A REAL-LIFE HERO

When the class 11th student Daksh, came to the emergency, he was very short of breath and coughing badly. His echo and CT scan showed that there were large blood clots in his right heart and blood vessels going f r o m the heart to the lungs and even inside both lungs as well. As these fresh and old clots were obstructing the flow of blood from the heart to the lungs, he was not getting sufficient oxygenated blood into the main circulation because of this somehow his life was going on, but with labored breathing. The clots that have stuck inside the lungs have become so firmly entrenched in the blood vessels of both the lungs that their complete release and removal was not only very difficult but also life-threatening. This disease is called Chronic Cardio-Pulmonary Thrombo Embolism.

The surgical procedure to remove all these clots only with special techniques and special instruments is called Cardio-Pulmonary Thromboendarterectomy (PTE). He became critical just before this operation.

Hence operation was started in a hurry, which lasted for 10 hours. The badly stuck clots in the blood vessels of the heart and lungs were gradually removed completely using special techniques for this process “without “ zero blood flow and zero BP technique which is called TCA -Total circulatory arrest technique. He recovered completely within 3-5 days.

During the total circulatory arrest body temperature is brought down to around 20 degrees by a special heart-lung machine and the blood flow to the body is stopped twice for 25-30 minutes each. Hence for this period, the Patient’s BP is almost zero.

By doing this, the operative field becomes blood and now you can see better to remove clots in the inner vessels of the lungs.

But we did not want the technique it has been founded by scientific research that if total circulatory arrest at a temperature of 20- 22 continues for 30 minutes or more there is a high possibility of temporary or permanent damage to the brain in the short term or long term. So to avoid TCA, we used special techniques and instruments to remove stuck clots from both lungs, one by one without stopping the circulation at normal temperature. By doing this we not only removed the clots from both lungs and heart but also saved the baby’s brain from the damaging effects of TCA.

He is the youngest patient in the country who underwent Pulmonary Thromboendarterectomy without using the total circulatory arrest technique to save his brain. If the operation is not done in time, then the heart and lungs fail and death occurs. — Vikas Sharma

DR SUNIL KAUSHAL Pediatric Cardiac Surgeon, Fortis Escort Hospital