First of its kind in the World

Past events at MIOT

First of its kind in the World

24th Dec 2009

A team of doctors headed by Dr. V.V. Bashi at MIOT Hospitals corrected seven abnormalities in the heart simultaneously through a hybrid procedure on 08/12/2009.

A 54 year-old-male, Mr. Narayanasamy was born with multiple birth defects in the heart called Tetralogy of Fallot with absent pulmonary valve. In addition he had two major arteries from the aorta supplying blood to the lungs which is also an another abnormality. This condition needs complex corrective surgery in childhood itself.

To date, he is the oldest person alive upto this age with this multiple anomaly. This patient came to MIOT with chest pain, breathlessness and palpitation and was in a serious condition. He was not able to carry out his normal activities. He was admitted at MIOT and underwent coronary angiogram and cardiac catheterization before surgery which showed the following abnormalities:

Two large blood vessels arising from the aorta supplying both the lungs.
One large hole in the ventricular septum.
One large hole in the atrial septum.
Enlarged muscle on the right side of the heart.
Absent pulmonary valve with severe leak.
Large aneurysm of the ascending aorta
Calcification and leak in the aortic valve.

The patient needed complete corrective surgery in which all abnormalities need to be attended. The most difficult problem for the operation in this case was the large abnormal blood vessels from the aorta going to the lungs. Normally, this has to be closed by a major operation. In this case, the doctors preferred to close it by an interventional procedure in the cath lab which is a closed procedure with minimal risk. Once this blood vessel was closed, the patient will not have enough oxygen in the blood. So, he has to be operated immediately. After closing these arteries the patient was taken from the cath lab to the operation theater and corrected all the abnormalities, which included closing the holes in the heart with patches, removing the enlarged muscle from the right side of the heart, replacing the pulmonary valve, replacing the aortic valve, ascending aorta and reimplantation of the coronary arteries.

SURGICAL DETAILS

I Procedure – In the cath lab

Device closure of 2 abnormal blood vessels going to the lungs.

II Procedure – same day in the operation theatre

Closure of VSD
Closure of ASD
Removal of excess muscle on the right side.
Replacement of pulmonary valve.
Grafting of aortic aneurysm with reimplantation of coronary arteries
Replacement of aortic valve

After anesthesia the patient was taken to the cath lab and by a percutaneous procedure, two closure devices were used to close the major abnormal blood vessel supplying the lungs. This was done by Dr. Sivakumar – Interventional Cardiologist. At this point, the oxygen level in the blood came down. So, the patient was immediately taken to the operation theater and connected him to the heart-lung machine and the blood was cooled to 22C. Then the heart was stopped. The doctors closed the ventricular septal defect and atrial septal defect with patches, excess muscle from the right ventricle was removed and pulmonary arteries were widened, artificial valve was implanted in the pulmonary position. The ascending aorta and aortic valve was replaced with reimplantation of coronary arteries. Patient was warmed to normal temperature and disconnected from the heart-lung machine. The patient showed good improved during the post operative recovery and left the hospital on 25/12/2009.

To date, this is the first of its kind of hybrid operation done in the world for a patient with these abnormalities. First of all, patient with Tetralogy of Fallot with absent pulmonary valve will not live this long. Secondly, the abnormal arteries arising from the aorta to the lung in Tetralogy of Fallot with absent pulmonary valve is not reported so far anywhere in the literature. That is why, this case is unique.

The surgical team was headed by Dr. V.V. Bashi, assisted by Dr. Harilal and Dr. Kannan. The interventional team was headed by Dr. Sivakumar. Anesthesia team was headed by Dr. Aju Jacob assisted by Dr. Jyotsna. Besides this, a team of dedicated perfusionists, nurses and technicians assisted the operation. About 8 units of blood was used for the operation which lasted for about 6 hours.

Prof. Dr. P.V.A. Mohandas – Managing Director, MIOT Hospitals during his welcome speech at the Press Meet organized on event of the “First of its kind in the World – An unique complex corrective hybrid surgery for congenital heart disease in an adult pati
Dr. V.V. Bashi - Chairman - Centre for Thoracic and Cardio Vascular Care, MIOT Hospitals explaining the press about the ailment of the patient and how MIOT successfully performed the First of its kind in the world – an unique hybrid surgery by treating se
During the press meet
Pictorial representation of the patient’s heart - Before Surgery
Pictorial representation of the patient’s heart - After Surgery
Dr. V.V. Bashi explaining the press about the uniqueness of this “first of its kind in the world” hybrid surgery.
Prof. Dr. P.V.A. Mohandas – Managing Director, MIOT Hospitals greeting the patient Mr. Narayanasamy who underwent the unique complex corrective hybrid surgery for congenital heart disease with seven abnormalities at MIOT Hospitals. Also seen Dr. V.V. Bash
Dr. V.V. Bashi introducing the patient Mr. Narayanasamy and his family to the press.
During the press meet.