by Ramya Rachamanti on  July 18, 2020 at 11:56 AM Senior Health News
Indian Doctor Performs Complex Treatment On Cancer Survivor
An Indian Doctor has performed a highly complex heart treatment on an 81 year-old cancer patient using a technology traditionally used to crush kidney stones.

The Doctor utilized a heart pump and 'Lithotripsy' (Sonic energy traditionally used to crush kidney stones) to clear the blocks in heart and limb.

The treatment was administered by Dr. Manoj S., Senior Consultant and Interventional Cardiologist, at Kauvery Hospital, a leading tertiary care and multi-specialty hospital in Chennai, on an octogenarian patient.


Highlighting the unique aspects of this treatment, Dr. Manoj said, "A review of the medical literature and journals revelated that this is probably the first time globally in the medical science that such a synchrony of advanced technology - 'double heart pump' and 'Rotablation' combined with 'Lithotripsy' were effectively put in place for successfully removing a critical block in main artery as well as the complete block in right arm artery in a patient with heart attack and heart failure."

Further, Dr. Manoj added, "The reason we need to create awareness about such successful treatments is for the people of this country to know India has the infrastructure for administering highly complicated treatments and Indian doctors have the capability that are second to none globally and there is hope for people suffering from similar diagnoses."

The patient had suffered from a critical heap of heavily cemented 99 percent block in the left main artery of his heart. This had resulted in very little blood flowing into the heart and causing it to start rapidly failing to pump blood. The patient was at a high risk of sudden cardiac death and required urgent medical intervention.

The patient also suffered from an acute fast progressing heart failure, fluid congestion in lungs lowering his oxygen levels and also with new onset severe leakage of the heart valve due to critically reduced blood flow to his heart.

After performing a high-risk Coronary Angiography (a diagnostic procedure to study the blood flow through arteries in a heart), it was noted that the patient had a heavy, intensely calcified rocky hard block in the left main artery and its major branches (Refer Figure 1). His heart was sustained on very trivial (<10%) blood flow that conferred high risk of sudden cardiac arrest any moment.

Along with this critical life-threatening heart condition, the patient who was also a cancer survivor, had other co-existing medical ailments such as irregular heart rhythm and was on blood thinners for stroke prevention besides suffering from Diabetes, Sleep Apnoea, Chronic Lung disease, compromised kidney function, Hypertension, High Cholesterol and Obesity. He had a permanent cardiac pacemaker as well.

He also has multiple stony hard blocked arteries - complete block of the arteries of both arms and critical blocks in all the three arteries of the Gastro-intestinal tract. These conditions added significant risk to any form of treatment with lower success rate - the chances of survival from the treatment were meagre.

Speaking about this complex medical treatment procedure, Dr. Manoj S. said, "Initially it was agreed to perform a bypass heart surgery, but further assessment of his health condition, the heart surgeon noted a very bleak outcome of recovery. Therefore, the option of Bypass heart surgery was dropped.

The only other option that was left was, to perform a very high-risk complex angioplasty to open the rocky hard block in the main artery to the heart. However, this angioplasty treatment required a heart pump device named 'IMPELLA' pump (that is inserted non surgically into the heart) to protect and support his failing heart."

Further, Dr. Manoj added, "To perform the highly complex angioplasty, we also had to create an access in the artery of his right arm that was completely blocked with dense calcium. However, opening of this artery to right arm carried significant risk of stroke as this artery was very close to the artery supplying blood to the brain.

His brain was sustained only on two of the 4 arteries for its blood flow. These complexities necessitated his treatment to be done in two stages to reduce the risks from the procedure and to his life."

"The first stage of peripheral angioplasty successfully created the access in the artery of his right arm by using high shockwaves energy to break down the hardened calcium laden blocks - PERIPHERAL SHOCK WAVE LITHOTRIPSY guided by an advanced Ultrasound imaging technique. During this procedure, temporary filters were placed in arteries on either side of his brain to help prevent a stroke and protect the brain.

This is the first time ever in South India, the novel and most advanced Shock wave balloon Lithotripsy treatment to blocks in peripheral arteries with ultrasound image guidance has been performed; lithotripsy is a conventional technique that has been used for many decades for crushing stones on the kidney; now this technology is more refined to crush and open very hard blocks in arteries of body including the arteries of the heart," said Dr. Manoj.

After 24 hours of the first successful procedure, the patient was wheeled into the Hybrid Cath Lab for his second procedure. The Hybrid Cath lab provides the most suitable arena to allow complex heart treatments as well as simultaneous heart surgeries in same operating room, increasing the probability of treatment success. The Hybrid Cath lab is completely and thoroughly equipped with advanced infrastructure to handle any life-threatening complications.

Continuing to speak about the second phase of treatment, Dr. Manoj S. said, "We began the complex high risk treatment, by insertion of the IMPELLA ventricular assist pump device into the heart, to help maintain the circulation of blood as well as reduce the work load of his failing heart. We had also placed him additionally on an ECMO (an external machine that functions as heart pump and as an artificial lung), as we anticipated a high risk of Cardiac Arrest.

With support from the IMPELLA heart pump and ECMO pump, we were certain that the patient was completely protected from any life-threatening complications. We were then able to successfully remove the hard-critical blocks in the main artery of his heart through a lifesaving Angioplasty that went on for over 11 hours duration.

It is for the first time in medical history that such an effective combination of advanced heart failure therapies with use of Impella Heart Pump, ECMO pump, Rotablation and the novel Shock Wave Lithotripsy treatment has been used in saving a life."

Undeterred during this COVID-19 pandemic, Dr. Manoj offered the best and appropriate advanced care and successful treatment. He was assisted by Dr. Sundar Chidambaram - Senior Cardiologist, Dr.A.Raghuram - Chief Cardio Thoracic surgeon with his able Cardiac Critical care specialist and perfusionist.

(It is a month now and patient is doing quite well. Any treatment is deemed successful if patient survives 30days after the treatment). There has been appreciation from international forums on this unique successful achievement on the heart therapy.

Speaking on this achievement, Dr. Aravindan Selvaraj, Executive Director, Kauvery Hospital, said, "The innovation and expertise put forth by the doctors at Kauvery Hospital never ceases to amaze me. I congratulate Dr.Manoj.S for successfully pulling off a very high-risk surgery and saving the life of the 81 year old gentleman.

With many odds against a positive favour, Dr.Manoj and his team came up with a brilliant surgical plan and executed it to perfection to bring out the best outcome. We are extremely happy to have supported him with infrastructure like advanced Hybrid Cath Lab that helps in facilitating these kind of challenging surgeries"



Source: Medindia

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