Q: My daughter aged 20 is suffering from CHD from birth. There is a hole in the heart and the heart position is on the right side. She was complaining of headache and foot pain. I consulted a doctor and her haemoglobin was found to be 23.3 g/dl. Doctors advised to tap the blood but I preferred to give medicine and after the medicine she is feeling better and there is no other complain. I want to know the reason for increase in haemoglobin and what type of food do we have to give her so in future this type of problem does not arise? I also want to know where this type of operation can be done and what is the cost of this operation?

A:The information provided is grossly insufficient to answer your question adequately. It appears that your daughter is suffering from cyanotic congenital heart disease (Blue child). These patients have either a low blood flow to the lungs because of a hole and some obstructions near the outlet of the right heart (pulmonary stenosis) or a high flow because of a hole (leading to very high pressures in the arteries supplying the lungs (pulmonary hypertension). The cause of high haemoglobin is reduced oxygen being carried in the arterial blood which stimulates the bone marrow to produce more red blood cells to compensate. This makes the blood very viscous and leads to the symptoms like headache and flushing etc. Blood letting leads to some relief in symptoms. Patients with cyanotic heart disease with low blood flow to lungs are usually amenable to corrective surgery after a thorough work up in any dedicated cardiac center. Patients with high flow and pulmonary hypertension however are not candidates for the usual corrective surgery. Only option is a transplant of a lung with correction of heart defect or replacement of the heart which is a difficult proposition which is not being performed regularly in our country and is also performed very infrequently in the western world ( they do not accept patients from other countries, because of donor organ shortage). Such patients should not get dehydrated and need care regarding this (plenty of fluid intake and prompt treatment with fluids in case of diarrhoea, vomiting etc).