Rarest Heart Surgery performed at Ivy

Bovine pericardinal patch was used to rectify the damage in the infarct exclusion technique without cutting into the infarct

Mohali, Sanjay Pahwa :

Dr Harshbir S. Pannu, an eminent Cardiovascular surgeon has conducted an unparalleled heart surgery to give life to a 65-years old woman at Ivy Hospital, Mohali. An expert in Minimally Invasive Cardio Thoracic & Vascular Surgery, he used a uniquely innovative technique of Infarct Exclusion to restore the proper functioning of heart of the patient. The exclusivity of the operation was that a bovine pericardinal patch was used to rectify the damage in the infarct exclusion technique without cutting into the infarct (dead heart tissue).

While addressing a press conference here today, Dr Harshbir S Pannu said, “The patient without any previous history of heart disease was admitted to a local hospital on complaint of breathlessness, but diagnosed to have 40% blockage in a heart artery. On recurrence of chest pain she came to Ivy emergency, where proper investigative ECG showed evidence of heart attack with heart failure. Urgent angiography revealed of 90% blockage which had resulted in permanent damage to the muscles it supplied blood to, medically termed as Aneurysm of Left Ventricle.”

Though the patient was stabilized on medical treatment, her family opted not to go for stenting thus leading to more complications as no other hospital was able to provide any respite from the problem. Her failure to improve brought her back to Ivy Hospital, where clinically left and right heart failure with kidney damage was detected. Echo tests showed that in addition to the aneurysm she had by then developed internal rupture of the muscle curtain dividing the two main pumping chambers of the heart termed as Ventricle septal rupture. Thus, three times blood was diverted to heart and lungs only via a shunt thru the ruptured curtain, causing flooding of lungs and extreme breathlessness. The situation was leading to failure of organs one by one. The Kidney showed the signs of damage and under similar conditions 40% patients die in first 24 hrs and 80% in one week.

A special balloon pump was placed in the main artery of the heart (aorta) to augment the failing circulation to the most vital organs that is brain, heart and lungs in that order. Being a very complex surgery and minimal success rate the surgery is termed as thankless operation. The technical challenges involve seaming on the margins of dead muscles during heart attack with remaining alive heart muscles in an open heart. In addition the aneurysm of adjacent muscle posed an additional technical challenge due to its weak nature and ballooning out of the muscle which impaired the pumping efficiency of the heart.

Speaking about this rare fete Medical Director of Ivy Hospital, Dr Kanwaldeep said, “Going by the repute of being the best hospital in the region Ivy Hospital has once again added another milestone to the service of humanity by making a rare achievement in medical sciences. The department of cardio-vascular surgery is well equipped to tackle all kinds of elective and emergency surgery cases.”

Due to the rare condition a new technique known as Infarct Exclusion Technique using Bovine Pericardinal Patch was used to put the torn and damaged pieces of the heart muscle together and make it beat again normally and function optimally. This recent technique was used for the first time in the region. In addition to this, another innovative felt support shift of Teflon was used to right ventriclize the entire damaged and torn area so that lower pressures of right side heart cause less post operative bleeding.

Dr Pannu who has the credit of having performed over 7000 surgeries said, “This innovative approach helped us in initiating an exceptionally excellent pattern of recovery of such patient with multi-organ damage. She was removed from breathing machine after 12 hrs, from balloon pump in 24 hrs and mobilized from the bed in 2 days. Now she faces discharge in 8 days to home. Routinely where these types of high risk operations on the heart are done no such patient leaves the hospital under 2 weeks. Besides life saving, this turned out to be a far satisfactorily economic operation as well.”