High-risk 11-hour surgery on patient successful

ST Correspondent
Wednesday, 14 August 2019

“While this was impacting the aortic valve, it also showcased a congenital bicuspid aortic valve disease causing leakage and a narrowing of the valve. From birth, he has got two leaflets rather than 3 leaflets. What made the case even more complex was the arch abnormality due to swelling on the arch connecting the valves to the heart,” said Dr Kaushik.

Pune: A 46-year-old city-based electrician, who started having chest pain on Sunday post a day of work in the renovation of the Intensive Care Unit (ICU), underwent an 11-hour-long surgery. 

Dr Rakesh Kaushik at Jehangir Hospital, who diagnosed the case, said that a 2D echo showed that something was wrong in the aorta and there was a large aneurysm.

“While this was impacting the aortic valve, it also showcased a congenital bicuspid aortic valve disease causing leakage and a narrowing of the valve. From birth, he has got two leaflets rather than 3 leaflets. What made the case even more complex was the arch abnormality due to swelling on the arch connecting the valves to the heart,” said Dr Kaushik.

During such a condition, the blood vessels in the aorta weaken and bulge, leading to heart attacks, kidney damage, and even death. According to doctors, Bentall Surgeries are performed in higher cardiac surgical centres but Bentall Surgery with hemi arch replacement is extremely rare with high mortality rate. Such surgeries require detailed surgical planning as the brain vessels are also involved.

A multi-skilled team of almost a dozen doctors including Dr Rakesh Kaushik, Dr JS Duggal and Dr CS Kulkarni performed this extremely complex procedure in Jehangir Hospital.

Dr Duggal, the Head of Department (HOD) of the Cardiology Department at Jehangir Hospital, who led this case, explained that this dilation and aneurysm of the heart, which was visible in the heart in the CT scan could have caused his blood vessels to rupture at any time. “In this surgery, the valve was reduced, the aortic abnormality was corrected and also the arch was replaced by a graft,”  he said. 

Explaining the intricacies of the open-heart surgery, Dr Kaushik said that during this time, the heart was stopped for 40 minutes and the root replacement was done, which involved the replacement of the aortic valve with an artificial valve and ballooned out ascending aorta with a graft. 

“Minimal blood was only pumped to the brain via arm vessels to maintain neurological function during the surgery. The coronary arteries, which arise near the valve, had to be transferred on the graft. After this was over, the circulation was stopped and arch replacement was done. Finally, the trifurcated graft was joined with the main aortic graft. This is considered the most dangerous portion of the operation as the patient can suffer brain death if the circulatory arrest is sustained for too long,” said Kaushik.

Dr Duggal added, “This surgery was a high-risk surgery, as it is a bigger surgery than even a cardiac transplant. The surgery is very demanding and can lead to complications if not done well. The blood supply to the brain is through the arch and all the arteries were implanted on the graft.”
The patient has now recovered and is under post-operative care.

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