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Past events at MIOT

A 32 year old lady from Vijayawada was a known case of Marfan’s Syndrome (a hereditary condition which is prone to have Aortic Aneurysm), had delivered a baby by caesarian section on 12.03.2012. Two weeks after the delivery she suddenly developed severe chest pain, back pain and breathing difficulty. Doctors at Vijayawada did tests and made a diagnosis of dissecting aneurysm of the ascending aorta with severe leak in the aortic valve, a block in the left main coronary artery and serious heart attack (myocardial infarction). The doctors from Vijaywada told us over the phone that they have no facilities to treat her there and the patient needed an emergency surgery to save her life. Over the phone itself we discussed about the treatment and told them to put her on life support system and to be transported to MIOT hospitals in an ambulance with a specialist doctor at the earliest. Meanwhile we made all arrangements here to do the operation including arrangement of blood. On the way to Chennai her condition became worse and she was admitted in a hospital to be stabilized.

While this patient was on her way here, we had a call from a hospital in Chennai regarding another patient, a 50 year old male who suffered the same problem – Acute Type A Dissecting aneurysm of the ascending aorta with a leaking aortic valve. This person had come down from Erode to attend a death ceremony in Chennai and here he developed severe chest pain and breathlessness. Since this patient also needed emergency operation we told the local doctor to shift him to MIOT Hospitals. Since the patient coming from Vijayawada would take 6 hours to reach here we decided to operate the 50 year old male first as he was in a very serious condition.

We took the 50 year old patient to the theatre and did a corrective surgery which involved replacement of the whole ascending aorta, proximal arch, aortic valve and reimplantation of the coronary arteries, after cooling the patient’s blood to about 18o and stopping the circulation for half an hour. By the time we finished this operation, the second lady from Vijayawada came to our emergency department. Within half an hour of her arrival we shifted her to the operation theatre. At the time of surgery we found that she had suffered a massive heart attack due to a block in the left main coronary artery by the dissecting aneurysm and the leak in the aortic valve. Her condition was much more serious than the first patient. She was connected to heart lung machine and blood was cooled to 18o and on circulatory arrest with antegrade cerebral perfusion we completed the operation which involved replacement of the ascending aorta, proximal arch, repair of the left main coronary artery and replacement of the aortic valve.

Both patients had an uneventful post operative recovery and were discharged on their 9th post operative day. Since the young lady has to breast feed her child, she is staying in Chennai for the first check up.

The surgical team was headed by Dr.V.V.Bashi assisted by Dr. Harilal, Dr. Kannan Nair and Dr. Dilip. Anaesthetic team was headed by Dr.Aju Jacob and assisted by Dr.Jyotsna and Dr. Ajith. Besides them a dedicated team of perfusionists, technicians and skilled nurses where involved in the conduct of the both operation.

Dissecting Aneurysm of aorta is a life threatening surgical emergency. 50 % of patients who are not treated by surgery die in the first 24 hours of the occurrence of the dissection. 2% of the patients die every hour while they are waiting for surgical treatment. This indicates the seriousness of the disease and the importance of doing the operation as early as possible. Diagnosis of this is difficult and needs advanced imaging technology. Some times this may be diagnosed wrongly as a heart attack in inexperienced hands. Surgery is very complex and has to be done by persons who are experienced in this and a good team work is essential. The mortality rate for this operation world wide is about 7 to 30%. At MIOT Hospitals, we have a dedicated team for doing this complex operation and they perform the maximum number of cases in India with success rate of 98% which is lower than any of the best centres in the world. A young lady after caesarean section developing dissecting aneurysm and getting successful treatment has not been reported in the world so far.