Cardiothoracic And Vascular Surgery Department

The department of CTVS at Fortis Hospital Mohali is fully equipped and manned by trained surgeons to deliver best surgical results to both Adult and Paediatric Cardiac Patients. This is the largest Cardiac and Heart Surgery Hospital setup North of Delhi in India , which offers total cardiac care under one roof. The centre is performing more than a thousand heart surgery operations annually with a success rate matching international benchmarks from Neonates to adults. All patients can be treated for their cardiac and heart ailments as the centre is one of the best equipped Heart Surgery Hospitals in India with high-precision gadgets in the operation theatres, surgical intensive care areas which are comparable to international standards, new generation heart-lung machines, intra aortic balloon pumps, telemetry monitors, ventilators, cell savers, and cardiac hill room beds to name a few are regularly used.

The surgeries done in Cardiac Surgery is from New Born to Geriatric age group:

1. CABG (Coronary Artery Bypass Graft)
2. Valve Surgeries (AVR - Aortic Valve Replacement, MVR - Mitral Valve Replacement, DVR-Double Valve Replacement)      
3. Valve Repairs and Bentall procedure
4. Combo Procedures: CABG plus Valve, Valve plus Congenital
5. Congenital Heart Surgeries
   i) Arterial Switch
   ii) TOF (Tetralogy of Fallot) total Correction,
   iii) Fontan surgery,
   iv) TCPC-Total Cavo-Pulmonary Venous Connection,
   v) Conduit Operations,
   vi) TAPVC surgery,
   vii)ASD-Atrial Septal Defect, VSD-Ventricular Septal Defect, Surgical Closure of PDA - Patent Ductus arteriosus, Coarctation and Shunt Surgeries (BT Shunt, Bidirectional Glenn Shunt).
6. Redo Surgeries: Redo CABG, Redo Valve surgery, Redo Congenital Heart Surgery
7. Cardiac Remodelling Aneurysm repairs:
   Ascending/Descending/Abdominal Aorta
   aneurysm repair, 
8. Vascular surgeries: Femoral-Femoral Bypass,
   Femoral-Popliteal Bypass, Aorto-Femoral Bypass
9. Thoracic procedures: Thoracotomy,
   Mediasternotomy, etc.

1) CABG

This particular heart surgery procedure is done to bypass clogged arteries supplying the heart

Coronary arteries are the small blood vessels that supply the heart muscle with oxygen and nutrients. Fats and cholesterol can accumulate inside these small arteries, and the arteries can gradually become clogged. This buildup of fat and cholesterol plaque is called atherosclerosis.

When one or more of the coronary arteries becomes partially or totally blocked, the heart does not get an adequate blood supply. This is called ischemic heart disease or coronary artery disease (CAD). It can cause chest pain (angina).

Sometimes CAD does not cause pain until the blood supply to the heart becomes critically low, and the muscle begins to die. The first symptom of CAD in this case may be a potentially deadly heartattack. Symptom less CAD is especially common in diabetics.

OVERVIEW OF THE PROCEDURE

Heart bypass surgery creates a detour or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. The surgery is commonly called Coronary Artery Bypass Graft, or CABG (pronounced "cabbage").

After the patient is anesthetized and completely free from pain, the heart surgeon makes an incision in the middle of the chest and separates the breastbone.

Through this incision, the surgeon can see the heart and aorta (the main blood vessel leading from the heart to the rest of the body). After surgery, the breastbone will be rejoined with wire and the incision will be sewn closed

2. Aortic valve replacement is an "open heart" procedure performed by cardiothoracicsurgeons for treatment of narrowing (stenosis) or leakage (regurgitation) of the aortic valve.

The aortic valve may malfunction for several reasons. For example, the aortic valve may be abnormal from birth ( congenital aortic valve disease), or it could become diseased
with age (acquired aortic valve disease).

The most common congenital abnormality is a bicuspidaortic valve. As shown below, the aortic valve normally has three leaflets, but a bicuspid aortic valve has only two. It may, therefore, not open or close completely.

A bicuspid aortic valve is a common abnormality and occurs in 1-2% of people. This is the second most common cause of aortic valve disease requiring surgery. Such valves may function normally for years before becoming stenotic, regurgitant, or both. People with a bicuspid aortic valve require antibiotic prophylaxis before dental procedures but generally no other special precautions are required other than regular follow up with a qualified cardiologist.

Tricuspid (left) and Bicuspid (right) Aortic Valves

The most common cause of aortic valve disease requiring surgery is called " senile aortic calcification, " meaning that the
valve has worn out with age. When a valve becomes worn, the body deposits calcium on it for reasons that are unknown. The calcium restricts or limits the motion of the valve leaflets. This may prevent the valve from opening (causing stenosis) or closing (causing leakage or regurgitation). Less common causes of aortic valve disease include diseases of the aorta, the main blood vessel coming out of the heart and carrying blood to the rest of the body, including ascending aortic
aneurysms, aortic dissection, and Marfan's syndrome.

ARE THERE ANY WARNING SIGNS FOR A FAILING AORTIC VALVE?

A failing aortic valve may cause a variety of symptoms including shortness of breath, chest pain (angina pectoris), and dizziness or loss of consciousness (passing out).

A narrow valve makes the heart work harder just to pump the blood through the valve to the body. A leaky valve lets blood back into the heart after it has been pumped out. The heart must therefore pump more blood forward to make up for the blood that is leaking backwards. Either way the extra work may cause symptoms of heart failure, such as shortness of breath. Early on the shortness of breath may be noticeable only with exercise. Later, with the progression of valve disease, a patient could experience shortness of breath with even light activity or at rest. Some patients will be unable to sleep flat in bed or may awaken from sleep short of breath. Another sign of heart failure that may occasionally occur is swelling of your feet, particularly prominent later in the afternoon or evening although other conditions, such as varicose veins, can also cause this to occur.

The extra work the heart has to perform may also cause chest pain or angina pectoris similar to the symptoms of a heart attack. It may be difficult to tell the difference between heart valve disease and narrowing of the blood vessels to the heart itself
(coronary arteries).

Aortic valve disease may also cause dizziness, light headedness or even fainting spells.

3. Bentall procedure

operation for repair of Type A aortic dissection, aneurysm of the
proximal ascending aorta, and aortoannular ectasia. It consists
of replacement of the root and proximal ascending aorta with a tube graft containing a prosthetic valve and re-implantation of the coronary arteries into the graft. Postoperative complications include leakage at the suture lines resulting in pseudoaneurysm of the aortic or coronary anastomosis.

Plain radiography may disclose enlargement or aneurysmal bulging of the right superior mediastinal margin after surgery. Pseudoaneurysms can be demonstrated by X-ray aortography, CT, MRI and contrast-enhanced three-dimensional MR angiography. Periaortic haematoma can be demonstrated by CT and MRI.

4. FONTAN SURGERY

The Fontan procedure is a surgery that redirects blood returning from the body to the lungs instead of to the right side of the heart. The superior and inferior vena cava are sewn to the pulmonary artery, a baffle is placed across the right atrium, and the shunt from the BT Shunt procedure is removed.

5. ASD

Atrial septal defect is an abnormality of the upper chambers of the heart (atria) where the wall between the right and left atria does not close completely. This defect is present at birth (congenital).

Atrial septal defect (ASD) is a congenital heart defect. In fetal circulation there is normally an opening between the two atria (the upper chambers of the heart) to allow blood to bypass the lungs. This opening usually closes about the time the baby is born. If the ASD is persistent, blood continues to flow from the left to the right atria. This is called a shunt.

ASD is present in 4 out of 100,000 people. When the person has no other congenital defect, symptoms may be absent, particularly in children. Symptoms usually have manifested by age 30. Individuals with ASD are at an increased risk for developing a number of complications including:

• infective endocarditis (a bacterial infection of the heart).
• heart failure.
• an abnormally fast heart rhythm known as atrial fibrillation.

Symptoms

• frequent respiratory infections in children
• difficulty breathing (dyspnea)
• shortness of breath with activity
• sensation of feeling the heart beat (palpitations)

6. VSD

Ventricular septal defect describes one or more holes in the muscular wall that separates the right and left ventricles of the heart -- the most common congenital (present from birth) heart defect.

Before a baby is born, the right and left ventricles of its heart are not separate. As the fetus grows, a muscular wall forms to separate these lower heart chambers. If the wall does not completely form, a hole remains. This is what is known as a ventricular septal defect, or a VSD.

It is estimated that up to 1% of babies are born with this condition. In the vast majority (80-90%) of babies born with this condition, the hole is small. They will have no symptoms, and the hole will close spontaneously as the muscular wall continues to grow after birth.

If the hole is large, then too much blood will be pumped to the lungs, leading to congestive heart failure. These babies are often have symptoms related to the problem and may need medicine or surgery to close the hole.

As with most types of congenital heart disease, no one knows what causes VSDs. This defect often occurs along with other congenital heart malformations. In adults, interventricular septal defects are a rare, but serious complication of heart attacks. These holes are related to the heart attack and do not result from a birth defect.

Symptoms  

• shortness of breath
• breathing fast
• breathing hard
• paleness
• failure to gain weight
• fast heart rate
• pounding heart
• sweating while feeding
• frequent respiratory infections in children

7. TOF

A type of heart defect present at birth (congenital) consisting of four different abnormalities. It usually results in insufficiently oxygenated blood being pumped to the body causing cyanosis (bluish discoloration of the skin).

The cause of most congenital heart defects is unknown. Multiple factors seem to be involved. Prenatal factors associated with higher than normal risk for this condition include maternal rubella or other viral illnesses during pregnancy, poor prenatal nutrition, maternal alcoholism, mother over 40 years old, and diabetes.

There is a higher incidence of tetralogy of Fallot in children with Down syndrome (a common genetic disorder which results
from having an extra 21^st chromosome).

Tetralogy of Fallot is classified as a cyanotic heart defect because the condition causes insufficiently oxygenated blood to be pumped to the body, which leads to cyanosis (a bluish-purple coloration to the skin).

The classic form of Tetralogy includes 4 defects within the heart structures:

• Ventricular septal defect (hole between the right and left
  ventricles)
• Narrowing of the pulmonic outflow tract (tube that connects the heart with the lungs)
• An aorta (tube that carries oxygenated blood to the body) that arises from both ventricles, rather than exclusively from the left ventricle
• A thickened muscular wall of the right ventricle (right ventricular hypertrophy)

There is flow of deoxygenated (blue) blood into the general body circulation and decreased blood flow to the lungs.

At birth, infants may not show the signs of the cyanosis, but later may develop sudden frightening episodes of bluish skin from crying or feeding (called "Tet spells"). Tetralogy of Fallot occurs in approximately 5 out of 10,000 infants.

Symptoms   

• Difficult feeding (poor feeding habits)
• Failure to gain weight
• Poor development
• Cyanosis which becomes more pronounced during periods of agitation
• Passing out
• Sudden death
• Clubbing of fingers (skin or bone enlargement around the finger nails)
• Squatting during episodes of cyanosis

8. PDA

Patent ductus arteriosus (PDA) is a condition where the ductus arteriosus, a blood vessel that allows blood to bypass the baby's lungs before birth, fails to close after birth. The word "patent" means open.

Prior to birth, blood flow in the fetus bypasses its lungs because the fetus gets oxygen through the placenta. After birth, the ductus arteriosus and foramen ovale close because blood must then go to the infant's lungs

PDA occurs in about 1 in 2,000 infants. Premature infants and those with respiratory distress syndrome are at higher risk. PDA is also associated with coarctation of the aorta, transposition of the great vessels, and ventricular septal defect.

Symptoms

• poor feeding habits
• shortness of breath

9. ANEURYSM

A thoracic aortic aneurysm is a localized expansion of the wall of the aorta.

Causes, incidence, and risk factors    

Atherosclerosis is by far the most common cause.

Thoracic aneurysms occur in the ascending aorta (25% of the time), the aortic arch (25% of the time), or the descending thoracic aorta (50% of the time).

Risk factors include various connective tissue disorders (such as Marfan's syndrome), atherosclerosis, previous dissection of the aorta, prolonged hypertension, and trauma (usually falls or motor vechicle accidents).

Symptoms    

Most patients have no symptoms until the aneurysm begins to leak or expand. Most non-leaking thoracic aortic aneurysms are detected by tests -- usually a chest X-ray or a chest CT scan -- run for other reasons. Chest or back pain may indicate acute expansion or leakage of the aneurysm.

The treatment depends on the location of the aneurysm.

• Dr. Gurcharan S. Kalra
• Dr. H K Bali
• Dr. Jagmohan Varma
• Dr. Rakesh K. Jaswal
• Dr Arun Kochar