The rare and extremely complex heart surgery, which took nearly five hours, was successfully performed by a team of experts led by Dr. Nagendra Prakash

Case highlights:

• 74-year-old senior citizen from Jayalakshmipuram experienced symptoms of fatigue, breathlessness and chest discomfort coming in the way of his daily lifestyle routine
• Investigation revealed thick calcium deposits in the valve of the main artery (aortic valve)as well as lack of blood supply due to blocks in all three major coronary arteries (Ischemic Heart Disease)
• Doctor suggested operation as risks of sudden death were very high 
• Patient underwent three bypass grafts and replacement of diseased aortic valve  
• Patient felt completely fine on the second post operative day and was discharged on sixth day after surgery

Mysore, May 17, 2012: If only heart attacks were predictable, Mr. J N Sridhar could have had a worry free life. But for now he could have never sensed that death was so close to him that it could have taken place at any moment.

“I could not walk for long and used to get fatigued very soon. It was very frustrating as I could not even exert myself to do petty chores. We came to know about the master health check at Fortis Hospitals. On getting a check-up done, the doctor suggested me to undergo an angiogram after which it was found out that my heart had certain defects,” said a 74 year old Sridhar.

“He visited Fortis Cauvery for a heart check up with symptoms of fatigue, breathlessness on exertion and chest discomfort. I realized what he was experiencing could be signs of an impending heart attack. We urged him to undergo further investigation to have a complete diagnosis at hand and plan the treatment accordingly,” says Dr. Nagendra Prakash, Cardiothoracic Surgeon, Fortis Cauvery Heart Hospital.

“On investigating the heart function on echocardiogram (graphical image of the heart produced by an ultrasound which studies the structure and motions of the heart) it was found that he was suffering from sclerosis (the leaflets of Aortic valve were thickened) and stenosis (leaflets laden with calcium deposits and were non-flexible, abnormally constricted due to calcium deposits in leaflets and sinuses). This narrowed down the aperture that opens into the aorta from the lower left chamber of the heart, and did not permit blood to flow freely from left ventricle to Aorta,” explains Dr. Nagendra Prakash.

“It was only after the Angiogram that I came to know about the gravity of my condition. The surgeon explained the risks involved in continuing the medical treatments and explained the benefits of undergoing a surgery. I had two options, either push for six months with medicine and take the risk or undergo a surgery and be safe. I chose the latter as it was better to get operated once and for all than wait for something unexpected,” recollects Sridhar.

This probably was an outcome of degenerative ageing process, but if not treated there is always a grave danger of patient having fainting attacks followed with sudden death on exertion in such cases. His treadmill test too, proved positive for ischemia of heart muscle (reduced blood blood flow to the heart muscle due to partial or complete blockage of an artery that carries blood to the heart). “He was then advised admission for further investigation and Coronary angiogram was performed, which revealed severe triple vessel disease (significant blockages in three coronary arteries which supply blood to the heart muscles) with left ventricular hypertrophy and diastolic dysfunction (thickening of the muscles of blood-pumping chamber of the heart, resulting in loss of its elasticity and eventually failing to pump with as much force as a healthy heart),” explains Dr. Nagendra Prakash.

“He finally underwent a combined operation of coronary revascularization by way of three bypass grafts and replacement of diseased Aortic valve, a very complicated combined surgery. It carries higher risk of mortality and morbidity, especially in older patients. And since the patient was already into his seventh decade, after due consideration and discussions with him and relatives, a Tissue valve was replaced,” said Dr. Nagendra Prakash. “The four bypass grafts were performed successfully on beating heart on April 11 2012 following which the patient’s heart and lung were stopped by placing him on a heart-lung machine and his aortic valve replaced. This surgery was uneventful and patient did well in the post operative period.”

“My father’s recovery and improvement post surgery was quite good. He was shifted to the ward on the second post operative day and after his discharge things got normal. Dr. Nagendra briefed us on the post operative care we should be giving to my father, as he made a steady improvement. Initial care was difficult but over one week things got normal as he made steady improvement,” said Vijay, son to Sridhar. “I owe my father’s life to Fortis Cauvery Heart Hospital. I am glad to see such complex operations being conducted successfully in Mysore. This saved us a lot of anxiety, hardships and stress if he had to undergo a surgery in Bangalore or other places,” he added. Vijay is a Software professional in Bangalore.

“Such kind of complexity is very dangerous and makes life very delicate. On one hand the left ventricle has to do more work to pump blood accross narrowed Aortic valve which will increase its demand of more blood to deliver more oxygen and nutrition. On other hand, the severe narrowing of all three major coronary arteries will curtail blood flow and reduce supply.  So there is gross mismatch between supply and demand and heart could infarct (heart attack) any time,” said Dr. Nagendra Prakash.

Advantage of using tissue valve in this surgery (Bioprosthesis) was that the patient would not require rigid anticoagulant drugs for life, thereby avoiding complications like bleeding into brain and stroke, bleeding into stomach, excessive bleeding from any injury etc.

For more information, email-  enquiries@fortishospitals.com

CPR Guidelines

The new first step is doing chest compressions instead of first establishing the airway and then doing mouth to mouth. The new guidelines apply to adults, children, and infants but exclude newborns.

The old way was A-B-C — for airway, breathing and compressions.

The new way is C-A-B — for compressions, airway, and breathing.

“By starting with chest compressions, that’s easy to remember, and for many victims that alone will be lifesaving,” says Michael R. Sayre, MD, chair of the emergency cardiovascular care committee for the American Heart Association and co-author of the executive summary of the 2010 AHA guidelines for CPR and emergency cardiovascular care.

According to WebMd The old approach, he says, was causing delays in chest compressions, which are crucial for keeping the blood circulating.

The new guidelines may inspire more people to perform CPR, says Sayre, an associate professor of emergency medicine at Ohio State University, Columbus. “Mouth to mouth is hard if you’re not trained,” he tells WebMD. ”Anybody can do chest compressions, whether they have had a class or not. Good chest compressions really help save lives. In many cases, there is a reserve of oxygen left in the patient’s blood and lungs, from the last breath, and we can take advantage of that oxygen reserve and just do chest compressions.”

How to Do the New CPR

Here is a step-by-step guide for the new CPR:

1. Call 911 or ask someone else to do so.

2. Try to get the person to respond; if he doesn’t, roll the person on his or her back.

3. Start chest compressions. Place the heel of your hand on the center of the victim’s chest. Put your other hand on top of the first with your fingers interlaced.

4. Press down so you compress the chest at least 2 inches in adults and children and 1.5 inches in infants. ”One hundred times a minute or even a little faster is optimal,” Sayre says. (That’s about the same rhythm as the beat of the Bee Gee’s song “Stayin’ Alive.”)

5.  If you’re been trained in CPR, you can now open the airway with a head tilt and chin lift.

6. Pinch closed the nose of the victim. Take a normal breath, cover the victim’s mouth with yours to create an airtight seal, and then give two, one-second breaths as you watch for the chest to rise.

7. Continue compressions and breaths — 30 compressions, two breaths — until help arrives

The soaring Celsius & Humidity have triggered a viral outbreak with residents from across the city complaining of high fever, sore throat & aching bones and muscles.

Microbiologists & doctors said the symptoms were caused by a group of viruses that thrives in hot and humid conditions. …

Infertility Treatment and Assisted Reproduction

Infertility treatment and Assisted reproduction Techniques
Creation, a dedicated centre for Infertility and Assisted Reproduction at Fortis Hospitals, Bannerghatta Road, is a one-stop-clinic that offers a comprehensive assessment and more importantly, an evidence based solution for infertile couples seeking assistance to overcome infertility. This state-of-the-art centre comes with the ideal combination of people, technology and processes to bring to you under one roof 360 degree care for all aspects of infertility.

The centre offers a wide range of services such as Basic infertility assessment, Surgical correction of pelvic pathologies, IUI, DI, IVF, Blasto-cyst transfer, Frozen embryo replacement cycles, and Surgical sperm retrieval to name a few. Having the specialist who has been associated with Reproductive Medicine & Surgery for more than 17 years at the helm, the centre comes with the dedicated team of an embryologist, an Andrologist and other Para-medical staffs.

Dr. Manisha Singh is an eminent Gynaecologist and a subspecialist in Reproductive Medicine & Surgery with over 17 years of extensive surgical experience. An acknowledged expert in Reproductive Medicine and Surgery services by Royal College of Obstetricians and Gynaecologists (RCOG), London, she has performed over 900 first operator complex Laparoscopic and Hysteroscopic procedures including LAVH, Ovarian Cystectomy, Salpingectomy, Adhesiolysis, Excision of pelvic endometriosis, and resection of sub-mucous fibroids. She has also performed over 1000 cycles of IVF / ICSI and about 3000 cases of ovulation induction successfully.

Dr. Joshua Peter – Consultant, Reproductive Biologist

Having been credited with setting up several IVF facilities such as the “Country’s first” at IRR (ICMR), Mumbai and Gunasheela Institute of Research in Reproduction (GIRR), Bangalore, Dr. Peter brings to Fortis Hospitals over 25 years of hands on extensive experience in Assisted Reproductive Technology (ART). He has been associated with India’s renowned IVF centres in Trivandrum, Coimbatore and Hyderabad; he is credited with several hundred “test tube” babies to date. Dr. Peter did his Ph.D. in Human Cytogenetics from University of Bombay in the year 1978, (working at the Institute for Research in Reproduction (IRR) currently known as National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR)).

Dr. Mohan Keshavmurthy MS, MCh ( Urology ) Fellowship in Uro Oncology

Medical Education

• Certification by the American Society Of Transplant Surgeons
• Fellowship in Renal & Pancreas Transplantation, Multiorgan Transplant Program QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
• Fellowship in Uro-oncology, Tata Memorial Hospital, Bombay
• M Ch (Urology) Seth GS Medical College and KEM Hospital, Bombay, INDIA
• MS (General Surgery) KM School of Postgraduate Studies, VS Hospital
• MBBS Bangalore Medical College, Bangalore, INDIA

Areas of Interest/Expertise:
Laser Urology/Onco Urology/Kidney Transplant Transplant/Andrology/Pediatric Urology



Dr.Sujata Datta MBBS, MRCOG, CCT (U.K.) Consultant Gynaecologist and laparoscopic surgeon, practicing as a consultant in leading hospitals like Fortis Kolkata, AMRI Hospital, having trained and practiced in the U.K. for 12 years.

Awarded the Royal College Certification (U.K.) in Laparoscopic and Hysteroscopic Surgery, has excellent surgical skills in advanced laparoscopic techniques such as laparoscopic hysterectomy, ovarian cystectomy, endometriosis ablation for infertility treatment, as well as urogynaecology operations for treatment of female urinary leakage and other traditional gynecological surgery.

Graduated from Calcutta medical college and went to London for postgraduate training. After completing MRCOG in 2000 and receiving a letter of commendation from Royal College , she trained extensively in leading hospitals in London in advanced laparoscopic techniques like total laparoscopic hysterectomy, endometriosis ablation, laparoscopic ovarian cystectomy and oophorectomy.

She also gained expertise in minimal invasive procedures for treatment of heavy bleeding such as transcervical resection of endometrium, hysteroscopic resection of fibroids and endometrial ablation, before receiving the Royal College Certification in Minimal access surgery. (U.K.)She developed an interest in urogynaecology and vaginal surgery and learned modern minimal invasive techniques for the treatment of female urinary leakage.During her tenure as a registrar in different London Hospitals she worked in busy obstetric units with more than 5000 annual deliveries, dealing with high risk pregnancies.After completing her C.C.T. she worked as a consultant in East Surrey Hospital U.K. before returning to work in Kolkata.

Fortis Hospitals starts its 2nd batch of ECG Training Workshop for general physicians to train on accurate ECG reading!

An erroneous ECG reading can prove fatal if the medical practitioner does not interpret the electrocardiogram precisely. It is very important for a physician to have hands-on knowledge about ECG reading to save many precious lives. Electrocardiography (ECG) plays an important role in the diagnosis of cardiac ailments and has significant implications in the management of emergency cardiac conditions.  Further, current textbooks and classroom instructional materials do not adequately integrate ECG interpretation into specific contexts.

“The medical curriculum in the country doesn’t stress much on ECG reading. Keeping this in mind, we have come up with a workshop which aims to improve the confidence and competence of physicians in the recording and reading of ECG (Electrocardiogram), through learning a systematic method of interpretation”, said Dr. Keshava R, Consultant Interventional Cardiologist, Fortis Hospitals.

Medical practitioners, especially family physicians would benefit from this workshop as they have to deal with cases ranging from kids to pregnant women and old age people in the families.

One of the doctors who attended this workshop, Dr. Anuradha Parmesh said, “I am more confident to read an ECG report and my reading is also more accurate. Practical reading of ECG is not taught in medical colleges as more emphasis is given to theory”

Further to this, Dr. Anthony Gomes added, “I am equipped to straight away diagnose the fluctuations in the heartbeat. Such details are not taught in the medical college. This workshop conducted by Fortis gives insights and classifies common, complicated and odd readings which are otherwise not taught to any doctor”.

“As a medical practitioner, it is imperative to have hands-on knowledge about ECG – its proper interpretation and functionality. This will go a long way in understanding the approach and treatment of cardiac cases and will help save many precious lives. Our programme is aptly designed to suit the day-to-day requirements of physicians and I am sure they will find this interesting and helpful,” added Dr. Keshava.

With this 40-hours’ ‘Interactive Training Program on ECG’ for doctors at Cunningham Road facility, Fortis Hospitals intends to provide information on standard ECG (electrocardiography) practices and their interpretations to physicians and practitioners there-by enabling them serve patients better. The scientific sessions will cover all essential topics in the field of electrocardiography so that physicians are better equipped to handle cases related to the heart. The workshop will also include other aspects of cardiology such as hypertension, heart attacks, heart failures and investigation of the heart.

Dr. Keshava R., Consultant Interventional Cardiologist, Fortis Hospitals, said, “The step-by-step interactive programme focuses on various aspects of ECG interpretation and consists of 16 sessions spanning over 8 weeks; each week with two sessions. The programme will focus on key topics like introduction to heart waves and rhythm, diagnosis and interpretation, chest pain evaluation, CPR, ECG review, etc.

13-YEAR-OLD BOY SUFFERING FROM RARE PENILE BIRTH DEFECT GETS NEW LEASE OF LIFE AT FORTIS HOSPITALS BANGALORE

Case highlights –

• 13-year-old boy from Bangalore was suffering from a rare birth defect including widening of pubic symphisis,an absent urinary control mechanism and incomplete male sexual organs leading to constant leakage of urine since he was born.
• The boy was operated on at the age of two for the ailment, but the problem continued to persist leading to social embarrassment and trauma.
• Finally, experts at Fortis Hospitals performed a set of surgeries leading to successful treatment of the issue.
• The boy’s urinary control mechanism is now normal and a normal looking penis has been reconstructed with tissues from his body. Urinary incontinence has also stopped.

Fortis Hospitals Bangalore recently performed a complex and rare surgery on a 13-year-old boy from Bangalore who was suffering from an unusual birth defect. The patient, Balaji, was born with a condition known as Exstrophy-Epispadias Complex where the patient had an inability to contol his urination, due to an absent continence mechanism (which normally helps to hold back urine) and incompletely formed male sexual organs.

After many check-ups and one failed surgery at different medical institutions, Balaji’s parents finally approached Fortis hospitals Rajajinagar as their last ray of hope. Dr. Mohan Keshava Murthy and Dr. Z. Shakir Tabrez, Consultant Urologists, along with Dr. J V Srinivas, Consultant Orthopedic and Joint Replacement Surgeon at Fortis Hospitals Rajajinagar performed 2 sequential complex surgeries and came up with a permanent solution to the boy’s problems.

When Dr. Mohan undertook the case, he advised the need for a staged repair.  This birth defect caused a constant leakage of urine without control. When he was 2 years old, he was operated for the defect. But the surgery didn’t help and though his parents consulted many other doctors, no solution was forthcoming. He continued to leak urine and was also ostracized by his classmates because of    the foul smell that this condition caused.

Before the surgery, the doctors at Fortis prepared an operational plan which was – a) to give good abdominal cover over the bladder b) to try and restore the God given continence mechanism (the ability to retain urine) by a procedure called bladder neck reconstruction (Young Dees Leadbetter technique) c) to take the help of our orthopaedic specialist for fusion of the pubic bone and d) to reconstruct the urethral tube with a good tissue and skin cover (Cantwell Ransley repair).

The surgeons performed the steps a, b and c together in the first sitting and after the wound healed and the continence mechanism was restored, urethral reconstruction surgery was done.  The specialists were also ready to augment or expand the capacity of the bladder by using a segment of bowel to reconstruct the urinary bladder if its capacity was found to be less. The entire procedure was performed under general plus regional anesthesia (for better post operative pain relief) which took about 4 hours and was absolutely uneventful.

The boy was discharged after 4 days in hospital. 4 weeks later when his catheter was removed, the boy could control his urine with ease.

The second part of the procedure was then planned – 6 weeks after the first. Again under similar anesthesia, the urethra was reconstructed (Cantwell Ransley repair). Some adhesions and tissues were freed along with the suspensory ligament, in order to give the boy better penile length. The urethra was then reconstructed over a catheter. He was discharged after 2 days in hospital. A week later his catheters were removed and Balaji was able to hold urine and pass it freely through his reconstructed urine passage.

He was also started on a testosterone supplement that would aid in growth of the supporting tissue, add length to his penis and help in his attaining puberty at the appropriate time.

The entire family was ecstatic as this would mean he would be able to mix and mingle with the rest of his school and society without being an outcast. Major part of the procedure took place during his summer holidays and hence he did not miss school either. Balaji’s treatment gives a ray of hope to all the other patients who suffer from such defects and don’t find the right medical treatment.

Exstrophy-Epispadias complex and other similar birth defects including hypospadias can and should be corrected at the appropriate time and with proper surgical technique and care.

“Treating such conditions requires a high level of expertise, keeping in mind the fragile nature of tissues and the tender young age of these patients. Procedures rectifying such rare defects require lot of expertise and medical support” added Dr.Mohan