Thousands of people could benefit from a new operating technique which is believed to halve the pain normally associated with open-heart surgery.The so-called mini-bypass is done through a cut in the chest which is three times smaller than usual.By causing far less trauma to the patient, surgeons say the recovery time is significantly reduced.

Within a day of the operation, patients can begin their recovery on paracetamol instead of the morphine painkillers they would usually need.Because the hospital stay is so short and the drugs bill so low, the operation is a third of the cost of a normal bypass.

The technique is currently done in just six surgical centres around the world. But its advantages are so great that it is expected to be rapidly adopted by other hospitals.

Recently Sky News was  there to  film the procedure at the Fortis Hospital in Bangalore. The patient was Abayomi Adebayo, a Nigerian man who travelled 5,000 miles to India because he was determined to have the mini-bypass.

He said: “With a smaller cut and a good rate of early recovery, it is far better for me. I am looking forward to seeing my children and grandchildren.” Cardiac surgeon Dr Mohammed Rehan Sayeed made a cut just 8cm (3ins) long in the lower part of Mr Adabayo’s chestbone.

Usually the incision would have to be 24cm (9ins) long, resulting in pain every time patients breathe.With a much smaller cut in the sternum, Dr Rehan had to carefully manipulate the heart until the diseased artery was directly below the hole.

He re-routed the blood supply to Mr Adebayo’s heart muscle through the mammary artery, which lies close by, and a transplanted section of artery from the lower arm.

Dr Rehan said patients leave hospital in as few as three days instead of seven, are back at work in two weeks instead of four, and are able to drive after one month instead of three.

He said: “What really pushes them to work quickly is the fact they don’t have pain. They can get up and walk the next day and not realise they have had some surgery done to them.

“I think it is the future of heart bypasses. If you can give the patient something that is less painful, then why not.”

~13 children from interiors of Madhya Pradesh and Rajasthan have undergone heart surgery at Fortis Hospitals~

It is happy days again for these bright little kids who are now all set to go back home and start a healthy life. These 13 little hearts from interiors of Madhya Pradesh and Rajasthan were suffering from complex heart conditions and have now undergone successful surgery at Fortis Hospitals.

“I was not sure why I couldn’t play with my fellow kids from our neighbourhood and why I had to gasp for breath every time I ran. All I want is to be like my friends who keeps running all day long and yet they don’t get tired” that is all that this little child Master Rishav Chourasia knows about his health.

At 8, he wonders why he is not like his friends. He was suffering from a complex disease of the heart called as Tetralogy of fallot (TOF). It is the most common heart defect in children. The condition is characterised by a combination of four heart defects i.e. pulmonary stenosis, ventricular hypertrophy, ventricular septal defect, and an aorta, and results in a situation wherein deoxygenated (blue) blood flows out to the body, thus making the children appear bluish. Rishav’s condition was unique as the critical blood vessels of the heart muscle were crossing the path which had to be cut to solve the problem of pulmonary stenosis.  The doctors had to do the procedure making sure that the surgery did not affect the blood vessels of this young boys’ heart.

Like Rishav there were 12 more children who walked smilingly into to the hospital, little did they knew that they had heart defects at birth and were undergoing complex surgeries at such a young age to correct their problem? CHD or  “Congenital Heart Disease is a serious problem plaguing the country. An early detection of the heart defects at birth could help in complete cure. It is very important that awareness about heart disease at birth is properly spread among the masses so that it is detected at the right time. Once the deformity is detected at the appropriate time, treatment is definitely possible and once treated these kids live a normal and healthy life” said Dr. Joseph Xavier, Consultant Pediatric Cardiac Surgeon Fortis Hospitals.

While explaining to the media about congenital heart disease Dr. Joseph Xavier touched upon some of the very complex cases which he operated, “Ram a 3 year old child from Madhya Pradesh son of a temple priest, was suffering from a rare condition of the heart called as total anomalous systemic venous correction where the entire impure blood was returning to the wrong chamber and was getting mixed with pure blood which was nearly fatal a kind of life threatening situation for Ram.  The surgery that we performed involved rerouting of his right artery correcting his deformity. The procedure was successfully done. Ram today is healthy and free from all complications and ready to go back home.”

“We had yet another challenging child Baby Sara who is just 7months old. She had multiple ventricular septal defect (VSD) which is commonly known as hole in heart. The challenge in doing the surgery on Baby Sara was her weight which was just 5 kg and also her age. However now Sara’s hole in the heart has been corrected after the surgery” added Dr. Joseph Xavier.

“There are many children in our country who are suffering from congenital heart disease or heart defects and there is a huge space for creating more awareness around these disease and how early detection and can help save these little hearts. We at Fortis Hospitals are making an attempt to extend our support to save these young hearts. We have been receiving such kids from various parts of India through our association with ENR and Father Chinnappan who is spearheading this initiative in our country” said P Davison, Head of operations Fortis Hospitals Bannerghatta.

Father Chinappan, a priest from Bhopal, has been working towards the cause of helping children suffering from congenital heart defects get their treatment. Father is associated with a German Foundation called ENR who helps raise funds for the surgeries. Fortis and Dr. Joseph Xavier has been actively supporting Father Chinappan’s cause by conducting congenital heart defect surgeries for the children, where the cost of the surgery at a subsidized rate.

Congenital Heart Disease refers to heart disease which is present at birth. These are primarily seen in neonates, infants and children; although in our country it is not uncommon to see adults with uncorrected heart defects. The percentage of children suffering from congenital heart disease in our country is likely to be humongous considering the high birth rate. This shows clearly that the emphasis on this kind of heart disease should be enormous. Though there have been rapid advances in the diagnosis and treatment of CHD over the last few decades, the mortality rate is still very high in our country due to lack of inadequate awareness, screening programs etc in the grass root level to detect the disease at the right time. Managing CHD in India is indeed an important issue and is often overlooked.

The total number of dedicated pediatric cardiologist and surgeons in our country are also very less and there are few centres which are equipped to perform such surgeries. Hence there is a need to spread more awareness around CHD and the fact that if diagnosed early this can be treated. Another essential element that needs to be highlighted is on Foetal Echocardiography. This is used to diagnose heart defects before a child is born. The diagnosis done through foetal echocardiography helps in treating the heart defect in the child at an early stage especially when many times some interventions need to be done immediately after the birth. If abnormalities of the foetal heart are discovered by a prenatal screening procedure, this special examination of the heart of can be performed with a referral from a physician which will help identifying the defect at the right stage, perform corrective procedures and reduce the mortality and morbidity rate.

“I was touched by the innocent smile of child when I saw him in one of the hospitals in Bhopal and came to know that he has a heart defect and his parents cannot afford his surgery. Since then my drive for spreading awareness about heart diseases in children started. My priest friend from Germany who came to know about this drive put me on to ENR and since then there has been no looking back. We are getting such kids to Fortis every year for treatment. It wouldn’t have been possible for me to complete my quest for helping these children without the support from Fortis, Dr. Joseph Xavier and ENR. I would like to urge my fellow brothers to wake up to this problem where many kids of our country are dying due to lack of treatment. A little help could save millions of lives” expressed Father Chinnappan.

Team of cardiac specialists at Fortis Hospitals performs two complex cardiac procedures in one patient giving him a new lease of life”

A complex combination of cardiac and cerebrovascular procedure was done on 50 year old Mr. Veerandra Gowda who was diagnosed with coronary artery blockage. Team of cardiac specialists led by Dr. Mohammed Rehan Sayeed, Consultant Cardiothoracic Surgeon and Dr. Gopi, Consultant Interventional Cardiologist performed the complicated and life saving procedure giving a new lease of life to Mr. Gowda

Mr. Gowda presented with recurrent chest pain and his cardio angiography revealed a critical left main stenosis (main blood supply to the heart) for which he needed an urgent bypass surgery. His pre-OP evaluation revealed 100% block in his left internal carotid artery and 90% block in his right internal carotid artery. (Carotid is an artery on each side of the neck called the carotid artery. This artery brings needed blood to your brain and face. The blood flow in this artery can become partly or totally blocked by fatty material called plaque. A partial blockage is called carotid artery stenosis (narrowing). A blockage in your carotid artery can reduce the blood supply to your brain. A stroke can occur if your brain does not get enough blood).“This posed a high risk for the patient to have a stroke during the surgery. One option was to do a combination surgery for both at the same time but unfortunately patient had received radiation in the neck for cancer of the larynx (voice box) and had a permanent tracheostomy done and thus the surgery in the neck was very difficult because the tissue would be very hard. Hence we decided to do a hybrid procedure of angioplasty to the carotid artery followed by bypass on the same day as the heart surgery could not wait for the usual 2 weeks needed after an angioplasty. During a carotid angioplasty there is a tendency of the blood pressure to fall temporarily but that would have been dangerous for the patient as this would have dealt to a significant reduction to the blood supply to the heart. Hence the angioplasty was done with stand by anesthesia and surgical back up for any emergency” said Dr. Gopi, Interventional Cardiologist, Fortis Hospitals.
After the angioplasty the patient was then shifted to the Operation Theatre immediately where he had to undergo triple vessel bypass. Mr. Gowda had a critical left main coronary artery blockage as left main is instrumental in supplying blood to the heart it was crucial to revive the blood flow as fast as possible. “It posed a major challenge to us to perform the coronary artery bypass surgery (CABG) on Mr. Gowda as the patient had a hole already due to the tracheostomy done earlier to treat his throat cancer. We had to opt for minimal invasive method to correct his blockage” which in a case of left main block is challenging and cutting edge said Dr. Rehan Sayeed, Cardiovascular Surgeon, Fortis Hospitals.

To perform a minimal invasive surgery one needs to undergo training and have to acquire certain skill sets. Dr. Rehan specializes in minimal invasive surgery and did the above complex procedure successfully. The patient was on his legs the day after his operation and was discharged within four days after his surgery.
“As the patient had a hole in his wind pipe and the doctors had to go for minimally invasive surgery inspite of critical left main block and since the cut was swollen and it was a challenge for us to sustain the blood pressure of the patient during the angioplasty and as well as during bypass surgery. Both surgeries were completed successfully without requirement of life saving machines like IABP and heart lung machine” said Dr. Dharmesh, Anesthesiologist, Fortis Hospitals.

Case highlights-
• Once angioplasty is done it takes at least 2 weeks to perform bypass surgery but as the patient left main coronary artery was blocked it was clear that the patient could not take it for 2 weeks and the doctors at Fortis successfully did 2 complex procedures in a single day
• As the patient had throat cancer and had under gone tracheostomy it was challenge for the doctors to put the patient on anesthesia
• The patient had block in both of his carotid arteries with one 100% block and the other 99% block it was challenge to perform angioplasty on this patient as the procedure had to be done in a short time as his blood supply to the brain was minimal
• The other challenge was to perform bypass on the patient, but this could not be performed in the traditional open heart surgery as the patient had a hole due to his previous complication where he had under gone tracheostomy and the surgery had to be performed minimal invasive way which requires high expertise.

MR compatible pacer case study~Now cardiac patients with pacemaker can undergo MRI without any restrictions~

Key Highlights
• 80 year old gentleman, hypertensive for the last ten years, was having frequent episode of giddiness & fainting

• An ECG showed he had complete heart block, a condition where the upper and lower chambers of the heart beat independent to each other

• This disassociation of the heart beats led Mr. Rangan’s pulse rate go down to 28-30bpm which proved to be life threatening. Mr. Rangan was advised to undergo a pacemaker implantation

Heart patients with rhythm disturbance or commonly called as Arrhythmia who needs to undergo a pacemaker implant can now opt for an MRI Compatible Pacemaker. Dr. Venketesh, Interventional Cardiologist from Fortis Hospitals Bannerghatta Road has successfully implanted the latest MR compatible pacemaker procedure on an 80 year old gentleman.

Important Facts:
1 million people worldwide get pacemaker implanted every year
50-75% of these patients need an MRI scan during lifetime of the device  After age 65, a person’s chance of needing MRI doubles
MRI is an accurate diagnostic tool and gives information that cannot be seen on an X-Ray, Ultrasound or CT Scan
Before this procedure, cardiac patients with pacemaker was barred from undergoing any MR scanning as exposure to magnetic radiation can lead to serious complications in the patients. However with this newly introduced technological advanced implant patients can easily undergo MRI at any given point in time.

Mr. Rangan, an 80 year old gentleman, hypertensive for almost a decade was suffering from frequent episodes of giddiness and fainting. Upon diagnosis it was revealed that he had a complete heart block – a condition where the heart rhythms / beats are irregular and upper and lower chambers of the heart beat independent to each other. This disassociation of the heart beats led Mr. Rangan’s pulse rate go down to 28-30bpm which proved to be life threatening for him. Mr. Rangan was advised to undergo a pacemaker implantation to correct the rhythm disturbances in his heart. Considering the old age and the probability of the need to undergo an MRI in the future doctors gave Mr. Rangan the option of MRI compatible pacemaker. Eventually Mr. Rangan successfully underwent the procedure and was discharged from the hospital within three days and now is leading a complete normal life.

“The MRI-compatible pacemaker will be a boon for patient, who has rhythm disturbances and needs a pacemaker, this generally occurs at an elderly age group above 50 years. These patients usually require an MRI for several conditions, the most common being brain, spine, joints and abdomen. Up until now they could not undergo an MRI scan for their entire life with the regular pacemaker” said Dr. Venketesh, Interventional Cardiologist, Fortis Hospitals.

He also added “This procedure offers safety to the patient and eliminates the inconvenience of frequent follow ups. The automatic feature in the implant automatically calibrates depending on the disease pattern of the patient saving the patient from any kind of risk or emergency.”

Considering that millions of patients in India get a pacemaker implanted every year and according to the estimates 50-75% out of these patients need an MRI scan during the lifetime of their device, the new innovation will be a boon to the patients.

MRI is the standard of care for soft tissue imaging. It is the primary tool in evaluating the central nervous system, the entire range of musculoskeletal disorders, tumors, areas of infection, internal organs and more.

Because of this patients with pre-existing comorbidity in one of the following areas may require an MRI :

Oncology
Neurology
Orthopedics
Cardiovascular (stroke-related)

Patients with a known condition that will likely require an MRI (e.g.: pituitary disease, multiple sclerosis, high thromboembolic risk etc)

An MRI compatible pacemaker will ensure that these patients can safely receive the diagnostic imaging. Since a substantial number of patients are denied MR scan because of the pacemaker implant they are at a huge risk of comorbid conditions as accurate diagnosis is not possible without an MRI. Hence this new device can eliminate such a risk and help the patients undergo magnetic radiation imaging safely.

Certain factors may increase your risk of developing an arrhythmia.The most serious arrhythmias affect people older than 60. This is because older adults are more likely to have heart disease and other health problems that can lead to arrhythmias.

As many as 2 million Americans are living with atrial fibrillation, a type of arrhythmia.During a 24-hour period about 20% of healthy adults are likely to have multiple types of premature ventricular beat

Older adults also tend to be more sensitive to the side effects of medicines, some of which can cause arrhythmias. Some medicines used to treat arrhythmias can even cause arrhythmias as a side effect.

Some types of arrhythmia happen more often in children and young adults. Paroxysmal supraventricular tachycardias (PSVTs), including Wolff-Parkinson-White syndrome, are more common in young people. PSVT is a fast heart rate that begins and ends suddenly.

Who are at risk of developing arrhythmia :

1.Age. With age, your heart muscle naturally weakens and loses some of its flexibility. This may affect how electrical impulses are conducted.Genetics. Being born with a heart abnormality may affect your heart’s rhythm.

2.Heart Related Complications :Coronary artery disease, other heart problems and previous heart surgery. Narrowed heart arteries, heart attack, abnormal valves, prior heart surgery, cardiomyopathy and other heart damage are risk factors for almost any kind of arrhythmia.Heart failure or cardiomyopathy, which weakens the heart and changes the way electrical signals move around the heart

3.Thyroid problems. Your metabolism speeds up when your thyroid gland releases too many hormones. This may cause fast or irregular heartbeats and may be linked to atrial fibrillation. Your metabolism slows when your thyroid gland doesn’t release enough hormones, which may cause a bradycardia.

4.Drugs and supplements. Over-the-counter cough and cold medicines containing pseudoephedrine and certain prescription drugs may contribute to arrhythmia development.

5.High blood pressure. This increases your risk of developing coronary artery disease. It may also cause the walls of your left ventricle to thicken, which can change how electrical impulses travel through your heart.

6.Obesity & Diabetes :Along with being a risk factor for coronary artery disease, obesity may increase your risk of developing an arrhythmia The r risk of developing coronary artery disease and high blood pressure greatly increases with uncontrolled diabetes,also episodes of low blood sugar (hypoglycemia) can trigger an arrhythmia.

7.Obstructive sleep apnea. This disorder, in which your breathing is interrupted during sleep, can cause bradycardia and bursts of atrial fibrillation.

8.Electrolyte imbalance. Substances in your blood called electrolytes, such as potassium, sodium, calcium and magnesium, help trigger and conduct the electrical impulses in your heart. Electrolyte levels that are too high or too low can affect your heart’s electrical impulses and contribute to arrhythmia development.

9.Alcohol/ Caffeine consumption. Drinking too much alcohol can affect the electrical impulses in your heart or increase the chance of developing atrial fibrillation. In fact, development of atrial fibrillation after an episode of heavy alcohol intake is sometimes called “holiday heart syndrome.” . Caffeine, nicotine and other stimulants can cause your heart to beat faster and may contribute to the development of more serious arrhythmias. Illicit drugs such as amphetamines and cocaine may profoundly affect the heart and lead to many types of arrhythmias or to sudden death due to ventricular fibrillation.

10.Several other risk factors can increase risk for arrhythmias. Examples includeheart surgery, certain drugs (such as cocaine or amphetamines), or an imbalance of chemicals or other substances (such as potassium) in the bloodstream