Priti Kana’s Story…
In 2013, 74 year old Priti Kana Bhattacharya, a resident of Silchar, Assam, started having difficulty eating. In the beginning, having rice was proving to be her only problem, everything else was still okay. She felt as if the rice was getting stuck in her throat. But slowly the problem increased and she started facing problems swallowing. Local doctors advised endoscopy and the results showed that she had a tumour in her esophagus.
It was during this time that Priti Kana and her family referred to a well known Medicine doctor at Silchar who reconfirmed the presence of the tumour and advised biopsy. The biopsy reports sadly stated that Priti Rani had esophageal cancer. Her doctor referred to Dr. Chanchal Goswami, Consultant Oncologist at Medica Superspecialty Hospital, Kolkata for advanced treatment.
Priti Kana had the most prevalent type of Esophageal cancer – The Squamous Cell Carcinoma of the Esophagus, where the thin & flat squamous cells lining the surface of the esophagus is affected.
“We started Priti Kana’s treatment in July 2013 with External Beam Radiation Therapy (EBRT) with Targeted Agent Nemotuzumab – Biomab. EBRT is a type of radiation therapy that directs a beam of radiation from outside the body at the targeted cancerous tissues inside.” – Dr. Chanchal Goswami
“Once the treatment started, Dr. Chanchal Goswami assured us that after the adequate number of sessions, my mother-in-law will get totally fine.” – Mrs. Bhattacharya, Priti Kana’s daughter-in-law.
After 6 sessions, in October 2013, on the auspicious day of Durga Panchami, Priti Kana walked out from her last EBRT session. A Couple of months later, she showed no evidence of the deadly disease anymore and is living a happy and healthy life with her family members back in Silchar.
Pappu can hear again! After 24 years!
Twenty four years ago, in the small village of Forbisganj, Bihar, 500 Kms away from Patna, 10 yr old Pappu fell from the first floor roof while flying a kite. It was the day of Muharram and he was rushed to Biratnagar, 12 Km away and then Patna in the middle of the night. Though he survived, little Pappu lost his hearing in that fateful fall.
Youngest of 6 siblings of a lower middle class family, Pappu used to be very good in studies. His family tried their best to provide him the best treatment possible and made many trips to Delhi but sadly Pappu could never hear again. Being one of the brightest in his class, he continued his education in the same school and never let his handicap get in the way of his performance. In his Class X, teachers advised Pappu’s family to send him to the city for higher education but having lost their eldest son suddenly that year, the grief-stricken family was not ready for that change. Pappu went on to do very well in his school and later ranked 6th in the Delhi Engineering College. Specializing in Electronic Communication, Pappu brought back medals in all the 4 years of his Engineering days, passed the IES with flying colours and is currently the Assistant Director of Ichapur Gun & Shell Factory.
In December 2014, Pappu went through Cochlear Implant (Procedure of implanting a medical device that sends sound signals to the brain) in Medica ENT Institute. On 22nd January 2015, Pappu’s cochlear ‘switching on’ took place and finally, twenty fours years later, he can hear again!
Mr. Bhagat, Pappu’s father is overwhelmed with joy – “Dr. Mohan is super, he is a very good Doctor, infact the entire ENT Team. We went to many places all over India, Vellore too, but my son’s boss, referred us to Medica and we are very happy.”
Now a Balloon to Cure Your Sinusitis!
Gone are the days when a person seeking surgical relief from sinusitis had to go in for the conventional surgery that required people to get admitted, stay overnight at the hospital, and be forced to take rest for about 7-10 days before returning back to their normal activities. Dr. Arjun Dasgupta and his expert team consisting of Senior Consultants Dr. NVK Mohan and Dr. Chirajit Dutta at Medica Superspecialty Hospital, Kolkata, performed the first ever Balloon Sinuplasty in Eastern India to successfully treat a patient suffering from chronic sinusitis.
Unlike the conventional endoscopic surgery, Balloon Sinuplasty is the latest ‘in’ thing in the ENT field that treats and cures chronic sinusitis in the safest and the least invasive way. Similar to the procedure followed by cardiac surgeons to treat heart blockages with balloon angioplasty, balloon sinuplasty involves no cutting of nasal bone or tissues, and only by inserting a balloon through a catheter, and inflating it thereafter, blocked sinus passages are opened and the patient can go back home the same day.
According to Dr. Dasgupta, “Our patient, a busy executive and frequent flier, found his lifestyle and work getting affected by his sinusitis problem. After the initial CT Scan, it was clear that he required his blocked sinus to be cleared. For a person like him who found it very difficult to take time off from work, balloon sinuplasty was the quickest and safest mode of treatment that brought quick relief with minimum trauma.”
Dr. Dasgupta and his team used Spin devices for this pioneering surgery, thus also becoming eastern India’s earliest users of this latest technology for successful ENT Treatment. With Medica, one of the largest Superspecialty hospitals in the East, taking this first, important step in treatment of Sinusitis, a perpetually blocked nose need no longer slow down the pace of a jet setting lifestyle!
Hi-tech, expert care revives critically ill newborn
In what can be termed as one of the most miraculous recoveries, a seriously critical child from the village of Bagula in Nadia, born with immature lungs, was saved by the timely efforts of a hi-tech Neonatal Team under Dr Ashok Mittal, Senior Consultant Neonatologist & Head of Dept, Paediatrics & Neonatology at Medica Superspecialty Hospital, Kolkata.
Like any other new parents, Mr. and Mrs. Biswas were elated at the arrival of their tiny bundle of Joy on the Sunday afternoon of 16th February 2014. However, the happiness was not to last long! The highly experienced Dr. Mittal, who happened to visit Sanjivani Nursing Home in Bagula on that very afternoon, got alerted by the first look at their child and the slightly irregular breathing sound it was making. The doctor immediately suggested shifting the baby to a nearby government facility equipped with newborn care services and was shocked to hear of no such existing facility. Knowing that there was very little time he acted promptly and arranged an ambulance for the transport of the baby to Kolkata.
In the words of Mr. Biswas – “On our way to Kolkata my son’s condition severely detoriated and I had to admit him to a hospital at Barasat under the guidance of my doctor. Initially no doctor in that hospital was willing to treat such a sick child and after repeated requests, the treatment was started and continued for 20 hours only to have my child’s condition detoriating further due to non-availability of high-end technical gadgets. On 17th Feb ’14, I got a chance to talk to Dr. Mittal again and he sent his expert Newborn Transport Team to immediately transfer my son to Medica at Kolkata.”
The Newborn Transport Team of Medica with all mobile equipments (including neonatal incubator, neonatal ventilator, cardiac monitor, infusion pumps etc) was sent to the hospital in Barasat to initially stabilize the child by inserting a breathing tube in its throat and thereafter shift the baby on the transport ventilator to the NICU at Medica, which is considered to be one of the best intensive care units for newborns in entire eastern India.
The critically ill baby, however, still showed inadequate oxygen level in its blood despite having been given very high oxygen on ventilator, and was diagnosed to have immature lungs. Simply put, the child was taking in only 30% oxygen resulting in very high blood pressure in the lungs. Such high lung BP is a state called Persistent Pulmonary Hypertension of the Newborn (PPHN) – a deadly disease with extremely high risk of death without very advanced medical support.
With very little time on their hands, Dr. MIttal’s team put the child on a special machine called “High Frequency Oscillator” – a higher version of ventilator and a life saver in some cases of bad PPHN. But when even the HFO did not help the baby, the team used the last resort by puffing in a gas called Nitric Oxide in baby’s lungs through the ventilator circuit. This gas, not commonly found in most other hospital, finally worked wonders and the baby got an immediate boost of oxygen in next 30 minutes!
“Imagine my condition when I was told that my son was able to inhale only 30% of oxygen and if nitric oxide doesn’t go into his body, it will be very difficult to save his life! But, I had full faith in Dr. Mittal. As soon as we reached the hospital, the treatment started, and the doctor explained to me the usage of all the equipment used on my son. When nitric oxide was externally given to my son his condition dramatically started improving and soon he was inhaling 100% oxygen, gaining a fresh lease of life!”
Finally, after 21 hours of gas usage, 3 days of ventilation and 6 days of oxygen…a total of 9 days of tedious intensive care and monitoring, a healthy and smiling child was in the arms of the relieved Biswas couple!
“I am sure that there is no other hospital which is equipped with such high tech and advanced equipment! The service provided by the nurses in this hospital cannot be described in words! My wife had to stay back in the Bagula Sanjibani Nursing Home owing to some complications, but her absence was never felt with the nurses taking care of my son so well, and Dr. MIttal is no less than God to my family. During my hard times, every doctor and every nurse involved in this case gave me constant hope and assurance. Today my whole family is indebted to Dr. Mittal and the whole team of Medica!” said a tearful and relieved Mr. Biswas.
CRT post valve replacement: A challenge well met!
Dr. Dilip Kumar, Sr Interventional Cardiologist at Medica, recently conducted an unusual procedure on a 53-year-old male patient. The person was a post valve replacement patient, having undergone Aortic Valve Implantation in 2006. However, when the patient came to Medica in end April, he was showing symptoms of heart failure. He complained of constant fatigue, limited mobility and shortness of breath. He was also struggling with psychological problems like low confidence, anxiety and tension, which had greatly compromised his quality of life.
After an initial assessment Dr. Kumar suggested Cardiac Resynchronisation Therapy. The surgery was performed successfully on 3rd May 2012. Just 24 hours post surgery, the patient started showing increase in functional capacity. He soon became ambulatory with no signs of shortness of breath and fatigue. His overall condition has shown a significant improvement. Very soon he will be able to resume all his normal activities including his professional work.
For Dr. Kumar, this was a very challenging case. This was the 3rd such case performed at Medica.
A proud moment for Medica
Medica’s Department of Physiotherapy & Rehab added another feather to its cap when sports therapist Mr. Joydeep Daschaudhuri accompanied the Indian National Archery Team when it participated in the World Archery Championship held at Ogden, USA, in an official capacity. It was a moment of great pride for us when the team won the Silver Medal at the championship, thus qualifying for the London Olympics.
Rare Double Switch procedure performed successfully
Medica Institute of Cardiac Sciences has written a new chapter in the history of paediatric cardiac surgery in Kolkata. Congenitally Corrected Transposition of Great Arteries (CCTGA) is a very rare cardiac anomaly which accounts for just 1% of the total population of children with cardiac disorders. This anomaly generally does not come alone but is associated with other disorders like VSD, Pulmonary Stenosis, Pulmoary Atresia etc. In this condition the stronger morphological left ventricle is pumping deoxygenated blood in to the pulmonary artery and the weaker right ventricle is pumping oxygenated blood into the Aorta, also there is a hole in between the left and the right ventricle better known as VSD and there is a blockage in the pulmonary artery not allowing smooth passage of blood in to the lungs. These children have breathing difficulties right from birth and turn blue due to decreased oxygen supply. Surgical correction of this anomaly is a very complex operation called as Double Switch Operation, There are other lesser complicated surgical procedures such as Bi Directional Glenn Shunt or Fontans Procedure, but these operations do not correct the defect but just redirect the flow of blood to the lungs via a tube graft. Double Switch Operation is the standard procedure as far as correction of CCTGA is concerned. Very few hospitals in India perform this procedure and as far as Kolkata is concerned none of the hospitals so far has done this procedure.
The cardiac surgery team led by Dr. Ratan Kumar Das, Clinical Director and Senior Consultant Cardiothoracic Surgeon of Medica Institute of Cardiac Sciences, successfully performed this complex Double Switch Operation (Combined Senning’s and Rastell’is procedure)on 6 June 2012 on a 5 year old female child who was diagnosed with CCTGA, VSD, Pulmonary Atresia, PDA and with previous history of surgery to increase blood flow to the lungs (B T Shunt) . This complex operation involved the following steps. At first the VSD was closed in such a way that the blood from morphological left ventricle is pumped in to the Aorta, secondly the pure and impure blood was redirected to their normal ventricles by means of an Atrial Switch(Sennings Procedure) and lastly the pulmonary artery was joined to the morphological right ventricle by means of a valved Bovine Jugular vein conduit. This whole procedure took close to eight hours and the child was removed from the ventilator next morning. She can now lead a normal life like any other kid of her age with no need for any reoperations in the near future. Prior to this case Dr. Ratan Das has successfully operated on two such children in another centre in a different city. The cardiac surgery team consisted of Dr. Ratan Das, Dr. Dhritabrata Das, Dr. Abhijit Paul, Dr. Saikat Banerjee, Dr. Ashima Bhelotkar, Mr. Chittaranjan Dash and Mr. Tanmay Acharya.
“Palm-sized” Miracle Babies.
Medica’s Department of Neonatology & Perinatal Medicine recently succeeded in performing the near impossible task of saving 26 weeks premature twins through state-of-the-art technology and untiring efforts by a team of doctors, led by Dr. Ashok Mittal (HOD) and and his dedicated team at the Hospital.
Being a high-risk pregnancy through In Vitro Fertilization (IVF), the premature babies – a boy (weighing 900 gms) and a girl (weighing 500 gms) – were born to Mr. and Mrs. Debnath in the hospital on March 2, 2012. Having survived serious medical complications over the last 70-odd days, the twins (the boy weighing 1250 grams and the girl weighing more than 1050 grams now) have been recently discharged from the hospital.
This couple had tough time in conceiving a baby, and had taken the help of an infertility specialist to conceive through the method of IVF (in-vitro fertilisation) technique. They were very happy that Mrs Debnath got pregnant with twin babies after the very first cycle of IVF. However, their happiness did not last as she started to have labour pains at around 26 weeks. She was immediately admitted to Medica Superspecialty Hospital, and a trial was taken to stop her labour from progressing. Steroids were also administered to the mother, with the aim to help the babies’ lungs to grow, in anticipation of premature delivery. Unfortunately, after 5 days of treatment, she started to bleed, and decision had to be taken to take the babies out to save both mother and the babies.
Start was not good for the two little ones, who were suddenly out of the mother’s womb, in this alien world at an incredibly low weight of 500 grams and 900 grams. Both babies required immediate assistance with breathing. Apart from oxygen, the babies also required distending pressure in the lungs through their nostrils using a machine called CPAP, considered the most gentle way of providing respiratory support to tiny infants.
A premature infant is born with an immature body with all the organs still not developed properly. During their 70 days stay in the Medica NICU they suffered all the possible complications of prematurity including breathing difficulty, a patent duct in the heart, feeding intolerance, blood-stream infection, deadly infection of the tummy etc. Surprisingly, the younger daughter weighing 500 grams fared better than her brother at 900 grams. She never required ventilator, against a common belief that such premature babies become dependent on ventilator.
Having saved hundreds of premature babies in the past, it was still a big challenge for Dr. Mittal as every premature baby is different. The common worry being internal bleeding inside the brain cavities (called intra-ventricular haemorrhage), which the baby girl escaped but the baby boy suffered a minor bleed. Their eyes when examined, revealed evidence of eye damage because of prematurity (called Retinopathy of prematurity) and hence a laser surgery had to be done on both the babies’ by an eye specialist.
The entire team in the NICU thanked the parents who never gave up and laid complete trust & faith in the teams’ abilities and intentions.
Minimally Invasive Mitral Valve Replacement Surgery Performed At Medica.
A team of surgeons at Medica Superspecialty Hospital recently added a new chapter to the History of Cardiac Surgery in Eastern India. Led by Dr. Ratan Kumar Das, Director Cardiac surgery, the team successfully conducted a Minimally Invasive Thoracoscopy Assisted Mitral Valve Replacement on 20 June on an 18 year old patient from Orissa, suffering from Rheumatic Heart disease with severe Mitral Regurgitation.
This was the first such surgery performed in Eastern India. The patient was extubated one hour after the surgery and is doing well now.
Rajiv Behera (name changed on request) had been suffering from breathlessness and fatigue for quite some time. When he visited a physician in Orissa, the doctor advised him to consult Dr. Das at Medica in Kolkata. After the initial round of check-ups Dr. Das was convinced that surgery was the best option and post discussions with his team and the patient’s relatives, he decided to conduct the surgery by the minimally invasive procedure.
The procedure involves performing surgery through a small hole in right side of the chest wall with special thoracoscopic instrument and femoro -femoral bypass. The procedure leaves a very small, cosmetically desirable, scar under the breast as in laparoscopic surgery.
Renowned Cardiac surgeon from Belgium Dr. Hogo Verman is credited with first bringing the procedure to public knowledge, the letter on it was popularised by Dr. Chitwood in USA and Dr. F Mohr of Leipzig Heart Centre in Germany. Medica launched this programme a couple of months ago after Dr Das spent some time with Prof F Mohr in Leipzig Heart Centre to learn this procedure. At present this procedure is used in only a handful of medical centres in India. However, it is gaining popularity very fast and is soon likely to become the procedure of choice in Mitral Valve Surgery.
Almost all types of Mitral Valve Surgery, Tricuspid Valve Surgery, Adult ASD closure, and Cardiac tumours can be operated by this technique.
Other members of the team involved in the surgery include Dr Abhijit Paul, Dr. Saikat Banerjee, Dr Ashima Velotkar and Mr. Tanmay Acharia.
Surgical Treatment for Parkinson’s Disease.
Medica Institute of Neurological Diseases has introduced surgical treatment of Parkinsonism, tremors and dystonias. Deep brain stimulation (DBS) is a surgical procedure used in the brain to treat a variety of disabling neurological symptoms – particularly the debilitating symptoms of Parkinson’s disease such as tremor, rigidity, stiffness, slowed movement, and walking problems.
The procedure is also used to treat essential tremor and dystonia, which cause uncontrolled involuntary neck or limb movements. Patients suffering from severe depression and chronic pain have also benefited greatly from this treatment.
DBS uses a surgically implanted, battery-operated medical device called a neurostimulator – similar to a heart pacemaker and approximately the size of a stopwatch – to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and abnormal symptoms.
This path-breaking treatment leads to many patients experiencing considerable relief from their symptoms and greatly reduces the intake of medication and their associated side effects. MIND provides a complete and most advanced setup for Deep Brain Stimulation.
The Institute held a two-day Medica Functional Neurosurgery Workshop at the hospital on the 8th and 9th of November 2010.
Prof. Tipu Aziz, Professor and Head of Functional Neurosurgery unit at John Radcliffe Hospital, Oxford, England and Dr. Dipankar Nandi, Consultant Neurosurgeon, Charing Cross Hospital and Sr. Lecturer Imperial College Healthcare NHS Trust, delivered incisive lectures in their respective fields.
Live surgery was performed for tremor (essential and Parkinson disease), by the renowned neurosurgeons along with MIND Director Dr. Tripathy and his team. The surgery was performed on a 53-year-old woman who has been suffering from Parkinson’s for the past 10 years. The patient had severe tremor in the right side of her body. Doctors installed a neurostimulator, known as Deep Brain Stimulation (DBS) to provide electrical stimulation to targeted areas of the brain that control movement and block abnormal nerve signals causing severe tremor. Post surgery the patient was completely cured of her symptoms.
ENT Uses Path-Breaking Procedure To Treat Child.
Medica ENT Institute is proud to have conducted a “sialendoscopy camp” in Kolkata, the first such case in eastern India. Sialendoscopy is a new technique that has been developed only in the last decade. This highly specialised technique that is practised in only select centres in the world as yet.
It involves introducing a very thin endoscope of about 0.7mm into the salivary glands and their ducts to see inside them so as to diagnose disorders of these salivary glands and also treat them.
Most patients with salivary gland disorders have either stones or constrictions (called strictures) in the outflow channels. Conventional forms of treatment usually involve extensive open surgery to remove the whole gland with the possibility of serious complications.
With Sialendoscopy it is now possible to extract stones and dilate constrictions in the channels to treat such disorders without the need for extensive operations.
Among the patients who underwent this path breaking new procedure for the very first time in West Bengal was a small child of 3 1/2 years with “Juvenile Recurrent Parotitis” a condition where recurrent infections in the major salivary glands (called the parotids) cause narrowing of the outflow channels. Not only was this new technique used to diagnose her condition but the doctors at Medica ENT Institute were also able to institute a therapeutic instillation of medicines in her channels to help improve her condition
Successful Surgery On 17-days Old Baby
Medica ENT Institute has added another feather to its cap. Doctors at the Institute recently operated successfully on a large vallecular cyst in the throat of a 17-day-old Mizo baby. This large cyst, sitting above the wind and food pipes, was making the baby very sick and without surgery the baby would not survive.
The child was a patient of renowned paediatric surgeon Dr. Ishika Ghosh of Bhagirathi Neotia Hospital. The child was shifted to Medica Superspecialty Hospital early in the morning where a team of doctors was waiting for him.
Medica’s Anaesthesia department did a most wonderful job intubating and anaesthetising such a difficult airway ably supported by a neonatologist.
The surgery was quite challenging and required excellent coordination between the operating team members with three pairs of hands working in perfect harmony to complete the surgery through the tiny mouth of the baby. Post surgery the child has been shifted back to Neotia safely.
This was the third case where another hospital has sought Medica ENT’s expertise to treat very sick babies, the previous two referrals having come from RTIICS to help diagnose and treat airway problems in small children.
Neurosurgery Using Brain Lab.
Congratulations to the team of MIND (Medica Institute of Neurological Diseases) for doing a pioneering case of Neurosurgery, performed 1st time in eastern India. The team used the Neuro Navigation System (Brain lab) to operate on a brain tumour of a 50-yr-old lady, successfully removing the tumour with help of navigation, MRI Tractography (DTI) and Pentero Microscope.
The tumour was located in the speech centre and speech was affected pre-operatively. After removing the tumour speech has recovered and the patient is doing well.
Mrs. Tripti Adhikari, a 72-year-old lady from Agartala, was diagnosed with Dilated Cardiomyopathy and complete heart block when she came to Medica Institute of Cardiac Sciences with chest pain and breathlessness. Dilated cardiomyopathy is a condition where the heart pumping goes down and patient develops recurrent heart failure. Gradually the dilated heart develops fibrosis, which leads to conduction abnormality. This conduction delay further decreases the cardiac output as the contraction becomes non-synchronized. Biventricular pacemaker is implanted in these patients to synchronise the contraction of the heart, which is why the procedure is also called cardiac resynchronization therapy.
The patient underwent biventricular pacemaker surgery at Medica Superspecialty Hospital on 14th August. For the first time in India, in a landmark surgery, three leads were introduced successfully through the cephalic vein. The conventional way of doing the surgery is by introducing three leads through subclavian vein puncture. This procedure is risky as it can cause pneumothorx, haemothorax and lead fracture if the leads get trapped between ribs and clavicle. However, introducing the leads through cephalic vein negates all such complications.
The procedure, though safer, had not yet been tried in our country. Introducing a single lead is often a routine procedure, but insertion of three leads through the cephalic vein is an exception. Even internationally, the procedure has been adapted by only some centres in America and Europe. The surgery was performed by Dr. J Naik, Dr. Dilip Kumar and Dr. S. Basu. All three leads were introduced in the same cephalic vein at different locations. The patient started feeling better within hours of the procedure. With passing of time benefits of the surgery will become more visible due to remodeling of the heart as a consequence of the synchronized heart beats.
Shoulder Hemiarthroplasty On a 151 Kg Patient.
An unusual challenge to the surgical & anaesthetic team. In an unanticipated challenge thrown to the medica orthopaedic & anaesthetic team, an operation had to be carried out for shoulder hemiarthroplasty on a 60 year old gentleman of Kolkata.
The person who weighed 151kgs, suffered from severe sleep apnoea, obesity hypo ventilation syndrome (i.e. unable to lie flat), ischemic heart disease, bifasicular heart block, besides being a heavy smoker, hypertensive and having ill-controlled diabetic symptoms.
Although the operation was carried out successfully by Dr Vikas Kapoor and team, it had posed difficult anaesthetic challenges for the entire team in terms of arterial, central venous access, airway and ventilation issues. Nevertheless, with the experienced team of Dr Saikat Bandapadhyaya, Abhijit Sen & Dr Abhijit Paul, the clinical challenges were overcome soon. The patient is extubated and doing fine in the post operative surgical ICU, waiting to be transferred to the ward.
Congratulations to the entire orthopaedic team of Medica Superspecialty Hospital for this wonderful achievement!
Successful Complex Mitral Valve Repair: A First In Kolkata.
A rare and difficult operation was recently performed by Dr. Ratan Kumar Das (Senior Consultant Cardiac Thoracic Surgeon) and his team. The operation, called Resection Sliding Plasty, is a type of Mitral valve repair and requires a high degree of skill and precision to perform. Mr. Sudhakar Singh, a 23-year-old man, was admitted under Clinical Director Cardiology, Medica Institute Of Cardiac science.
The patient presented with congestive heart failure with inability to lie down. He had a past history of fever, which he had two years ago, suggestive of infective endocarditis (infection of heart). Echocardiogram revealed severe leak (regurgitation) in the mitral valve with poor LV function. First he was stabilized with injections and oxygen supplementation and then referred to the cardiothoracic surgery department.
Dr. Ratan Kumar Das took on this case as a challenge. In India valve replacement is preferred over repair because of the simplicity of the procedure. However, valve replacement at such a young age, wherein the patient would have deterioration in the LV function and also require lifelong anticoagulation, would have been a gross injustice done to the patient.
Dr. Das has been trained in Sydney where valve repair is a common thing with a high degree of success. Preserving the native valve was Dr. Das’ top most agenda when he started operating on the patient. In Resection Sliding Plasty, the diseased part of the valve leaflet is removed and the healthy parts are mobilized and attached to each other. The valve apparatus is finally strengthened by placing a semicircular ring around the annulus. The operation was performed successfully by Dr. Das, being the first such instance in Kolkata. The patient was discharged 10 days after surgery, with no further symptoms of heart failure.
High-Risk Patient Undergoes Successful Surgery.
Medica Superspecialty Hospital’s anaesthesiologist team is proud to announce its recent achievement of anaesthetizing a very high risk patient for bilateral total knee replacement, with great success. As the functional status of the patient was difficult to assess, coronary angiography was planned. Trans radial angiogram was done by Medica’s Cardiology team as she could not lie flat.
The complicated surgery was performed on Harda Bhawsingka, a 75-year-old lady with a history of recurrent severe aortic stenosis following aortic valve replacement, performed 10 years back, peak systolic gradient of 115mmHg, cancer of breast – status post radical mastectomy, bed-ridden due to severe bilateral osteoarthritis in the knee, morbid obesity, hypothyroidism, biventricular hypertrophy, Bifascicular block in ECG, and early parkinsonism. The patient required total knee replacement surgery on both knees.
The co-morbid combination of the patient is an anaesthesiologist’s nightmare as any form of traditional anaesthetic technique would lead to sudden cardiac death due to coronary blood flow compromise due to any hypotensive event following anaesthesia. Following a multidisciplinary cross referral and approach the anaesthesia team administered a combined spinal-epidural anaesthesia using titrated isobaric spinal anaesthesia and titrated epidural just to cause enough sensory block without causing any hypotension or low cardiac output state. All invasive monitoring like continuous cardiac output, filling pressures of the heart were monitored very closely during the entire surgical procedure which was completed within two hours thus reducing morbidity further.
Dr. Vikash Kapoor and his team comprising Dr Sutanu Hazra, Dr Vivek Sharma and Dr Sudipto Sarkar, completed the surgery on both the knees in a record time of one hour.Post operation, patient had a total pain free period with early ambulation and got back to her feet with excellent physiotherapy support after many months in bed.
The anaesthesia and pain management team comprised of Dr Abhijit Sen, Dr Pankaj Mondal and Dr Abhijit Paul.