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Dr. Anil Kumar . D

Senior Consultant Pediatric Cardiac Surgeon & Head of Pediatric Cardiac Services

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Brief Profile

Dr. Anil Kumar Dharmapuram graduated from S.V. Medical College, Tirupathi (MBBS, April 1984). After that, he completed his post-graduate training in General Surgery in K. J. Hospital, Chennai and obtained the DNB degree in General Surgery from the National Board of Examinations, New Delhi (May 1991). He pursued his cardiac surgical training at the All India Institute of Medical Sciences (AIIMS), New Delhi (Jan 1996), and
later he worked as a specialist pediatric cardiac surgeon at Al Mafraq Hospital, Abu Dhabi, UAE (April 1999 to April 2003). He received advanced training in pediatric cardiac surgery as a Clinical Instructor in Lucille Packard’s Children’s Hospital, Stanford University, California, USA (June 2007), under the supervision of internationally renowned surgeons. He performs a range of operations in neonates and infants diagnosed with heart disease. The common & routine surgeries include Atrial septal defect (ASD), Ventricular septal defect (VSD), Multiple ventricular septal
defects (Multiple VSD’s), Tetralogy of fallot (TOF), Coarctation of aorta repair (CoA), and Aorto-pulmonary window (AP window). Apart from this, he does several major & complex cardiac surgical procedures like Total anomalous pulmonary venous connection (TAPVC), Arterial switch operation for transposition of great arteries (TGA), combined repair of the aortic arch and ventricular septal defect, Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA), Complete AV canal defect (CAVCD), Mitral valve repair (MV repair), Truncus Arteriosus repair with RV to PA conduit, Fontan repair (final stage of single ventricle palliation- TCPC), Senning operation, Double switch operation for c-TGA, Unifocalization for TOF with Pulmonary atresia and MAPCAS and Pulmonary Root Translocation (PRT) for d-TGA with VSD and LVOT obstruction.
He established the Paediatric Cardiac Surgery unit in February 2012 in KIMS Hospitals. He has performed around 3400 cases of cardiac surgical operations in children with heart disease. He operated on several cases in very small-weight babies. In the VSD category, the smallest weight baby operated was 2.0 kg. Similarly, in the TGA/TAPVC category, the smallest weight baby operated was 2.0 kg.

Experience with arch repair in neonates and infants:
His unique achievement is successful outcomes in arch repair operations in neonates and infants with the Stanford University technique of “Innominate artery cannulation using selective cerebral perfusion.” In this technique, he performs the repair of the aortic arch without circulatory arrest (DHCA). This work was presented as a poster in the Asian Cardiovascular Surgeons Association meeting (ASCVTS) Hongkong in May 2015 and was awarded the best poster award in the conference.
Also, the same work was published in the “Indian Journal of Thoracic and Cardiovascular Surgery” (IJTCVS 2015; vol 31, No. 2) titled as “Single stage repair of aortic arch and associated cardiac defects with antegrade cerebral perfusion using direct innominate artery cannulation in neonates and infants”.

Innovation in repair of Tetralogy of Fallot (TOF) :
  1. Valve and annulus sparing repair in Tetralogy of fallot (TOF) :
    He has pioneered a new innovation in TOF repair of preserving the native pulmonary valve and avoiding cutting across the pulmonary artery annulus if the morphology of the pulmonary valve looks okay without significant dysplasia and with pliable leaflets. This technique prevents pulmonary valve regurgitation and preserves the right ventricle function in a better way in the long term. In the recent past, he has improvised the surgical technique of valve sparing by using a new concept of delamination of the valve. This has shown very good outcomes in the patients. The smallest weight baby in the TOF category operated by him is 4.5 kg. He has published the experience with this technique very recently in the July 2021 issue of the Annals of Pediatric Cardiology (APC) as an original article titled as “Early experience with surgical strategies aimed at preserving the pulmonary valve and annulus during repair of tetralogy of fallot”.
  2. TOF repair using cormatrix patch for RVOT reconstruction: 
    The early outcomes of this technique has been published in the World Journal of Paediatric and Congenital Heart Surgery (WJPCHS) titled “Preliminary experience with the use of an extracellular matrix to augment the native pulmonary valve during repair of tetralogy of Fallot” in the March 2017 issue. This data was also presented as an oral presentation by him in the conference of the World Society of Paediatric and Congenital Heart Surgery (WSPCHS) in Abu Dhabi during October 2016.
  3. TOF repair using PTFE valve for RVOT reconstruction:
    In the recent years, he has innovated another superior technique of RVOT reconstruction in TOF repair if the patient’s pulmonary valve is small and abnormal. He creates a new valve in the RVOT by using a synthetic thin membrane called 0.1 mm polytetrafluoroethylene (PTFE) membrane. The results of this technique have been excellent and the valve function looks very good during follow up of these patients. Also, in cases of TOF with absent pulmonary valve syndrome he has been doing the reconstruction of the RVOT using a two leaflet valve of the same material.

Experience in repairing multiple VSD’s :
He has pioneered a new and safe technique of repairing these multiple VSD’s called “endothelial suturing”. This technique preserves the heart function better. He has done this in small-weight babies as small as 2.7kg. The outcomes of this technique have been excellent with minimal mortality.

Comprehensive surgical approach adopted to repair mitral valve :
Repair of congenital mitral valve disease is a challenge to a surgeon. A combination of techniques are required to minimize the stenosis and regurgitation and avoid valve replacement which is a very difficult option in this subset.
He has pioneered a new technique of repairing the mitral valve using artificial chordae with synthetic material called goretex neo-chordae. This is used as a substitute to the support mechanism of the valve leaflet that is insufficient and causes the valve leak. Using this material to repair the mitral valve in small infants is really challenging and the outcomes of this technique have been good. The use of the artificial neo-chordae is in addition to the other techniques like annuloplasty, leaflet augmentation and excision plasty.

Experience with Unifocalization during repair of TOF with pulmonary atresia with MAPCAS:
The MAPCAS (major aortopulmonary collaterals) have to be disconnected from the aorta and connected to the reconstructed pulmonary artery (Unifocalization surgery) to achieve complete correction and normalcy of circulation to the lungs. This is usually done in stages and after the first stage of surgery, which is the Unifocalization, the intra-cardiac repair of VSD and RV to PA conduit is done later. Across the world, the Unifocalization type of complex cardiac surgery is not done routinely in many centers. Stanford University, California, USA, is the world leader in this particular operation.
Dr. Anil Kumar Dharmapuram was trained at Stanford, and he brought home the technology of unifocalization surgery. He has done this operation in 18 patients here with good outcomes.

Experience with Double Switch Operations for cc TGA :
Anatomical repair in ccTGA depends on the patient's age, the presence of the VSD and the requirement for staged repair by PA banding to train the LV in the absence of VSD. Double switch operation (DSO) for this anomaly is a technically challenging operation to the surgeon and to the team for management. It involves the atrial switch called the senning operation and the arterial switch operation for the great arteries. The outcomes of this operation are good only in selected centers worldwide. Dr. Anil Kumar Dharmapuram has performed this operation in 14 patients with minimal mortality and good outcomes.

Experience and innovation with a new technique called Pulmonary Root Translocation for d-TGA with VSD and LVOT obstruction:
D-Transposition of great arteries (d-TGA) with VSD and obstruction to the left ventricle outflow tract (LVOT) is a very difficult surgical challenge. Across the world, the standard operation for this is called Rastelli Operation. Unfortunately, a conduit from RV to PA is required in this operation. This has to be changed when the baby grows and this is not a good option in the long term. A new operation for this problem called Pulmonary Root Translocation (PRT) has been reported from the Brazilian group of surgeons. The advantage of this operation is that the baby’s own pulmonary valve which is smallish is removed from the LVOT and moved to the RV and hence a conduit is avoided. We have started doing this procedure in the last few years and did 16 cases till date with satisfactory outcomes. Only a few centers in the world have the expertise to do this operation and in our country we have pioneered this technique with a very aggressive approach. We are very proud of the outcomes of this PRT operation in our unit. This experience has been recently published as an original article in the World Journal of Pediatric and Congenital Heart Surgery (WJPCHS) March 2021 issue titled as “Early Experience With Pulmonary Root Translocation in Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction”.

Experience with repair of coarctation of aorta with arch hypoplasia in neonates and infants
Coarctation of aorta (CoA) is often associated with hypoplasia of the aortic arch. In these babies, if there is no VSD in the heart, the repair can be done from the side (thoracotomy) without the use of cardiopulmonary bypass (CPB). We have pioneered a modification of this technique of repair called “end-to-side anastomosis” and successfully published our excellent outcomes in the Annals of Pediatric Cardiology journal during September/October 2018 titled as “Early outcomes of modification of end-to-side repair of coarctation of aorta with arch hypoplasia in neonates and infants”. We have done this technique in babies as small as 1.4 kg with good outcomes.

Presentations (Poster/Oral) at International Conferences:

    Overseas operating experience and mentorship :

      1. Simplified Single Patch Technique for the Repair of Complete Atrio-Ventricular Septal Defect.
        Presented at 37th Annual Meeting of European Paediatric Cardiac Society (AEPC) at Porto, Portugal, May 2002 as a poster presentation. Published in Cardiology in the Young Vol 12, Suppl 1 as an abstract. D. Anil Kumar, RN Suresh Kumar, CG Venkatachalam, VR Pillai, YA Nazer, TB Cartmill and IM Rao. Department of Cardiac Surgery, Al Mafraq Hospital, Abu Dhabi, UAE
      2. Biventricular Repair for Rare Variety of 200% DORV variant.
        Presented at 4th World Congress of Pediatric Cardiology & Cardiac Surgery, Buenos Aires, Argentina. September 2005 as a poster presentation.
      3. Selective cerebral perfusion using innominate artery cannulation to repair aortic arch anomalies associated with intracardiac defects in neonates and early infants.
        Presented in the Asian Association of Cardiovascular and Thoracic Surgery meeting (ASCVTS, Hong Kong, 2015). Presented in the annual meeting of the Pediatric Cardiac Society of India PCSI) October 2012 at Chennai, India as an oral presentation.
      4. Preliminary experience with using Cormatrix patch to augment the native pulmonary valve during repair of tetralogy of fallout.
        Presented as an oral presentation at the 4th Scientific Meeting of the World Society of Pediatric and Congenital Heart Surgeons (WSPCHS) on July 20, 2014, in Sao Paulo, Brazil.
      5. Repair of tetralogy of fallot with pulmonary valve and annulus preservation from the trans atrial and trans-PA approach.
        Presented as an oral presentation at the 5th Scientific Meeting of the World Society of Pediatric and Congenital Heart Surgeons (WSPCHS) October 2016, Abu Dhabi, UAE
      6. Repair of tetralogy of fallot with pulmonary valve and annulus preservation using a separate infundibular incision.
        Presented as an oral presentation at the 6th Scientific Meeting of the World Society of Pediatric and Congenital Heart Surgeons (WSPCHS) July 2018, Orlando, USA
      7. Pulmonary root translocation in transposition of great arteries with left ventricular outflow tract obstruction
        Presented as a surgical video in the video presentation session of the Regional Scientific Meeting of the World Society of Pediatric and Congenital Heart Surgeons (WSPCHS), Bali, Indonesia in November 2019
      8. Repair of tetralogy of fallot with a new technique of delamination of the fused cuspal apparatus as a strategy to preserve the pulmonary valve and annulus.
        Presented as an oral presentation in the 7th Scientific meeting of the World Society of Pediatric and Congenital Heart Surgeons (WSPCHS), June 2022, Marrakesh, Morocco.

      Overseas operating experience and mentorship :

      1. Was involved in training pediatric cardiac surgeons and personnel including establishing a pediatric cardiac center at Biket Medical Center, Oshun State, Nigeria. Have conducted two successful medical missions first in Jan 2014, the second in Dec 2014. The medical mission involved the pediatric cardiac surgery team from the KIMS Hospitals, Secunderabad.
      2. Conducted two successful medical missions in a MoH Hospital in April 2022 and August 2022 in Baghdad, Iraq. The mission involved the entire team from the pediatric cardiac surgical unit in KIMS Hospitals, Secunderabad. Was the lead surgeon for both the missions. The missions were conducted for two weeks, including complex cardiac surgeries like arterial switch operation and single-stage correction of intracardiac defects. The missions also involved training pediatric cardiac surgical professionals in the local team.
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