• 83 year old suffered a massive heart attack due to sudden blockage of the main artery supply in the heart leading to death of the heart muscle causing heart rupture
• Patient came with low blood pressure and high heart rate of 140/min, stabilised and treated
• High risk open heart surgery performed to save life
• A multidisciplinary team of 10 members including clinicians, technicians, OT staff and nurses worked relentlessly
• Patient discharged from Max Hospital, Vaishali, in stable condition within a week of surgery
@ Vikas Sharma | Sr Journalist
New Delhi: Heart diseases claim significant number of lives in India across a wide range of demographic profiles. Men are known to be at a higher risk in comparison to women and with age and pre-existing co-morbidities, complexities go up. But, a slowly weakening heart is much easily treatable in comparison to a massive heart attack, which leads to internal bleeding and may cause permanent damage. Such was the case of 83 year old N.S. Mehra, a retired businessman from Preet Vihar, who underwent complex open heart surgery which saved his life. A rare medical feat as only very few rupture cases are successfully treated within stipulated timelines in India and globally.
Sequence of events and important facts:
Patient’s name and age
• Mr. N.S. Mehra, a retired businessman from Preet Vihar, Delhi
• 83 year old
Time of arrival at emergency • Time taken to take to emergency: 20-25 minutes
Condition at arrival
• Patient had a history of hypertension
• Suffered a massive heart attack due to instantaneous blockage leading to hole in wall of left ventricle
• Heart was beating at double the normal rate @ 140/min
Immediate diagnosis
• Patient’s ECG and ECHO revealed that the heart attack had led to a severe rupture in the left ventricle wall of the heart
• This resulted in internal bleeding causing accumulation of blood in the pericardium (the membrane enclosing the heart)
Surgery and treatment
• Patient was scheduled for an immediate surgery (From emergency to OT in record time of 25 minutes)
• Patient was brought Max Super Speciality Hospital, Vaishali on a ventilator to be treated by Dr. Gaurav Mahajan, Principal Consultant & Head – CTVS
• Requisite medication given to stabilize the BP @ 90/60 for the surgery
• The patient was put on a heart-lung machine and his heart was arrested for almost 2 hours
• The rupture was repaired through a double suturing, also known as ‘double-layered repair’ using a small part from synthetic materials or PTFE (Polytetrafluoroethylene) and the pericardium (the outer the membrane enclosing the heart)
• The 6 hour high-risk cardiac surgery was successfully carried out on 1st Feb, 2019.
Long term prognosis
• Mr Mehra was discharged a week of undergoing this life-saving surgery and is currently doing well
• He has gone back to doing his regular chores and even attended his grand daughter’s wedding 20 days after the surgery
Talking about the case, Dr. Gaurav Mahajan, Principal Consultant & Head – CTVS, Max Super Speciality Hospital, Vaishali says, “In majority of heart rupture cases, the patients are unable to reach the hospital in a treatable condition as the condition deteriorates at a life threatening rate. In this case, owing to effective emergency response, timely and accurate diagnosis and immediacy of surgery, we were able to save Mr. Mehra. Being an aged individual with history of hypertension, he suffered a sudden heart attack which ruptured wall of left ventricle of the heart leading to internal bleeding. The ECHO confirmed our diagnosis and without losing a single second, a highly complex open heart surgery was performed by team of multidisciplinary team of doctors including cardiac surgeons, physicians, anaesthetists, nurses and perfusionists. We repaired the rupture through a double suturing, also known as ‘double-layered repair’ using synthetic materials i.e. PTFE (Polytetrafluoroethylene) and the pericardium. After a week of post-surgery care and observation, Mr. Mehra was discharged with a positive prognosis.”
