dr pankaj goel: April 2015

Profile

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.

Wednesday 29 April 2015

Case of the Month- Giant Right Atrium with Rheumatic Heart disease

Case History- A 52 yearly presented with signs of gross CHF. She had ascites, pleural effusions and class IV dyspnea on exertion. Her chest X Ray (below) revealed massive cardiomegaly with a CT ratio 0f 0.95. Echocardiographic diagnosis was rheumatic heart disease with severe mitral stenosis and severe tricuspid stenosis with tricuspid regurgitation. The pulmonary artery pressures were calculated at 75 mmHg (systolic). The right atrium was giant with a calculated volume of 950ml.

Pre- opChest X Ray

Pre-op CT - giant right atrium.

The operative findings were similar to CT and echo- a hugely enlarged right atrium occupying the chest cavity. She underwent a mitral and tricuspid valve replacement with mechanical valves with reduction pasty of the right atrium. Post-op she required prolonged ventilation for persistent hypercarbia. She was eventually extubated, recovered well and discharged after 20 days.

Peri-op photo- giant right atrium entirely filling the mediastinum .

Comment- Huge enlargement of the right atrium may occur in children as a congenital anomaly. In the adults it is usually associated with pulmonary hypertension. This may be a consequence of rheumatic heart disease with mitral stenosis and tricuspid stenosis/regurgitation. Symptomatic patients need surgery. The operation should correct the primary problem and reduce the size of the atrium.