CABG Procedure Overview
drramjimehrotra Blog

CABG Procedure Overview

Coronary Artery Bypass Grafting (CABG) is a surgical procedure commonly performed to treat coronary artery disease (CAD), a condition in which the blood vessels supplying the heart muscle (coronary arteries) become narrowed or blocked. CABG is also known as heart bypass surgery. Here is an overview of the CABG procedure:

1. Preoperative Evaluation:

Medical History and Physical Examination: A physical examination is performed after assessing the patient’s medical history and overall health.

Diagnostic Tests: These may include an electrocardiogram (ECG or EKG), an echocardiogram, coronary angiography, and other imaging tests to evaluate the extent and location of coronary artery disease.

2. Anesthesia:

Pre-anesthetic Assessment: The anesthesiologist evaluates the patient’s overall health and determines the appropriate anesthesia plan.

General Anesthesia: During surgery, the patient is put under general anesthesia, which makes them unconscious and pain-free.

3. Harvesting of Grafts:

Graft Selection: Healthy blood vessels, often taken from the patient’s own body (autografts) or occasionally from a donor (allografts), are chosen for bypass grafts. Commonly used vessels include the internal mammary artery, radial artery, and saphenous vein.

4. Surgical Access:

Sternotomy or Thoracotomy: A sternotomy (cutting through the breastbone) is the most common approach, but in some cases, a thoracotomy (a small incision between the ribs) may be used.

5. Cardiopulmonary Bypass (if needed):

Connecting to a Heart-Lung Machine: The heart may be temporarily stopped, and blood is rerouted through a heart-lung machine, providing oxygen and circulation for the body while allowing the surgeon to work on a still heart.

6. Graft Placement:

Bypassing Blockages: The surgeon attaches one end of the graft to the aorta and the other end to a coronary artery beyond the blockage, creating a new pathway for blood flow.

7. Weaning off Bypass and Closing:

Restoration of Blood Flow: If a heart-lung machine is used, the patient is gradually weaned off it, and the heart resumes pumping.

Restoration of Blood Flow: If a heart-lung machine is used, the patient is gradually weaned off it, and the heart resumes pumping.

Closure: The chest has been closed, and the incision has been sutured.

8. Postoperative Care:

Monitoring: Initially, the patient is monitored closely in the intensive care unit (ICU) before being moved to a regular room.

Recovery: Rehabilitation and recovery involve medications, lifestyle changes, and follow-up care to ensure a smooth recovery.

9. Potential Risks and Complications:

Infection, bleeding, or blood clots: As with any surgery, there are potential risks, and complications can arise. The medical team closely monitors the patient to address any issues promptly.

According to Dr. Ramji Mehrota – Best Heart Specialist Doctor in India, It’s important to note that the specifics of the procedure can vary based on individual patient characteristics and the surgeon’s preference. CABG is considered a major surgery, and the decision to undergo the procedure is made after a thorough assessment of the patient’s condition and the benefits of surgery. For personalized information, it’s best to consult healthcare professionals.

It’s important to note that the specifics of the procedure can vary based on individual patient characteristics and the surgeon’s preference. CABG is considered a major surgery, and the decision to undergo the procedure is made after a thorough assessment of the patient’s condition and the benefits of surgery. For personalized information, it’s best to consult healthcare professionals.

drramjimehrotra Blog

Minimally Invasive Direct Coronary Artery Bypass Grafting

Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) is a less invasive surgical procedure for treating coronary artery disease (CAD). Unlike traditional coronary artery bypass grafting (CABG), which requires a median sternotomy and the use of a heart-lung machine, MIDCAB is performed through a small incision on the left side of the chest, offering several advantages.

Procedure Highlights

  1. Small Incision: MIDCAB involves a small incision between the ribs, eliminating the need for a sternotomy. This results in less chest trauma and reduced postoperative pain.
  2. On-Beating Heart: Unlike traditional CABG, which temporarily stops the heart with a heart-lung machine, MIDCAB is performed on a beating heart. This reduces the risk of complications associated with bypassing the heart’s normal function.
  3. Shorter Recovery: Patients undergoing MIDCAB experience a shorter hospital stay and a faster return to their regular activities, making it an appealing option for those seeking quicker recovery.
  4. Reduced Scarring: The small incision in MIDCAB results in less visible scarring, providing cosmetic benefits for some patients.

Patient Eligibility

MIDCAB is suitable for patients with single or double-vessel disease, meaning they have blockages in one or two coronary arteries. It is not appropriate for complex multi-vessel disease requiring multiple grafts. Favorable patient anatomy and good overall health are essential for candidacy.

Procedure Steps

  1. Incision: A small incision is made between the ribs on the left side of the chest to access the target coronary artery.
  2. Graft Placement: A healthy blood vessel, often the internal mammary artery or radial artery, is harvested and prepared for grafting. It is then attached to the blocked coronary artery, creating a new pathway for blood flow.
  3. Heart Monitoring: Specialized equipment is used to monitor the heart throughout the procedure to ensure it continues to beat.
  4. Closure: After successfully placing the graft, the incision is closed, and the chest is sutured. No sternotomy is required.

Benefits and Considerations

Advantages:

  1. Less Invasive: MIDCAB results in reduced chest trauma, postoperative pain, and discomfort.
  2. Quicker Recovery: Patients have a faster recovery and shorter hospital stay.
  3. Cosmetic Appeal: The small incision leads to less visible scarring.

Considerations:

  1. Limited Applicability: MIDCAB is suitable only for patients with single or double-vessel disease.
  2. Long-Term Efficacy: Long-term outcomes compared to traditional CABG are still under investigation.
  3. Operator Skill: MIDCAB requires a highly skilled and experienced surgeon.
  4. Patient Selection: Careful patient evaluation is crucial to ensure the best outcomes.

Summary

Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) is an attractive option for many patients with CAD due to its less invasive nature, faster recovery, and improved cosmetic results. However, patient suitability and careful evaluation by doctors are key factors in determining the most appropriate treatment approach.

67 year old woman got life, doctors created history by doing two surgeries together
drramjimehrotra Media Article

67-Year-Old Woman Gets Life as Doctors Create History with Dual Surgeries

Medical science has made significant strides in the field of surgery, shattering age barriers for medical interventions. In a significant achievement, a team of skilled doctors at BLK-Max Super Specialty Hospital successfully performed two surgeries on a 67-year-old woman, granting her a new lease of life. Dr. Ramji Mehrotra, the Chief of Cardiology & Vascular Surgery at BLK-Max Super Specialty Hospital, led the remarkable medical feat.

According to Dr. Mehrotra, the surgical team utilized bilateral mammary artery grafts for Coronary Artery Bypass surgery, demonstrating exceptional coordination. Given the complexity of the case, they opted for a safe myocardial revascularization with total arterial bypass, which yielded outstanding results. Arterial grafts are more likely to remain patent even without blood thinners.

Due to the dedicated efforts of Dr. Mehrotra and the medical team at BLK-Max Super Specialty Hospital, the patient made a swift recovery and was discharged in just six days after the surgery.

Ref: thehealthsite.com

Pulmonary Valve Stenosis
drramjimehrotra Blog

What is Pulmonary Valve Stenosis?

Pulmonary valve stenosis is a medical condition in which the pulmonary valve, which regulates blood flow from the right ventricle of the heart to the lungs, becomes narrowed or obstructed. This can lead to difficulty breathing and reduced oxygen levels in the blood, causing a range of symptoms and potentially serious health complications if left untreated.

Causes of Pulmonary Valve Stenosis

There are several potential causes of pulmonary valve stenosis. One common cause is congenital heart defects, which are present at birth and may be inherited or caused by environmental factors during pregnancy. Rheumatic fever, a condition that can develop as a complication of strep throat, can also lead to pulmonary valve stenosis. In rare cases, the valve may become narrowed or obstructed due to scarring or inflammation. In some cases, the cause of the stenosis is unknown.

Symptoms

Symptoms of pulmonary valve stenosis can vary depending on the severity of the condition. In mild cases, individuals may not experience any symptoms or may only have mild shortness of breath during physical activity. More severe cases may cause significant difficulty breathing, chest pain, fatigue, and fainting. In severe cases, the condition can also cause heart palpitations, swelling in the legs and ankles, and a bluish tint to the skin due to low oxygen levels.

Diagnosis and Treatment

Diagnosis of pulmonary valve stenosis typically begins with a physical exam and a review of the individual’s medical history. The doctor may also order several tests to confirm the diagnosis and assess the severity of the condition. These tests may include an echocardiogram, a chest X-ray, and an electrocardiogram.

There are several treatment options available for pulmonary valve stenosis, depending on the severity of the condition and the individual’s overall health. In mild cases, treatment may include medications to manage symptoms and reduce the risk of complications. These may include diuretics to reduce fluid build-up in the body and beta blockers to reduce the heart’s workload.

For more severe cases, surgery may be necessary to repair or replace the valve. Repair surgery involves making changes to the existing valve to improve its function, while valve replacement surgery involves replacing the faulty valve with a new one. There are several different types of valves that can be used in replacement surgery, including mechanical valves, which are made of man-made materials, and biological valves, which are made from animal tissue.

In some cases, a procedure called balloon valvuloplasty may be used to widen the narrowed valve. This procedure involves inserting a balloon catheter into the narrowed valve and inflating the balloon to widen the opening.

It is important for patients with pulmonary valve stenosis to work closely with their doctors to manage their condition and reduce the risk of complications. This may include regular check-ups and monitoring of symptoms, lifestyle changes such as quitting smoking and eating a healthy diet, and taking prescribed medications as directed.

Conclusion

Pulmonary valve stenosis is a serious condition that can have a significant impact on an individual’s quality of life. With proper treatment and management, however, it is possible to live a full and active life. It is important for individuals with the condition to stay in close communication with their doctors and follow their treatment plan to ensure the best possible outcomes.

Patent Ductus Arteriosus
drramjimehrotra Blog

What is Patent Ductus Arteriosus (PDA) Defect?

Patent ductus arteriosus is a very common heart condition found in new born babies. It occurs because the ductus arteriosus blood vessel doesn’t close properly after birth.

Babies born prematurely are more likely to be affected by PDA. The risk of PDA increases the earlier the baby is born. PDA affects 10% of babies born between 30 and 37 weeks of pregnancy, 80% of babies born between 25 and 28 weeks of pregnancy and 90% of babies born earlier than 24 weeks of pregnancy.

PDA is also more commonly seen in girls than in boys.

Cause of PDA

Every baby has a ductus arteriosus, which is a foetal artery connecting the aorta and the pulmonary artery. This opening usually narrows and closes within a few days after birth. If it continues to remain open it is known as patent ductus arteriosus (PDA).

While a small PDA may not generally cause any problems, a large PDA can lead to the flow of poorly oxygenated blood in the wrong direction. This can cause heart failure and other complications such as pulmonary hypertension and blood vessel damage.

Causes of PDA include genetic disorders or a family history of the condition. Babies with neonatal respiratory distress syndrome which is a breathing problem or those born to mothers who had rubella during pregnancy are also at risk of developing PDA.

Symptoms

PDA symptoms vary according to the size of the defect. Small PDAs may not have symptoms apart from a heart murmur and may go undetected until adulthood.

Large PDAs may cause symptoms such as:

  • Persistent rapid breathing.
  • Breathlessness
  • Sweating often
  • Fatigue
  • or tiredness
  • Feeding and eating problems
  • Poor weight gain
  • Rapid heart rate

It is important to consult a doctor immediately if any of these symptoms are noticed in the baby.

Diagnosis and Treatment

PDA in premature babies and in neonates may be the cause of respiratory compromise. Many a time’s medicine is effective. In cases where medicine has failed or cannot be given due to many reasons, surgery is required. 

The paediatric cardiologist may recommend various tests such as Chest X-ray, Electrocardiogram (ECG), Echocardiogram, etc to diagnose the PDA.

A small PDA may close on its own as the child grows and may not require treatment. Doctors will prescribe the medication as required.

Large PDAs may require treatment that includes cardiac catheterization or surgery. Catheterization is a minimally invasive procedure where the doctors use a flexible tube or catheter and insert a coil through it into the heart to close the PDA. In PDA surgery an incision is made to the side of the chest and the PDA is closed with stiches or a metal clip.

Life after PDA treatment

After receiving treatment for PDA, children can lead normal, healthy lives. Activity levels, appetite, and growth will return to normal within a short duration. Periodic check-ups with the paediatric cardiologist will ensure that there are no heart or lung problems.

omricon xe
drramjimehrotra Blog

Signs and Symptoms of Omicron XE

The XE variant of Covid-19 is a mutation of Omicron BA.1 and BA.2 strains. It is a recombinant where two related parent viruses exchange genetic material to create offspring with genes from both parents.

XE variant was first discovered in the United Kingdom in January 2022. It is more highly transmissible when compared to other variants. Mumbai is the first city in India to report cases of the Omicron XE variant. Subsequently cases have been reported in other places including NCR, Gujarat, etc.

XE variant is 10 times more infectious than BA.2 variant. BA.2 reports the highest number of cases in the world currently and is called the stealth variant as it is not easy to detect.

Symptoms of Omicron XE

The new variant is exhibiting similar symptoms as those of the original Omicron. These include fever, cold and cough, sore throat, skin irritation, gastric trouble, etc. Loss of smell, shortness of breath, exhaustion, body ache, loss of appetite, and diarrhoea are the other symptoms. The symptoms are generally milder and not very severe.

Generally, people afflicted with XE variant also experience a loss of smell and taste. Severely affected people may experience heart trouble, palpitation and nerve issues as well.

Omicron XE is observed to be thrice as contagious as the Delta variant. However, the risk of hospitalisation is lower in XE than was observed in the earlier Covid variants. It is also reported to be less severe than the Delta variant in children less than five years old.

According to doctors, the XE variant may prove to be more dangerous for people who are already suffering from serious ailments. It is recommended to seek medical advice immediately if any of the symptoms become visible.

Potential Fourth Wave

The XE variant is causing concerns about a potential fourth wave of Covid-19 in India. Though it comprises only a small proportion of total sequenced cases, there is evidence of community transmission.

According to the National Technical Advisory Group on Immunisation (NTAGI) there is “nothing to panic” as the cases reported have not caused many serious infections.

The World Health Organisation (WHO) has said that it will not classify XE as a variant of concern separate from Omicron until major differences in disease transmission or severity are observed.

Conclusion

Health experts are advising the continuation of public health precautions such as physical distancing, wearing masks, practising proper sanitation, and staying home when sick. According to them, vaccinations is the best protection and is very effective in preventing any complications because of the XE virus.

The central and state governments are also keeping a close eye on the situation and are issuing directives to the health authorities as and when required.

drramjimehrotra Blog

Effect of a Positive Mental State on Heart

Mental health is an important component of the overall health of an individual. It involves a combination of psychological, emotional, and social well-being. Benefits of good mental health include reduction in stress and anxiety, clearer thinking, improvement in moods and inner peace, reduced chances of depression, etc.

Relation between Mental Health and Heart

Research has shown that mental health is related to the health of the heart. According to Dr Ramji Mehrotra, cardiovascular health is negatively affected by negative psychological factors and mental health disorders, while positive attributes make a positive impact and can lower the risk of cardiovascular disease and death.

Negative psychological conditions like chronic stress, anxiety, and depression can cause harmful biological responses such as irregularities of heart rate, increased blood pressure, and reduced blood flow to the heart. Smoking, unhealthy diet, obesity, lower levels of physical activity, etc. all negatively impact psychological health apart from directly influencing the heart negatively which in turn is connected to heart disease. To improve mental and psychological health, stress reduction therapy, meditation and exercise are recommended.

On the other hand, people with positive psychological health are likely to have lower blood pressure and lower cholesterol. Consequently, they are at a lower risk of developing cardiovascular disease. Health behavior that is likely to increase positive psychological health includes consuming healthy food, physical activity, regular health screening, and check-ups, etc. apart from stress reduction therapy including meditation.

Adopting a Healthier Lifestyle for Healthy Mind and Heart

While the risk of developing cardiovascular and heart diseases is high if a person has a mental health condition, the positive news is that it can be reduced with appropriate changes to one’s lifestyle. These steps towards improving both the body and mind include:

  • Be physically active: Physical activity boosts mental health by releasing chemicals into the brain that reduces depression and anxiety. It also ensures better sleep, less stress, and higher energy levels, etc.
  • Consume a healthy balanced diet: Eating a balanced and healthy diet is essential for mental health along with physical health. A healthy diet controls not only weight but also BP and cholesterol levels which reduce the risk of heart disease.
  • Stop smoking: Though smokers may think that smoking reduces their stress, in reality it increases stress, tension, and anxiety. It also leads to a high risk of lung cancer and all other cancers as well as heart and circulatory diseases. Hence, it is essential to cut down on smoking and eventually stop it altogether. Infect tobacco in any form is injurious and should be avoided.
  • Reduce alcohol: Alcohol is a depressant and affects the mood and mental state of a person. People consuming large amounts of alcohol lose control of their feelings and can become angry, aggressive, anxious and depressed. It can also cause several other health issues.
  • Other activities: Mental health can also be improved by taking up several activities such as adopting spirituality and meditation, improving social relationships, expressing gratitude, practicing kindness, cultivating optimism, etc.

Conclusion

It has been observed that people with mental health issues like stress, anxiety, and depression may experience physiological effects like increased cardiac activity and reduced blood flow to the heart. This may lead to abnormal calcium build-up in the arteries and heart disease. Hence, it is very important to maintain positive mental health by adopting a healthy lifestyle with physical activity, proper diet, stress reducing activities, meditation, cultivating hobbies, feeling good and avoiding smoking, tobacco etc.

Dr. Mehrotra’ says that along with taking care of physical conditions such as blood pressure, diabetes, cholesterol levels, etc., the negative aspects of mental health must be monitored and addressed regularly to reduce the incidence of heart disease in patients.