Team of doctors saves life of man with 15 per cent active heart

Timely and prompt treatment by a multidisciplinary team of doctors at Max Hospital, Saket, provided a new lease of life to a man whose heart functioned merely at 15 per cent of its capacity. In addition to his complications, he had also developed acute renal failure post his heart operation. However, his life was saved after a set of complex surgeries.

The hospital said that the man was suffering from end-stage heart failure at Max Hospital and soon after the heart transplant, he developed acute renal failure raising the risk of organ rejection. The hospital told that the doctors managed the patient efficiently, who is now fully recovered three months after his surgery.

29-year-old Raj Kumar Rawat was brought to the emergency of Max, Saket in June in a critical condition and was diagnosed with Class IV dyspnea (shortness of breath) and only 15 per cent of heart function, is also a known case of severe LV dysfunction.

The hospital said that medical investigations during hospitalization revealed that Rawat's chest had an enlarged heart with fluid accumulation in the pleural cavity which could be an after-effect of a series of heart surgeries. "Earlier in 2012 he had undergone a major heart surgery at the age of 21 years, for treating the abnormal thickening of his heart muscles that caused severe disruption in the pumping efficiency of the heart. Later in 2015, the patient had a dual chamber pacemaker implantation," the hospital informed.

"He underwent the procedure where his heart was replaced with a donor heart, and upon being hemodynamically stable he was extubated after 1st postoperative day," said Kewal Krishan, Director - Heart Transplant & Ventricular Assist Devices, Principal Consultant - Cardiac Surgeon, Max.

"Since two of his heart valves were not functioning effectively causing backward flow of the blood leading to the mixing of oxygenated blood with the de-oxygenated blood. ECHO also revealed a uniform decrease in the motion of his ventricles causing the pumping pressure to reduce to 55 mm Hg. With his deteriorating condition and looking at the history of the patient, he was advised for an immediate orthotopic cardiac transplant procedure," he explained.

The hospital said that even though the blood flow in the patient's heart was hemodynamically stable, he had intermittent Atrial Fibrillations, a condition when irregular heartbeats occur. The situation may elevate to clot formation or even heart failure. Doctors told that he was instituted with antiarrhythmic medications and immune-suppression strategy as per the protocols.

However, the post-operative investigations revealed that the patient had developed mild RV dysfunction with increasing TLC count. "He had to be electively re-intubated when the team observed oliguria (low Urine output) and immediately consulted the nephrology team," Krishan said.

Rawat was administered with Continuous Renal Replacement Therapy (dialysis for acute renal failure) to revive his kidney functioning. "After three days the patient showed improvement in urine output and his last Sustained Low Efficiency Dialysis (SLED) was done. As his haemodynamics improved and R.V. dysfunction resolved he was extubated and gradually started on a regular diet," Krishan informed.

Rawat was later transferred to the general ward where his pacing wires were removed and review was done, which showed good biventricular functions. "The rest of his recovery was satisfactory and he got discharged in stable condition to remain on close follow up," the hospital stated.