The Telegraph
Since 1st March, 1999
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Rare cardiac condition set right

When Uzir Ahmed landed in the city to seek medical advice for a cardiac condition which doctors in Dhaka had failed to address, little did he realise that he himself would soon be at the heart of a rare medical procedure in Calcutta.

The 35-year-old Bangladeshi had scarcely suspected anything could be seriously amiss, till he complained of chest pain in May this year, and suffered a mild heart attack. Investigations in Dhaka revealed that unlike normal individuals, he had his heart on the right side of his chest, a condition called ‘dextrocardia’.

The doctors did an angiography, which showed a 100 per cent occlusion or block in the right coronary artery, and Ahmed was referred to Calcutta for angioplasty. He ended up at the Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), after a few other heart hospitals in the city gave him only a “50 per cent chance”.

“Dextrocardia is a very rare condition, afflicting less than 0.6 per cent of the population, and a cardiac interventionist may not encounter such a case even once during his lifetime. On top of that, the patient had chronic total occlusion, which called for a complex angioplasty,” said J. Naik, consultant coordinator, invasive cardiology services, RTIICS.

Naik performed the angioplasty on Ahmed on Thursday to open his blocked vessel, and the patient was discharged on Sunday morning from the super-speciality heart hospital off the E.M. Bypass. “He is doing fine and the entire family is relieved,” said a relative.

“I think this is the first time that such a procedure has been done in Calcutta on a dextrocardia patient, and I would be happy to share my rare clinical experience with fellow-cardiac interventionists,” said Naik.

The procedure was fraught with “technical challenges”. Routine coronary guide catheters or Judkins catheters were not useful in this case, since they “don’t sit comfortably” on the mouth of the artery. “So, we chose the Amplatz catheter, which takes time to manipulate. Besides, we had to change the camera angle from the conventional view of left side cranial to right anterior oblique to be able to sight the distant part of the artery,” Naik explained.

The total occlusion was crossed with a stiffer guide wire and subsequently, ballooning and stenting was done. “Since it’s a large vessel, the possibility of restenosis (regrowth of cells around the stent) is less than 15 per cent and the patient may not need a repeat procedure. He just has to follow the same lifestyle norms as the rest of the population with coronary artery disease,” said the doctor.

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