After Chennai and Delhi, for the first time in Western India, a critical Frozen Elephant Trunk surgery was successfully performed at Deenanath Mangeshkar hospital on a 33 year old woman.
What makes this Frozen Elephant Trunk Surgery an even more important landmark is the unique effort by a dedicated team of doctors to treat the woman, who had undergone a previous open-heart surgery, was pregnant and post-operation, suffered from Covid- 19.
“The woman was 30 weeks pregnant and was diagnosed with a rare heart condition. The patient was operated 10 years ago for aortic valve endocarditis (infection of the aortic valve). Aortic valve repair was done to correct the defect. After her marriage, and in consultation with the operating surgeon and cardiologist, she planned her pregnancy. During this pregnancy, she was on regular follow-up with echocardiography (sonography of heart). Around 30th week of her pregnancy, the echocardiography diagnosed her with a rare condition called aortic aneurysm with aortic dissection involving the descending thoracic aorta,” Dr Dhairyasheel Kanase, cardiac surgeon at Deenanath Mangeshkar Hospital told The Indian Express.
In this condition, the main artery arising from the heart (aorta), which supplies blood to the entire body balloons (aortic aneurysm). Due to extremely high blood pressure, there was an internal tear in the wall of the aorta with blood entering into its layers (aortic dissection). The condition is a very high-risk situation which had the potential of rupture as well as ripping off/shutting the blood supply to major organs such as brain, kidneys or heart itself, which can lead to death, stroke, kidney failure or massive heart attack. This condition needed an operation called Total Aortic Arch Replacement with Frozen Elephant Trunk, Dr Kanase explained.
The patient had an increased size of the ascending aorta (the origin of the aorta) and her previous operation had also deteriorated leading, to narrowing of the aortic valve (heart valve at the origin of the aorta). Hence, changing this part along with the aortic valve was also required, which is called aortic root replacement or Bentall procedure. “So we clubbed and executed three major operative procedures,” Dr Kanase said.
A caesarean section was performed and the woman gave birth to a healthy girl in October last year. The woman was monitored in ICU post-delivery. After monitoring and stabilising the patient’s parameters, the main surgery was planned 10 days after the delivery. Initially, the Bentall procedure was performed where the aortic valve along with ascending aorta was replaced with an artificial prosthesis, followed by the the replacement of the aortic arch with the Frozen Elephant Trunk procedure. It is a unique, hybrid prosthesis which is a combination of a tubular graft and stent. The surgery took 15 hours to complete. “A week after the procedure, the woman tested positive for Covid-19. She was treated as per protocol, three months since the procedure, both mother and daughter are healthy,” Dr Kanase said.
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