Naresh Trehan


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Robotic Surgery

Provided by Escorts Heart Institute
Brought to you by Healthbase

Surgeon on Robotic Console

Robotic System-daVinci Telemanipulation Robotic Cardiac Surgery is performed with the help of da Vinci telemanipulation system (Intutive Surgical, Inc, Mountain View, California, USA). The da Vinci system is computer enhanced system that consists of surgeon’s console and cart mounted manipulators.

 

Such endoscopic surgery works well for several types of operations (such as gall bladder removal and knee repairs) where part of the body to be operated upon motionless and surgical maneuvers to be performed are relatively simple. Thus endoscopic surgery has achieved only limited success in more complicated operations such as heart surgery, where the heart is beating and the necessary surgical maneuvers are complex.

 

The console houses the display system showing three dimensional pictures of the patient’s chest cavity, the surgeon sits away from the patient at the console and gets the view of inside of the patient’s chest cavity. The manipulators hold the tiny instrumentswhich go inside the patient’s chest. Surgeon’s hand movements are transmitted to these instruments facilitate different cardiac operations. Coronary artery bypass grafting (CABG), mitral valve repairs and closure of atrial septal defects have been performed successfully through this technique.

IMA – LAD Anastomosis with Robotic Instruments

T-CAB (Totally Endoscopic Coronary Artery Bypass) T-CAB is performing Coronary artery Bypass totally endoscopically without opening the chest at all. T-CAB is performed with the help of computer assisted robotic technology(da Vinci telemanipulation system). The robot is not autonomous. On the robotic console surgeon’s hand motions are captured, transformed and then transmitted to tiny instruments inside the chest cavity to perform complicated cardiac procedures. The surgeon’s had movements are transmitted to tiny instruments that facilitate and endoscopic anastomosis. The control is so perfect that cardiac surgeons are able to construct an anastomosis in the customary fashion without placing a hand inside the chest cavity. The surgeon sits at a console, peering into the chest with 3-dimensional vision and working with perfection. This technique has great cosmetic advantage as there are only 3-incisions, each only 1 cm in diameter on the side and lower part of chest instead of long cut in the front of the conventional surgery. A smaller incision (cut) also means less pain, faster healing and recovery and short hospital stay.


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©2006 Healthbase Online Inc. All rights reserved. | About us
The contents or materials provided in this website are for general information only and are not intended as medical advice

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Preventing a Heart Attack

(Source: Raffles Hospital)

Heart attacks come without warning and strike with deadly force. Whilst the spectrum of treatment modalities has improved over the years, they can sometimes be available too late. Prevention is the greatest cure for heart attacks and you should start today.

 

  1. Be mindful of your diet and your weight
  2. Watch what you eat. You should cut down on the fatty, cholesterol enriched foods and sugar. Eat balanced meals with lots of fruit and vegetables. Drink water instead of sugared drinks. Start on an exercise routine that is easy to maintain. Control your weight through proper nutrition and exercise. Spare your heart the extra load.

  3. Don’t smoke.
  4. If you are a non-smoker, don’t start. If you are a smoker, try to kick this habit. You will do better without it.

  5. Be more active
  6. Put more zest into your life and more spring into your steps. Walk more. Use the stairs instead of taking the lifts. Try going to work on public transport and walking instead of driving once in a while.

  7. Manage your stress; don’t let stress manage you
  8. There are many ways to cope with stress in your life. Learn to manage your time more efficiently and take control of stress instead of letting stress take control of you.

  9. Keep blood pressure, blood cholesterol and diabetes under control
  10. If you are already suffering from hypertension, high cholesterol or diabetes, follow the advice of your doctors and take your medications as prescribed. Go for your regular check-ups and follow your doctor’s recommendations faithfully.

  11. Check Early to Save Your Life
    • Don’t put yourself at unnecessary risks. The following tests are conditions that are risk factors for coronary heart disease. You should consider doing these tests on a regular basis. They are simple to do and may save your life.
    • Have your blood pressure checked by your doctor at least once a year.
    • Do a blood cholesterol test at least once in every 5 years, or more frequently if you have a high cholesterol level. Review the results with your doctor and listen to his advice.
    • Have your blood glucose checked at least once a year for diabetes. Diabetes can also be screened for by doing a simple urine dipstick test.
    • If you are particularly at risk of coronary heart disease, you should follow-up with your doctor regularly. Your doctor may advise you to do an ECG (electro-cardiogram) to assess the status of your heart. In some instances, you may need to do an exercise treadmill test to determine the fitness of your cardio-respiratory system.

Remember, early detection of heart disease allows for early treatment, and early treatment could well prolong your life.


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©2006 Healthbase Online Inc. All rights reserved. | About us
The contents or materials provided in this website are for general information only and are not intended as medical advice.

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Coronary artery bypass graft surgery (CABG)

Provided by Escorts Heart Institute
Brought to you by Healthbase

Coronary artery bypass graft surgery (CABG) involves sewing one end an artery or vein above a blocked coronary artery and the other end below the blockage, thereby allowing blood an alternative means to get to the heart. The arteries or veins used for the bypass (which are known as “grafts”) are usually obtained from the leg or the chest wall. Bypass surgery may not be possible if the coronary artery is heavily calcified or if the disease is very widespread. CABG can be done with or without connecting the patient to heart-lung machine, depending on the kind of blockages and surgeon’s decision.

Several new surgical approaches are being developed, which can potentially reduce the discomfort and complications associated with traditional bypass surgery. These are collectively referred to as being “minimally invasive.” In general, these approaches focus on performing bypass surgery though a very small chest incision and performing bypass surgery while the heart is still beating (ie, without the need for a heart/lung bypass machine).

OPCAB (Off Pump Coronary Artery Bypass)
The bypass surgery done without connecting the patient to of heart-lung machine or pump is called OPCAB.

MIDCAB (Minimally Invasive Direct Coronary Artery Bypass)
is bypass surgery done through a small cut (incision) in the lower part of the sternum (chest bone) only, rather than full cut across it. This type of surgery, which is possible in selected cases only, is associated with a small scar, lesser pain and faster recovery. Alternatively, this surgery can also be done through a small cut on the left side of the chest.

The location and degree of coronary artery blockages are determined before surgery by using a procedure called heart catheterization, or coronary angiogram. This procedure provides an outline, like a road map, of the arteries of the heart.

Factors favoring bypass surgery
Bypass surgery is often recommended over angioplasty when the left main coronary artery is narrowed by more than 50 percent, when angioplasty does not relieve angina, when many arteries are narrowed, or when the heart’s left ventricular pumping function is substantially impaired. Bypass surgery is also preferred over angioplasty in diabetic patients who have two or three vessels involved.

Benefits
Bypass surgery can very effectively relieve angina and can even prolong life in people with severe coronary heart disease, such as those with three-vessel involvement associated with impaired left ventricular pumping function. However, the success of bypass surgery on symptoms and on survival depends upon several factors, including the pattern and extent of arterial narrowing, the general progression of coronary heart disease over time, and the blood vessels used for bypass. In general, bypass surgery is more likely than angioplasty to provide complete revascularisation.

About 95 percent of people who have narrowing of several arteries have improvement or complete relief of their angina immediately after surgery. About 85 to 90 percent of people remain angina-free at one to three years after surgery, and about 75 percent of people remain angina-free or free of major coronary events at five years after surgery. By 10 years, about one-half of all grafted vessels become narrowed or occluded, and by 15 years, about 85 percent of grafted vessels become narrowed or occluded. These late events usually require a second surgery

Recovery from bypass surgery
It usually takes a while to recover from even routine bypass surgery. However, about 70 to 80 percent of people who have this surgery are eventually able to return to work; this is about the same as the percentage of people who are treated medically and are able to return to work. Factors that appear to have a role in a person’s ability to return to work are the presence or absence of angina after surgery, employment status before surgery and income, the function of the heart’s left ventricle, and age.


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©2006 Healthbase Online Inc. All rights reserved.  |  About us
The contents or materials provided in this website are for general information only and are not intended as medical advice

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Healthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.Healthbase Logo

Aortic Aneurysms & Dissections

Provided by Escorts Heart Institute
Brought to you by Healthbase

An aneurysm is an abnormal swelling in a weakened blood vessel while dissection is said to have occurred when blood enters through a lengthwise tear between layers of the wall of aorta or an artery (a blood vessel carrying blood from the heart to the body). These layers then separate and swell, making a thin walled balloon-like formation that causes severe pain. This condition can be a birth defect, a complication of disease like atherosclerosis or injury. High blood pressure also contributes to this disease.The patient may experience pain in chest, abdomen, or back, and may affect the hips and legs, coughing up blood, shortness of breath, nausea, vomiting, blood in stools, fainting, difficulty in swallowing, or just headache.

The diagnosis can usually be arrived at following review of history, chest x-ray, electrocardiogram (ECG), CT scan (computerized x-rays), Angiogram (x-rays after a dye has been injected into an artery), Echocardiogram, and blood tests.

How is it done?
The preferred treatment is immediate surgery. The doctor will replace the weakened part of the artery with a graft made of artificial material, and is carried out with the help of heart lung machine on many occasions. Depending on the location of the aneurysm/dissection, aortic valve may have to be replaced in some situations. The coronary arteries may also have to be implanted on the new graft for continued blood supply to heart. After surgery, blood pressure and other vital signs will be monitored in the recovery room set up.

After Care
It is important to strictly follow certain guidelines as listed:

  • Stop smoking.

  • Maintain your ideal weight.

  • Eat a healthy diet that includes:

    • Low salt food.

    • Avoiding foods high in fat and cholesterol.

    • Increasing fiber in your diet.

    • Adequate precautions against constipation.

  • Exercise daily; walking is recommended.

  • Get enough rest and learn to use relaxation techniques to help reduce stress.

  • Keep blood pressure under control.


Brought to you by Healthbase www.healthbase.com info@healthbase.com1-888-MY1-HLTHHealthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.

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©2006 Healthbase Online Inc. All rights reserved.  |  About us
The contents or materials provided in this website are for general information only and are not intended as medical advice.