Sewing your Heart in COVID!

India finds itself facing the strongest opponent as yet the SECOND wave of Covid Just when things were looking better a new variant changed the picture completely It stimulated the set up of multiple medical centres to help all those who were affected It brought back the unity and harmony amongst the people The nations less severely affected extended their support wholeheartedlyDoctors and medical staff were always ready and so were able to combat the increase in numbers As I write this post we are seeing the numbers in Mumbai decline That is a huge pat on the back for each and everyone who were involved in this processMedical emergencies unfortunately pop up anytime without a notice A massive heart attack is one of them In our country heart attack kills 1 person every 33 seconds To make matters worse this condition affects us Indians in the most productive middle years of life almost a decade earlier than the West This growing epidemic has earned us the title of being the lsquocoronary capitalrsquo of the worldWe had a similar episode in the worst time possiblethe covid pandemic A 67 year old lady suffered a massive heart attack and was brought to the hospital She was stabilized and started on blood thinners Her ECG and Blood biomarkers were positive So an angiography was planned and if any single vessel showed a critical blockage an intervention would be done That was our plan but the almighty disagreed The angiography was completed but it wasnrsquot a single vessel which was blockedAll the three vessels supplying the heart were critically blocked with mounds of calcium inside them Plus the fact that all the vessels were already stented seven years back removed the option of Angioplasty If this wasnrsquot bad enough the coronaries which supply the heart and are usually located on its surface in her case were buried deep inside the muscle The vessels could not be seen and now we had a bypass to do So with a very difficult situation at hand an urgent surgery was done On a beating heart a bypass was done after cutting open the coronaries and removing the calcium core inside them The obstructed stent was also removed and then the bypass had to be performed These are the most difficult subset of patients and have high risks associated with it This was accomplished in an Indian hospital in Mumbai Dr L H Hiranandani hospital with the patient going home within a weeks time The whole procedure called coronary artery bypass grafting with endarterectomy and stent removal isnrsquot a common occuranceAs shown in the image the heart after bypass and the blocked stent with the calcium cast can be seen clearlyIn times of COVID these surgeries can be life saving but entail a lot of difficulty Availability of blood ICU beds and other consumables are not easy as they are in limited supply Doctors and medical staff pool in their resources and try their best to deliver a stellar performance in these demanding timesWith Sputnik coming in we have expanded the armamentarium of vaccines to fight covid Vaccines help in developing antibodies to combat infection More the people vaccinated greater would be the herd immunity We hope that this pandemic ends soon And we are able to resume the normal chores albeit with a mask on and a sanitiser in our pocketsDr Swarup Swaraj PalCVTS surgeon at DR L H HIRANANDANI HospitalMBBS MS Gen SurgKEM MCh CVTS KEMH MumbaiFellowship in Complex Coronaries Aortic Aneurysms Transplants ECMOs Robotic cardiac Sx MICSConsultant CVTS and Transplant MICS surgeonEx Consultant Apollo hospitals Chennai and Navi MumbaiEx Asst Prof KEM hospital MumbaiEx Hon Consultant Tata Memorial hospital MumbaiLife MemberIACTSWB Assoc of CTVS surgeonsMumbai assoc of CVTS surgeonsNorth Zone Cardiac surgeonsTrauma societyVascular Assoc IndiaSociety of Minimally Invasive Cardiac Surgeons