Patient Testimonials

First Anniversary at Ivy Hospital, Amritsar.

Completion of a successful and fulfilling year at Ivy, Amritsar. We are now the preferred care provider (adult cardio vascular surgery) in the region. Thanks to highly skilled and motivated team.

Launch of Heart Valve Repair Centre at Ivy Amritsar.

Chondrosarcoma of the Sternum- Radical Excision and Sternal Reconstruction using customised composite prosthesis.

Case Report- A 60 year old gentleman came with the history of gradually increasing swelling in the upper midline chest for last 6 months. He had been investigated elsewhere and a fine needle aspiration was done. The diagnosis was chondrosarcoma of the manubrium sterni. The CT scan images were also suggestive of the diagnosis. The tomor appeared to be locallu containe with no involvement of the mediastinal structures.

We advised the patient surgery and did a PET scan to rule out any secondaries. The PET scan was negative for tumor spread.

CT Image showing tumor with destruction of both tables of sternum (arrow)

PET Scan negative for any metastasis.

 Surgery- A wide excision with a 5cm margin was planned. This meant removing nearly half of sternum, 1-3 ribs and medial end of clavicles. This would result in a large defect requiring reconstuction.

                                                     

                                             Wide gap in the chest wall after radical excision.

Resected sternum with 1-3 ribsand clavicles (medial ends).

A median sternotomy incision was used and adequate resection carried out. The defect was repaired with a customised composite prosthesis made in the OR using double polypropylene mesh and acrylic bone cement. The prosthesis was covered with bilateral pec major flaps sutured in the midline.

Customised Composite prosthesis for sternal reconstruction using polypropylene mesh and acrylic bone cement

Composite prosthesis being sutured in place to fill defect

The patient was extubated on table and made an uneventful recovery and discharged on the 3rd postoperative day. 

Histopathology Report- Chondrosarcoma Grade II.

Comment-
Primary sternal tomors are rare and account for 1% of bone neoplasms. Chondrosarcoma is the commnest primart sternal tumor. It is resistant to chemotherapy and radiotherapy and curative resection is the only hope. Survival after curative resection is good if the tumor has not metastasised. Surgery involves radical resection with reconstruction of the anterior chest wall with various techniques.

Plication of Apical Left Ventricular Aneurysm on Beating Heart

Total Arterial Bypass and On Table Extubation makes Heart Bypass Surgery more safe and reliable.

Life After Heart Valve Surgery- Symposium organised on 18th March.

Organised a symposium on life after heart valve surgery. More than 50 patients who have undergone heart valve surgery by me attended. They shared their experiences, challenges and how their life has changed after surgery.

Launch of ECMO Service at Ivy Hospital Amritsar

Mechanical Complications of Myocardial Infarction I - Post Myocardial Infarction VSR

Post MI VSR

The 30 day mortality after heart attack ranges from 2-10%. Mechanical complications after MI i.e ventricular septal rupture, acute papillary muscle rupture and free wall rupture, remain a significant cause of death after heart attack.

Post MI VSR occurs due to gangrene of interventricular septum (Figure1,) leading to rupture and acute left to right shunting. This leads to cardiogenic shock and rapidly progressive liver and kidney failure. If not operated nearly 85% patients die in the next 4-6 weeks. This complication occurs in 1-6% of patients and is responsible for 15-30% of deaths after heart attack.

The diagnosis should be suspected in any patient with acute MI and cardiogenic shock. A holosystolic murmur is heard over praecordium. The diagnosis is confirmed on echocardiography (Figure2).

Specimen showing post MI VSR

Echo showing VSR with shunt across defect.

The treatment of this condition is urgent surgery. IABP is initiated in preparation of surgery. The purpose of the surgery is to debride necrotic septum and close the defect  with a synthetic patch. It creates a water-tight partition and abolishes the left to right shunt. If the patient is stable enough to allow coronary angiography, it is done pre-op and coronary bypasses are also done simultaneously.

Certain selected cases can be closed using devices thus avoiding surgery.

Despite the technical advancements, the surgical mortality remains as high as 25-30% . Patients who recover have a good survival and quality of life..