies. Earlier, 3 to 4 patients used to visit Indraprastha Apollo Hospital from Philippines every month. But ever since the lockdown began, these sick children had been awaiting liver transplant. These children were in grave health condition and delay in treatment any further would have serious health implications, thus the dire emergency to get them treated. Six kids need Liver Transplant and one required post – transplant assessment. Dr Anupam Sibal, Group Medical Director and Paediatric Gastroenterologist, Indraprastha Apollo Hospitals, said, “At Indraprastha Apollo we used to regularly get patients from Philippines in the pre-Covid times, but ever since countries imposed restrictions on travel and movement due to this pandemic, a lot of patients with pre-existing conditions of NCD’s have been deprived of medical attention. Also, owing to the fear of COVID-19, people who require surgeries are opting out, consequently leading to life threatening health complications. Similar was the case of these children seeking liver transplant, where any further delay in medical intervention could have been fatal. But we were fortunate to have immense support from embassies of both the countries who helped ease the process, charitable organisations that voluntarily offered to pay for the treatment and Actor Sonu Sood who helped in arranging flights for the children. All this helped us fasten the process of their travel.” Dr. Neerav Goyal, Head – Liver Transplant, Hepatobiliary and Pancreatic Unit, Indraprastha Apollo Hospitals, said “Due to fear of COVID-19, many patients who require essential lifesaving surgeries, are opting out of it, preferring to wait till this pandemic ends. In liver transplant, surgery is usually done when patients have a high risk of dying from their disease, in the ensuing one year. Since COVID-19 is not going away anytime soon, many of these patients are unlikely to survive the period of pandemic without a liver transplant. In our hospital we have made strict zoning and segregation of COVID-19 positive and negative areas, and thus we have been successfully carrying out complex transplants routinely. I can just say that for these patients, fear should not become so overwhelming and overpowering that they deny themselves life-saving surgeries. Transporting these children to India was a daunting task in itself. There was no direct flight operating from Manila to New Delhi. Moreover, a medical team was required to travel with these sick children. But because of strict quarantine rules and regulations, no doctor was willing to take the risk. Fortunately, it was found that there were more than 10 interns who after finishing their medical training in Philippines, were flying down to Delhi in the same flight. These doctors were contacted, and they willingly volunteered to help these children in case of any emergencies in flight. To transfer these children to India, the hospital contacted FICCI, Philippines, for assistance. They also reached out to Bollywood Actor Sonu Sood who has helped thousands of migrant workers reach their native states. He arranged a Spice Jet flight to bring these children to India. “Our child has waited for a long time for a liver transplant. We were due to visit Apollo Hospitals for his treatment in April”, said a child’s parent. “Due to lockdown, we could not visit. In the meantime, his condition deteriorated. We did not think that he would be able to make it. But God heard our prayers.” The children parents said that they were in constant touch with the staff from Apollo Hospitals. They were hoping that the Indian government would operate flights from Manila to Delhi. In the end, constant efforts by the Apollo Hospital, Government Officials, FICCI Philippines, and Actor Sonu Sood bore fruit. The children reached the hospital safely, where they are currently undergoing medical treatment.

Doctors at Apollo Children’s Hospitals Chennai successfully saved two young lives by performing complicated living donor liver transplants on a six-month-old baby from Jharkhand and an eleven-year-old girl from Trichy during the pandemic. The surgical team led by Dr. K. Elankumaran, Surgical Gastroenterologist, Liver Transplant Surgeon Apollo Children’s Hospitals performed the transplant surgeries and mothers of both the children gave a new lease of life to them once again by donating part of their livers. Read more about the two complicated Liver Transplants performed at Apollo Children’s Hospitals

In what might be called a miracle, a 16-year-old boy who suffered from a severe electric shock was brought back to life after coming in contact with a high voltage live wire that had fallen on an iron railing, at his shop. The incident occurred in Old Delhi when the boy was inspecting damage caused to his shop due to heavy rains that lashed the city. The boy was found in a lifeless condition by people from nearby in a state of shock, stuck motionless to railing while current still running through his body. He could only be rescued after 10 minutes when people got the electricity supply cut from the powerhouse of that area. He was rushed to Indraprastha Apollo Hospitals and was admitted on 1st August. On admission, the patient had no heartbeat, an absent pulse rate and progressively falling blood pressure owing to the damage caused by the continuous flow of electricity to his body. With exceptionally low chances of survival, Dr Priyadarshini Pal, Emergency Head, Emergency & Critical Care, Indraprastha Apollo Hospitals and her team quickly responded to his critical condition and with timely treatment the patient regained his consciousness after 36 hours, and was discharged after five days of his treatment on 5th August. Dr Priyadarshini Pal, said, “The boy was brought into the Emergency in an unconscious and unresponsive state and did not have a heartbeat. Upon evaluation it was discovered that due to the severe and prolonged electric shock he had suffered a cardiac arrest and his pulse could not be felt. We immediately gave him a CPR (Cardiopulmonary resuscitation) to try and revive the patient. The process was extremely critical because any delay in CPR after a cardiac arrest could have led to a possible irreversible brain damage, but we were able to revive the patient after CPR that lasted for an unusual time of almost 45 minutes. “ Dr Sudhir Tyagi, Senior Consultant, Neurology, Indraprastha Apollo Hospitals, said, “Such cases are very critical as slight delays can cause irreparable damage to the brain. If this patient had not been given CPR immediately it could have led to a condition of decrease in flow of oxygen to the brain (brain hypoxia). This condition can manifest brain damage in the form of severe neurological deficit, delayed or complete inability of the patient to regain consciousness and weakness/numbness in different parts of the body. Even if the patient had regained consciousness, there was possibility that his cognitive brain functions like- memory, responsiveness, recognition would be adversely affected. “Timely treatment and quick response to his deteriorating condition is what saved the patient’s life.Fortunately, his other organs had not suffered any damage, hence after 36 hours the patient regained full consciousness. His progress was closely monitored for five days and the patient was discharged in a healthy state after that”, she further added. Expressing his gratitude to the Apollo team, the patient’s brother said, “We had lost hope when initially the doctors informed us that chances of my brother’s survival are low, but Dr Pal and her team put in all their efforts and helped bring him back to life”.

As the world remains engulfed with the fear of the COVID-19 pandemic, other health conditions that need immediate medical attention have taken a toll. It has been observed that people are delaying their surgeries owing to the fear of visiting a hospital and contracting the infection. There is no health condition irrespective of the age group that can be ignored or the treatment for which can be put on hold. More so in the case of infants who are born with congenital heart diseases. Dr Muthu Jothi, Senior Consultant, Pediatric Cardiothoracic Surgery, Interventional Cardiology at Indraprastha Apollo Hospitals, Delhi said, “Congenital heart diseases can be life-threatening for children especially when the treatment is delayed. If not detected and simultaneously treated at birth, the child develops symptoms like shortness of breath, heart murmurs, recurrent respiratory and lung infections. This not only impacts the quality of life of the child but also affects the child’s development and limits life expectancy.” Recently, a three-day old infant born in Uttar Pradesh was referred to Indraprastha Apollo, Delhi, post developing breathing trouble right after birth. Understanding the urgency and criticality of the situation Apollo Hospitals arranged for the baby’s travel to Delhi immediately. The child travelled for 17 hours on ventilator in an ambulance and was successfully operated at Indraprastha Apollo Hospitals. Post-surgery within 10 days of neonatal intensive care, the baby showed immense improvement and was discharged. Lead surgeon for the procedure, Dr Muthu said, “This case was specifically challenging as we had lost a lot of time in getting the baby here and beginning his treatment. The surgery was a high-risk procedure owing to the infant’s low birth weight (1.5 kgs). This was the lowest weighing child at 1.5kgs, to have ever gone through such a complex cardiac procedure at this hospital. The timely treatment of the kid saved him from losing his life”. Similarly, was the case of a seven-year-old child, hailing from Ludhiana, who was born with a hole in her heart leading to very high pressure in the lungs (a large ventricular septal defect and severe pulmonary hypertension). The child’s surgery had been delayed for a few years owing to financial limitations of the family. Consequently, she was brought into Indraprastha Apollo Hospitals, Delhi in an emergency situation when episodes of pneumonia and breathlessness worsened. Amidst, stringent travel and lockdown rules, arrangements were made for the child’s transportation to Delhi, where she was operated successfully.

The team of doctors at Apollo Children’s Hospital successfully saved a five-month-old baby by performing a high-risk procedure. The parents brought the baby to Apollo Children’s Hospital when she suddenly developed breathlessness. Dr CS Muthukumaran and Dr Anuradha Sridhar, Senior Interventional Paediatric Cardiologists, confirmed that the baby was suffering from Left Atrial Appendage Aneurysm, a rare condition. The surgical team consisting of Dr Neville Solomon, Dr Musthafa Janeel Moosa and Dr V Swaminathan took the baby up for an open heart surgery. The surgery went uneventfully, and the aneurysm was closed off and excised. Read more about how the high-risk procedure was performed by Apollo Children’s Hospital        

The Apollo Proton Cancer Centre (APCC), the first Proton Therapy Centre in South Asia and The Middle East, has been accredited by the Joint Commission International (JCI), the recognized global leader in health care accreditation. This makes Apollo Proton Cancer Centre, Chennai, India’s first dedicated advanced cancer centre to receive this international accreditation, and the 8th hospital in the Apollo Hospitals Group to join the portfolio of JCI accredited hospitals. Read more about JCI accreditation of Apollo Proton Cancer Center

TAVR or Transcatheter Aortic Valve Replacement, a minimally invasive surgical procedure, was successfully performed on a 93-year-old patient at Apollo Hospitals, Indore despite numerous challenges due to the lockdown. The nonagenarian with severe breathlessness and inability to lie down was airlifted to Indore, where he was diagnosed with a critical condition of severe stenosis of the aortic valve. The only alternative was a valve replacement that had to be carried out immediately. Open-heart valve replacement surgery was not an option due to age and co-existing health issues including history of bypass surgery, angioplasty, and renal dysfunction. The patient was offered the advanced option of TAVR or Transformative Transcatheter Aortic Valve Replacement (TAVR), an advanced minimally invasive technique that allows surgery on patients who are considered as unsuitable or high-risk for open-heart surgery. The advanced procedure was successfully performed on 17th June 2020. The patient recovered well and was out of bed in just 4 hours after surgery, ready to be discharged the next day. Dr. K Roshan Rao, Senior Consultant Interventional Cardiologist, Apollo Hospitals, Indore said, “Patients with calcification of the leaflets of the heart valve, that open and close with the flow of blood, often present with symptoms only after the age of 70-75 years. At this age, a majority are not suitable for open-heart surgery. However, if not treated, survival is difficult. TAVR is a revolutionary technique and a blessing for such patients so that they can have a prolonged healthy lifestyle with improved quality of life. Whereas in conventional open heart surgery, the chest cavity needs to be opened by cutting through the sternum to allow the surgeon to operate on the heart, TAVR is a minimally invasive surgical technique where inner organs are accessed via needle-puncture of the skin, rather than a scalpel.” In TAVR, a miniaturized valve is inserted through a catheter, a thin flexible tube, from the groin into a blood vessel under local anaesthesia. The deployed valve reaches the base of the aorta at the site of the aortic valve. The doctor then opens a balloon that inflates the valve pushing aside the old valve and overcoming the stenosis or narrowing. Using MAC anaesthesia or monitored anaesthesia care, the patient is aware but relaxed throughout the procedure that takes about an hour as compared to 5-6 hours required for an open-heart surgery. There is no need of general anaesthesia, a midline sternal incision, which was required in open heart surgery, thereby reducing prolonged hospitalization, and instead of a week’s stay, a patient who has undergone TAVR, goes back home walking on the third day. The other benefits of TAVR include reduced and negligible need for blood transfusions, and reduced stroke risk of less than 1% as against 5-7% in conventional open-heart surgery. Dr. Sarita Yadav Rao, Senior Consultant Interventional Cardiologist, Apollo Hospitals, Indore said, “We are proud of having pulled off this feat at a time when the nation was in a lockdown to fight the COVID pandemic. Reports suggest over 5 lakh elective surgeries were postponed across the country. However, in this case, we could not afford to wait for the lockdown to end, as any delay could have worsened the patient’s condition and could have been fatal. The team of doctors included the medical and surgical teams and also experts in infection prevention and control to ensure that all measures for the safety of the patient were taken, and the procedure took place with precautions including the highest Standards of Excellence in Infection Control Protocols and Best Practices. It was a testament to the efforts of the entire team that the procedure was performed with 100% success.” The other members of the team at Apollo Hospitals, Indore included Dr. Shirish Agarwal, Jr. Consultant/ Associate Consultant Cardiologist, Dr. Vikas Gupta, Senior Consultant, Anaesthesia and Dr. Kshitij Dubey, Senior Consultant, CTVS. Dr. Hari Prasad, President, Apollo Hospitals said, “TAVR and other advanced procedures are all set to change the face of cardiac care in India. The benefits when compared to conventional open heart surgery are incomparable. These advanced minimally invasive procedures allow us give a second lease of life to many patients who were previously classified as too high risk or inoperable. Apollo Hospitals is constantly striving to bring the latest advanced therapies for patients in India. Our trained experts with years of experience in cardiac care use scientific evidence based approaches, precision techniques, cutting-edge devices and medical equipment to overcome any medical challenges. On the anvil are newer structural interventions including Mitral clip, trans-catheter mitral, tricuspid and pulmonary interventions which would allow many patients who cannot undergo surgery, to benefit from minimally invasive therapies, giving them new hope and an improved quality of life.” He added, “That this procedure was carried out during the COVID-19 pandemic is testament to our teams’commitment to deliver world-class healthcare in the face of any and all challenges. We are proud that even amidst the COVID pandemic and lockout, we have continued to deliver lifesaving healthcare with proper precautions and protocols in place.”

Amidst the COVID-19 situation, a rare liver auto-transplantation surgery was successfully performed at Apollo Hospitals, Bangalore. The patient, a 46-year-old mother of two from Kolkata, had a malignant tumour in her liver which was inoperable due to the tumour’s location and that made conventional surgery risky. Dr. Sanjay Govil, Consultant – Gastrointestinal Surgery, Hepatobiliary & Pancreatic Surgery, Liver Transplantation at Apollo Hospitals Bangalore performed the complex surgical procedure that involved removing the liver, cutting out the cancerous tumour and re-implanting the liver back into the patient. The successful completion of the liver auto-transplant makes Apollo Hospitals one of only few hospitals in the world to have successfully performed this procedure. The patient, Mrs. Srijitha visited Apollo Hospitals with complaint of severe stomach pain for past few months that had worsened with the patient falling unconscious multiple times on the same day. Tests revealed a malignant tumour in her liver that would require to be resected or cut out. However, while not large, the tumour’s hard-to-reach location that involved several small and large blood vessels in close vicinity made a conventional approach and surgery risky and with uncertain success. Dr Sanjay Govil, Consultant – Gastrointestinal Surgery, Hepatobiliary & Pancreatic Surgery, Liver Transplantation said, “A radical resection or cutting out of the tumour or liver transplantation is the best treatment for patients with advanced hepatic cancer. The advantage of a liver auto-transplant is that it eliminates the need for a donor liver or any immunosuppressive therapy after the surgery. In this patient’s case, we had an additional challenge of the tumour being difficult to reach, so it was decided to go in for an auto-transplant.” “An eight-hour long surgery involved removing the liver, resecting the tumour from the liver outside the patient’s body and transplanting the healthy liver without the tumour back into the patient. Extensive experienced teamwork is required for the technical challenges during surgery as well as the pre and postoperative management. The patient’s husband expressed his happiness on the successful surgery, “I started looking for the best treatment option & meet lot of doctors in Kolkata, and I found out that very few surgeons in India are capable of performing this surgery. Few of my reference led me to Dr Sanjay Govil in Apollo Hospitals, Bangalore. I had immediately made the travel arrangements after taking an appointment. I am glad we made the trip as my wife now has got a new lease of life.” The patient began oral feeding the day after surgery and made an uneventful recovery. She was discharged on 15th June 2020. Back at the hospital during her weekly check-up, a smiling Mrs. Srijitha said, “Within five minutes of interacting with Dr. Govil, I knew he was my surgeon. I could put my complete trust and faith in him. We are thankful to the doctors and the team at Apollo Hospitals, Bangalore for their timely intervention to get my life back on track again. I can’t wait to go back to Kolkata and meet my family!”

Amidst the COVID-19 situation, Apollo Proton Cancer Center successfully treated an eight-year-old from Singapore who was diagnosed with a Grade IV medulloblastoma. The patient underwent surgery to remove the tumour but it was complemented with irradiation and chemotherapy so that  tumour recurrence could be avoided, said Dr. Rakesh Jalali, Medical Director of Apollo Proton Cancer Centre (APCC), Chennai. Read more about how Apollo Proton Cancer Center treated Grade IV tumour, medulloblastoma

The team of doctors at Indraprastha Apollo Hospitals performed a complicated liver transplant surgery on a 10-month-old, Baby Noor from Malaysia. Baby Noor, soon after birth had developed jaundice that advanced with time and was further diagnosed with biliary atresia, a rare liver and bile disease which has a ratio of 1:12000 in infants worldwide. In addition to this, Noor also had heterotaxy, an abnormal arrangement of the internal thoracic-abdominal organs across the left-right axis of the body. Her liver and stomach were in the middle of the abdomen and her heart was in the middle of the chest. At about 2 months of age, Baby Noor underwent a Kasai surgery that connects the under surface of liver directly to the intestines to achieve biliary drainage. She also underwent abdominal surgery to correct intestinal malrotation. However, both the surgeries were unsuccessful. According to Dr. Anupam Sibal, Group Medical Director, Apollo Hospitals Group and Senior Paediatric Gastroenterologist & Hepatologist, Indraprastha Apollo Hospitals, “If Kasai surgery fails to clear jaundice, then the only treatment is a liver transplant. Noor fell into this category of failed Kasai and developed progressive liver failure leading to severe jaundice, a bloated belly with ascites, growth failure, bleeding episodes due to liver dysfunction and increased pressure in the veins supplying her hardened liver. She was hospitalised in Kuala Lumpur multiple times, and once during her treatment she suffered a massive gastro-intestinal bleed in February, leading to a near death like situation. Initially her transfer to India was cancelled as she was on ventilator but since it was a very high-risk case requiring immediate surgery, she was referred to us.” According to Dr Neerav Goyal, Senior Consultant and Head, Apollo Liver Transplant, Hepatobiliary and Pancreatic Surgery Unit, Indraprastha Apollo Hospitals, “The day after the family landed in Delhi, an advisory was issued by the Government of India to quarantine all travellers from Malaysia for a minimum of two weeks. It was an ethical dilemma for the team of doctors and nurses, as we were not hopeful that Baby Noor could survive so long without immediate treatment. The team acted quickly and put the family in quarantine, for a period of two weeks post which the liver transplant was planned.” “Meanwhile Baby Noor developed a rhythm disturbance with a very slow heart rate while awaiting a transplant. She immediately required a temporary pacemaker. Post the quarantine period, after testing for SARS-COV- 2 which was negative and taking all precautions including PPE, she underwent a living related liver transplant on 31st March 2020. The donor was her mother. At the time of the transplant, Noor had a bilirubin level of about 45 mg/dl as against a normal of less than one. Her weight was only 6.5 kg at the age of 9 months.” Said, Dr Smita Malhotra, Consultant, Paediatric Gastroenterologist & Hepatologist, Apollo Hospitals, Apollo Hospitals Delhi. “Starting with the first successful liver transplantation in India in 1998, the Apollo Liver Transplant Program has now performed more than 3500 liver transplants including 361 in children. “Because of heterotaxy, low weight, precarious overall condition due to pronounced liver failure and the heart condition, this liver transplant was very high-risk procedure. Our extensive experience in liver transplantation helped us conduct an uneventful Liver transplant in a very complicated situation,” added, Dr. Sibal. We value the trust our patients. We have performed the most complicated of liver transplants (e.g., in babies weighing as less as 4 kilograms), combined liver–kidney transplants and multi-organ transplants,” Said Dr. Goyal. Baby Noor is doing well now and her vital stats are under control. The Liver transplant was done under the expert supervision of Dr. Anupam Sibal, Medical Director, Apollo Hospitals Group and Senior Paediatric Gastroenterologist & Hepatologist and his team comprising Dr Neerav Goyal, Dr Smita Malhotra, Dr Vikas Kohli, Dr V Arun Kumar, Dr Sanjeev Kumar Aneja. Baby Noor smiled beautifully at the staff and the sparkle in the eyes of the parents hides all the torment they have been through. She has now been discharged and awaits her return to Malaysia.