 Unique surgery at MIOT
A team of doctors headed by Dr V V Bashi at MIOT Hospital performed three major operations on the heart simultaneously.
A 50-year-old male, Shanthi Prakash Bonegala, from Guntur was suffering from breathlessness and chest pain since December 2005. He was diagnosed as a case of large aortic aneurysm and was examined by major hospitals. They had advised a surgery. However, most of these hospitals deferred surgery because of the high-risk involved. He was admitted at MIOT Hospital on March 6, 2006. He underwent CT scan and angiogram and was found to have three problems in the heart.
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90 per cent narrowing of the left main coronary arteries and 100 per cent occlusion of the right coronary arteries which supply blood to the heart.
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Large aneurysm of the ascending and the arch of aorta. Aorta is the main tube that takes blood out of the heart to the rest of the body. Aneurysm is a balloon dilation of the tube and it can burst at any time. If it bursts, death will occur in three minutes.
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A leak in the aortic valve.
In view of these problems, he needed urgent surgery to correct all the three conditions. He was subjected to a major open-heart surgery on March 13, 2006. Three bypass grafts were performed - the leak in the aortic valve was repaired. The team also repaired the aneurysm with an artificial graft.
Surgery done: First the patient was connected to heart lung machine by putting two tubes in the arteries and veins in the groin before opening the chest. Then the patient’s blood was cooled to 160 C. During this time, the team did three bypasses for the block in the coronary arteries. Then the blood circulation to the brain, kidney, heart, lungs, liver, intestine and the whole body was stopped for one hour. During this time, the doctors stitched tube grafts of 20 cm length to replace the diseased aorta. The blood vessels supplying the brain were then stitched on to this graft and the blood circulation was re-started. The aortic valve was then resuspended on to this graft to repair the leak in the valve. After this the patient was warmed to normal temperature and disconnected from the heart-lung machine. He had an uneventful post-operative recovery and would leave the hospital in two days' time.
To date, this is the first of its kind operation done in India for the combination of three major problems in the heart. Only two other such cases have been reported in the world. The surgical team was headed by Dr V V Bashi and assisted by Dr Srinivas Babu and Dr A K Baburajan. The anaesthesia team was headed by Dr Aju Jacob. Besides this, a team of dedicated perfusionist, nurses and technicians assisted the operation.
The operation took about six hours and 15 units of blood needed were donated by the hospital staff, since he did not have any relatives to donate blood. The normal cost for this operation would come to Rs. 4.5 lakh, since the team had to use expensive synthetic grafts, which are imported. Since the patient comes from a poor family, he was charged only Rs 2.5 lakh and the rest waived as concession.
R Rangaraj
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