Chennai hospital performs a complex Pulmonary Endarterectomy successfully
After a thorough assessment, the Pulmonology team led by Dr Srinivas Rajagopala considered a diagnosis of severe CTEPH and complex Sleep Apnea leading to heart failure
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CHENNAI: A private hospital in Chennai's Alwarpet has performed a successful life-saving pulmonary endarterectomy surgery on a 49-year-old patient suffering from heart failure due to severe Chronic Thromboembolic Pulmonary Hypertension (CTEPH).
The surgical procedure, carried out by the expert medical team under the leadership of Dr. Kumud Dhital, Director of the Cardiovascular & Thoracic Surgery Department & Heart-Lung Transplantation Unit, is a notable achievement in the hospital’s dedication to offering state-of-the-art healthcare and advanced medical therapies.
The patient suffered from advanced heart failure, which led to kidney failure requiring dialysis and liver congestion. The cause of heart failure had not been diagnosed and contrast CT could not be done due to ongoing dialysis for acute chronic kidney failure. He was admitted to Kauvery Hospital with breathlessness at rest, swelling of both legs and breathing issues during the nights.
After a thorough assessment, the Pulmonology team led by Dr Srinivas Rajagopala considered a diagnosis of severe CTEPH and complex Sleep Apnea leading to heart failure. CTEPH is a condition in which permanent blood clots form in the major vessels leading from the heart to the lungs, causing heart failure due to the inability to pump blood into the lungs. Medications or stents are typically ineffective, and surgery is the only option. Perfusion scans confirmed this diagnosis in his case, prompting a change in the treatment plan.
His heart failure was aggressively managed, eventually leading to discontinuation of dialysis, while being supported with oxygen, home ventilator, anticoagulation, medications and home heart support by continuous milrinone pump. Subsequently, a careful dose-monitored contrast CT and pulmonary angiogram were done with caution to avoid worsening of his kidneys. This confirmed CTEPH and a complex pulmonary endarterectomy surgery was meticulously planned with inputs from pulmonology, cardiology and interventional radiology services.
The procedure involves placing the patient on a heart-lung machine and cooling the patient to 20°C with carefully controlled cardiac arrest. Careful removal of all the chronic organized clots from deep inside the pulmonary arteries is crucial for a complete cure & prevention of postoperative complications and this is why meticulous pre-operative planning is important. Post-surgery he was diligently monitored in the Heart-Lung Intensive Care Unit (ICU), where he made remarkable progress with normalization of pulmonary pressures and heart function, leading to a quick discharge by the eighth day of surgery. He remains off dialysis and has been able to stop oxygen, home ventilator, continuous heart support and most of his medications. He continues on anticoagulation pills alone to prevent recurrence of blood clots. He rejoined work after 4 weeks and resumed all activities now at 2 months post-discharge. Despite his complex medical condition, he exhibited remarkable morale and resilience throughout his treatment journey.
"We are delighted to share our success," said Dr. Srinivas Rajagopala, Senior Consultant, Interventional Pulmonology & Sleep Medicine, Director of Transplant Pulmonology & Lung Failure Unit at Kauvery Hospital. "While we are offering endarterectomy routinely, this patient had multiple reasons including CTEPH at its most end-stage leading to heart failure and our optimization of all factors and collaborative efforts led to a favorable outcome. This is possible only in a few collegiate environments like Kauvery Hospitals in this country” he added.
“We are delighted to see the results of the breakthrough surgical procedure, giving hope to many who could benefit with this. This further motivates us to continue to provide cutting-edge therapies and advanced techniques to ensure optimum outcomes every time. Kauvery Hospital continues to lead the way in revolutionizing healthcare, ensuring a brighter, healthier future for all.” said Dr. Aravindan Selvaraj, Co-Founder and Executive Director, Kauvery Hospitals.