Aneurysmal ballooning of coronary artery closed successfully sans surgery
| Date :10-Sep-2019 |
A grab of the screen showing the device with the help of which the procedure was performed.
Principal Correspondent :
Device closure of aneurysm by catheter done on a 52 year-old patient by SSH cardiologisits
The surgery was first case in the world
Dr P P Deshmukh
A man suffering from heart disease with a stent placed in his coronary artery in 2014, was admitted in emergency in SSH’s respiratory unit due to torrential blood expectorated from lung, on August 8. To stop bleeding, attending doctors initially did it by drugs. To this, the 52-year-old patient responded within a day. On conducting CT scan, doctors noticed a huge 6x4 cm aneurysmal ballooning originating from heart. This aneurysm was touching the right lung and had partially ruptured it resulting in massive bleeding. In the coming week, the patient coughed out blood, about 100 ml each time. He was then referred to Cardiology Department where a repeat CT contrast angiography was done, that revealed that this aneurysm was originating from right coronary artery.
His real time angiography also confirmed the same. Till date, the only management option described in literature is resection of aneurysm by on pump open cardiac surgery. The case was discussed with Cardio Vascular Thoracic Surgeons who explained the very high risk surgery as the aneurysm was adherent to covering of heart called pericardium. Dr P P Deshmukh, Associate Professor in Cardiology at Super-Speciality Hospital (SSH) was of the opinion that this case could be managed by catheter closure as the aneurysm neck was narrow and a device could be jutted inside it which would ultimately prevent the aneurysm from expanding. It would gradually closed.
The device which is like a button and used for closing another heart ailment called patent ductus arteriosus was considered for use. Sharing the success of the rare surgery with ‘The Hitavada’,Dr Deshmukh said, “The most difficult part was to convince relatives of the patient. They outrightly rejected the idea as they felt there was high risk involved in surgery and consented to pay from their pockets as patient had already bleeding. It could have been fatal.”
The procedure of device closure was performed by Dr P P Deshmukh, assisted by Dr Mahendra Maske and Dr Sandeep Chourasiya on August 30. The procedure warranted great deal of planning, precision and skill as there was no scope of imperfection as the life of patient was at stake. It also required multiple exchanges of guide wires and catheters. It was successfully completed with valuable inputs from Head of the Department Dr Mukund Deshpande and Dr Sunil Washimkar. The patient was discharged on September 3 uneventfully. Thorough literature search failed to reveal even a single report of such case dealt in such novel way. Doctors in SSH will be shortly sending this case in a reputed journal for publication, Dr Deshmukh made it clear.