Cardiac Surgical procedures
Cardiac surgery consists of basically two types of procedures, Open heart and Closed heart, the former being done with the help of a heart lung machine and the latter, without the need for a heart lung machine.
• The commonest open heart procedures, include coronary artery bypass CAB (the commonest surgical procedure in the world today), valve replacements, aneurysm repairs and correction of congenital heart defects.
• In SSSIHMS, a majority of Coronary artery bypass procedures are done without the help of a heart lung machine, (Off pump Coronary Artery Bypass – OPCAB) but with a fully assembled pump available, if needed.
• Majority of the valve procedures are replacements, with repairs accomplished when feasible.
• Aortic aneurysms depending on their location, are treated appropriately, with valve conduits or grafts as indicated.
• Total correction procedures form a major part of the pediatric surgical procedures, with palliative closed procedures when indicated.
• Examples of closed heart surgery include PDA ligation, Bi-Directional Glenn, Blalock-Taussig shunt, Coarctation of Aorta repair, and so on.
Following are the most common procedures done in the department of CTVS at SSSIHMS Wfd.
1. ALCAPA repair: Anomalous Left Coronary Artery Arising from Pulmonary Artery. This is a rare congenital anomaly where the Left Coronary Artery instead of arising from the aorta arises from the Pulmonary Artery. The surgical procedure involves re-implanting the left coronary artery back to the ascending aorta where it should have been arising, to start with.
2. Aortic Root Replacement: A surgical procedure where both the aortic valve and the ascending aorta are replaced with artificial valve and graft and re-implantations of the coronary buttons into the prosthetic graft.
3. AP Window closure: Aorto Pulmonary Window closure – a communication between ascending aorta and the pulmonary artery. Repair involves closure of this communication using a prosthetic or pericardial patch.
4. ASD closure: Atrial Septal Defect –Surgical closure of a defect in the septum/partition between the left and right atria, usually with a pericardial patch.
5. AV canal repair: Atrio-Ventricular canal repair. This is a complex defect where not only are the valves incompletely formed, but the atrial and/or ventricular septae / partitions are also deficient. Repair consists of not only repairing the two valves but also reconstituting the septae.
6. AVR: Aortic Valve Replacement, a procedure where the Aortic valve is replaced with a prosthetic (mechanical) /bio-prosthetic (tissue) valve.
7. BD Glenn: Bidirectional Glenn – It is an initial procedure that improves the blood flow to lungs, by connecting the Superior vena cava to the right pulmonary artery, as a prelude to connecting the inferior vena cava to the main pulmonary / left pulmonary artery.
8. Modified BT Shunt: Modified Blalock Taussig Shunt – A palliative procedure for many cyanotics with decreased pulmonary blood flow, Tetralogy of Fallot being the most common, where the subclavian artery is connected to the corresponding pulmonary artery using an an appropriate sized artificial tube graft.
9. CABG: Coronary Artery Bypass Graft: This is a procedure whereby blocked coronary arteries are bypassed using conduits from another part of the body (Left/Right Internal Mammary Artery from the chest wall, radial artery from the forearm and / or veins from the legs). The surgery is usually done with out the help of a Heart lung machine using myocardial tissue stabilizers, called as OPCAB and in selective case using cardio pulmonary bypass.
10. CoA Repair:This is a condition where there is a narrowing (Coarctation) of the aorta usually occurring in the proximal thoracic aorta section. The surgery involves removing the narrowed segment and connecting the two ends of the aorta directly whenever possible, or by placing a prosthetic graft between the two aortic segments.
11. Cor Triatriatum repair: An abnormal membrane in the Left Atrium that divides the LA into two chambers. The membrane is surgically removed during this procedure.
12. DCRV repair: Double Chambered right ventricle – abnormal obstructing muscle bundles inside the Right ventricle that are surgically removed.
13. DORV repair: Double Outlet Right ventricle generally occurs with both the great arteries arising from the right ventricle. The repair consists of closing the ventricular septal defect such that the left ventricle pumps blood into the aorta and the right ventricle into the main pulmonary artery.
14. Fontan: A procedure for congenital heart diseases with a functionally single ventricle where the systemic venous return is directly sent to the pulmonary circulation by detaching the SVC and the IVC and connecting them to the Pulmonary arteries. It is most often done without the use of heart lung machine, by using SVC-RA and IVC- RA shunts.
15. Lung resection: A procedure for removal of tumors and cysts in the lungs.
16. MV Repair: Mitral Valve Repair, where the mitral valve is surgically repaired.
17. MVR: Mitral Valve Replacement, where the Mitral valve is surgically replaced with a prosthetic (artificial) / bio-prosthetic (tissue) valve. This is done only when the valve is beyond salvage and cannot be repaired.
18. Myxoma excision: a surgical procedure where a myxoma – a connective tissue tumor usually found in the heart chambers, is excised (cut and removed). Commonly occurs in atria.
19. PAPVC repair: Partial Anomalous Pulmonary Venous Connection repair. One are more of pulmonary veins drain into RA. Surgical correction involves closure of the associated ASD, routing the pulmonary vein/s to LA.
20. PDA Ligation / Division: Patent Ductus Arteriosus Ligation /Division, a procedure in which the Patent Ductus Arteriosus, a connection between the pulmonary artery and the aorta is ligated (tied) or divided (cut).
21. Pericardiectomy: A surgical procedure for the condition of Pericarditis (infection of the pericardium) involves removal of the adhered pericardium.
22. RSOV repair: Ruptured Sinus Of Valsalva repair – a condition where one of the cusps of aorta in the sinus of Valsalva ruptures (tears / opens up) into one of the right sided chambers of the heart. Repair involves closure of the rupture.
23. SAM Excision: Sub Aortic Membrane excision, a surgical procedure on the aorta where a membrane below the aortic valve is obstructing the outflow of blood into the aorta.
24. Supra Valvular Aortic Stenosis: Surgical repair of severe narrowing supra valvular portion of the ascending aorta.
25. TAPVC repair: Total Anomalous Pulmonary Venous Connection repair – condition in which all the pulmonary veins drain into RA instead of LA. Surgical correction involves routing them to LA.
26. TGA: Transposition of great arteries is a serious congenital condition where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle leading to parallel systemic and pulmonary circulation. Senning’s, Mustard are procedures at the atrial level, while Jatene’s is an arterial switch operation with coronary transfer. These procedures are named after their founders.
27. Thymectomy: A surgical treatment for the condition of Myasthenia Gravis which involves excision of the thymus gland. This is also done for tumors of the Thymus.
28. T.O.F Repair: A surgical procedure performed for the Tetralogy of Fallot (TOF) condition (Ventricular Septal Defect, Pulmonary Stenosis, Right Ventricular Hypertrophy, Overriding Aorta,), the VSD is closed and the Right Ventricular Outflow Tract (RVOT) is reconstructed / augmented.
29. VSD closure: Ventricular Septal Defect – Surgical closure of an abnormal opening in the septum/partition between the left and right ventricles. There are various types of VSD depending upon the position of the opening in the septum.
Neurological conditions evaluated and treated routinely at SSSIHMS include the following:
1. Face head and neck pain
2. Epilepsy and related conditions
3. Cerebrovascular diseases
4. Infections of the CNS
5. Multiple Sclerosis (MS) and other demyelinating disorders
7. Parkinson’s Disease and movement and ataxic disorders
8. ALS and Other Motor Neuron Diseases
9. Trigeminal Neuralgia, Bell’s Palsy, and Other Cranial Nerve Disorders
10. Spinal Cord Diseases
11. Peripheral Neuropathies including Guillain-Barre´ Syndrome
12. Neuromuscular diseases
13. Tumors of the Nervous System
14. Psychiatric disorders and Mental health problems
Face, Head and Neck pain: These patients are generally managed on OPD basis.
1. Atypical Facial Pain
2. Cervical Spondylosis
3. Migraine, other headaches and variants
4. Muscle Contraction Tension Headache
5. Chronic Back Pain
6. Post-herpetic Neuralgia
7. Trigeminal Neuralgia
Epilepsy and related conditions: These patients are investigated as required and treatment instituted. Some patients depending upon their condition are admitted as part of their management.
1. 1. Fits, black outs, jerks and faints
2. 2. non – epileptic attacks
3. 3. Sleep disorders
Cerebrovascular diseases : Acute cases are admitted and managed with anti-coagulants and physiotherapy. Chronic cases are evaluated as required.
1. Acute Stroke Management
2. Cerebral Venous Thrombosis
3. TIA Transient Ischemic Attack
Infections of the CNS.: These patients are managed following diagnosis of the infections based on Lumbar puncture and other investigations with admission and institution of appropriate anti-microbial therapy.
1. Meningitis-acute and chronic-bacterial/viral/protozoal/fungal
3. Brain abscess
Multiple Sclerosis (MS) and other demyelinating disorders:
1. Optic Neuritis
2. Transverse Myelitis
3. Other demyelinating disorders
Dementia: These patients are investigated.
1. Alzheimer’s disease
2. Vascular dementia / Multi-infarct dementia
3. Reversible dementias
4. Prion (Creutzfeldt-Jakoband Gerstmann-Straussler-Scheinker disease)
Parkinson’s Disease and movement and ataxic disorders : These patients are seen on an OPD basis and treatment is instituted and optimized as required.
3. Parkinson Disease and related disorders
4. Spinocerebellar ataxias
ALS and Other Motor Neuron Diseases : ENMG and conduction studies are used to reach a definitive diagnosis in these patients.
1. Amyotropic lateral sclerosis / MND
2. Spinal muscular atrophy
Trigeminal Neuralgia, Bell’s Palsy, and Other Cranial Nerve Disorders: Are investigated and treated appropriately.
Spinal Cord Diseases: When surgical intervention is required then the patients are reffered to the sister dept of neurosurgery.
2. Spinal cord tumors
3. Cervical spondylosis
4. Prolapsed disc
5. Transverse myelitis
Peripheral Neuropathies including Guillain-Barre´ Syndrome: ENMG, NCV and Nerve biopsies are conducted for diagnosis.
1. Polyneuropathies eg.diasetic
2. Acuteneuropathies eg GB Syndrome
Neuromuscular diseases: These are investigated by ENMG and Muscle biopsy.
2. Inclusion Body Myositis
3. Limb-Girdle Muscular Dystrophy
4. Metabolic Myopathies
5. Periodic Paralyses
Tumors of the Nervous System: These once diagnosed are dealt by the Neurosurgery department. Psychiatric disorders and Mental health problems: Psychiatric problems when secondary to neurological disorders if diagnosed are treated in-house by a Consultant Psychiatrist.
OBSTETRICS AND GYNAECOLOGY
Services offered include normal deliveries, episiotomies, Caesarean section, assisted breech deliveries, assisted Twin deliveries, retained placenta, forceps deliveries, cervical cautery, dilatation & curettage, suturing cervical tear, examination under anaesthesia, ectopic pregnancies, tubectomy in certain cases, cervical cytology (pap smear), hysterectomies (both abdominal & Vaginal), Caesarean hysterectomy, laparotomies, removal of ovarian cysts etc.
The General Surgery department
The following laparoscopic and open surgeries on regular basis: