Jamshedpur, Dec. 28 : Rupture of chest after severe heart attack is very rare but a lethal complication Md. Yusuf suffered from. Even most of the patients usually do not reach hospital within time as immediate surgery is required in such cases. Also massive bleeding puts his life at risk. The mortality rate of required surgery in such cases is almost 70-80%. But experienced team of cardiac doctors of Dr. P. Alam (Sr. Cardiac Surgeon), Dr. Ajay Agarwal (Interventional Cardiologist), Dr. Rahul Devdas (Cardiac Anesthesiologist) & Dr. Ramanuj Lal (Cardiac Anesthesiologist) at Brahmananda Narayana Multispeciality Hospital (BNMH) Jamshedpur took up the challenge and now Md. Yusuf is showing fast recovery.
Recently Md. Yusuf was admitted to BNMH in causality department with severe chest pain with sweating as his ECG was suggestive of heart attack. On examination, his pulse was very week and thready and BP was not recognizable, though the patient was conscious but had breathing difficulty & chest pain. Echocardiography was done which showed massive blood collection around the heart & compressing it. On diagnosis of Acute MI with post PMI, free wall LV rupture with haemopericardium with cardiac temporal was made.
Patient was shifted to Cath Lab for emergency coronary angiopgraphy and then immediately shifted to cardiac operation theatre for emergency heart surgery to save his life. His chest was opened and a jet of free blood came out of the chest relieving the compression on heart following which BP started coming up. There was a linear tear on left side of the heart which was source of bleeding. The torn area of the heart was pressed thumb to control the bleeding and stitch taken on torn heart muscle & then bleeding controlled. Surgical haemostatis agent was also applied on the repair site to further control the bleeding.
Heart was repaired; pulse, BP and other parameters were stabilized. BP was raised further with medicines to check any further bleeding. Then chest was closed and he was kept on ventilator for further 12 hours and then it was removed. Patient showed improvement. Two units of blood was also transfused in process. Post operative echocardiography also showed satisfactory recovery and there was no further bleeding with normal chest function. Md. Yusuf was discharged on sixth post operative day.
Dr. P. Alam, Sr. Cardiac Surgeon, BHMH said that, “Surgery in such cases is also very challenging as it should be done at the earliest. Being a rarest and life threatening condition the entire process was complicated at multiple levels, but I am thankful to my team for cooperation in this successful surgery.”
Also in procedure the aim was to open the chest as soon as possible after anesthesia, before it crashed, surgical technique to control the bleeding is very important to salvage these patients. Most of the heart surgeries are done on hear lung machine, where patient’s blood is diverted, also which functions as patient heart and lung so that heart becomes empty of blood and surgery can be performed easily but in such mentioned cases patient do not give time to establish heart lung machine. So the team decided to repair without hear lung machine. The tear on the heart was controlled with fingers of the assistant surgeon and then surgeon repaired the heart with loose suture to avoid cutting through of suture in the thin muscle and then surgical hemostatic agent was applied to further control bleeding and all these repairs were done without heart lung machine on the elevated heart while patient’s clinical parameters were maintained.
