Fed up with so much negativity about our profession but we should publish good outcomes , hard work and share them public domain.In this series I am sharing one case which was operated on emergency basis without worrying about result, as death was on knocking the door.

 

I got a call from cardiologist from Jamshedpur that one 75 year old patient is in acute pulmonary edema and on ventilator and diagnosed as Acute Aortic Dissection with pericardial collection and nobody was ready to take the patient for surgery as it was only option to operate and fix the emergency but again it was very high risk and some bad Facebook posts came into my mind too but ignored and ready to take up the case . I ask them to send patient on cardiac ambulance and if he will be able to reach then I will operate in same night although I was 300 KM away from hospital for community outreach programme.

 

We started the preparation for emergency surgery , coordinating on phone . Started to see options to reach Ranchi some how . By the time patient reached we sent investigations and complete essential work up started as his blood group was also negative so it was difficult to arrange blood too but some how blood bank arranged 5 units . My radiologist friend also warned me about his condition of aortic dissection as it was ruptured into pericardium . By 11 pm I reached at hospital and our team comprising cardiac anaesthetist and OT staff was ready with everything and shifted the patient to OT at 11.30 pm and started the case midnight . I made preparations for emergency Bypass by axillary canullation so that we can use it for antegrade cerebral perfusion for circulatory arrest. His pericardium was full of blood and we put him on CPB and started cooling , his aortic intima was torn , blood was flowing beneath aortic adventia his coronary Ostia was dissected too so we had reconstruct them. And his Aortic root , ascending aorta with part of proximal arch were being replaced with valved conduit and coronaries reimplanted under Moderate hypothermic circulatory arrest as we are using antegrade cerebral perfusion . Operation was completed by 6 am in morning . And at 6 pm in evening he opened his eyes then whole team got relax. By coming morning he was weaned off from ventilator then his family members felt happy. Now he is ready for discharge . After taking so much of risk he was saved.