Sunday 9 September 2012

CROSSED 100 MARK IN CARDIAC SURGERIES AT MAX HOSPITAL,MOHALI WITH 99.2% SUCCESS RATE

Crossed the 100 mark in cardiac surgeries at Max Superspeciality Hospital, Mohali. The profile of patients varied from one year to 80 years. CABG included the highest risk  situations tackled successfully. Started the paediatric cardiac surgery program with a complex blue baby who was corrected fully.
GREAT TEAM WORK WITH GREAT INFRASTRUCTURE COUPLED WITH VERY QUALITY ORIENTED ETHICAL APPROACH.

Friday 13 July 2012

High Risk End stage Coronary Artery Disease treated successfully with Beating Heart Surgery


High Risk End stage Coronary Artery Disease treated successfully with Beating Heart Surgery

Recently we operated upon a 63 yrs old male who had CAD since last 10years and was very symptomatic as he had myocardial infarction or heart attack couple of times with the result his heart function went down to bare 15%. He was refused intervention every where in view if the high risk involved in it. Even his one of relatives in USA is a cardiologist and he also advised very high risk for surgery. He went into heart  failure a number of times and was treated at local hospitals for that. Looking at the heart function he was refused surgery but treated medically or was suggested PTCA in one of arteries with doubtful benefit..

                                                              He came to us again and on ECHO his ejection fraction was only 15%, dilated heart and muscle looked to be thin. His angiography done in NCR showed severe triple vessel disease. Dilated heart with low heart function makes it very high risk surgery. His “Euro score” a criteria to assess risk of surgery based on the clinical and investigative parameters was 14 indicating a mortality of 40%.We decided to do a further work up and went for PET scan(positron emission tomography) which gives us a very good idea that whether the heart muscle is viable or not and can it be revived by revascularization. Luckily for him PET showed good muscle with reasonably good viability in most of areas except two areas. Based on this we came to a conclusion that he will benefit if preoperatively he tolerates the procedure. We decided to offer him a beating heart surgery a new technique adopted with us for last 10years where you avoid heart lung machine and its side effects which is very crucial in such cases for good recovery. Intra-operatively we used special gadgets to monitor functioning of the heart continuously with continuous cardiac output catheter. Adequate preparation i.e. decongestion and putting intra-aortic balloon pump (IABP) preoperatively was done which helps heart in giving more blood. After 24hrs we took him for OPCAB(beating heart surgery) and did three by- passes on his heart. His lung pressures were very high which were manipulated with drugs and they settled down after the grafting. He sustained the procedure well and in the post operative period did very well. IABP was removed on 3rd day and all drugs to help heart were off by 5th post operative day. He was mobilised and shifted to HDU to see his early mobilization under close supervision. He was very comfortable in walking around extensively with normal parameters and was discharged on 9th day. Before discharge his heart function came up to 30% from 15% a massive improvement. It will further improve but slowly. These patients are ideally suitable only for heart transplant but facilities for this in our country are few and too expensive to maintain it also. If left untreated the prognosis is not very good as low output state and repeated heart failure damages the other organs like kidneys, liver and they succumb to multi-organ failure. Careful planning and extra care with new technologies help saving such lives and gives them quality of life also.

                                       Thus “Time is muscle and do not lose it in waiting.” By- pass surgery done at appropriate time in stable condition is the best thing to happen to heart and it increases your quality of life and prevents further set- backs to heart muscle. He was operated by a team headed by Dr Virendar Sarwal, In charge Dept. Of CTVS Max hospital, Dr Ajay Sinha, Dr Arat Nahak, Dr Srinivas, Dr Goswami, Dr Shailender at Max Superspeciality Hospital, Mohali.

Sunday 22 April 2012

Invited to present a paper at Heart Valve Society of America in New York



Invited to present a paper at Heart Valve Society of America in New York on End Stage Valvular Heart Disease. Got good appreciation of the work. Pictures from conference Venue at Hotel Marriot Marquis, New York.

Sunday 19 February 2012

Self CPR

What are you to do if you have a heart attackWhile you are alone.
If you've already received this,
It means people care about you.
The Johnson CityMedicalCenter staff actually
Discovered this and did an in-depth study
On it in our ICU.
The two individuals that discovered this then did
An article on it, had it published and have had it incorporated into ACLS and CPR classes.
It is very true and has and does work.
It is called Cough CPR.
A cardiologist says it's the truth,
If everyone who gets this sends it to 10 people,
You can bet that we'll save at least one life.
It could save your life!
Let's say it's 6:15 p.m. And you're driving home
(alone of course), after an usually hard day on the job.
You're really tired, upset and frustrated.
Suddenly you start experiencing severe pain
In your chest that starts to radiate out
Into your arm and up into your jaw.
You are only about five miles from the hospital
Nearest your home.
Unfortunately you don't know if you'll be
Able to make it that far.
What can you do?
You've been trained in CPR
But the guy that taught the course didn't tell
You what to do if it happened to yourself.
Since many people are alone when they suffer a heart attack, this article seemed to be in order.
Without help, the person whose heart is beating improperly and who begins to feel faint,
Has only about 10 seconds left before losing consciousness.
However, these victims can help themselves by coughing repeatedly and very vigorously.
A deep breath should be taken before each
Cough, and the cough must be deep
And prolonged, as when producing sputum
From deep inside the chest.
A breath and a cough must be repeated
About every two seconds without let up
Until help arrives, or until the heart is felt to be beating normally again.
Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and
Keep the blood circulating.
The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital.

Wednesday 8 February 2012

Advantages of Off Pump Surgery or Beating Heart Surgery.

What are the Advantages of Off-Pump Coronary Bypass Surgery (OPCAB)?

An alternative to traditional CABG is off-pump or beating heart surgery, where surgeons don't use the heart-lung machine. The procedure is also called OPCAB (Off-Pump Coronary Artery Bypass). The surgeons sew the bypasses onto the heart while it continues beating. Various types of heart stabilizers are used to restrain the heart one section at a time so the surgeon can operate on it. The chest is opened through a midline sternotomy incision. After the target coronary vessel is exposed and stabilized, it is occluded and opened. A bridging plastic tube -- which allows blood flow during suturing -- may be placed. The bypass graft is then sutured to the coronary artery.
The potential benefits/advantages of off-pump surgery may include the following:
  • Reduced need for blood transfusions
  • Reduced risk of bleeding, stroke and kidney failure
  • Potential for reduced psychomotor and cognitive problems
High-risk patients with additional diseases like lung disease, kidney failure and peripheral vascular disease may benefit from this kind of operation

Off-Pump Surgery