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
  • Stages: Hyaline degeneration
       - fragmentation - Enzymatic
       digestion- fissure formation septal
"After the patient was transferred to the CCU at Nanavati, she was optimised and stabilised prior to the surgery with elective ventilation, IABP Inotropic support and diuretics. Intraoperatively standard LV apical approach was used. Extra care was 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, and a single SVG graft was put to LAD. The patient recovered uneventfully, and follow-up has been positive."

– Dr. Rohit Shahapurkar

  • 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

Dr. Rohit

Cardiovascular &
Thoracic Surgeon
Nanavati Super
Speciality Hospital

1 1