Why a street vendor decided to get a bypass operation

Extraordinary reason for bypass surgery

Majority of patients undergo bypass surgery for one of two reasons. Either they suffer from bad angina (chest pain) or there exists a definite threat to their lives because of the nature or location of coronary artery narrowing. However this one was different.

Four days after his surgery Mr. Miyan asked me if he would be able to carry 10-20 kg weights. That was and odd query in my practice where I have to push people to exercise. The reason is understandable.

Mr Miyan occupies a patch of pavement during the day, to sell his wares in an old Delhi market. The Delhi police is his only trouble, they often come charging and ransack or confiscate any goods that Miyan fails to grab and run, since his stall is illegal.

Over the years he developed worsening chest pain and it became hard for him to grab his wares and run, at times he would lose all his wares to the marauding police. Initially he would place a sorbitrate tablet under his tongue and make a dash, but in the recent months he lost all his merchandise and with it his livelihood at least four times.

Having had his surgery, he wanted to be certain that he would get back to his professional life and "to pick his wares and run from the charging policemen". I can only wish him luck.

Posted on January 3, 2013 .

Massive Aortic Aneurysm: surgery is the only option

About a month ago 29 year old father of three young kids came to my hospital seeking treatment for a massive ascending aortic aneurysm. While aortic root replacement is a large operation, Arvind Tomar's case was more complicated because his severe heart failure had already caused lung failure, kidney failure and liver failure. We went ahead with his operation despite multiorgan failure. With the correction of his heart condition, his other organs also started improving rapidly. 3 weeks post-op, and he's fit as ever.

Posted on December 28, 2012 .

Surgical site care following heart surgery

Good wound healing is helped by many factors. None is more important than the patients time in the operating theatre. From a surgeons perspective; it’s handling tissue gently, appropriate control of bleeding, minimal use of foreign material and perfect wound closure i.e basic principles of wound care that are most important. 

Posted on September 4, 2012 .

Quality life after heart surgery is good

A diseased heart limits your capacity to excercise and impairs the quality of your life, while also restricting life expectancy. Heart surgery is performed to alleviate illness, improve oxygen delivery to the heart and increase its efficiency. When the heart gets more nourishment and is working optimally with excellent efficiency- patients feel better.

Thats when you can work without stopping, run in the fields, dance to a tune.
Thats when the quality of your life is good.

Posted on August 15, 2012 .

Who needs a heart transplant?

“An otherwise well person, whose heart can no longer keep him (or her) alive and healthy.”

A profound statement in itself, but it does explain the very essence of Cardiac Transplantation. The heart must be dysfunctional enough that it seriously impairs the quality of life and is also a threat to life. For a patient who is unlikely to live a year with his or her heart a change of heart i.e. heart transplant is perfectly reasonable.

Posted on August 2, 2012 .

Heart Valve Disease

The heart has four one way valves arranged in ‘series’ that help guide blood flow in the normal direction without posing obstruction. There are two basic types of disease that might afflict an heart valve: Stenosis and Regurgitation.

Posted on July 29, 2012 .

"Can I please have a stent instead?"

I am no longer surprised when I hear patients begging for a stent just as the doctors inform them that they require a Bypass Operation. The scenario is standard: A young patient has severe disease in his coronaries, always much worse than what is recommended for a stent; so the doctors recommend that the patient undergo a bypass surgery.

In their desire to get home quick and also to avoid an operation, the patient and family either request for or insist upon the doctors that ?please doctor, please put in a stent for now?. It is rare that a Cardiologist would decline to pass in a stent in such a circumstance. I have on occasion been privy to counselling where certain unscrupulous doctors have been economical with the ill efects of stents.

What are the implications? For the young patient specially, they can really not avoid a bypass surgery in the medium to long term. There are many points to consider:

  • The number of drugs post stent
  • complications
  • effects on lifestyle
  • need for repeat angiography
  • repeat stenting or bypass surgery
.Morally and legally it is now the patients responsibility since they asked for a stent despite the doctors advice to undertake a bypass operation. I suppose that even when this situation is tested on legal grounds, the dotors or hospitals may not be easily faulted.

A patient should be seeking the best course of action from his physicians and surgeons rather than insisting for one treatment or the other based upon a small amount of information he might have collected from his own limited resources. The ideal practice, as recommended by the European EACTS/ESC would be that a Heart Team comprising a Cardiologist and Cardiac Surgeon evaluate each patient together, discuss the best course of action based upon available scientific evidence, and then recommend further course of treatment.

Posted on July 17, 2012 .

Centrimag VAD - bridge to recovery; a first in India.

50 year old Ravinder came to Sir Ganga Ram Hospital with breathing difficulty. He was diagnosed with cardiogenic shock, heart failure and severe chest congestion. Despite powerful medications to improve heart function, his blood pressure remained between only 70–80. His heart was barely working at 15% of its normal capacity.

The patient was then referred to me for a possible salvage operation. He was in a very precarious situation, he wouldn’t survive a week without an operation. The only possible solution was to implant an artificial heart device also called Ventricular Assist Device, or VAD, to completely take over the functions of his faltering heart.

Posted on July 1, 2012 .