NARAYANA MULTISPECIALTY HOSPITAL, JAIPUR

SUCCESSFULLY PERFORMED BEATING HEART BYPASS SURGERY (CABG) ON A PATIENT HAVING HEART ON RIGHT SIDE (DEXTROCARDIA WITH SITUS INVERSUS)

The cardiac surgery team at Narayana Multispecialty Hospital, Jaipur have performed the first-of-its-kind beating heart coronary bypass surgery in Rajasthan. The surgery was led by Dr C.P. Srivastava, Chief Consultant & HOD Cardiothoracic Surgery at Narayana Multispecialty, Jaipur.

The patient, 73-year-old Hanuman, a retired army personnel has a rare condition - Dextrocardia with Situs Inversus. He suffered a heart attack and his Coronary Angiography revealed significant blockages in all 3 major heart vessels with reduced heart power, for which he was advised to undergo a Bypass surgery (CABG).

Mr. Hanuman knew his heart is on the right side since long and because of this condition doctors at few other hospitals discouraged him for CABG since it was a technically difficult case.

The patient was then referred to Narayana Multispecialty Hospital where he consulted Dr. C.P. Srivastava who accepted his case and he underwent a Beating Heart Bypass Surgery in which 5 bypasses were done successfully.

Dextrocardia with Situs Inversus is a condition in which the heart as well as other organs such as the lungs, liver, stomach, and Gall bladder is a mirror image of the normal. The tip of the heart (apex) is positioned on the right side of the chest, and the position of the heart chambers as well as the visceral organs such as the liver and spleen, is reversed (Situs Inversus). However, most affected individuals can live a normal life without associated symptoms or disability.

Dr. C.P. Srivastava says “This case was technically very demanding and required a lot of precision, as the orientation of the patient’s heart was reverse and very weak. His total internal system is a mirror image; organs which are normally on the right side, are situated on the left and vice versa.”

Beating heart bypass surgery is, in simple terms, a bypass surgery that is performed on a beating heart. The heart is not stopped during the surgery and the patient does not require a heart-lung machine. While the heart and lungs continue to function during the surgery, surgeons use a tissue stabilization system to immobilize the area of the heart where the surgery is required. Beating heart bypass surgery is also called Off Pump Coronary artery bypass surgery(OPCAB).

“Only 32 cases have been reported worldwide and this is the first-of-its-kind Beating Heart Bypass surgery performed in Jaipur in a patient having Dextrocardia with Situs Inversus. The cardiac team at the hospital has rich experience to perform complex cases, as the hospital is equipped with state-of-the-art infrastructure. The success of this case is yet another milestone for the hospital.”

Patients with Dextrocardia require special preoperative evaluation, selective intra-operative approach in terms of cannulation and choice of conduits, graft placement and configuration, that relate appropriately to the abnormal position and rotation of the heart. Post the Beating Heart Bypass, the patient is totally fit and is leading a normal life. The patient recovered uneventfully in spite of his weak heart and was discharged 7 days back.