The Hindu : Front Page : Rare cardiac surgery to repair aneurysm

Online edition of India's National Newspaper
Sunday, Nov 23, 2008
ePaper | Mobile/PDA Version

Front Page

Front Page

Rare cardiac surgery to repair aneurysm

Shyama Rajagopal

The procedure, called thoracic chimney technique, is the first to be done in the country

A longitudinal section of the body (the image at left) shows the bulge in the aorta at its arch rubbing against the vertebrae. The arrow shows the metallic sheath of the fabric graft on the aorta that cut out the dilatation of the artery.

KOCHI: A 61-year-old man got a virtual second lease of life and went home to Goa on Saturday after a team of doctors from the Amrita Institute of Medical Sciences here performed a rare keyhole procedure to repair an aneurysm on the main blood vessel from the heart.

The aneurysm, which is a dilatation of the blood vessel on the arch of aorta, was done without an open-chest surgery while preserving the blood flow to the brain. The procedure, called the thoracic chimney technique, is the first to be done in the country, said cardiologist K.K. Haridas, who led the team.

Aortic aneurysms are abnormal massive dilatations of the main blood vessel. They have a tendency to distend and rupture over a period of time. Rupture of the blood vessel would have meant immediate death. Aortic aneurysms are seen in one in 10,000 people past the middle age worldwide.

The Goan was referred to the Amrita Institute with an aneurysm of the aorta, measuring nearly 8 cm at its longest spread, which was pressing on to his ribs and vertebrae giving him a severe backache. The aneurysm was distorting the patient’s windpipe and food pipe, with the result that there was difficulty in breathing and sleeping in certain positions.

Conventionally, the repair is done by a major surgery lasting 3-6 hours involving stoppage of blood circulation through the heart using a heart-lung machine. The risk in the surgery is said to be about 20 per cent that includes paralysis, stroke or death. However, the cathlab procedure on this patient took only a little over two hours.

The team planned the procedure to manage the risk optimally after studying the morphology of the aneurysm. Not all aneurysms can be removed with this technique, said cardiologist M. Vijaykumar, a member of the team.

Three keyhole incisions were made. One, from the femoral artery on the leg to put the synthetic fabric graft into the aortic arch so that it excludes the aneurysm from the main vessel. The second one was from the neck to introduce a simple metallic stent at the beginning of the carotid artery that carries blood to the brain as the graft that was put would compromise the blood flow to the brain and the upper limbs. The third puncture was on the left arm artery to reach the aorta plugging the artery to the upper limbs that could leak blood into the aneurysm and cause it to recur.

Blood to the upper limbs will be supplied by the other branches of the blood vessel going to that part of the body. In a CT scan image taken a week after the procedure, the aneurysm already started shrinking. The patient said he was symptom-free for the last four days. The procedure done on November 11 cost Rs. 5 lakh, of which cosumables such as the stent and the graft cost Rs. 4.5 lakh.

According to Dr. Haridas, this recent innovation obviates the need for surgery. An abdominal chimney procedure was done in the country earlier, but the risk factor in the thoracic chimney is much greater because blood supply to the brain has to be restored within three minutes of introducing the aortic stent graft. Worldwide, the procedure has been done not more than 20 times since it was first introduced, said Dr. Haridas, who heads the Department of Cardiology in the 1200-bed hospital.

The percutaneous endovascular stent graft technique generally obviates the risk involved in conventional surgery. The advantages of the procedure are that it avoids major surgery and use of the heart-lung machine; the patient is ambulant in 24 hours and it provides him better comfort.

“Application of this technique will depend on the long-term follow-up results which look encouraging in endovascular aneurysm repair in other locations in the aorta,” said Dr. Haridas.

Cardiologists M. Vijaykumar and Rajiv C; surgeons S. Sudheendran, Manoj P. and G. Unnikrishnan; anaesthetist Suresh G. Nair; radiologist Sreekumar K.P. and a well trained group of technicians and nurses comprised the team that conducted the procedure.

Printer friendly page
Send this article to Friends by E-Mail

Front Page