The donor heart, obtained from a 23-year-old brain dead patient, was transported to the hospital in just 20 minutes.

The patient from Puducherry had been experiencing severe breathing difficulties since February. However, he sought medical attention only when he was unable to lie flat on his back and his breathing problems began to interfere with his daily activities.

An echocardiogram (ECHO) revealed severe left ventricular dysfunction with heart failure. A cardiac MRI subsequently confirmed the diagnosis of dilated cardiomyopathy (DCM) with heart failure. In DCM, the heart muscle becomes enlarged and weakened, particularly the left ventricle, reducing the heart’s ability to pump blood effectively. Over time, this condition had progressed to heart failure.

Dilated cardiomyopathy is the most common type of cardiomyopathy. In this case, the condition was inherited from the patient’s father, who is also undergoing treatment for the disease. During his hospitalisation, the patient suffered a cardiac arrest but was successfully resuscitated and his condition was stabilised.

After deciding that heart transplantation was the best treatment option, the medical team listed the patient for a transplant and began searching for a suitable donor heart based on blood group compatibility, body weight, age, crossmatch results, and immune compatibility. A suitable donor heart became available through the state’s organ sharing network.

The transplant team reached the donor hospital early in the morning, and transported the donor heart to SIMS Hospital within 20 minutes. Meanwhile, another surgical team had already begun removing the patient’s diseased heart and placed the patient on cardiopulmonary bypass support, which temporarily took over the functions of the heart and lungs during the procedure. The transplant surgery was completed in approximately four hours.

Following the surgery, the patient was kept under intensive care monitoring for seven days.

The transplant team was led by Dr. Bashi, Chief Cardiac Surgeon and Director, ICAD, and comprised Dr. Rajeev Thilak Chellasamy, Heart Transplant Surgeon; Dr. Mohammed Ibrahim, Cardiac Surgeon; Dr. Shilpa Menon, Heart Failure Cardiologist; Dr. Aju Jacob, Chief Cardiac Anaesthetist; Dr. Arunkumar, Cardiac Anaesthetist; and Dr. Kishore, Cardiac Anaesthetist.

Commenting on the procedure, Dr. Bashi said, “For patients with end-stage heart failure, a heart transplant offers renewed hope when all other treatment options have been exhausted. A successful heart transplant requires seamless multidisciplinary collaboration and coordination. Dedicated co-ordinated efforts of the transplant team and the donor centre was ensured for swift transportation of the donor organ without a single moment waster. Surgeons, cardiologists, anaesthesiologists, transplant coordinators, nurses, and critical care teams work as one to transform the gift of organ donation into a new beginning for the recipient.”

Dr. Rajeev Thilak said, “Since the patient had suffered a cardiac arrest during hospitalisation, we meticulously planned every aspect of the transplant. Both the transportation of the donor heart and the transplant surgery were carried out with utmost precision and care. Following the surgery, the patient will require close monitoring for the next six months, as the risk of organ rejection is highest during this period.”

In her comments, Dr Shilpa Menon said, “The management of advanced heart failure extends far beyond transplantation. Every patient undergoes a comprehensive evaluation to determine the most appropriate treatment, which may include optimized medical therapy, device-based treatment, mechanical circulatory support or heart transplantation. A multidisciplinary approach is essential to achieving the best possible outcomes.”

Dr. Ravi Pachamuthu, Chairman, SRM Group, said, “This successful heart transplant reflects our commitment to advancing specialised cardiac care and providing patients access to complex, life-saving treatments. The achievement was made possible by the dedication of our cardiac specialists, surgeons, anaesthetists, transplant coordinators, nurses and support teams. At SIMS Hospital, we remain committed to strengthening advanced medical capabilities and clinical expertise, enabling patients to access complex treatments closer to home.”

Heart failure, especially in younger adults, severely affects quality of life and often requires frequent hospitalizations. It can also significantly limit their ability to work, pursue daily activities, and lead an active, independent life. Early diagnosis, timely medical management, lifestyle modifications, and regular follow-up are essential to control symptoms, prevent disease progression, and improve quality of life.

The surgery was particularly challenging for several reasons. The patient’s severe degenerative scoliosis had significantly distorted the normal alignment of the spine and narrowed the spaces surrounding the spinal nerves. This anatomical distortion made the uniportal endoscopic spine surgery technically demanding, requiring exceptional precision to safely navigate the compressed neural structures through a single 8 mm portal.

The patient’s pre-existing cardiac condition added another layer of complexity. He had previously undergone coronary artery bypass graft (CABG) surgery and had a permanent cardiac pacemaker. These factors increased both surgical and anaesthetic risks, necessitating meticulous multidisciplinary planning and seamless intraoperative coordination to ensure patient safety while achieving effective nerve decompression.

The procedure was performed by a multidisciplinary team comprising Dr. G. Venkatesh Kumar and Dr. Vignesh Jayabalan, Senior Consultants in Orthopaedics, along with a cardiologist.

In his comments, Dr. Venkatesh Kumar said, “The patient presented with severe functional limitations. He suffered from debilitating leg pain and was unable to walk more than a few steps. Our evaluation revealed severe degenerative scoliosis, a spinal deformity that had caused significant nerve compression in the lumbar region. Traditionally, patients with this condition often require extensive deformity correction surgery using pedicle screws and rods. However, advances in spine surgery enabled us to perform a full endoscopic uniportal lumbar stenosis decompression through a single 8 mm incision. The procedure successfully relieved the nerve compression, and the patient was mobilised pain-free shortly afterwards.”

Dr. Vignesh Jayabalan commented, “One of the biggest advantages of this advanced endoscopic technique over conventional open spine surgery is that it achieves the desired outcome with minimal disruption to normal tissues. The procedure involves negligible blood loss, no muscle stripping, less postoperative pain, no sutures, faster recovery, and precise decompression of the pain-generating pathology while preserving the spine’s normal anatomy. Our philosophy is simple: to preserve the spine’s natural supporting structures while removing only the diseased tissue responsible for nerve compression and pain.”

Dr Vijay C Bose, Joint Director and Senior Consultant, Department of Orthopaedics said, “Medical knowledge in orthopaedics is vast, and research continues to expand it further. It’s impossible for one person to be an expert in everything. At SIMS, we have five sub-units under the Department of Orthopaedics. Each unit focuses on a specific area such as joint replacements, sports injuries, trauma, and foot and ankle conditions. Very few institutions across the country have this kind of in-house expertise, and we are fortunate to be one of them. In this context, this particular case marks a breakthrough in spine surgery.”

Dr. Ravi Pachamuthu, Chairman of SIMS Hospital, said, “This case exemplifies SIMS Hospital’s commitment to delivering advanced, patient-centric care through innovation and multidisciplinary collaboration. With only a handful of specialists in the city performing uniportal endoscopic spine surgery, we are proud to offer patients access to cutting-edge treatment that enables faster recovery, reduced surgical trauma, and an early return to mobility. We remain committed to investing in advanced technologies and clinical excellence to provide world-class care, even for the most complex cases.”

இந்த மையத்தை நடிகை ஐஸ்வர்யா ராஜேஷ் சிறப்பு விருந்தினராகக் கலந்து கொண்டு திறந்து வைத்தார். இவர் சமீபத்தில் ‘DeAr’ என்ற தமிழ் படத்தில், குறட்டையால் புதுமண தம்பதியினரிடையே ஏற்படும் சிக்கல்களையும் அவர்கள் எதிர்கொள்ளும் சவால்களையும் மையப்படுத்திய கதாபாத்திரத்தில் நடித்தவர் என்பது குறிப்பிடத்தக்கது. எஸ்.ஆர்.எம் (SRM) குழுமத்தின் தலைவர் டாக்டர் ரவி பச்சமுத்து இத்திறப்பு விழா நிகழ்வில் கௌரவ விருந்தினராகக் பங்கேற்றார்.

உறங்கும் நேரத்தில் மாரடைப்பு, இதயச் செயலிழப்பு பாதிப்புகள் மற்றும் பக்கவாதம் ஆகியவற்றை விளைவிக்கக்கூடிய தூக்கத்துடன் தொடர்புடைய கோளாறுகளுக்கு இந்த தூக்கவியல் சிகிச்சை மையம் சிறப்பு சிகிச்சையை வழங்குகிறது. காது-மூக்கு-தொண்டை (ENT) நிபுணர்கள், நுரையீரல் நிபுணர்கள், நரம்பியல் நிபுணர்கள் மற்றும் பல் மருத்துவர்கள் அடங்கிய ஒரு கூட்டு மருத்துவக் குழு உலகளவில் சிறந்த தரநிலைகளுடன் CPAP, BiPAP போன்ற நவீன சுவாசக் கருவிகள் மூலம் சிகிச்சை அளிக்கிறது. மிகத் துல்லியமான, வலியற்ற மற்றும் இரத்தம் வராத எண்டோஸ்கோபி, பிளாஸ்மா அடிப்படையிலான மற்றும் கதிர்வீச்சு அதிர்வெண் சிகிச்சை (RF) வழிமுறைகளும் இதில் உள்ளடங்கும்.

இங்குள்ள பிரத்யேக ‘தூக்க ஆய்வகத்தில்’, தூக்கத்தின் போது மூளைச் செயல்பாடு மற்றும் இதயத் துடிப்பு கண்காணிக்கப்பட்டு நிகழ்நேர தரவுகள் பகுப்பாய்வு செய்யப்படுகின்றன. குறட்டை உட்பட உறக்க பிரச்சனைகள், உடலியக்கவியல், மூளையின் செயல்பாடு மற்றும் இதய இரத்தநாள ஆரோக்கியம் ஆகியவற்றை எப்படி பாதிக்கிறது என இதன் மூலம் மதிப்பீடு செய்யப்படுகிறது. மேலும், DISE எனும் நவீன தொழில்நுட்பம் மூலம், மயக்கவியல் மருத்துவரின் ஆதரவோடு நோயாளிக்கு உறக்க நிலையைத் தூண்டி சுவாசப் பாதையில் எங்கு அடைப்பு உள்ளது என்பதைத் துல்லியமாகக் கண்டறிய முடியும்.

விளையாட்டு வீரர்கள் வெளிநாடுகளுக்குச் செல்லும்போது ஏற்படும் தூக்க நேர மாற்றத்தைச் சரி செய்வற்கான சிறப்பு செயல்திட்டத்தையும், உறக்கத்தின் போது திடீரென மூச்சு நின்றுவிடும் பிரச்சனைக்கு சிகிச்சையையும் மற்றும் உளவியல் ரீதியான ஆலோசனையையும் (CBT) இந்த மையம் வழங்குகிறது.

நடிகை ஐஸ்வர்யா ராஜேஷ் இந்நிகழ்வில் பேசுகையில், “குறட்டை விடுவது இயல்பானதாக தெரிந்தாலும், நோய் பாதிப்புக்கான இடர்வாய்ப்பை வெளிப்படுத்தும் அறிகுறியாகவும் அது இருக்கலாம். இது நிம்மதியான தூக்கத்தைக் கெடுப்பதுடன், தம்பதியினர் தனித்தனியாக வெவ்வேறு இடங்களில் தூங்குவது போன்ற பிரிவிற்கும் வழிவகுக்கிறது. சிம்ஸ் மருத்துவமனையில் தொடங்கப்பட்டிருக்கும் உறக்கவியல் சிகிச்சைக்கான இந்த புதிய மையம், உடல்நலத்தை மட்டுமல்லாமல், குடும்ப உறவுகளையும் காக்க உதவும் என்பதில் நான் மகிழ்ச்சி அடைகிறேன்,” என்று கூறினார்.

இந்த மையத்தின் குறிக்கோள் குறித்து டாக்டர் ரவி பச்சமுத்து கூறியதாவது: “இந்தியாவின் முதல் ஒருங்கிணைந்த தூக்கவியல் மையம் தொடங்குவதில் நாங்கள் மகிழ்ச்சியடைகிறோம். இந்தியாவில் தூக்கக் கோளாறுகளை கண்டறிவதிலும், சரியான சிகிச்சை அளிக்கும் முறையையும் இந்த மையம் மாற்றியமைத்துள்ளது. நோயாளிகள் வெவ்வேறு மருத்துவ துறைகளுக்கு சிகிச்சைக்காக செல்ல வேண்டிய அவசியம் இல்லை. குழந்தைகள் முதல் பெரியவர்கள் வரை அனைவருக்கும் ஒரே இடத்தில் தூக்கம் தொடர்பான அனைத்து பிரச்சனைகளுக்கும் முழுமையான தீர்வுகள் சிகிச்சையின் மூலம் கிடைக்கும் வகையில் அனைத்து வசதிகளையும், நவீன தொழில்நுட்பத்தையும் மற்றும் அனுபவமிக்க மருத்துவர்களையும் இம்மையம் கொண்டிருக்கிறது”.

மையத்தின் இயக்குநர் டாக்டர் கார்த்திக் மாதேஷ் ரத்னவேலு கூறியதாவது: “இரவு நேரத்தில் வரும் மாரடைப்பு மற்றும் பக்கவாதம், பெரும்பாலும் தூக்கக் கோளாறு உள்ளவர்களுக்கே ஏற்படுகிறது. புகைப்பிடிப்பது எப்படிப் புற்றுநோயை உண்டாக்குமோ, அதேபோல் சிகிச்சையளிக்கப்படாத தூக்கக் கோளாறுகள் இதய நோய்க்கும் வழிவகுக்கும். இங்கு ஒவ்வொரு நோயாளிக்கும் ஒரு ‘வழிகாட்டி’ நியமிக்கப்பட்டு, பரிசோதனை முதல் சிகிச்சை முடியும் வரை நோயாளிகளுக்குத் துணையாக இருப்பார்கள்.”

தூக்கத்தைச் சீராக்க ஆலோசனைகள்:

தினமும் ஒரே நேரத்தில் தூங்கி எழுவதை வழக்கமாக்கிக் கொள்ள வேண்டும்.
காலை வெயில் உடலில் படுவது, பகல் முழுவதும் சுறுசுறுப்பாக இருக்க உதவும்.
இரவு தூங்குவதற்கு 2 மணி நேரம் முன்பே உணவு உட்கொள்ள வேண்டும்.
படுக்கை அறையில் வாக்குவாதங்களையும், மொபைல் போன் போன்ற கவனச் சிதறல்களையும் தவிர்க்க வேண்டும்.

The institute was inaugurated by the Chief Guest actress Aishwarya Rajesh, who played the lead role in DeAr, a Tamil film portraying the challenges faced by a newly married couple when the wife’s snoring disrupts the husband’s sleep. Dr. Ravi Pachamuthu, Chairman of SRM Group was the Guest of Honour at the event.

The Sleep Institute offers specialised treatment for sleep-related disorders, which are linked to sleep-time cardiac events, and stroke. A multidisciplinary team comprising ENT surgeons, pulmonologists, neurologists, bariatric specialists, oral and maxillofacial surgeons, and conservative dentists work collaboratively to deliver personalised care, adhering strictly to gold-standard protocols. The treatments provided include Positive Airway Pressure (PAP) therapy – CPAP, Auto PAP, BiPAP, and gold standard conservative solutions using advanced, minimally invasive technologies including endoscopic, plasma-based, and radiofrequency (RF) methods that are designed to be precise, bloodless, and painless.

The facility houses a dedicated sleep lab staffed by experienced sleep technologists who conduct attended sleep studies in exclusive cabins. Live, real-time data is captured and analysed to evaluate how sleep impacts physiology, brain function, and cardiovascular health. The institute is equipped to perform DISE (Drug Induced Sleep Endoscopy), conducted using monitoring leads similar to ECG. With the support of an anesthetist, sleep is induced to closely simulate natural sleep, during which a flexible endoscope is introduced into the airway to observe obstructions live and in real time.

The institute provides counselling, and cognitive behavioral therapy (CBT)-based treatment for insomnia and sleep apnea. It also offers specialised sleep optimisation programmes for sports professionals who frequently travel across time zones and need rapid circadian adjustment to remain match-ready.

In her comments, Actress Ms. Aishwarya Rajesh said, “While snoring can be normal, there are disease-related forms of snoring that pose a risk. These may arise from neurological or psychological issues, leading to disturbed sleep, difficulty waking from deep sleep, insomnia, or even involuntary physical actions during sleep. There is also the issue of ‘sleep divorce,’ where a snoring partner is forced to sleep separately. I am happy that with the launch of the Integrated Sleep Institute at SIMS, the city now has a comprehensive solution that can address not just health concerns but also relationship challenges within families that arise out of snoring.”

Speaking about the institute’s vision, Dr. Ravi Pachamuthu said, “We are happy to launch India’s first dedicated multidisciplinary institute for comprehensive sleep care. The Advanced Institute of Sleep Health redefines how sleep disorders are diagnosed and treated in India. Unlike conventional models where patients move between disconnected departments, this institute functions as a fully integrated, multidisciplinary centre. Medical, surgical, diagnostic, and supportive services operate through a unified pathway rather than isolated consultations. We are equipped to manage the complete spectrum of sleep-related conditions – from pediatric to adult – through collaborative, evidence-based protocols.”

Dr. Karthik Madesh Ratnavelu, Director and Senior Consultant, ENT, who heads the Sleep Institute, said, “Stroke and nighttime heart attacks frequently occur in individuals with sleep disorders. In fact, at least three-fourths of patients who experience these life-threatening events have underlying sleep disorders. The problem with snoring is that oxygen intake reduces while carbon dioxide elimination becomes inadequate, leading to serious systemic complications. In many ways, untreated sleep disorders are as risky for heart disease and stroke as cigarette smoking is for cancer.”

Talking about the care delivery model at the Institute, he explained that every patient will be assigned a dedicated sleep navigator, a trained professional who serves as a single point of coordination, guiding the patients through diagnosis, treatment, and follow-up until discharge. The institute’s sleep board ensures shared decision-making. Once investigations are completed, the board, comprising airway specialists, pulmonologists, neurologists, CBT experts, and other specialists, discusses all available options with patients and their families, outlining the benefits and risks of treatments ranging from medication and CBT-based insomnia therapy to surgical interventions. A tailored treatment plan is then finalised with the patient’s informed consent.

On preventive care, Dr. Karthick Madesh emphasised the importance of sleep hygiene: “Waking up at a consistent time helps regulate when we fall asleep. Exposure to morning sunlight suppresses melatonin and triggers cortisol release, which keeps us alert for 12 to 14 hours. Thereafter, melatonin secretion resumes naturally to promote sleep. It is important to avoid arguments and distractions during sleep hours, complete dinner at least two hours before bedtime, and refrain from partying at midnight, late-night eating, or spending entire weekends awake. Such habits disrupt the body’s natural rhythm and increase long-term health risks.”

The patient, a working woman, incidentally diagnosed to have a mass attached to the main pumping chamber of the heart (the left ventricle). An MRI of the heart confirmed it to be a left ventricular mass/thrombus measuring 1.6 × 1.5 cm.

Primary cardiac tumours accounts for only about 0.6% of all cardiac surgeries performed in the country. Specifically, the left ventricular tumour is extremely rare, occurring in only about one in 20-30 million people.The usual approach for treating this condition is a sternotomy, an open-heart surgery.However, doctors at SIMS Hospitals opted for an endoscopic cardiac surgery, a minimally-invasive keyhole procedure. It involves creating small openings between the ribs, passing through the muscle, accessing the chambers of the heart, and removing the tumour.

The elective procedure successfully removed the tumour and eliminated the risk of complications like stroke. The surgery was performed by Dr. A. Mohammed Ibrahim, Consultant – Cardiothoracic Surgeryunder the guidance of Dr. V. V. Bashi, Director & Senior Consultant – Institute of Cardiac & Advanced Aortic Diseases.The surgery involvedendoscopic guidance and specialised minimally invasive instruments to remove the tumour.

Congratulating the team on this historicachievement, Dr. Ravi Pachamuthu, Chairman, SIMS Hospitalsaid,“This success reflects the strength of our clinical environment, the sophistication of our endoscopic capabilities and infrastructure, and above all the dedication and precision of our team. Together, we continue to uphold the highest standards of care and deliver hope and healing when it matters most.”

In his comments, Dr V. V. Bashi said, “Left ventricular mass is a rare condition, and performing its removal through a minimally invasive technique is exceptionally uncommon in the world. It is done for the first time in India. The patient was under general anesthesia and placed on heart-lung machine support through the blood vessels in the right groin. Through a tiny 3 cm incision, right chest cavity was approached. Right lung was collapsed, after the patient was initiated on heart-lung machine support. Heart was stopped and chambers of the heart were opened.Endoscope was used to visualise the main pumping chamber and the tumour was excised completely. The chambers were closed and the heart was allowed to beat. The patient was gradually weaned off the heart-lung machine. She is now completely normal and has resumed her routine work without any discomfort in two weeks.”

Commenting on the benefits of the key-hole surgery, Dr Mohammed Ibrahim said, “cardiac surgery generally involves cutting through the central sternal bone, which increases pain, hospital stay and the risk of morbidities. However, endoscopic cardiac surgery is an advanced minimally invasive approach that enables faster recovery while reducing pain and blood loss. It also avoids a prominently visible scar in the middle of the chest after surgery. Endoscopic assistance further enhances precision and allows us to access areas that may not otherwise be easily reachable. We have already performed five such cases with a 100% success rate. We also use minimally invasive approaches to treat other cardiac conditions such as coronary artery disease, valvular heart disease, septal defects of the heart, and mediastinal tumours. About 90% of cardiac tumours happen due to random changes in the heart’s cells, with no clear reason. The remaining 5-10% occur in people who have a genetic tendency to develop these tumours.

The young man had been experiencing severe breathing difficulties for two months. After visting several hospital in Kerala, he was diagnosed with a rare combination of two serious heart issues – a “porcelain aorta” (a severely hardened and fragile main artery) and “aortic valve stenosis” (a narrowing of the valve that controls blood flow from the heart). Due to the complexity and high risk of surgery, local hospitals advised against surgery.

Not giving up hope, the patient travelled to Aortic aneurysm Centre at SIMS Hospital in Chennai, where a team of expert heart surgeons took on the challenge. The surgical team performed a mechanical aortic valve replacement, navigating the extraordinary challenge of suturing the heavily calcified aorta, the very structure on which the aortic valve sits. The complexity of the case posed a high risk, given that a porcelain aorta is brittle and difficult to operate on, making the surgery extremely challenging.

The complex surgery, lasting over five hours, was performed by Dr. V V Bashi, Director & Senior Consultant, Institute of Cardiac & Advanced Aortic Diseases, and Dr. Mohammed Idhrees, Consultant Cardiothoracic Surgeon, with the support from anesthetists: Dr. Aju Jacob, Senior Consultant, Cardiac Anaesthesia, and Dr. Arun Kumar A, Consultant, Anaesthesia and team of nurses and perfusionists.

In his comments, Dr. Bashi said, “The aorta, the body’s largest artery, carries oxygen-rich blood from the heart, while the aortic valve ensures smooth blood flow and prevents backflow. In this patient, the valve was severely narrowed and the aorta heavily calcified. This was a highly complex case because of the dual risk posed by a stenotic aortic valve and a porcelain aorta, both of which are extremely rare in young people. Aortic valve stenosis is common in older adults, usually developing gradually due to calcium buildup over many years. However, it is extremely rare in someone under 30. Likewise, a porcelain aorta is very uncommon in young patients. Our team meticulously planned and executed the procedure carefully managing the risks to ensure the patient’s safety while restoring normal heart function. If we also had refused surgery for him, he would not survived for long due to his serious condition.”

Dr. Mohammed Idhrees, Consultant Cardiothoracic Surgeon, said, “In this case, we needed to perform a mechanical valve replacement, which involves suturing both the valve and the aorta. However, the porcelain aorta is so heavily calcified that its walls are as fragile as an eggshell. Cutting or suturing such calcified tissue carries significant risks: small fragments of calcium can break off and enter the bloodstream, potentially causing a stroke or other serious complications, and even if suturing is technically successful, there is a high risk of blood leakage. Because of these challenges, two major hospitals in Kerala had deferred the surgery, considering it too risky. Our team, after careful planning and preparation, executed the procedure with precision, taking every precaution to minimise risks. The patient is now recovering well and is expected to lead a normal life with appropriate post-operative care.”

Commenting on this achievement Dr. Ravi Pachamuthu, Chairman, SIMS Hospital, said, “The achievement of our surgical team is nothing short of a medical milestone. Because of the tremendous skill required, successfully treating a 28-year-old patient with an extraordinary combination of almost ‘eggshell’ calcified aortic valve and a porcelain aorta is a medical triumph. The surgical staff’s expertise, tenacity, and creativity in highly complex cardiac situations not only saved a life but also created a new standard in the field. This accomplishment brings new meaning to the commitment in patient care at SIMS Hospital”

The multidisciplinary team at the hospital made a timely diagnosis and carried out a complex surgery to remove the bony growth, repair the damaged artery, and restore blood flow, successfully preventing a possible leg amputation. The patient has since recovered and is back on his feet.

Doctors diagnosed the patient with a popliteal artery aneurysm, a balloon-like swelling in the artery with blood clots, caused by the bony growth (femur exostosis), which originated from the thigh bone and pressed against the main artery behind the knee. This rare combination, which led to sudden blockage of blood flow to the leg (acute limb ischemia), has so far been reported in fewer than 60 cases worldwide, with only a handful of cases in India.

The patient underwent a complex surgery that involved removing the femur exostosis, ligating the affected popliteal artery, and performing a bypass from the popliteal to the posterior tibial artery using a reverse saphenous vein graft.

The procedure was carried out by a multi-disciplinary team, with Dr. Sairam Subramanian, Consultant Vascular and Endovascular Surgeon, leading the vascular bypass, and Dr. Kalaivanan Kanniyan, Senior Consultant Orthopaedic and Arthroplasty Surgeon, handling the femur exostosis excision, supported by a senior anesthetic team.

In his comments, Dr Sairam Subramanian, said, “The 48-year-old patient developed sudden pain in his right leg below the knee, preventing him from walking more than 100 metres. A CT scan revealed a bony growth from the lower thigh bone causing constant irritation and a balloon-like swelling in the main artery behind the knee, with clots blocking blood flow. We performed a complex surgery to remove the growth, correct the arterial defect, and bypass the artery using the patient’s own saphenous vein, ensuring long-term graft durability. Thanks to the combined expertise of our vascular, orthopedic, anesthetic, and cardiology teams, we were able to save his leg and restore normal circulation. Post-operatively, he can now walk normally.”

He added that osteochondroma, or femur exostosis, is relatively common and occurs in about 3% of the population. However, vascular complications such as aneurysm or embolisation caused by exostosis are extremely rare. Worldwide, fewer than 60 such cases have been reported, and only a very small number have been documented in India.

After the tumour was removed, the patient’s skull was reconstructed. Then, the scalp was repaired in stages using skin grafts ,flaps tissue expander and the final repair using a piece of tissue from the patient’s thigh. A metastatic lung nodule was also removed during the procedure.

Dermatofibrosarcoma Protuberans is extremely uncommon, affecting only 1–5 individuals per million. DSFP begins as a painless skin lump or patch and, if untreated, can significantly increase the risk of affecting the skin, muscle and even the bones. The patient had been battling this condition for over 8 years with multiple recurrences despite three prior surgeries.

Speaking about the case, Dr. Krishnamoorthy, Former Director, Plastic Surgery, Institute of Craniofacial, Aesthetic & Plastic Surgery (ICAPS), said, “This was not a single-step surgery. The tumour had eroded both scalp and skull, making each stage, from brain protection and skull repair to hair bearing scalp reconstruction which was highly complex. Careful planning, staged procedures, and precise coordination were key to achieving a safe and lasting outcome.”

Dr. Shyamnath Krishna Pandian K., Consultant, Plastic Surgery, Institute of Craniofacial, Aesthetic & Plastic Surgery (ICAPS), noted, “The greatest challenge in this case was balancing tumour clearance with safe reconstruction. The cancer had invaded critical structures like the skull and was dangerously close to the brain, which meant that every step carried was high risk including the staged procedures, complex reconstructions, and managing recurrences.”

Commenting on this landmark achievement Dr. Ravi Pachamuthu, Chairman, SIMS Hospital, said, “This landmark procedure brings in a new era for our hospital and demonstrates our unwavering dedication to quality and innovation in cardiac care. Over the course of the procedure, our team displayed remarkable surgical skill and endurance in handling the case of skull and scalp reconstruction. I am incredibly proud of our staff and clinicians for providing our patients with top-notch care.”