The Telegraph
Since 1st March, 1999
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Medical feat in aorta repair

For Asit Ranjan Sen, it was like being born again. The 57-year-old professor of mathematics has recovered from a cardiovascular emergency following a rare surgery at a city heart hospital, and the success of the “extremely critical” procedure promises to open up new vistas in the treatment of cardiovascular conditions in eastern India.

Sen was admitted to Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS) with acute dissection of the aorta, which is a tear or a split in the main blood vessel of the body arising from the heart and ending in two divisions, each supplying the legs.

“It causes a rupture of the aorta, disconnecting the principal arteries to the brain, kidneys and intestines, from the circulation. The condition has a world-wide mortality rate of 20-25 per cent, but in our country, almost nine out of 10 emergency aortic dissection cases are fatal,” observed cardiac surgeon Kunal Sarkar, who headed the team that performed the landmark ‘repair of ascending aortic dissection’.

The patient was referred to RTIICS as “an emergency” by another cardiac centre on February 15, with an exclusive aortic dissection involving the entire extent of the aorta, from its origin in the heart up to the legs. He was operated upon two days later and the split was repaired with a prosthetic graft, along with repair of the aortic valve.

After two weeks of intensive post-operative critical care, Sen is preparing to return to his Lake Town home. “The doctors have told us he can go back to his college after a couple of months’ rest and we are all delighted,” said daughter-in-law Kajari Sen.

Surgeons at the super-speciality cardiac institute off the Bypass maintained, while they have treated four to five cases of aortic aneurysm, or the chronic version of aortic dissection before, emergency dissection cases are “quite uncommon” and often go undetected.

“The symptoms — excruciating and sudden pain between the shoulder blades — can often mimic a severe myocardial infarction (or a heart attack). Since detection is rare, it usually presents itself as a medical catastrophe. But our professor friend was lucky, since his condition was diagnosed by one of the doctors treating him initially,” says Sarkar.

The technically demanding operation, “which makes a three-vessel CABG (coronary artery bypass grafting) seem like child’s play”, was done at the cost of “standard cardiac procedure cost” by the institute, keeping in mind the rarity of the problem. “Given the magnitude of the operation, the cost to the patient would have run into several lakhs, which is why such emergencies are more readily tackled in the West and so often turn fatal in our country,” said RTIICS clinical director Ashutosh Raghuvanshi.

Echocardiogram and CT scan are used to detect the rare condition, often precipitated by the deposition of fat and uncontrolled hypertension, factors which cause the layers of the blood vessels to split like a bamboo shoot. Once dissection is diagnosed, the doctors have to move lightning fast, and blood pressure has to be controlled on a war footing.

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