18-yr underprivileged boy from Kashmir gets new lease of life at Max Super Specialty Hospital, Mohali

His free cardiac surgery was funded by Max India Foundation
CHANDIGARH: Partially deaf by birth, 18-year old Asif Wani sordid tale of despair and victory is heart rending. The sixth child of a daily laborer, Abdul Azeea Wani, Asif was brought to Max Super Speciality Hospital, Mohali with complaints of breathlessness and palpitation.

He was diagnosed with complex birth heart defects multiple conditions of Atrial septal defect, PDA and severe Pulmonary Stenosis (Congenital disorder) comprising of hole in the upper chambers of the heart, along with a flowing channel between main artery of the body and artery feeding the lungs which normally closes soon after birth. The surgery that saved the life of this innocent teenager was not only complex from the medical point of view but also gave a new lease of life to the hapless boy.
Asif’s mother Zareefa Bano was speechless with gratitude as her son narrated the story of their strife to get treatment for their son. Asif had been diagnosed with the multiple congenital heart defects as early as 2 months of his birth. His parents took him to the local doctors at Srinagar but were turned away due to lack of funds. Even the best hospital in Srinagar refused free treatment to the boy. The procedure to save him, the family was told, would cost lakhs of rupees, which was impossible for the destitute daily wager to collect. Through a common acquaintance, Max India Foundation took up the case and Asif was successfully operated upon by Dr. Virendar Sarwal, Senior Consultant, Cardiology at Max Super Speciality Hospital Mohali. The 5-hour surgery involved one week of post operative care under expert supervision of critical care experts.
Belonging to an obscure little village Handwara in the far reaches of Kupwara Distt about 10-12 Kms from LOC, Asif’s parents were devastated when they realized that he was suffering from congenital heart disease. Asif was advised immediate surgery. Helpless and penniless, Asif and his family were in a dilemma as to how they would bear the cost of such an expensive surgery. It was then that he was referred to Dr Sarwal, who volunteered to take up his case. Since Asif belonged to a poor family and his parents could not afford the expensive treatment, an acquaintance, who had been helping the family since last 2 years in arranging funds, approached Max India Foundation for financial assistance. Max India Foundation decided to help the young boy by bearing the entire cost of surgery and offering him world class medical treatment at Max Super Speciality Hospital.
Ever since Abdul Azeea Wani, Asi’s father lost his eyesight 5-6 years back, Asif’s mother has been working as a labourer on a meager daily wage with no other source of income. We have been running from pillar to post for 2 years but all efforts to secure funds for the surgery bore no fruit. Our fellow villagers managed to gather Rs 16000 for our travel and stay once they came to know that Max Hospital was helping us, said .
Dr. Sarwal said that since these were birth defects, these were high risk surgeries. Asif lungs had developed early hypertensive changes and it was a long on pump surgery because of three congenital defects. His pulmonary valve was too small for his age. Asif underwent intracardiac repair on Cardiopulmonary bypass at Max Super Speciality Hospital on October 14 and soon recuperated. He would be requiring regular medication to support his heart condition.
For the past 18 years, my world was full of just pain and helplessness, said an emotional Asif, while expressing gratitude towards Max India Foundation for their support With this crippling disease, all I could do was sit or lie down on my bed and take a few faltering, painful steps to go to the toilet. It was a very depressing state of affairs for my family and me and many times I would wonder what was the point of existing like this, he remarked.
Ms Mohini Daljeet Singh, Head, Max India Foundation said that living up to our social responsibility of an integral part of the core philosophy of Max India Foundation, we were very glad that we have been able to get an opportunity to serve the needy. We would continue doing so in the times to come with sincerity and passion, she asserted.
It may be mentioned here that under various CSR programs like immunization, health awareness and health camps, artificial limbs camp, palliative care for cancer patients, Max India Foundation has now crossed the 1435 free and subsidized surgeries mark. Over 477147 people have benefitted from the various CSR programmes of Max India Foundation till now.
Dr. Ashutosh Sood, GM operations at Max Super Speciality Hospital Mohali said that this whole package bearing cost of Rs 2 lacs, was done entirely free of cost. However, it was well worth it because today Asif presented a heartwarming sight. Having recovered very well, he was up and about, talking and playing like a normal teenager.. The joy on his face was priceless and nothing compared to the satisfaction of having helped tears turn into smiles, remarked Dr Sood.

High risk Octogenarian successfully treated for Coronary Artery Disease with Beating Heart Bypass Surgery successfully

 

·         Patient presented with critically blocked and calcified heart vessels which are difficult to tackle surgically

·         Off Pump Coronary Artery Bypass (OPCAB) or Beating Heart Bypass Surgery is a safe and proven option for bypass surgery in elderly patients

 3^rd September, Mohali: Elderly patients, compared with patients of a younger age group, present for surgery with a greater burden of risk factors and reduced functional levels. Short‐term outcomes are hence poorer in them. But symptomatic relief occurs in most patients and is accompanied by excellent rates of long‐term survival and a good quality of life when treated with beating heart surgery. Max super speciality Hospital Mohali recently treated an 84 year old male, Ramnarayan, who had his all three major heart arteries critically blocked. Along with this complication, the major arteries going to his brain were also blocked on both sides by 90% and 60%. The main artery on the left side of the heart (called left main ) was having 90% stenosis- in such critical conditions, bypass surgery becomes an urgent requirement. Also other three arteries, two on the left and one on right side were also blocked by 90% and 99%.

“He was very symptomatic” avers Dr Virendar Sarwal, Principal Consultant and Chief of Cardiac Surgery, his treating physician “Ramanarayan was offered high risk bypass surgery on beating heart at the time of angiography because of his age. In octogenarians, the risk to life becomes very high as all organs of the body are aging due to wear and tear. Reserves  are substantially low which make it difficult for the body to undertake the stress of surgery.”

Ramnarayan decided to take some time off and went home but had to get readmitted twice in the next 10 days because of severe heart symptoms. The family accepted the high risk  involved and the medical team collectively decided to work him up for surgery. “For this category of  patients  beating heart surgery which is now an  established technique  serves as very good  option . But, an individualized risk–benefit profile must be carefully constructed by clinicians, taking into account several different factors and not just age alone.

On investigations, it was found that Ramnarayan’s both carotid arteries (supplying blood to the brain) were also critically blocked and we had to take extra care to avoid brain damage during surgery especially because of acute blood pressure variations. His CT scan had dilated lateral ventricles and cerebral atrophy. As there was no evidence of any major stroke we decided to go ahead with beating heart bypass by taking special precautions in the OT. Three grafts were given to him on beating heart by using octopus stabilizer and maintained higher blood pressure intra operatively.”

Ramnarayan was fully mobilized  on 3rd day and discharged from the hospital on 5th day.

 

Discussing the advantages of off pump coronary artery bypass (OPCAB) or beating heart Bypass surgery as it is commonly called, Dr Sarwal said “ OPCAB is though technically demanding is a safe and prove option for high risk bypass surgery. Doing surgery on a beating heart eliminates the need for heart lung machine,  results in fewer side effects. Some potential benefits of beating heart surgery are lower risk of stroke, fewer problems with memory loss and thinking skills, reduced injury to the heart, fewer heart rhythm problems and shorter hospital stay, less ICU stay and less usager of blood. Long term success of OPCAB includes improvement or complete relief of their symptoms and being symptom-free for several years. They may recover from surgery more quickly than those who go "on pump" and they may suffer from fewer post-operative complications.”

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.

YOUNG PATIENT SALVAGED WITH HEART SURGERY FOR TERMINAL STAGE BY- BIRTH DEFECT

Atrial septal defect is an abnormality present in a person from birth where there is a hole in the partition between the upper chambers of the heart called the atria. As a rule many times if it is small it can close on its own by 2yrs of age beyond that[a1]  if it is of simple nature then one comes to know of it only in second decade. If the type of this defect is atypical which is called Sinus Venosus  type of defect then symptoms happen earlier and needs early intervention also. Here most of times one vein carrying pure blood from lungs which was to drain into left upper chamber is opening into right upper chamber this increasing the flow to lungs. Or some time all veins from right lung are opening into the superior Vena Cava (Vein draining impure blood from upper parts of body to right upper chamber) along with large gap in the partition between the two upper chamber. In such a situation the flow to the lung increases markedly and permanent damaging changes start setting in and a stage comes when resistance of lung vasculature increases so much that blood flow direction reverses. Normally it is left to right but then it becomes right to left and patient start becoming blue also. This is a stage where surgery is not possible and patient become in-operable. Otherwise if heart surgery for this carried out at the right age and time is suitable and patient becomes absolutely normal for rest of his /her life.

Recently a 21yrs female who had given birth to a child 4 months back presented to us at Alchemist Hospital, Panchkula with severe breathlessness and palpitation. On examining we found her to be having a hole in the heart in both the upper chamber and investigating her with echo-cardiography and going through her previous record we found that she had atypical sinus venous type of atrial septal defect which manifested after child birth but along with her pressure in the lung vasculature had become very high almost equal to the body’s blood pressure. In view of this outside other peripheral  hospitals had denied her surgery in view of very high risk including the risk to life. Infact she was sent Delhi for  opinion.

When she presented to us we also felt the same way but then we decided to further investigate looking at her young age. The only chance for correction or treatment through surgery was now and otherwise it could be fatal. We admitted her and did a cath study on her. The lung pressures had peaked to 110mmHg which was equal or slightly more than her own blood pressure and shunt across the defect got reduced to 1.3:1 (normal criteria for surgery is shunt more than 1.5:1 or 2.1). The pulmonary vascular resistance came out to be 12 wood units, close to the terminal  limits, where one becomes in- operable. Only positive finding in the study was that she was still maintaining almost normal oxygen levels in left side of upper chamber i.e left atrium about 97% that was a sign that she was not de-saturating but other parameters pointed towards non-operability.

We decided to plan her treatment and give her a chance. We started her on certain newer drugs to lower her lung pressure before surgery, talked to the family of high risk involved and total picture and need to prepare her for about a week before surgery by drugs including lungs pressure lowering drugs, to flush out extra fluid from body and to give rest to right heart and also some thing to improve the contractions of right heart.

Looking at the literature again she was in that rare group where surgery was not possible. After nine days of preparation we decided to do a repeat echocardiography and she did responded to medication but  marginally and also there was no bluish discoloration involved, so we felt that changes were not irreversible. On 17.06.2011 she was operated for open heart surgery and her hole was closed with a patch made out of the outer layer of heart called pericardium, diverting all the right lung veins which were connecting to lower part of superior Vena  Cava  to the left. We did one more innovation in creating a flap- valve type of patch in her case. The idea of this is that incase after surgery the right heart pressure increases the flap valve allows the right chamber to dicompresss by opening up. Heart  muscle  was  protected well during surgery with various newer Techniques. She responded well to treatment and surgery and her lung pressure came down to 50% of arterial pressure in the immediate post- op period. They further were controlled with the new drugs which we had started earlier in the pre- op period. Over all she responded very well and lung pressure almost came to normal range.

She was discharged on 8^th day with detailed explanation about the medications and precaution and on her follow up visit  on 1^st June it was very heartening to see her healthy and progressing well. Well thought of strategy and extra effort in treatment goes a long way in saving these high risk patients along with a good and skilled infrastructure and highly experienced team of doctors. 6 Senior doctors were involved in her care on day to day basis and it was very satisfying for all of us to save this young life. She was operated by a team headed by Dr Varinder Sarwal, Head- Dept. of CTVS, Alchemist hospital, Panchkula, Dr Arath Nahak, Dr Ajay Sinha, Dr Deepak Oberoi, Dr N Srivastava and Dr Dheer

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