NewZNew (Chandigarh) : Patiala resident Karamjit (23) was suffering with severe fever, cough and fatigue. When he approached Max Super Specialty Hospital (MSSH), Mohali the doctors there found that all his major organs were positioned in the reverse manner. Besides two of his major heart valves were also damaged.
While sharing details of Karamjit rare surgery to media at a hotel in Sector 43 here today, Dr. Virendar Sarwal, Director & HOD, Cardio Thoracic & Vascular Surgery (CTVS), MSSH informed that this very young patient was suffering from a congenital anomaly called Dextrocardia with Situs Inversus Totalis (SIT) where organs and vessels were positioned in the opposite directions.
Dr Sarwal explained that the patient heart and spleen were on the right side and his liver was on his left. His lungs were also inverted. While this would not cause any problem as the abnormality was congenital, it became difficult when the patient has to undergo a surgery. This anomaly usually found 1 in 50,000 births.”
The complex surgery of Karamjit was performed by a team of MSSH surgeons comprising of Dr. Sarwal , Dr Deepak Puri ,Director, CTVS, Dr Aratatran Nahak, Sr. Consultant , CTVS & Dr. Ajay Sinha, Head- Cardiac Anaesthesia.
Dextrocardia with SIT was a rare congenital condition in which all organs like liver, spleen and inferior vena cava including the heart have switched sides. Such condition was normally associated with complex congenital disorders like polysplenia .
The valve heart surgery in Dextrocardia with SIT was rare. Surgeons required a prospective strategy for handling problems such as poor exposure of the cannulation site and diseased valve.Karamjit was suffering from severe aortic stenosis the narrowing of the aortic valve with moderate aortic leakage was taken up for aortic valve replacement surgery after thorough work up.
Explaining the reverse location of the veins in the body of the patient, which made the case even more complicated, Dr Sarwal said that Aortic Arch, which was normally on the left, was to the right and right atrium the upper chamber that drained the impure blood from upper and lower parts of the body was to the left with the major vein that drains impure blood from upper and lower parts of the body on left. There was abnormal origin of the left coronary artery and it was posterior and right, he maintained.
The case of Karamjit with disoriented anatomy made the operative conditions of aortic valve surgery very challenging. Approaching the aortic valve through an incision seemed to provide excellent exposure for valve surgery but going on pump before that posed the challenge. During on-pump surgery, the heart has to be arrested for at least an hour and half for opening the chamber to remove diseased valve and put a new one. During this period all other body organs were supplied blood through a Heart Lung Machine, asserted Dr Sarwal.
Meanwhile this is the first case of isolated Aortic Valve Replacement in Dextrocardia with SIT. Earlier two cases of double valve replacement have been reported one in Turkey and one from Vellore.