When 66-year-old Mukesh Shah’s voice became hoarse he sought treatment from an ENT specialist. But with no improvement after two months and the added symptom of breathlessness, Mr. Shah’s family friend, a pulmonologist, advised a chest x-ray.
The x-ray proved a turning point. An abnormal shadow led the pulmonologist to advise a CT scan which revealed a 7 cm aortic aneurysm. Mr. Shah was then referred to a cardiologist.
The patient, on medication for 20 years for hypertension, underwent an echo cardiogram which showed that his heart function was only 40%. Doctors at SIMS Hospital Vadapalani, then did a coronary angiogram that showed severe blockages in all coronary arteries supplying blood to the heart muscle.
Mr. Shah needed two procedures – a coronary bypass graft (CABG) and treatment for an aortic aneurysm. A CABG patient is generally put on a heart-lung machine during surgery but in Mr. Shah’s case, this was not possible, as doing so could put pressure post-operatively on the aorta, rupturing the aneurysm and causing bleeding in the heart. If he were to undergo treatment for the aneurysm first before the CABG, then he could have sustained lethal cardiac complications. The patient also had kidney dysfunction.
“Decision making is important,” explained V.V. Bashi, director and senior consultant of the Institute of Cardiac and Aortic Disorders. A staged procedure intervention was planned, for which the patient’s consent was received. “As a team we decided to do the CABG on a beating heart as the first procedure, and then the stenting of the aorta,” he said.
Performing CABG surgery for patients with damaged heart muscle like this patient requires balloon support, where the balloon is placed in the aorta to support the heart, Dr. Bashi said, but as Mr. Shah’s aorta was dilated, placing the balloon could rupture the aneurysm. “So, with utmost care, we did a bypass surgery on a beating heart without the need for a heart-lung machine and the balloon pump,” he said.
Throughout the surgery, doctors maintained control over Mr. Shah’s blood pressure. He was then put on medication for six weeks post surgery. When he had recovered, he was treated for the aneurysm. Stenting was done through his groin as a minimally invasive procedure. “We strongly believe that the timely diagnosis and staged treatment was responsible for his smooth recovery,” Dr. Bashi said. The hoarseness was because the aneurysm was pressing on the voice box, he added.
Mr. Shah, who recently became a citizen of the United States, is originally from Bengaluru. He currently lives in Houston, Texas. He said post-surgery, he was no longer breathless. Also, his BP was normal. His kidney function is also improving, doctors said.
On seeking treatment in India, he said in the U.S., he would have to wait for several years for a procedure, unlike in India. His wife, Dolly, said she was happy with the doctors and hospital authorities who saved her husband’s life.
