Nagpur- A 45 year-old man from Nagpur was detect with atypical chest pain and breathlessness at a local hospital here and was diagnosed to have a large pseudo aneurysm (abnormal swelling) arising from ascending aorta. He was referred to Dr. Sameet Pathak (Cardio Thoracic surgeon and Vascular Surgeon) at Wockhardt Nagpur. All the necessary investigations were done after thorough clinical examination. This pseudo aneurysm was eroding the sternum from below. It was partially filled with organised thrombus and its wall was also calcified at places. Pulsations from aorta could be felt over the sternum.
An urgent surgical intervention was planned by Dr Pathak and his team Dr Awantika Jaiswal (Anesthetist) and Dr Ketan Chaturvedi (neurologist). As sudden rupture of this aneurysm would have been fatal. The patient and relatives were counseled regarding need of surgery and its possible complications. Patient was taken up for surgery. Opening the sternum is usually the first step in cardiac surgical procedures.
But in this patient it was not at all possible because the pseudo aneurysm was touching the sternum from below and could have ruptured instantly on sternotomy (opening the sternum). Dr Awantika Jaiswal (Anesthetist), Dr. Ketan Chaturvedi (neurologist). This surgery was done by a very special technique called the Deep Hypothermic Circulatory Arrest.
Patient was electively ventilated overnight and neurological assessment was done next morning by Dr Ketan Chaturvedi (neurologist) which showed that he had weakness in his left upper limb. Haemodynamically he made an uneventful recovery with no bleeding issues. He gradually improved neurologically and was discharged home in stable condition. Its been a year now and he still comes for regular follow up and is doing well.
Dr Pathak said very few cases like this have been reported till date in literature and deep hypothermic circulatory arrest is the only technique by which this peculiar presentation can be successful.
