A 77-year-old Portuguese was rendered clinically dead in an Indian hospital ifor a complex surgery. The man is recovering.
Taken up for the surgery on January 1, Antonoio Soaias was cooled from 37 degrees to a temperature of 17 degrees celsius (by passing the blood through a heart-lung machine) and his blood was completely drained.
"At that point, he is 'clinically dead' - nothing works, neither the heart, lungs or brain. A person can survive like that (without oxygen) for 45 minutes, and his surgery took 30 minutes,'' said cardiothoracic and vascular surgeon Anand Somaya, who performed the operation along with cancer surgeon J N Kulkarni and anaesthetist Pradnya Kulkarni. The procedure is medically called deep hypothermia with circulatory arrest.
Within the half-hour, the surgeons skilfully removed the tumour in one piece. Once done, his blood was rewarmed to 37.4 degrees and slowly put into his body to restart circulation.
Calling his condition one of the "rarest of rare'', surgeon Anand Somaya, explained that in Soaias' case, the cancer had spread from the right kidney, entered the inferior vena cava (the large vein that carries deoxygenated blood from the lower half of the body to the right atrium of the heart), travelled through the liver into the right atrium of the heart.
Tumours entering the inferior vena cava are heard of, but they enter the heart only in 0.5% of cases, Madhavi Rajadhyaksha reported for Times of India.
"When the tumour is inside the blood vessel, doctors need to take all the blood out so that they can remove the tumour in a bloodless field. While we find tumours entering the inferior vena cava, they rarely enter the heart,'' said Dr Somaya. This is unlike usual heart surgeries which use a heart-lung machine to keep the blood pumping and maintain the patient's blood pressure. Soaias made for a challenging patient as he suffers from diabetes and had a mild form of Parkinson's.
Retired judge Antonio Soaias was holidaying in Goa when he felt a shooting pain in his legs. His relatives took him to Manipal Hospital in Panjim where scans indicated cancer of the kidney. When doctors opened him up for surgery on December 23, they found a tumour stretching from his right kidney and eating into 30% of his heart instead.
"At first, we thought his kidney had been affected because of diabetes, but we didn't know what to do when they told us about the tumour. We didn't even tell Antonio,'' recalled wife Carolina. Fortunately, the Goa doctor, who removed the infected kidney, remembered a similar surgery done in Bombay Hospital 15 years ago and suggested that the family head there.
Soaias was rushed to the Bombay hospital, where the 17-cm tumour was removed in a cutting-edge surgery which lasted eight hours and gave him a new lease of life on the first day of the new year.
The operation cost Rs 8 lakh, but the Soaias' are relieved it's all over. "I am eagerly waiting to get home and meet my grandchildren,'' said Antonio from his ICU bed in Bombay Hospital, even as a relieved Carolina said this was one holiday to India they wouldn't forget.
Independent doctors, however, said such cases aren't unheard of. "I have seen around eight such cases which happen in cases of renal carcinoma,'' said cardiothoracic surgeon and chief of Asian Heart Institute Ramakant Panda. He said circulatory arrest, in which patients are 'cooled', are used in types of cardiac surgeries such as these and aneurysms.
"I would consider it a remarkable surgical achievement but I can't vouch that it is a very rare case as such cases have been reported in Indian and international literature,'' said senior cardiologist and surgeon G B Parulekar. "It is an expected condition, but I don't recall a recent case in India,'' he said.