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  • Timely diagnosis and treatment of rare lung condition at Kokilaben Hospital saves life

    Published on April 8, 2021

    Mumbai: The timely diagnosis of a rare and life-threatening lung condition, Chronic thromboembolic pulmonary hypertension (CTEPH) in a 42-year-old lady, Mrs. Puja Bansode allowed doctors at Kokilaben Dhirubhai Ambani Hospital (KDAH) to carry out the complex surgical procedure called pulmonary thrombendarterectomy (PTE) to remove organized blood clots in the blood vessels of the lungs. Mrs. Bansode was referred to KDAH with massive coughing of blood and was in advanced Class IV heart failure. After a thorough investigation and correct diagnosis of CTEPH, the procedure was successfully performed at KDAH. Mrs. Bansode is currently at home and has resumed her routine activities.

    Dr. Prashant Bobhate, Consultant, Children’s Heart Centre, Kokilaben Dhirubhai Ambani Hospital said, “Mrs. Puja Bansode was earlier wrongly diagnosed as having, Idiopathic Pulmonary Arterial Hypertension (IPAH), a condition that is extremely difficult to treat and may even need lung transplantation. At our Pulmonary Hypertension (PH) Clinic, she was investigated and found to have CTEPH due to clot formation in the arteries of her lung, which in turn increased blood pressure in the lung arteries leading to right heart failure. Unlike IPAH, CTEPH is curable and can be treated with surgery.” 

    Dr. Vidyadhar S. Lad, Consultant – Adult Cardiac Surgery, Kokilaben Dhirubhai Ambani Hospital added, “CTEPH is a rare and deadly form of pulmonary hypertension that is seen in 1 in 200,000 patients[1]. If left untreated, CTEPH can lead to heart failure. Fortunately, unlike all the other forms of pulmonary hypertension, this can be cured through a surgical procedure known as pulmonary thrombendarterectomy. Here the surgeon tenaciously removes the blood clots from the affected lung arteries and in the case of Mrs. Bandsode, we could successfully remove clots from every affected lung artery.”

    PTE was developed at the University of California, San Diego (UCSD), USA. It is a complex and extremely challenging procedure as the endarterectomy or removal of part of the inner lining of the artery, together with any deposits blocking the blood flow has to be done gently during brief periods of circulatory arrest, which are limited to 20 minutes. The operation is done through a chest wall incision followed by doctors stopping the heart, draining the blood from the heart and lung arteries, and inducing hypothermia to prevent brain damage. 

    Mrs. Bansode’s son, Jay was grateful. He said, “We are happy and completely satisfied with the treatment. At some point, we had lost hope, but an accurate diagnosis by Dr. Bobhate and successful surgery by Dr. Lad helped my mother get a new life. The PH clinic at Kokilaben Hospital is very advanced with the latest infrastructure, friendly staff and outstanding doctors. We owe them an unpayable debt.”

    Dr. Santosh Shetty, Executive Director and CEO, Kokilaben Dhirubhai Ambani Hospital said, “The PH clinic at KDAH is one of its kind in Western and North India and led by a PH specialist. This case is an example of how PH Clinics can help in timely and accurate diagnosis of the cause of pulmonary hypertension. Pulmonary thrombendarterectomy needs experience and expertise and we are proud that Kokilaben Hospital is amongst the few centres where this is possible. We are glad to have given the patient a new lease of life and offer new hope to patients with pulmonary hypertension.”

    The PH Clinic at KDAH has 425 patients enrolled. The clinic holds the world record for the highest number of Potts shunt conducted in a single center. This palliative procedure helps prevent lung transplant in patients with IPAH. The clinic has successfully diagnosed rare causes of pulmonary hypertension like Abernathy malformation of which five patients have been treated successfully. The clinic has also pioneered the introduction of prostacyclin therapy for PH taking the lead in ensuring the availability of the medicine that although very effective, has not yet been marketed in India. This therapy has been initiated in 16 patients, most of whom were moribund and very sick, and the therapy has improved exercise tolerance, breathing, blood circulation, allowing them to live a near-normal life.