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Chennai: The aorta is the largest blood vessel in the body and is the blood vessel that carries oxygen-rich blood away from the heart to all parts of the body. The commonest diseases of the aorta requiring invasive treatment include Aortic Aneurysm which is an abnormal swelling of the wall of the aorta or Aortic Dissection which is a tear in the wall of the aorta. Both these conditions can be life threatening and replacement of the diseased aorta with a synthetic graft is the best treatment. When left untreated, such aneurysms can rupture and majority of patients die in 3 to 4 minutes making it very unlikely for quick treatment to be delivered in that short period.
Mr S K who hails from Vijayawada had an aortic repair done with stent grafts in 2016 for a life-threatening condition. Over the last few weeks, he became increasingly unwell and his family including his son and wife were very concerned and took him to various hospitals at Vijaywada. He was diagnosed of severe renal failure and blood loss due to a leaking aortic aneurysm. Treatment for aortic diseases is only offered by a few centres in the country. Therefore the patient obtained opinions from various leading surgeons in Vijaywada, Bangalore and Chennai. All concluded that no treatment can be offered for Mr S K’s critical condition and that fatality was unavoidable.
In despair, the family contacted Dr A B Gopalamurugan, senior interventional cardiologist and Chief of Aortic Interventions at Kauvery Hospital’s newly-opened 24-hour Aortic Department. Dr Gopalamurugan is renowned for taking on very high risk patients for heart and aortic diseases and is a pioneer in various cutting edge treatments in the country. The 24-hour Aortic Department at Kauvery headed by Dr Gopalamurugan consists of various super-specialists including Cardiovascular Surgery headed by Dr Raguram, Vascular Surgery headed by the pioneer Prof Sekar, Renal Medicine headed by Dr Balasubramanian and Cardiac Radiology by Dr Zeeshan. Mr S K was urgently transferred to Chennai to Kauvery Hospital for immediate treatment.
After initial assessment, Dr Gopalamurugan was shocked to observe the critical status of the patient. He had a blood level (Heamoglobin) of 5 (normally over 10) and significant kidney impairment. He had a CT scan within minutes in the state of the art scanner for aortic diseases at Kauvery which revealed a massive aneurysm measuring about 10cm in the chest wall which had slowly started to leak. Dr Gopalamurugan realised why no one in the country was prepared to treat Mr S K as the treatment options were limited. With the possibility of only life or death, a high risk procedure was planned and executed by Dr Gopalamurugan to prevent death and maintain quality of life.
CT scan on arrival showing massive aneurysm of Aorta, and 3D image of the Aorta showing the large blood leak into the aneurysm in the chest wall
The aortic team then put in their best over the next 6 hours. The plan was to treat the kidney disease, replace lost blood immediately, perform a high risk procedure through the groin vessels to seal the leak and most importantly perform all of these simultaneously as time was not a luxury. The patient was anaethetsisec by the cardiac anaesthetists. Chief Renal physician Dr Balasubramanian immediately performed dialysis for the patient. Professor Sekar and team immediately started to expose the groin vessels. Dr Raguram, Chief Cardiac Surgeon provided back up cardiac surgical support.
Dr Gopalamurugan then deviced an indigenous plug using a routine existing stent graft and this is called as a “Candy Plug”. This device was designed and created in the cardiac cath lab. This “Candy Plug” was then used to seal off the aneurysm leak by introducing it into the groin vessel and then navigating it into the neck of the aneurysm leak. This immediately sealed off the aneurysm and leak. The patient stabilised. The patient could come of anaesthesia on the same day and in a day the patient started feeling better and starting walking 2 days later.
CT Scan after the procedure showing the leak completely sealed off, and 3D image of the aorta after the “Candy Plug” technique showing no leak into the anurysm.
Mr S K and his family are extremely glad that what was deemed a mortal condition has now been treated to have their loved family member back alive and more importantly able to have a normal quality of life.
Diseases of the aorta require a large team of highly trained experts available 24-hours a day and equipped with all the latest machinery to be able to deal with any eventuality as the aorta supplies blood to almost every single organ in the body. Therefore dealing with aortic diseases requires vast experience and skills along with attention to detail to achieve good outcomes.
Dr Gopalamurugan, head of aortic interventions feels that it is most important that patients get to such aortic departments quickly as every minute lost can cost the life of a patient. Awareness of aortic disease and its treatment and available centres will help patients get the right treatment at the right time thereby saving lives and their loved ones’ hopes.
