dr pankaj goel: 2017

Wednesday 13 September 2017

Bypass Surgery on a Right Sided heart- Rare heart Surgery performed Successfully at Ivy Hospital amritsar.

In a press conference organised by Ivy Hospital Amritsar, Dr pankaj Goel Director and Chief Cardiac Surgeon claimed to have successfully performed beating heart bypass surgery in a young lady with dextrocardia and situs inversus. In this rare birth defect, the heart and other organs like liver and spleen are situated in a mirror image position. The heart is situated in the right side instead of left. This anomaly occurs in 0.01% of population. Dr Goel elaborated that only 28 cases have been reported worldwide of bypass surgery being performed in such patients. In his 20 yrs experience this is the first instance he added.

The operation becomes challenging due to the change of orientation and most cases have been performed on CPB. Dr Goel performed this case on beating heart despite the technical challenges.

Speaking to media persons, patients husband said that they are thankful to Dr Goel and his team . His wife has made good recovery and is discharged on 5^th day. He said that they had been to several hospitals but surgery was refused. In fact they were told that nothing could be done for her.

Dr Goel complimented the team and management for providing the support to perform such challenging cases at nearly half the cost as compared to Delhi. The Ivy Hospital management complimented Dr Goel and his team for providing world class health-care in the city.

Normal Situs Inversus

Thursday 4 May 2017

Leriche Syndrome- Treatment by thoraco bi-femoral grafting.

A 32 year old gentleman was referred to us with pain in calf and blackening of toes of his right foot for a week. He gave history of weakness in both lower limbs and erectile dysfunction for past 2 weeks. On examination he had absent femoral arterial pulses bilaterally. The pre-operative CT angiogram showed complete occlusion of juxta renal abdominal aorta with filling of iliac vessels via collaterals.(figure1). The symptoms and angiogram findings are classical features of Leriche syndrome. He had an absent right brachial pulse with occlusion of rt. axillary artery on angiogram. Since the patient was anon smoker the findings were suggestive of aorto arteritis as etiology.

Figure 1.-Pre-operative CT - complete occlusion of juxta reanl aorta (arrow)

In view of his symptomatic status we decided to offer him surgery. A thoraco bifemoral graft was performed. Thoracic aorta was exposed via a lt thoracotomy(black arrow) and using a bifurcated aortic graft vascular supply was restored to both lower limbs (white arrows)relieving his pain and preventing gangrene.

Post-operative CT- thoraco bifemoral graft in place with restoration of blood supply.

Conclusion- Aorto iliac occlusive disease is a serious disease causing lot of morbidity and mortality. Amputation rates are very high in these patients. Atherosclerosis is the most common cause. Smoking is another major cause. Aorto arteritis is a cause in the young. In the symptomatic patients blood supply has to be restored either by surgery or percutaneous intervention to relieve symptoms and prevent amputation.

Monday 24 April 2017

Case of The Month- Cabrols Procedure for Chronic Dissecting Aneurysm of Ascending Aorta

A54 year old gentleman was referred to me with progressive dyspnea and chest pain for one month. His echocardiography was suggestive of aortic dissection with aortic regurgitation. We diid a CECT of the chest which showed a chronic dissecting aneurysm of aorta measuring 8.5 cm. His echo also revealed a severe aortic regurgitation with dilated LV but normal EF.
A chronic aortic aneurysm may occur in patients who survive acute aortic dissection. In acute aortic dissection the layers of aorta split creating true and false lumens. In patients who survive or are not operated the weak aortic wall dilates with time and leads to aneurysm formation. The loss of support to aortic leaflets leads to development of aortic regurgitation. The tretment of this condition is surgery as rupture of aneurysm can cause sudden death.
The surgical procedure entails excising all diseased tissue i.e. aneurysmal aorta, aortic valve and replacing it with a prosthetic conduit and valve. The coronarie have to be reimplanted on to this conduit. This is the Bentalls operation. In this case however due to the large diameter of aneurysm and dense adhesions between aorta and pulmonary artery, coroary button fashionon for Bentall seemed impossible. I therfore chose to perform a Cabrols procedure. In this operation the aortic valved and aorta are replaced with a conduit the coronaries however are not implanted as buttons. They are connected with another graft which is then connected to aortic graft.