Times of India
03 June 2010
By Malathy Iyer
Mumbai, India

1 In A Lakh Has Four Aneurysms In The Coronary Arteries
When a Gandhi Market merchant complained of chest pain, his family thought he was having a heart attack. But what unfolded over the next two weeks surprised them as much as his doctors: it turned out the 47–year–old merchant, Ashok Veera, had not one but four aneurysms in his coronary arteries.

An aneurysm is a soft bulge on an artery; it looks like an overfilled water balloon ready to burst and in worst cases, it does rupture, with mostly fatal results. While the incidence of aneurysms is between 1% and 3% among adults, most patients would have one aneurysm unlike Veera’s four.

“Aneurysms are themselves rare, and I have operated on 150 cases in the past 15 years. Veera’s case is unique because I have never seen or heard of any patient having four aneurysms in the coronary arteries,” says Dr Ramakant Panda of Asian Heart Institute at the Bandra–Kurla Complex. Even more interesting, adds Dr Panda, is the fact that he had to make nine bypasses to overcome the four bloody balloons that had formed around Veera’s heart for seemingly no reason.

Suffering from diabetes and hypertension for a long time, Veera’s new medical problem started on March 19. Veera, who commutes from his home in Kandivli to Gandhi Market, King’s Circle, returned home with a complaint of severe chest pain. He also started vomiting and could barely take a few steps at a time.“We took him to a local nursing home where they found nothing abnormal with his heart but found his sugar levels fluctuating. He stayed there for two days,” says his wife Jyoti.

It was through recommendations over the next two days that the Veeras reached a fivestar hospital in Andheri that found the four aneurysms.“The cardiologist conducting the angiography said my husband’s diagnosis was one in a lakh and that we would need a senior surgeon to help us,” Jyoti said. On April 5, they went to Asian Heart Institute.“Given the fact it would be a long operation,we ultimately got a date on April 22,” says Jyoti.

Over seven hours, Dr Panda performed a beating heart surgery, beginning with harvesting grafts from Veera’s arteries and veins (that could be used as bypass grafts over the aneurysms).“An artery is usually 2 mm in thickness, but each of Veera’s aneurysm was over 3 cm. The one bulging out of his aorta was bigger than the others and was difficult to manage with surgery,” says Dr Panda. An AHI team, comprising Dr Sudhir Vaishav and Dr Hemant Deshmukh, then used a coil to tackle the huge bulge.“Once the aneurysms clotted and bypasses started working, Veera was as fine as possible,” say his doctors.

Dr K S Neelakandhan, the Indian cardiac surgeon who has performed the most aneurysm surgeries, said Veera’s case was indeed“relatively rare”.“The fact that nine bypass grafts were used is not common either,” said the Trivandrum–based surgeon. Veera, meanwhile, is on a six–week rest. The merchant spent almost Rs 6 lakh to fix his heart.

Heart of the Matter

What is an Aneurysm?
It’s a bulge in a blood vessel, much like one on an overinflated inner tube. An aneurysm may burst, spilling blood outside the aorta that may lead to haemorrhaging within the abdominal cavity of the patient. High blood pressure and high cholesterol are the main causes for an aneurysm. Smoking is also one of the risk factors

Treatment
An aneurysm can be removed surgically and a patch or artificial blood vessel can be sewn in its place to reinforce aorta so it does not burst again

What Is Different Here
The 47–year–old patient was diagnosed with four aneurysms, while people usually have one. He needed nine bypass grafts to fix the problem. In most bypass surgeries, a patient needs only three or four grafts