RP a 31years old gentleman presented to max hospital, Mohali with acute
breathlessness, vomiting for last four days. He was having this problem for the
last one years and was in the follow up of another hospital where he was
diagnosed to be having leakage of both the major valves of heart following fever and cough with expectation.
For the last four days even he was not able to lie down flat in the bed because
of severe breathlessness and heart failure. His liver was severely enlarged and
his echo cardiograph showed a dilated
heart with severe leakage of one valve and moderate leakage in the other with a
hole in the leaflet of one of the valve (aortic valve) with sign of vegetation on it. He was on medical treatment with the
other Institute before getting admitted under Dr Anurag Sharma Sr. Consultant Cardiology.
He was put on decongestive treatment and echo here showed ruptured leaflet of
aortic valve with severe leakage and liver was congested with fluid in the
lungs. After two days of his treatment he was planned for valve replacement
surgery .As he started responding to medical treatment he was shifted to the ward
from ICU but as he was poor and was not able to afford surgical treatment which
was required urgently for him, Max Hospital, Mohali decided to arrange finance
for him through Max India foundation and they very graciously arranged 1.2 lakh for him for the surgery with
further contribution from the hospital. But a day later his condition worsened
and he went into shock state because of congestive heart failure with his heart
rate dropped to 30/per mint. His urine output also dropped and he went into
renal shutdown. He was shifted back to ICU and had to be put on ventilator as
an emergency and drugs started to maintain his B.P. Next day his condition
improved and he started stabilizing under Doctor Anurag Sharma and this
team. With great efforts again he stabilized
and was removed from the ventilator but still was
on medication to support his heart. After five days of aggressive
treatment he was weaned of from all drugs but his liver functions were still
deranged. As there was no other alternative he was planned for emergency
surgery requiring replacement of both the valves as his echo showed second
valve also leaking severely after this episode. The case was renewed by Dr. Virendar Sarwal,
In charge of Cardiac Surgery and his team and
a request for more funds was made to Max India foundation and additional money was sanctioned for him.
After four days of more stabilization and with improvement in liver functions
he was taken for surgery with a plan to change the ruptured aortic valve and
repair of the mitral valve. On Trans
Esophageal echo cardiograph in O.T it was observed that the leakage in mitral valve
is due to jet of leakage of the aortic valve and as such mitral valve was normal.
Other factor for the leakage of this valve was dilated left chamber of the heart. So it was planned that with the
change of aortic valve the leakage of mitral will go down because the jet from
aortic valve will disappear and dilatation of chamber will also go down. Under
cardiopulmonary bypass his aortic valve was changed with a 22 sized mechanical
valve by a team composing of Dr.Virendar
Sarwal, Incharge dept. of CTVS, Dr.Ajay Sinha, Cardiac Anesthesia, Dr. Aratatran Nahak , Dr Goswami, Dr Deepak Oberoi, and Dr Rajit and after coming off CPB, TEE was done again which
showed disappearance of the leakage of the other valve.He was shifted to ICU
with moderate inotropics support and was weaned off from ventilator next day. He
progressed very well in his post operative period and was discharge on the 5th
day from the hospital in a very stable condition. On first follow up he is doing very well back to
normal life after about a month of hospitalization and stormy course which could
have been life threatening for him. Thanks to the untiring efforts of the whole
team and a big help from Max India Foundation he is alive today.
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