Fortis Hospitals Mulund doctors give new life to octogenarian with DVT and severe hip fracture in the same leg

~Minimally invasive surgery done resulting into no blood loss and early discharge~

Doctors at Fortis Hospitals, Mulund, Mumbai recently treated an exceptional case of DVT (deep vein thrombosis) and hip fracture in the same leg of an obese octogenarian lady.

Mrs. Godavari Vagad, an 84yr old obese lady had fallen while walking and fractured her left hip. She also had Deep Vein Thrombosis of the left leg. Doctors at a general hospital in Thane found her condition very critical and referred her to Fortis Hospitals, Mulund (formerly Wockhardt hospital).

Highlighting upon the case, Dr Milind Sawant, Consultant Orthopedic Surgeon, Fortis Hospitals said, “We faced key challenges like advanced age, obesity, osteoporotic bones and pre-existing DVT, all at one go. These implied difficulty in operative procedure and fracture reduction. Osteoporotic bones made fracture fixation challenging. Also, the presence of DVT in the leg to be operated increased the risk of the clot breaking up and embolising during fracture fixation and so fracture manipulations would have to be done carefully. Hence we had to consult a cardiologist before finalizing the line of management.”

Dr Hasmukh Ravat, cardiologist said, “What makes this case rarest of rare is the introduction of IVC filter (Inferior Vena Cava) implantation. A filter was put into the Inferior Vena Cava pre-operatively so that even if the blood clot was to break off and flow towards the lung, the filter would trap it before it would compromise the lung circulation.”

After insertion of the IVC Filter, the patient was taken for the orthopedic line of treatment :
“Minimally invasive technique of per-cutaneous insertion of Proximal Femoral Nail (device) was used to fix the fracture without opening the fracture site – which meant minimal blood loss (and therefore no need for blood transfusion), minimal tissue trauma (and therefore less pain and faster recovery) and no disturbance of the fracture hematoma (which meant early fracture healing without need for bone-grafting). A high-frequency, high resolution C-arm Image Intensifier (machine) was used which gave clear images of the fracture fragments and made fracture reduction and fixation easy and accurate said Dr. Sawant.

In addition to the above, a titanium implant was used to fix the fracture, whose modulus of elasticity is closer to that of bone. The device is light but extremely strong to take the weight of this obese patient. Being an intra-medullary device it was biomechanically superior to take the stresses and strains at the fracture site till the fracture unites. This allowed early mobilization of the patient out of bed and early discharge, he said.

The recovery was uneventful and patient was discharged after few days.

Fortis Hospitals Mulund (formerly Wockhardt Hospitals) performs complex beating heart coronary artery bypass surgery on an infant.

A team of cardiac experts at Fortis Hospitals Mulund (formerly Wockhardt Hsopitals) performs complex beating heart coronary artery bypass surgery on an infant.

Fortis Hospitals Mulund (formerly Wockhardt Hospitals) marks a feat in the field of pediatric cardio-thoracic surgery by performing a complex beating heart coronary artery bypass surgery on an infant. A team of cardiac experts led by Dr. Suresh Joshi, Consultant Pediatric Cardiac Surgeon, Fortis Hospitals Mulund has successfully corrected a complicated and rare congenital deformity called ALCAPA (Anomalous Left Coronary Artery From the Pulmonary Artery) giving the baby a new lease of life.

Baby Sharon was born with normal delivery without any specific symptoms of heart defect during her birth. However after 4 months she suffered from severe cold and cough and was admitted in a city hospital as she was diagnosed of pneumonia. The baby seemed to suffer from increased breathlessness with a very high heart rate. On further investigation the baby was diagnosed of having an enlarged heart and the parents were advised to consult a pediatric cardiac surgeon.

“Baby Sharon was brought to us in a severe condition where she was suffering from severe breathlessness, excessive crying and was extremely feeble due to poor intake of feed. Upon further investigation we diagnosed her with a congenital heart defect called ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery). ALCAPA is a rare birth malformation where the positions of the arteries are switched and the left coronary artery comes out of the pulmonary artery. It occurs in approximately in 1 in 4-5 lakh live births (0.25% - 0.5% of the total birth defects) and if not treated at the appropriate time accounts for 65 % - 85 % of deaths with in 1st yr of life from congestive cardiac failure,” said Dr. Suresh Joshi, Consultant Pediatric Cardiac Surgeon, Fortis Hospitals Mulund.

At the time of birth babies born with such deformities remain active like any normal child but as the child grow the symptoms manifests into breathlessness, inactivity and weak intake of food and they grow very weak and uncontrollable.

“ALCAPA is a serious problem and requires surgery immediately after the birth or as soon as the diagnosis is confirmed. The aim of surgery is to connect the Anomalous left coronary artery with the aorta. The precise surgery depends on the exact location of the Anomalous left coronary artery. Sometimes, it can be moved, along with a button of tissue, from the pulmonary artery and sewn into the aorta. If the Anomalous left coronary artery is located too far away from the aorta to move, a "tunnel" is made from the aorta to the Anomalous left coronary artery or by pass surgery is done by using artery of left arm.”

“Usually to perform such complex surgery heart lung machine is required which is also commonly called On-pump bypass surgery. However in the case of Baby…. we performed the surgery successfully without using heart lung machine, which means, off pump Coronary artery Bypass Graft (CABG) procedure with the self equipped instruments. Off pump bypass surgery are much common in the adult procedure group, but in neonates such procedure till date is only heard off” added Dr. Suresh Joshi, Consultant Pediatric Cardiac Surgeon, Fortis Hospitals Mulund.

The challenges that involve in this surgery were:

1. Grafting vessels on a moving heart which needs small compact stabilizer. Stabilizer for small neonate is not devised till date.

2. Left coronary artery was not appropriate for the graft

3. Poor functioning heart of the baby, Ejection fraction = 25%

Beating heart surgery was performed on the baby to avoid the post operation complication like fluid retention, kidney failure, lung injuries, and acute inflammatory reaction with mild to moderate heart dysfunction, hence helping the baby for the easy & early recovery. The surgery was done without using any stabilizer as such small size stabilizer for newborn babies is not manufactured by any company in the world. It is with the skill of the surgeon who has managed out the surgery without the stabilizer. Baby Sharon’s story showcases the expertise the country has in correcting the most complex congenital defects in the rarest of condition with a combination of skillful hands and technical finesse.

“The diagnosis of Sharon suffering from congenital heart problem came to us as a surprise. When Sharon was not keeping too well, we had the remotest thought of having anything to do with her heart. In fact before this I had very less awareness on congenital heart problems. In our country many kids succumb to faith due to lack of awareness on the defects and availability of expertise to correct such deformities. We need to create more and more awareness on congenital heart disease in India and the facilities provided by hospitals like Fortis Hospitals Mulund to operate upon the most complex cases. We are immensely thankful to Dr. Suresh Joshi and the entire team at Fortis Hospitals Mulund who came to us as saviors and gave a new life to our baby” says Mr. Bonni D’Souza (father of Sharon).