Dynaneshwar Sadafule, an electrician, was a ticking time bomb. Only the 46 year old didn’t know it yet. A chest pain on a Sunday, post a day of work in the renovation of the ICU, brought to the fore the issue he was living with. “He was absolutely fine before that. No pain or no health issues barring a back pain,” explains his wife.
“A 2D echo showed that something was wrong in the aorta and there was a large aneurysm in the aorta. While this was impacting the aortic valve, it also showcased a congenital bicuspid aortic valve disease-causing leakage and a narrowing of the valve. From birth, he has got 2 leaflets rather than 3 leaflets which is common. What made the case even more complex was the arch abnormality due to swelling on the arch connecting the valves to the heart!,” says Dr Rakesh Kaushik who diagnosed the case says,
During such a condition, the blood vessels in the aorta weaken and bulge, leading to heart attacks, kidney damage, stroke, and even death! As per doctors, Bentall surgeries are performed in higher cardiac surgical centres around the world but Bentall surgery with hemi arch replacement is extremely rare with high mortality rates.
Such surgeries require detailed surgical planning as the brain vessels are also involved.
A multi-skilled team of almost a dozen doctors, including Dr Rakesh Kaushik, Dr Duggal and Dr C S Kulkarni performed this extremely complex procedure in Jehangir Hospital on the July 28.
“This dilation and the aneurysm of the heart which was visible in the heart in the CT scan could have caused his blood vessels to rupture at any time. In this surgery, the valve was reduced, the aortic abnormality was corrected and also the arch was replaced by a graft,” explains Dr Duggal, the HOD of the cardiology department at Jehangir Hospital who led this case.
Explaining the intricacies of the eleven-hour-long open heart surgery, Kaushik, a senior cardiologist at Jehangir Hospital explained the complex process.
He said, “The aneurysm was 6.5 cms which was quite large. Besides, since the arch was swollen, it would also have to be replaced. So we created a graft at the top for antegrade cerebral perfusion. It was joined to the 1st head vessel coming out of the arch. The trifurcated graft was then joined to the 3 arch vessels one by one.”
Dr Kaushik informed, “After this, the patient was slowly cooled to 23 degrees centigrade. During this time the heart was stopped for 40 minutes and the root replacement was done – which involved the replacement of the aortic valve with an artificial valve and the ballooned out ascending aorta with a graft.”
He elaborated, “Minimal blood was only pumped to the brain via arm vessels to maintain neurological function, during the surgery. The coronary arteries, which arise near the valve, had to be transferred on the graft. After this was over, the circulation was stopped and arch replacement done. Finally, the trifurcated graft was joined with the main aortic graft. This is considered the most dangerous portion of the operation, as the patient can suffer brain death if the circulatory arrest is sustained for too long.”
Cardiac Anaesthetist Dr C S Kulkarni, the surgery at Jehangir Hospital needed him to be on his toes for this surgery. “The importance of minimizing blood loss and to maintain vigilance on all parameters was key as the patient was on the Cardiopulmonary bypass machine,” Dr Kulkarni said.
“Extensive work has to be done in monitoring the blood count – from plasma to platelets. This kind of surgery where the patient’s heart is stopped from pumping also hampers blood clotting and can create multiple side effects. But this patient did well and the post-operative care by Dr Yash Sharma and Dr Meera was phenomenal,” added Dr Kulkarni.
Dr Duggal rounded this “high-risk surgery as a bigger surgery than even a cardiac transplant. The surgery is very demanding, and can lead to complications if not done well. The blood supply to the brain is through the arch and all the arteries were implanted on the graft.”
The patient has now recovered and is under post-operative care since the last three weeks. The family is under shock. “He was absolutely hale and hearty. We had no idea of the congenital disease. And the fact that the Jehangir hospital helped us finance the operation through the multiple charities they work with, has been a Godsend for us,” says his wife. Currently, in recovery mode, it may take Dyaneshwar a few weeks more before he is back at work.
George Eapen, CEO & Director of Jehangir Hospital commended the entire team on the process. He said, “What remains heartening for us is that the medical team has been able to perform this surgery without any bleeding or neurological disorder. And the patient has been discharged within a week.”