When 70-year-old Hla Hla Sein Sakinar, a Burmese woman of Tamil origin, first went to the doctor ten months ago in her hometown of Yangon in Myanmar, she never thought her journey to recovery would bring her all the way back to the land of her ancestors. However, months after she was first diagnosed with liver disease, her search for better health brought to Chennai’s Chettinad Hospital.
What was unique about Hla Hla’s condition was that not only did she require a liver transplant, but also required a cardiac bypass surgery for her heart.
“She came to us with end-stage liver disease. When the liver is affected to such an extent, it becomes incredibly intolerant to almost all anaesthetic medication and chances of severe bleeding occurring during the surgery are extremely high,” explains Dr Karthik Mathivannan, Head & Clinical Lead, Chettinad Institute of Liver Sciences who oversaw the woman’s operation.
Her liver, however, wasn’t the only complication. Hla Hla also required cardiac bypass surgery. This procedure is done when there is either a complete or partial blockage in the arteries which supply blood to the heart muscles. Blockage in these vessels could result in the death of these muscles which is clinically called a heart attack. Upon examination, doctors had noted that the woman required a bypass surgery to prevent a heart attack.
As per protocol, whenever an individual requires surgery they must first undergo a routine examination conducted by an anesthetist (sometimes also called intensivist). Anesthetists do pre-surgical check-ups to determine if an individual’s vitals are stable enough to handle the surgery. Only upon receiving clearance from the anesthetist will the individual be able to undergo the required procedure.
“No cardiac surgeon would take up a patient for surgery if the patient didn’t have a healthy liver,” adds the doctor. However, after considerable study of Hla Hla’s status, doctors at Chettinad Hospital in Chennai opted to take her up for the risky procedure. In a 16-hour surgery, Dr Sanjay Theodore, a minimally invasive cardiothoracic surgeon and the director of the department of Cardiothoracic surgery along with Dr Karthik and his team simultaneously performed two procedures.
While Dr Karthik performed a live liver transplant, Dr Sanjay and his team performed a cardiac bypass surgery. Hla Hla’s 30-year-old niece donated part of her liver to her aunt.
“After the surgery, she is slowly making progress in her recovery. We were referred here by her doctors in Myanmar who said that doctors in India have more experience with taking up such risky cases,” says the woman’s daughter Fathima Thanthanstayt to TNM.
“This is the first such successful combined procedure in south India. This is unprecedented, so starting from pre-op, a lot of planning and coordination went in between the liver and cardiac teams to work simultaneously. The patient needed psychological motivation, we restricted her diet, encouraged her to walk more. We prepared for multiple outcomes during surgery and the most challenging task was to remove the entire clot from the portal vein to re-establish blood flow,” stated the doctor.