3 Cases of a Cardiac Flaw Cause Surprise
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11 June 2011
Matters of the heart are not restricted to heart attacks. Chest pain can have several reasons, among them aneurysms of the heart, which are the rarest of cardiac abnormalities. In an aneurysm, a portion of the wall of an artery becomes so thin that it starts to bulge out. If it bursts, it could lead to a medical emergency.
Some aneurysms are rarer than the others. So, Dr Pavan Kumar of Lilavati Hospital was surprised to operate on three patients within two months with complaints of sinus of Valsalva aneurysms (SVAs) that had ruptured. "(An SVA) arises from the coronary sinuses, which is also the base of coronary arteries. In the West, it accounts for 0.09% of all cardiac ailments or 1 in 10,000 cardiac cases," said Dr Kumar.
A doctor from a government hospital said he had seen only half a dozen SVA cases in his career. Bandra resident Sunil Shelar (29), who works in the merchant navy, returned for a break when pain in his chest started. "The pain was so intense that I could barely walk," he recalled after his operation in the first week of May.
SVAs are congenital defects that flare up in the second or third decade of life. But about 90% these aneurysms remain silent.
The diagnosis is not difficult, said Dr Kumar. "The minute you put a stethoscope to the chest, you can hear blood rushing in a peculiar tone."
The other two patients, operated on just ahead of Shelar, are Thane residents Mangala Mohite (49) and Ashok Abnave, whose problem was detected when he was brought to Lilavati Hospital with what seemed like a heart attack. "An angiography showed blocks, but failed to show the aneurysm in the right coronary sinus.
It was only when he was in the operation theatre that we found a rupture of the aneurysm," the doctor said. "In my 20–year experience, of more than 8,000 open heart surgeries, I have come across only a dozen such cases. It’s unusual that there were three in two months."