Aortic Dissection at SIMS Hospital

SIMS Hospital arranged media conference with Dr V.V. Bashi, held on Dec 19th 2019. First in India, An Elderly Person Undergoes Complex Surgery for Acute Type-A & Type-B Aortic Dissection at SIMS Hospital, Chennai”

For the first time in India, an elderly gentleman underwent successful surgery to correct multiple Aorta anomalies (Acute Type-A Dissection, Leakage in Aortic Valve and A Tear in the Distal End of Aorta) in a single-stage operation at the Aortic Aneurysm Centre, SIMS Hospital, Chennai.

For the first time in India, an elderly gentleman underwent successful surgery to correct multiple Aorta anomalies (Acute Type-A Dissection, Leakage in Aortic Valve and A Tear in the Distal End of Aorta) in a single-stage operation at the Aortic Aneurysm Centre, SIMS Hospital, Chennai.

Type-A dissection in the ascending aorta itself is a lethal condition that poses a challenge to cardiac surgeons. When this happens suddenly, the majority of patients do not survive unless surgery is performed in the first 48 hours. In addition, the treatment of the leaking aortic valve and the tear in the lower part of the descending aorta was a major challenge in this case. At present, in most centres, only the ascending aorta is corrected in such situations, leaving the other issues to be addressed after 1 or 2 years. Yet, at SIMS, the surgeons repaired all 3 different parts of the aorta in a single operation that lasted about 6 hours.

Case Details:
A 65-year-old gentleman (name withheld) from Coimbatore was admitted to SIMS Hospital with serious chest pain in the back and abdomen. The discomfort was very severe one day before the patient came to SIMS for consultation. He was diagnosed with Acute Type A Aortic Dissection along with a leaking aortic valve and a tear at the lower end of the descending aorta. It was a life-threatening situation for the patient who needed emergency surgery. The patient then rushed in for surgery within half an hour, which is mandatory in such a situation.

Talking on the complexities of aortic disorders, Dr. V. V. Bashi – Director of the Institute of Cardiac & Aortic Disorders (ICAD) at SIMS said, “It is quite difficult to detect aortic conditions on a preventive basis, and it would be difficult to detect 3 conditions in one case unless an appropriate diagnostic approach is taken. Another obstacle for us was to carry out all the surgical corrections in one session, even on an emergency basis.

The patient underwent a successful total remedial replacement of the entire diseased aorta with the repair of the aortic valve as a single-stage operation and had an inadvertent recovery. He’s doing well and expecting a normal life.

Such complex cases are conducted only in a few elite medical institutions in the world because they require superior surgical expertise, the latest technology and the availability of advanced hybrid graft (Thoraflex Graft).

Explaining the complexity of surgery, Dr. Bashi said, “Multi-stage operations over the years leave the patient and family in a state of fear and anxiety due to the risk of temporary mortality.

SIMS Hospital recently launched the First Exclusive Center for Aortic Diseases in India to offer a focused approach to the diagnosis and management of Aortic Disorders. The Center aims to raise awareness of various aspects of the disorders, such as risk factors, innovative treatment methods, etc.

Expressing his joy at this excellent surgical feat, Shri. Ravi Pachamoothoo – Chairman of the SRM Group, said, “It has always been our intention to be at the forefront of healthcare innovation and excellence in India. And our heritage of being in the field of education gives us that edge to bring new ideas and technologies, to cultivate and mentor future clinical talents in order to achieve that aim. We are fortunate enough to have outstanding doctors like Dr. Bashi, who has his own legacy in the field of cardiothoracic surgery, particularly in the treatment of aortic disorders, to guide our young doctors into a bright future.

Approximately 3-4 lakh people in India suffer from various types of Aortic Disorders every year, of which only about 1,000 people are treated. If the illness can be diagnosed early, the majority of patients can be successfully treated with a success rate of more than 95%. Very few centers in our country conduct aortic surgery in large numbers. Dr. Bashi and his team performed more than 1,500 aortic procedures, one of the biggest in any country to reach international standards.

The Relationship between Lupus & Heart Disease

Often called a mysterious illness, lupus is an autoimmune disorder that can affect any part of your body, including the skin, blood, brain, lungs, and kidneys. While the disease is rather widespread, the causes still remain unknown, and strangely, no two cases are alike. Yet, most people inflicted with lupus do not even seem sick. 90% of the people living with lupus are female. The disease is frequently found in women of Asian, Hispanic, or African descent more than in Caucasian women.

Lupus can attack arteries, blood vessels, tissues, and organs, which lead to their inflammation. Patients who have lupus must know that they are at an increased risk for cardiovascular disease, including heart failure, strokes, and heart attacks. For some, these cardiac symptoms may go unrecognized, especially if they are unaware of them. Most of the time, the patients overlook heart disease symptoms and attribute it to their inflammation since the disease limits their ability to exercise and stay fit.

Cardiac Symptoms

Patients with lupus can experience traditional risk factors such as:

  • High blood pressure or hypertension primarily due to steroid use or kidney disease
  • Diabetes also due to steroid use
  • High cholesterol levels steroids inducing plaque that narrow the arteries
  • Joint and muscle pain as a result of physical inactivity and excess weight

Generic symptoms noticed:

  • Feeling tired & weak
  • Chest Pain
  • Shortness of breath

Other lupus-specific risk factors may also be evident depending upon the dosage of the steroid, degree of inflammation, and the length of time that the person has had lupus.

Heart Disease

One of the most significant complications of lupus is heart disease, which is also a leading cause of death among people who have lupus. To determine if you have a heart condition on account of lupus, blood tests, chest X-rays, electrocardiogram, or an echocardiogram, may be required.

Myocarditis

The myocardium or muscle tissue of the heart is inflamed due to lupus. Unexplained irregular heartbeats and chest pain are some of the symptoms of myocarditis. However, even fungal, bacterial, and viral infections are caused due to the disease. Particularly for patients on immunosuppressants, lupus comes with an additional risk of myocarditis.

Pericarditis 

When there is inflammation of the pericardium or the sac surrounding your heart, it is known as pericarditis. The patient experiences a sharp pain in the chest along with shortness of breath. The condition does not directly involve the heart tissue and therefore is not a contributing factor to the heart’s ability to function. Long-lasting or chronic inflammation, however, can interfere with the heart’s ability to pump blood while, additionally, scarring the heart tissue. If your heart does not have the strength to pump enough blood to the different tissues and organs, heart failure may occur. Although severe heart muscle disease may not be commonly caused due to lupus.

Coronary Artery Disease

Fatty molecules and other materials attach themselves to the walls of the coronary arteries that are responsible for moving blood to and from the heart. Over time, plaque is formed, and the blood vessels become narrower, restricting blood flow. Angina develops are a result of decreased flow of blood that eventually may lead to a heart attack. Lupus increases the risk for CAD or Coronary Artery Disease. People with lupus are more likely to develop atherosclerosis, which is also one of the leading causes of heart disease.

Endocarditis

Inflammation of the endocardium or the tissue that lines the inner walls and valves of the heart and enables separate chambers, is known as endocarditis. The surfaces of the heart valve develop lesions or wart-like growths and thicken as a result of lupus endocarditis. Bacterial endocarditis evolves when the lesions become infected. At times, a blood clot is formed, when a lesion breaks off and travels to the brain leading to potentially dangerous results.

Circulatory System

Capillary inflammation can cause breakage of the blood vessel, resulting in internal tissue bleeding. A small, purple or red dot may appear indicating inflammation, which can also be dangerous when it finds its way to the brain. The blood vessel walls are inflamed leading to vasculitis. Lupus-induced vasculitis varies depending upon the tissues that are involved.

Reach out to experts at SIMS Hospitals, Nungambakkam, for treatment of all cardiological & vascular diseases.

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