Woman undergoes rare quadruple bypass for abnormal heart arteries at Ojas
KI Singh/ royalpatiala.in/ Chandigarh
A 68-yr woman underwent a rarest surgery of abnormal heart arteries on beating heart successfully at a private hospital in Panchkula recently.
Giving details of surgery, Dr Virendar Sarwal, director of cardiothoracic & vascular at Ojas Hospital said that anomalies of arteries is very rare especially for the main artery i.e. left anterior descending artery (LAD). Its somewhere between 0.64% to 1.30% and most of them are benign. But if they get diseased, it become serious as the supply to major area of the heart supplied by LAD to the tune of 50% is at risk and angina is quite severe.
The patient angiogram showed LAD arising from the right coronary artery (RCA) proximal part and then crossing over the right ventricle to descend along intraventricular septum, informed Dr Sarwal.
RCA was 100% blocked and PDA/PLV branch of RCA was filling retrogradely through collaterals. Most of the septal branches were arising from this abnormal origin artery making it more important and to be taken care of during surgery. The other left side artery ramus intermedius was also critically blocked.
The patient was taken for CABG and 4 grafts were put on her including left internal mammary artery. The crucial part of surgery was to identify the site of arteriotomy in the abnormal origin LAD and to identify whether the other LAD required graft or not, said Dr Sarwal.
This type of malignant anomaly may result in blackout, sudden death, irregular rhythm and heart failure. In fact this is the second leading cause of death in the athletes as 19% when it is coupled with disease of other arteries, he remarked.
Moreover surgical intervention requires more attention and care as to give proper revascularization more so in off pump or beating heart surgery, as wrong anastomosis can lead to intra-operative ischemia, arrhythmias and other problem, maintained Dr Sarwal.
The patient was discharged on 6th postoperative day in stable condition, said Dr Sarwal adding only 9 such cases have reported worldwide till 2016 so far, he pointed out.