dr pankaj goel: November 2013

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Dr Pankaj Goel, is currently working as a Director and Head of the Cardio-thoracic and Vascular (Heart, Lung and Vascular Surgery) unit at the Ivy Hospital, Amritsar.

After completing his MCh in cardio-thoracic and vascular surgery from GB Pant Hospital, Delhi University in 1998, Dr Goel worked at Madras Medical Mission, Chennai for three years. Here he obtained training in complex paediatric cases. Thereafter he went to Australia (Royal Perth Hospital) for further training and experience.

Dr Goel joined the Fortis Escorts Hospital, Amritsar in 2003. Since 2008 , in his capacity as HOD at the same hospital he has done pioneering work and established cardio-thoracic and vascular surgery in the city.

The Goel's unit now routinely performs all types of cardiac, thoracic and vascular surgeries with results comparable to the best centres in the world. Dr Goel is responsible for many firsts in the region.

Dr Goel has several research papers published in indexed journals. He has authored a book on cardiac surgery. He has an original technique for harvesting saphenous vein to his credit.

In 2009, Dr Goel was elected member of the prestigious Society of Thoracic Surgeons , USA. He is also a member of the Indian Association of Cardio-thoracic surgery and CTS Net.

At Ivy Hospital, Dr Goel routinely performs all types of Cardiac, thoracic (including thoracoscopic) and vascular procedures.

Tuesday 19 November 2013

Case of the Month- Left atrial Myxoma- Commonest Tumor of the Heart.

Left Atrial Myxoma.

Tumors of the heart are rare. The commonest tumor of the heart is a myxoma which accounts for 40-50% of primary cardiac tumors. Majority of the myxomas(90%) are solitary and pedunculated and nearly 75% occur in the left atrium. Myxomas are lobulated gelatinous in appearance. They are benign in nature but local recurrence has been reported after inadequate resection. majority of the myxomas are sporadic, 10% are familial

Myxomas can produce symptoms either by mechanical obstruction or embolisation. Symptoms of mechanical obstruction include left or right sided heart failure, depending on the site of the tumor. Syncope and dizziness may also occur. Embolic phenomenon may present as stroke, seizures and peripheral embolisation leading to infarction and gangrene.

Echocardiography is the diagnostic investigation of choice. The site and size of the tumor are clearly delineated.

The treatment is surgical excision. The tumor along with its stalk and a rim of surrounding normal tissue is excised. The prognosis is excellent. The recurrence rate is 1-3%, the familial variety has a recurrence rate of up to 20%.

Excised gelatinous tumor with stalk and margin of interatrial septum.

Wednesday 6 November 2013

Carotid Endarterctomy with PTFE patchplasty.

A 54 year old gentleman presented with recurrent right sided TIA's. MR angiography revealed a tight obstruction at the left carotid artery bifurcation. He was taken up for carotid artery stenting but the procedure was unsuccessful and resulted in a peri-procedural right upper limb monopareisis. He was then referred to us for carotid endarterectomy.

Pre-op MR angio showing tight lt carotid bifurcation stenosis.

Post-operative CT angiogram.

He underwent a left carotid endarterectomy under general anesthesia. A carotid shunt was used and a PTFE patch arterioplasty was performed. He made an uneventful recovery and was discharged the next day. At one month follow up his is recovering well and a CT angiogram shows a widely patent carotid bifurcation with no residual obstruction.

Comment- Despite the advances in carotid stenting, carotid endarterectomy still remains the gold standard for treating carotid artery obstruction.

Removed ulcerated plaque.