Wockhardt Hospitals Blog

Bangalore, March 26, 2009: Wockhardt Hospitals Bangalore set yet another benchmark in cardiovascular surgery with one of its consultants Dr. Ganeshakrishnan Iyer, Consultant Cardio Vascular Surgeon,Wockhardt Hospitals performing a Mitral Valve Replacement surgery through Minimally Invasive Endoscopic Technique called the Minimal Thoracotomy Approach. The most important benefits being reduced surgical trauma and a shortened hospital stay.

Two patients were operated through this method with small incision in the right side of the chest measuring 3-4 inches as against the conventional midline sternotomy where the incision is in the front of the chest and measures about 12-14 cms. The rarely used minimally thoracotomy incision can confer the advantages of a smaller surgical wound, reduced blood loss, decreased risk of infection, shorter ICU stay, early discharge, decreased postoperative pain and a smaller cosmetically more acceptable postoperative scar.

T. Ashokan, 46 year old gentleman from Vellore was suffering from exertional dyspnea (breathlessness on exertion) for the last 4-5 years. He is a known case of Rheumatic Heart Disease (RHD) and his echocardiography showed severe mitral stenosis. After diagnosis he was advised for a Mitral Valve Replacement. Mr. Ashokan was admitted at Wockhardt Hospitals and underwent Minimally Invasive Endoscopic Mitral Valve Replacement. His post operative recovery was uneventful and recuperation has been very speedy.

Mrs. Ana Fernandes a 52 year old lady from Goa was suffering from breathlessness on exertion. She is a known case of rheumatic heart disease and her echo report revealed severe mitral stenosis and mild mitral regurgitation and was advised for a Mitral valve replacement surgery. She was admitted at Wockhardt Hospitals and underwent Minimally Invasive Endoscopic Mitral Valve Replacement. Her post operative recovery has also been uneventful and speedy recovery is seen.

Traditionally Mitral valve replacement is an open heart procedure performed by cardiothoracic surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, and into the heart through the mitral valve. When it opens, the mitral valve allows blood to flow into the heart's main pumping chamber called the left ventricle. It then closes to keep blood from leaking back into the lungs when the ventricle contracts (squeezes) to push blood out to the body. It has two flaps, or leaflets. Occasionally, the mitral valve is abnormal from birth (congenital). More often the mitral valve becomes abnormal with age (degenerative) or as a result of rheumatic fever.

In rare instances the mitral valve can be destroyed by infection or a bacterial endocarditis. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease). Often the mitral valve is so damaged that it must be replaced. Through this new and advanced minithoracotomy method the heart is approached between the ribs, providing the surgeon access to the mitral valve. There is no sternal incision or spreading of the ribs required for this surgical technique. The surgeon inserts special surgical instruments through the incision to perform the valve repair.

An aneurysm is a bulge or "ballooning" in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. If an aneurysm grows large, it can burst and cause dangerous bleeding or even death.

Most aneurysms occur in the aorta, the main artery traveling from the heart through the chest and abdomen. Aneurysms also can happen in arteries in the brain, heart and other parts of the body. If an aneurysm in the brain bursts, it causes a stroke.

Aneurysms can develop and become large before causing any symptoms. Often doctors can stop aneurysms from bursting if they find and treat them early. Medicines and surgery are the two main treatments for aneurysms.

Aortic dissection occurs when the layers of the wall of the aorta separate or are torn, allowing blood to flow between those layers and causing them to separate further. When the aortic wall separates, blood cannot flow freely, and the aortic wall may burst.

Any condition that causes the walls of the arteries to weaken can lead to an aneurysm. The following increase the risk of an aneurysm or an aortic dissection:

Aneurysms can be detected by physical exam, on a basic chest or stomach x-ray, or by using ultrasound. The size and location can be found through echocardiography or radiological imaging, such as arteriography, magnetic resonance imaging (MRI), and computed tomography (CT) scanning.

• Aortic dissection may cause sudden and severe pain, and patients often feel like something is ripping or tearing inside of them. The pain is mainly felt in the chest, but it can spread to the back or between the shoulder blades. Aortic dissection may also cause sudden stomach pain, lower back pain, or flu-like symptoms. If blood leaks from the dissection and builds up in the chest, the blood may enter the pericardial space (the sac that surrounds the heart) and prevent the heart from filling properly. This can lead to a life-threatening condition called cardiac tamponade.

Treatment depends on the size and location of the aneurysm and your overall health.

Aneurysms in the upper chest (the ascending aorta) are usually operated on right away.

Aneurysms in the lower chest and the area below your stomach (the descending thoracic and abdominal parts of the aorta) may not be as life-threatening. Aneurysms in these locations are watched regularly. If they become about 5 centimeters (almost 2 inches) in diameter, continue to grow, or begin to cause symptoms, your doctor may want you to have surgery to stop the aneurysm from bursting.

For aortic aneurysms or aneurysms that happen in the vessels that supply blood to your arms, legs, and head (the peripheral vessels), surgery involves replacing the weakened section of the vessel with an artificial tube, called a graft.

For patients with smaller or stable aneurysms in the descending aorta or abdominal parts of the aorta—those farthest from the heart, doctors usually ask patients to come in for regular check-ups so they can follow the growth of the aneurysm. If the aneurysm does not grow much, patients may live with the aneurysm for years. Doctors may also prescribe medicine, especially medicine like a beta blocker that lowers blood pressure, to relieve the stress on the aortic walls. Medicine to lower blood pressure is especially useful for patients where the risk of surgery may be greater than the risk of the aneurysm itself.

For patients with aortic dissection, surgery is usually recommended right away, especially if the dissection is in the part of the aorta closest to the heart. For dissections farther from the heart, patients will be given medicines (such as beta-blockers to lower blood pressure), and the dissection will be watched closely. But, if the dissection begins to leak blood, cause a blockage, or get bigger, surgery is needed.

They New York Times yesterday published an article on Medical Tourism outlining the benefits of medical tourism specially in times of increasing depressing economic conditions.

The article talks about an American executive working for Bank of America chose to go to Costa Rica for his double hernia operation rather than going to a local hospital in Columbia
Going Abroad to Find Affordable Health Care - NYTimes.com

With over 85,000 Americans choose to travel abroad for medical procedures each year, according to a recent report by the consulting firm McKinsey & Company.

Most American patients or medical travelers which they are mostly known as , Treatment includes dental implants, hip and knee replacements, heart valve replacements and bypass surgery. The cost of surgery performed overseas can be as little as 20 percent of the price of the same procedure in the United States, according to a recent report by the American Medical Association.

While the Nytimes reports accepts that the bulk of medical tourism candidates are uninsured and underinsured people paying their own bills and looking for low-cost alternatives to American care. Most Medical tourism advocates and Americans who have actually been to countries like India argue that the quality of care overseas is often equal to or better than that in the United States. Many countries have high success rates, American-trained English-speaking doctors and the newest facilities, often built specifically to attract foreign patients.

While this is not the first time that the mainstream US media has started to cover medical tourism in a big way,what would be interesting if this Medical Tourism Growth has any affect on the Obama's proposed rehauling of the American Health care system While it is clear that outsourcing has been one of the issues that the Democrats has taken on a very tough stand on, Medical Outsourcing of Health is something that is independent of Government Regulation or Idealogy. As long as Hospitals in the Developing countries provides quality at competitive costs medical Tourism will continue to grow..

The American Medical Association, has issued guidelines on medical travel, which ymou can check here issued guidelines on medical tourism . (They’re available on the Web at tinyurl.com/cpklcw.)

The Human heart pumps nearly 5 quarts of blood through your body every minute. Even while sitting still, your heart beats 60 to 80 times each minute. These heartbeats are triggered by electrical impulses that begin in your heart's natural pacemaker, called the sinoatrial node (SA node). The SA node is a group of cells located at the top of your heart's upper right chamber (the right atrium.

Any irregularity in your heart's natural rhythm is called an arrhythmia. Almost everyone's heart skips or flutters at one time or another, and these mild, one-time palpitations are harmless. But if you have recurrent arrhythmia's, you should be under the care of a Cardiologist or Rather an Electrophysiologist.

Arrhythmia's can be divided into two categories: ventricular and supra ventricular. Ventricular arrhythmia's happen in the heart's two lower chambers are, called the ventricles are affected. Supraventricular arrhythmia's happen in the structures above the ventricles, mainly the atria, which are the heart's two upper chambers are affected.

Arrhythmia's are further defined by the speed of the heartbeats. A very slow heart rate, called bradycardia, means the heart rate is less than 60 beats per minute. Tachycardia is a very fast heart rate, meaning the heart beats faster than 100 beats per minute. Fibrillation, the most serious form of arrhythmia, is fast, uncoordinated beats, which are contractions of individual heart-muscle fibers.

Heart block happens when the SA node's electrical signal cannot travel to the heart's lower chambers (the ventricles).

Many factors can cause your heart to beat irregularly. Some people are born with arrhythmia's, meaning the condition is congenital. Some medical conditions, including many types of heart disease and high blood pressure, may be factors. Also, stress, caffeine, smoking, alcohol, and some over-the-counter cough and cold medicines can affect the pattern of your heartbeat.

Whether you have symptoms and what those symptoms feel like depend on the health of your heart and the type of arrhythmia you have. Symptoms also depend on how severe the arrhythmia is, how often it happens, and how long it lasts. Some arrhythmias do not produce any warning signs. Contrary to popular belief, heart palpitations do not always mean that you have an arrhythmia.

Symptoms of Bradycardia: You may feel tired, short of breath, dizzy, or faint.

Symptoms of Tachycardia:You may feel a strong pulse in your neck, or a fluttering, racing heartbeat in your chest.

Symptoms of Fibrillation:You may feel chest discomfort, weak, short of breath, faint, sweaty, or dizzy.

• A standard Electrocardiogram (ECG or EKG) is the best test for diagnosing arrhythmia. This test helps doctors analyze the electrical currents of your heart and determine the type of arrhythmia you have.

• Holter Monitoring gets a non-stop reading of your heart rate and rhythm over a 24-hour period (or longer). You wear a recording device (the Holter monitor), which is connected to small metal disks called electrodes that are placed on your chest. With certain types of monitors, you can push a "record" button to capture your heart's rhythm when you feel symptoms. Doctors can then look at a printout of the recording

• Electrophysiology Study (EPS) are usually done in a cardiac catheterization laboratory. A long, thin tube called a catheter is inserted into an artery in your leg and guided to your heart. A map of electrical impulses from your heart is sent through the catheter which helps doctors find the kind of arrhythmia. During the study, doctors can give you controlled electrical impulses to show how your heart reacts. Medicines may also be tested at this time to see which will stop the arrhythmia. Once the electrical pathways causing the arrhythmia are found, radio waves can be sent through the catheter to destroy them. (See radiofrequency ablation in treatment section below.)

• A tilt-table exam is a way to evaluate your heart's rhythm in cases of fainting. The test is noninvasive, which means that doctors will not use needles or catheters. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted to 65 degrees. The angle puts stress on the area of the nervous system that maintains your heart rate and blood pressure. Doctors can see how your heart responds under carefully controlled times of stress.

How is arrhythmia treated?

Dr V. RAJASEKHAR a Consultant Cardiologist and Electrophysiologist with Kamineni Wockhardt Hospital. He has successfully implanted many ICD devices and Pacemakers and is considered to be one of the leading experts in this field. Dr. Rajasekhar is also an expert in EP study as well as Radio Frequency Ablation. He can be contacted at enquiries@wockhardthospitals.net

The words "heart failure" sound alarming, but they do not mean that your heart has suddenly stopped working. Instead, heart failure means that your heart is not pumping as well as it should to deliver oxygen-rich blood to your body's cells.

Congestive heart failure (CHF) happens when the heart's weak pumping action causes a buildup of fluid called congestion in your lungs and other body tissues. CHF usually develops slowly. You may go for years without symptoms, and the symptoms tend to get worse with time. This slow onset and progression of CHF is caused by your heart's own efforts to deal with its gradual weakening. Your heart tries to make up for this weakening by enlarging and by forcing itself to pump faster to move more blood through your body.

According to the American Heart Association, people 40 and older have a 1 in 5 chance of developing CHF in their lifetime. This is because people are living longer and surviving heart attacks and other medical conditions that put them at risk for CHF. People who have other types of heart and vessel disease are also at risk for CHF.

• Previous Heart Attacks
• Coronary artery disease
• High blood pressure (hypertension)
• Irregular heartbeat (arrhythmia)
• Heart valve disease (especially of the aortic and mitral valves)
• Cardiomyopathy (disease of the heart muscle)
• Congenital heart defects (defects you are born with)
• Alcohol and drug abuse

Symptoms can help doctors find out which side of your heart is not working properly.
If the left side of your heart is not working properly (left-sided heart failure), blood and fluid back up into your lungs. You will feel short of breath, be very tired, and have a cough (especially at night). In some cases, patients may begin to cough up pinkish, blood-tinged sputum.

If the right side of your heart is not working properly (right-sided heart failure), the slowed blood flow causes a buildup of fluid in your veins. Your feet, legs, and ankles will begin to swell. This swelling is called edema. Sometimes edema spreads to the lungs, liver, and stomach. Because of the fluid buildup, you may need to go to the bathroom more often, especially at night. Fluid buildup is also hard on your kidneys. It affects their ability to dispose of salt (sodium) and water, which can lead to kidney failure. Once CHF is treated, the kidneys' function usually returns to normal.

As heart failure progresses, your heart becomes weaker and symptoms begin. In addition to those listed above, here are some other symptoms of CHF:

• You have trouble breathing or lying flat because you feel short of breath.
• You feel tired, weak, and are unable to exercise or perform physical activities.
• You have weight gain from excess fluid.
• You feel chest pain.
• You do not feel like eating, or you feel like you have indigestion.
• Your neck veins are swollen.
• Your skin is cold and sweaty.
• Your pulse is fast or irregular.
• You feel restless, confused, and find that your attention span and memory are not as good as they were.

• Electrocardiography (ECG or EKG) can be used to check for an irregular heartbeat (arrhythmia) and stress on the heart. It can also show your doctor if you have had a heart attack.

Other imaging techniques, such as nuclear ventriculography and angiography, can provide a firm diagnosis and show doctors how diseased your heart is.

Many therapies can help to ease the workload of your heart. Treatment may include lifestyle changes, medicines, transcatheter interventions, and surgery.

• If you smoke, quit.
• Learn to control high blood pressure, cholesterol levels, and diabetes.
• Eat a sensible diet that is low in calories, saturated fat, and salt.
• Limit how much alcohol you drink.
• Limit the amount of liquids you drink.
• Weigh yourself daily to watch for fluid buildup.
• Start an aerobic exercise program that has been approved by your doctor.

• Angioplasty is a procedure that is used to open arteries narrowed by fatty plaque buildup. It is performed in a cardiac catheterization laboratory. Doctors use a long, thin tube called a catheter that has a small balloon on its tip. They inflate the balloon at the blockage site in the artery to flatten the fatty plaque against the artery wall.

• Stenting is used along with balloon angioplasty. It involves placing a mesh-like metal device into an artery at a site narrowed by plaque. The stent is mounted on a balloon-tipped catheter, threaded through an artery, and positioned at the blockage. The balloon is then inflated, opening the stent. Then, the catheter and deflated balloon are removed, leaving the stent in place. The opened stent keeps the vessel open and stops the artery from collapsing.

• Bi-ventricular pacemaker is recommended for patients with Moderate to severe heart failure who have a low ejection fraction , as the name suggests this device stimulates both the heart ventricles simultaneously so that they co-ordinate in synchrony. This improves the ejection fraction (which is a measure of the pumping capacity of the heart) thereby improving the quality of life of the patient. Commonly known as a CRT device is a device which is smaller than the palm of an adult hand. A specially trained cardiologist implants the device.

• Studies have shown that Heart Failure patients are at a higher risk for Sudden cardiac arrest. Special CRT devices are available which can potentially stop life threatening ventricular fibrillation (very fast heart rates) by delivering an electrical shock (called defibrillation in medical terms) to the patient. This device is a combination of a conventional Implantable Cardioverter Defibrillator (the “shock box”) and the pacemaker. It is commonly called as a “Combo” device or a CRT-D (D stands for Defibrillator).

The best way to prevent heart failure is to practice healthy lifestyle habits that reduce your chances of developing a heart problem. It is also important to find out if you have any risk factors that contribute to heart failure, such as high blood pressure or coronary artery disease. Many patients with congestive heart failure can be successfully treated, usually with a percutaneous coronary intervention.Patients should carefully follow their doctors' advice. In doing so, they can continue to live full and productive lives.

Minimally invasive spinal surgery has revolutionized the surgical treatment of sciatica, disc prolapse, canal stenosis. Minimal Access Spine Surgery has become a boon to patients suffering from these problems, who dread a spinal surgery due to the fear of postoperative pain, rehabilitation and risk of general anesthesia.

The spinal cord is a delicate fluid filled long tube with multiple nerves coursing through it like tendrils. The above-mentioned diseases cause pressure on the bag or the nerve roots giving rise to pain, tingling, numbness and even weakness in the lower limbs. Left neglected it can lead to permanent weakness of the leg, foot, or urinary system. The vertebra encloses delicate structures within it, protecting the vital cord & nerve from injury.

To remove the pressure on the nerves and the cord it is imperative to remove the prolapsed disc, thickened ligaments or the bony growths.

In Standard Laminectomy surgeries the whole posterior part of 1 & 2 vertebrae would be excised, so as to access the diseased part. This procedure does relieve the patient of his symptoms but due to the excision of the lamina & Interspinous ligament it predisposes the patient to developing spinal instability & Postoperative adhesions. Laminectomy has a high incidence of repeat surgeries and also the postoperative recovery is prolonged (1 – 3 days).

As a commitment towards improving the quality of life by enhancing the level of medicare, we at Wockhardt Hospitals, continuously strive to make the best use of cutting edge Medical Technology. The YESS system is being used in India for the first time at Wockhardt Bone and Joint Hospital, Hyderabad. With the help of YESS apparatus, Endoscopic spine surgeries can be carried out under local anesthesia and the postoperative stay of the patient is reduced to only a few hours..

Tennis elbow is an inflammation around the bony knob on the outer side of the elbow. It occurs when the tissue that attaches muscle to the bone becomes irritated. The bony knob is called the lateral epicondyle, and tennis elbow is also called lateral epicondylitis (ep-ih-kondah- LY- its).

Playing a racket sport can cause tennis elbow. So can doing any thing that involves extending your wrist or rotating your forearm- such as twisting a screwdriver or lifting heavy objects with your palm down. With age, the tissue may become inflamed more easily.

The most common symptom of tennis elbow is pain on the outer side of the elbow and down the forearm. You may have pain all the time or only when you lift things. The elbow may also swell, get red, or feel warm to the touch. And it may hurt to grip things, turn your hand, or swing your arm.

The muscle that allows you to straighten your fingers and rotate your lower arm and wrist are called the extensor muscles. These miles extend from the outer side of your elbow to your wrist and finger. A cordlike fiber called a tendon attaches the extensor muscles to the elbow. Overuse or an accident can cause tissue in the tendon to become inflamed or injured.

Your doctor can usually diagnose tennis elbow from your symptoms and from the look and feel of your elbow. He or she may order an x-ray to be sure the bone is not diseased or fractured. In some cases, other tests may be needed.

Wearing a tennis elbow splint allows the inflamed tendon to rest, so it can heal. Using your other hand or changing your grip also helps take stress off the tendon. And oral anti inflammatory medications and heat or ice can relieve
pain and reduce swelling.

To prevent flare-up after treatment , you may need to change the way you do some things. Gripping with the palm up, lifting heavy objects with both hands ,or vary activities through out the day will help reduce stress on the tendon. When you play racket sports or golf ,be sure to condition your muscles ,do warm-up and cool-down exercises, and use the correct strokes.

About Wockhardt Hospital, Bone and Joint care :The Wockhardt Hospitals Bone and Joint care is one of our super specialties and is a center of excellence with highly skilled clinical expertise.

The Wockhardt Bone and Joint Care is equipped to treat all types of musculo-skeletal problems ranging from Trauma Surgery to Minimally Invasive Arthroscopy Surgery. The hospital also specializes in surgery for joint replacements, sports medicine, ligament repair, knee surgery, spine surgery and physical therapy for rehabilitation.

Wockhardt Bone & Joint Care has complete technology and advanced skills to perform Microscopic Lumber & Cervical Discectomy, Endo-scopic Spine Surgery and Arthroscopic surgeries such as Ligament Reconstruction in the knee, Subacromial Decompression in the shoulder.For online appointments write into enquiries@wockhardthospitals.net or logon to our website at wockhardthospitals

Doctor Sachin Bhonsle,(MS (Orthopaedics, FRCS Glasgow, UK) Consultant Joint Replacement and Orthopaedic Surgeon Wockhardt Bone and Joint Care, Mumbai,India answers some most commonly asked questions on Knee Surgeries .



1. Evolution around knee surgeries in India over the years.

This decade has been very progressive for orthopaedics in India to the extent that we can call it an orthopaedic decade. A lot is now on offer to improve quality of life to those with arthritis and joint injuries. As late as 1980s most people with worn out joints had no choice but to lead an invalid life. There are very few surgeons in our country with resources to provide reconstructive joint surgery. Also to those few who could afford, the treatment options were limited as well as expensive. In late 80s Arthroscopic or keyhole surgery started gaining popularity in India. This was a boon to youngsters involved in sports. Around the same time Joint replacements became more readily available. This is when Indian companies started coming up with reliable prostheses. As we rolled into the third millennium standard knee and hip replacements were optimised in a number of cities and centres across the country.

2. Percentage of Indian undergoing Knee Replacements every year

This varies greatly compared to western countries. Reliable figures are not available but a vast majority of Indian patients tend to procrastinate on knee arthritis rather than having surgery. Knee tends to be most commonly replaced joint in India because of higher incidence of knee arthritis compared to hip in our subcontinent.

3. Who is a candidate for knee replacements?

Any person with a painful and irreparably worn out knee joint can be a candidate. There has been a classic approach to do it after the age of 60 because older prostheses tended to last only 10 to 15 years and revision surgery was difficult. But now the contemporary designs are long lasting, techniques are more refined and revision surgery facilities have been developed optimally. Therefore we contemplate doing joint replacements at much younger ages.

4. What advancements have been made in total knee replacements? Advancements in surgical methods and how it has been revolutionized over the years
To know more about Bone and Joint care at Wockhardt Hospitals, or to schedule an appointment with Doctor Sachin Bhosel,please write to enquiries@wockhardthospitals.net