LOAD OFF
THE CHEST

Expert intervention by doctors at Nanavati relieves a female
patient from chest pain, perspiration and breathlessness

A 56-year-old female patient was brought to Nanavati Super Speciality Hospital, with sudden onset of chest pain, perspiration and breathlessness. The patient had a massive heart attack and was in a very unstable condition. The ICU team at the hospital managed to stabilise the patient. A 2D Echo on the patient was performed immediately. A massive heart attack lead to death of heart muscles. The 2D Echo showed apical VSD which confirmed our suspicion of a hole in the heart. Immediate supportive measures were taken. In view of the poor haemodynamics, IABP was placed and elective incubation was done.

Next Day, Coronary Angiography was done which showed 100% blockage in the most important coronary artery. Her preexisting medical condition was a major



Post-surgery, the patient was ventilated for 2 days and then extubated. IABP was removed in the evening of extubation. Inotropic supports were tapered the next day.

The patient's recovery was uneventful and the patient was discharged in good health on day 7. On follow up after 3 months, the patient was asymptomatic with improved

deterrent for immediate heart surgery, which otherwise could have been lifethreating for the patient. Alternatively, a long wait would have proven critical for the patient. We stabilised the patient for 3 days with advance ICU set-up. The patient was operated after the next 3 days.

Ventricular Septal Defect (VSD) closure with SFD patch through LV apex was done using 5-0 prolene interrupted pledgeted sutures in horizontal matters manner. A venous graft from the aorta to LAD was also placed. In other words, the hole in the heart was closed and bypass was also done in the same sitting.

exercise capacity. 2D Echo showed an LVEF of 40%. Currently, the patient is doing fine and leading a good quality life. Discussion:

• • The incidence of repair of ischemic
     VSD is 1 to 3 % without any
     reperfusion therapy
• • Bimodal acute presentation - a)
     within 24hrs and b) In 3 to 5 days
• • Chronic VSD - 4 to 6 weeks after
     infarct
• • Stages: Hyaline degeneration
     - fragmentation - Enzymatic
     digestion- fissure formation septal
     rupture

• • The patient was optimised and
     stabilised prior to the surgery
     with elective ventilation, IABP
     Inotropic support and diuretics.
     This definitely played a vital role in
     the outcome
• •    Intraoperatively standard LV apical
     approach was used with care being
     taken to take VSD closures sutures
     in healthy area of the septum
• •    LV apex was closed with Teflon left
     buttresses used on either side to
     avoid bleeding
• •   A single SVG graft was put to LAD
• •    Post-op recovery was uneventful,
     and the patient is asymptomatic on
     follow-up