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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, 16 October 2012

Amritsars First Aortic Dissection Surgery

Dr Pankaj Goel and the team of surgeons, anesthetist and nurses with the first Aortic Dissection Repair patient.
In March 2008, we created history by performing the first Aortic dissection repair inthe city of Amritsar. The 58 year old patient had an a acute aortic dissection with  leaking aortic valve and underwent a Bentalls operation. At nearly four and half years, the patient is well and enjoying a normal life.
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Aortic Dissection- A True Surgical Emergency.

There are a few real cardiac surgical emergencies and Aortic Dissection tops the list. It is an emergency as the death risk is nearly 25% per hour after the onset of symptoms.  Only a few survive beyond 24 hours. The treatment is emergency surgery.
What is Aortic Dissection?- Aorta is the large artery (pipe) that delivers blood form the heart to all the organs of the body. Normal aorta is made up of layers of tissue which are held together by a natural tissue glue. In patients with certain diseases, this glue is weak and the blood tears the inner mambrane of aorta and dissects between the layers creating a false passage. This leads to formation of two passages within aorta- a true lumen and a false lumen.

CT Scan- Tear in Aorta

 
Why is Aortic Dissection Dangerous?- Once the blood leaks into the outer layers of aorta, it is contained only by a very thin layer of tissue. This layer may rupture leading to massive blood loss and sudden death. The dissection may spread to various arteries blocking off the blood supply to vital organs leading to massive heart attacks, stroke, renal failure and gut ischemia. All of these conditons may lead to sudden death.
What are the symptoms of Aortic Dissection?- This condition presents as severe chest pain radiating to the back usually accompanied by sweating and a feeling of impending doom. In many cases it mimics the symptoms of heart attack.
How is Aortic Dissection Diagnosed?- The characterstic symptoms should raise the alarm. The key to save life is to have a high index of suspicion. An echocardiogram can diagnose this condition, a contast CT chest is diagnostic. The important thing is not to waste time and refer the patient to a place where it can be managed surgically.
What is the treatment of Aortic Dissection?- The treatment of this conditon is emergency surgery. Without wasting time, the patient is shifted into the operating room. A transesophageal echo is done to confirm the diagnosis. The patient is put on heart lung machine and the area of the aortsa where the tear started is replaced with an artficial tube graft. The operative risk is about 10%.
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Saturday, 6 October 2012

Coronary Bypass- Two Mammary Arteries Are Better Than One

The left internal mammary artery (LIMA) has been used for coronary artery bypass grafting (CABG) for the last six decades. It has stood the test of time. The LIMA to left anterior descending artery (LAD)  has a patency rate of 95% at 15 years. It is more than any other graft or stent. In fact, the LIMA to LAD anastomosis is responsible for improved survival after CABG.
With the age of patients coming forward for bypass surgery showing a decline, it is logical to assume that the addition of another arterial graft- Right internal mammary artery(RIMA) should further increase the survival. A series of recent research papers have shown that the addition of RIMA to bypass other left sided arteries of the heart (circumflex system), further improves survival.
The latest issue of Annals of Thoracic Surgery has an article re enforcing the concept that in Bypass surgery two mammary arteries are better than one.

Bilateral Internal Thoracic Artery Grafting Is Associated With Significantly Improved Long-Term Survival, Even Among Diabetic Patients

John D. Puskas, MDa,*, Adil Sadiq, MS, MCha,Thomas A. Vassiliades, MDa, Patrick D. Kilgo, MSb,Omar M. Lattouf, MD, PhDaa Clinical Research Unit, Division of Cardiothoracic Surgery, Rollins School of Public Health, Emory University, Atlanta, Georgia
b Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta,
Ann Thorac Surg 2012;94:710-716. 
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