dr pankaj goel: Case of The Month- Cabrols Procedure for Chronic Dissecting Aneurysm of Ascending Aorta

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.

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.