Operation relief for man with bulging heart

MUMBAI: Until a month ago, 28-year-old Vishnu Yadav was scared to hear his own heartbeat. "I would feel as though my heart was trying to pop out. If I stood against a wall, one could hear it beat rapidly," said the mithai-maker from a small village in Bihar.

The reason for his unusual heartbeat was a rarest of rare complication: an oversized bulge emerging from one of his heart's chambers. It took heart surgeon Ramakant Panda five hours to surgically sort out Yadav's problem at Asian Heart Institute in Bandra-Kurla Complex.

"He had an aneurysm emerging from his left ventricle. While this in itself is rare for someone so young, what was surprising was the fact that the aneurysm was more than five times the size of his heart," said Dr Panda. The operation, he said, was as complex as doing a second bypass heart surgery, which is considered the most difficult of all cardiac surgeries.

Aneurysms are balloon-like structures that develop from the wall of an artery; they are so thin that they can fatally rupture in some cases. "When we opened his chest, we were shocked to find that the aneurysm stretched from the liver to the spleen. His heart was, in fact, pushed into a corner," said Dr Panda.

Doctors concluded that Yadav had an aneurysm from his birth. However, it started bulging out a few months ago when he lifted something heavy during a family function at his village, Kamlawadi Arraha. He started feeling breathless, giddy and weak. "I went to various local doctors for two to three months, but in vain."

Yadav came to Mumbai after an altercation with his family members. "My younger brother, who lives in Mahim, was initially upset that I had dropped in. However, he took me to J J Hospital in Byculla," said Yadav.

J J Hospital's cardiologist Anil Kumar, who treated Yadav, said: "Aneurysms from the left ventricle occur among patients who have had a heart attack, but Yadav had healthy arteries. Yet, he had one of the biggest aneurysms I have seen in 20 years."

The family was asked to consult Dr Panda, who agreed to operate on Yadav for free. "I can breathe and walk freely and plan to return home in a couple of months," said Yadav.

New cancer drug more potent than medicines

University of Missouri researchers have created a new drug that is 10 times more potent than current cancer-fighting drugs.

In a new study, MU medicinal chemists have taken an existing drug that is being developed for use in fighting certain types of cancer, added a special structure to it, and created a more potent, efficient weapon against cancer.

"Over the past decade, we have seen an increasing interest in using carboranes in drug design," said Mark W. Lee Jr., assistant professor of chemistry in College of Arts and Science.

"Carboranes are clusters of three elements — boron, carbon and hydrogen. Carboranes don't fight cancer directly, but they aid in the ability of a drug to bind more tightly to its target, creating a more potent mechanism for destroying the cancer cells," he explained.

In the study, Lee and his research team used carboranes to build new drugs designed to shut off a cancer cell's energy production, which is vital for the cell's survival.

All cells produce energy through complex, multi-step processes. The key to an effective drug is targeting the process that cancer cells depend on more than healthy cells.

By increasing the binding strength of a drug, a smaller dose is required, minimizing side effects and increasing the effectiveness of the therapy. With carboranes, Lee found that the drug is able to bind 10 times more powerfully.

"The reason why these drugs bind stronger to their target is because carboranes exploit a unique and very strong form of hydrogen bonding, the strongest form of interactions for drugs," Lee said.

Lee said that this discovery also would lead to further uses for the drug.

"Too often, after radiation or chemotherapy, cancer cells repair themselves and reinvade the body. This drug not only selectively shuts off the energy production for the cancer cells, but it also inhibits the processes that allow those cancer cells to repair themselves," he said.

"When we tested our carborane-based drugs, we found that they were unimaginably potent. So far, we have tested this on breast, lung and colon cancer, all with results," Lee added.

According to Lee, this is the first study to show systematically how carboranes can improve the activity of a drug. Lee believes this discovery will open additional possibilities of improving drugs that are used to treat other diseases, not just cancer.

While it will be several years before the new drug would be available on the market, Lee said that clinical trials could begin within the next two years.
Their study was published in the Journal of Medicinal Chemistry, a publication of the American Chemical Society.

In rare surgery, woman undergoes complete heart reconstruction

During the 10-hour operation at Asian Heart, blood supply to the patient’s brain had to be stopped for an hour and her body temperature kept at 18 degrees


In an extremely rare surgical procedure in India, a woman successfully underwent a complete heart reconstruction operation at the Asian Heart Institute in Bandra-Kurla Complex recently.

The complicated operation took 10 hours to perform and included five critical procedures. During the entire process, blood supply to the woman’s brain had to be completely stopped for an hour, and the woman’s body had to be kept cooled at 18 degrees.

While Veena Rane (name changed) was operated upon at Asian Heart in February, given the complexity of the case the doctors chose not to speak about it immediately, but to keep her continuously under observation and perform follow-ups until they were sure there were no complications.

“I have operated upon over 17,000 patients but never seen anything like this. I wanted to be sure before I spoke about it,” said cardiac surgeon Dr Ramakant Panda, adding that the patient’s condition was so sensitive that she could have died any moment. The fact that her father and younger sister had earlier died of similar heart complications was also taken into account.

What began last December as mere breathlessness and minor chest pain for the 36-year-old Nashik school teacher, turned out to be a rather complex ailment with doctors amazed to discover that every part of her heart was defective.

Following a series of tests and examinations, Veena was diagnosed with a bicuspid aortic valve - a condition wherein the aortic valve only has two leaflets, instead of three.

In addition, she had an aneurysm of the ascending aorta, hand arteries and brain arteries. In simple terms, her aorta (largest artery in the body), hand arteries (that supply blood to the arms) and brain arteries (that supply blood to the brain) were dilated.

Furthermore, Veena had an anomalous right hand artery which was situated on the left side of her heart, even as the left hand artery was already located on the left.

“We find only one or two of these complications in a single patient at one time. But such a combination of defects was new for me,” said Dr Panda. “In short, every part of her heart had a problem which needed to be dealt with,” he added.

Dr Panda and his team decided to perform a total heart reconstruction surgery on Veena. “This is a rather complicated procedure that has been done in some western countries, but probably never at one go in India,” he said.

Renowned cardiac surgeon Dr Sudhanshu Bhattacharya, who is known for his innovations on the operation table, agreed that Veena’s was a rare case presenting multiple complications at the same time. “It is definitely a rare and a challenging surgery,” said Dr Bhattacharya.

According to Dr Prafulla Kerkar, head of KEM Hospital’s cardiology department, the team of doctors need a pat on the back for successfully carrying out such a tricky procedure. “I don’t know of any other centre that would have taken up the challenge,” he said.

On Wednesday, Veena’s family said they were very relieved with her recovery. Her brother said, “She is driving around the city, going to work and leading a very normal life now.

We find it hard to believe that she underwent such a complicated heart surgery.” He added that the entire procedure cost around Rs 13 lakh.

 The five procedures

Valve replacement
Veena had a leaking valve due to which blood supply to the heart was disturbed. To start with, Dr Panda replaced the aortic valve with a bioprosthetic one.

Reimplanting coronary artery
According to Dr Panda, the aorta or the main pipe had ballooned out considerably in Veena’s case due to which the coronary artery was bulging out. “Therefore, we had to reimplant the coronary artery to a new artificial aorta,” explained Dr Panda.

Reimplanting hand and brain arteries
Due to a severe aneurysm in the arteries carrying blood to the brain and arms, the doctors decided to reimplant them too. “In order to work in a blood-free surgical field, we had to completely stop blood supply to the entire body including the brain while performing the reimplantation for about an hour,” said Dr Panda. He added that the patient was put on a heart-lung machine and the body was cooled down to 18 degrees which allowed them to carry out the reimplantation.

Experts say that at normal temperature, any more than three minutes of stopped blood supply to the brain could result in permanent damage. “Here we needed the blood supply to be stopped for about an hour. It was like operating on a dead body and running against time,” said Dr Panda.

Redirecting the right hand artery
As Veena’s right hand artery was located on the left of her heart, the doctors redirected it to the right side.

Elephant trunk
To direct blood flow into the descending aorta, which supplies blood to the rest of the body, an ‘elephant trunk’ shaped implant was fixed to the first graft. This resulted in a piece of implant hanging inside the patient’s aorta which looks like elephant’s trunk. “A descending aorta stent will be inserted through the elephant trunk about four months later,” said Dr Panda.

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Dr Ramakant Panda