CHENNAI: A 91-year-old man was referred to the doctors at Madras Medical Mission recently with a serious heart problem called Ventricular Septal Rupture following a heart attack that disabled him from his previous independent life.
A reasonably healthy man, he was living alone in Puducherry till January 2021. He had no lifestyle diseases like diabetes, hypertension or high cholesterol levels. He had age-related hearing loss, but was able to live comfortably till one day when he experienced a heart attack.
He was given medications rather than aggressive treatment options such as angiography or surgery, considering his advanced age. He started developing heart failure with accumulation of fluid around his lungs, one litre of which was tapped once to make him comfortable. This illness necessitated a second admission one month later for breathlessness in another hospital and medications were adjusted.
A minor improvement in his health permitted him to travel to Delhi to visit his son, though in a wheelchair, but unfortunately a second heart attack there led to a cardiac arrest, that was revived with electrical shocks, chest compressions, aggressive resuscitation, support of ventilators and he was brought back to life without any neurological insult.
The second heart attack caused a further damage to the heart and he developed a large rupture of the weakened infarcted heart muscle leading to a large hole between the left and the right ventricles of the heart. This further worsened his breathlessness and was managed with modification in medication; he then was airlifted to Chennai for interventional closure in Madras Medical Mission hospital.
Dr K Sivakumar, head of Paediatric Cardiology and senior consultant, in Madras Medical Mission identified a large ruptured hole between the two lower chambers of the heart and realised that closure of the hole is the only way to help him recover. The absence of common lifestyle problems reduced his procedural risk and he was admitted for non-surgical closure through small pin-hole punctures in the groin blood vessels, rather than an open heart surgery.
The procedure was performed in a conscious state with local anaesthesia. In an operation that lasted around one hour, the large hole was closed successfully with a device resulting in immediate improvement of his heart function. After spending a couple of days in intensive care where the large amount of fluid around his lungs was removed, he was able to return to his son at the end of 48 hours.