Sewing your Heart in COVID!

Dr Swarup Swaraj Pal

India finds itself facing the strongest opponent as yet, the SECOND wave of Covid! Just when things were looking better, a new variant changed the picture completely! It stimulated the set up of multiple medical centres to help all those who were affected. It brought back the unity and harmony amongst the people. The nations less severely affected extended their support wholeheartedly.

Doctors and medical staff were always ready, and so, were able to combat the increase in numbers. As I write this post, we are seeing the numbers in Mumbai decline. That is a huge pat on the back for each and everyone who were involved in this process.

Medical emergencies, unfortunately, pop up anytime without a notice. A massive heart attack is one of them! In our country , heart attack kills 1 person every 33 seconds! To make matters worse , this condition affects us Indians, in the most productive middle years of life.. almost a decade earlier than the West! This growing epidemic has earned us the title of being the ‘coronary capital' of the world!

We had a similar episode in the worst time possible-the covid pandemic! A 67 year old lady suffered a massive heart attack and was brought to the hospital. She was stabilized and started on blood thinners. Her ECG and Blood biomarkers were positive! So an angiography was planned and if any single vessel showed a critical blockage , an intervention would be done . That was our plan, but the almighty disagreed. The angiography was completed , but it wasn't a single vessel which was blocked.

All the three vessels supplying the heart were critically blocked with mounds of calcium inside them! Plus the fact that all the vessels were already stented seven years back, removed the option of Angioplasty! If this wasn't bad enough, the coronaries which supply the heart ,and are usually located on its surface, in her case were buried deep inside the muscle! The vessels could not be seen and now we had a bypass to do! So with a very difficult situation at hand, an urgent surgery was done. On a beating heart a bypass was done after cutting open the coronaries and removing the calcium core inside them! The obstructed stent was also removed and then the bypass had to be performed. These are the most difficult subset of patients and have high risks associated with it. This was accomplished in an Indian hospital, in Mumbai [ Dr L H Hiranandani hospital] with the patient going home within a weeks time! The whole procedure , called coronary artery bypass grafting with endarterectomy and stent removal isn't a common occurance!

As shown in the image the heart after bypass and the blocked stent with the calcium cast can be seen clearly.

In times of COVID, these surgeries can be life saving but entail a lot of difficulty. Availability of blood , ICU beds and other consumables are not easy , as they are in limited supply! Doctors and medical staff pool in their resources and try their best to deliver a stellar performance in these demanding times!

With Sputnik coming in , we have expanded the armamentarium of vaccines to fight covid. Vaccines help in developing antibodies to combat infection. More the people vaccinated, greater would be the herd immunity. We hope that this pandemic ends soon. And we are able to resume the normal chores, albeit with a mask on and a sanitiser in our pockets!

Dr Swarup Swaraj Pal

CVTS surgeon at DR L H HIRANANDANI Hospital

MBBS, M.S [Gen Surg,KEM], M.Ch CVTS [KEMH, Mumbai]

Fellowship in Complex Coronaries, Aortic Aneurysms, Transplants, ECMOs, Robotic cardiac Sx, MICS

Consultant CVTS and Transplant/ MICS surgeon

Ex Consultant Apollo hospitals, Chennai and Navi Mumbai

Ex Asst Prof KEM hospital, Mumbai

Ex Hon Consultant, Tata Memorial hospital, Mumbai

Life Member-

IACTS

WB Assoc of CTVS surgeons

Mumbai assoc of CVTS surgeons

North Zone Cardiac surgeons

Trauma society

Vascular Assoc -India

Society of Minimally Invasive Cardiac Surgeons