In September 2016, Dr Prateek Bhatnagar, a Cardiac Surgeon from Hyderabad, along with a team of other specialists, including his daughter Dr Shubhi Bhatnagar, undertook a gargantuan task: performing a
bypass surgery for a man who with a rare heart condition called Mesocardia.
Two years after the surgery, the patient is doing well and Dr Prateek and team’s efforts have been chronicled and have been published in the July 2018 edition of Annals of Thoracic Surgery as having undertaken successfully the world's first bypass surgery in a case of mesocardia.
Their patient, a 52-year-old man, had gone to Ajmer Sharif Dargah in Rajasthan for a pilgrimage where he suffered a heart attack and was taken to a hospital in Mumbai for treatment.
In Mumbai, doctors doing his initial assessments discovered that he had a unique heart condition known as mesocardia and referred him to Dr Prateek in Hyderabad.
Mesocardia and Bypass Surgery
“In a person with mesocardia, the heart is essentially twisted counterclockwise and is pointed towards the center of the chest. The right atrium and aorta of the heart are also positioned behind the
heart which is abnormal,” Dr Prateek explained to TNM.
The patient, who suffered a heart attack, required a bypass surgery, but given the anatomical structure of his heart, this was a challenge.
“Coronary arteries are the vessels which supply oxygen-rich blood to the heart. When there is a blockage in these vessels, mostly due to plaque buildup, it can lead to a condition known as coronary artery disease (CAD) which can cause heart attacks,” says Dr Prateek.
Bypass surgery is done to create a new pathway, using another blood vessel (the “graft” vessel), which will go around the blocked vessel to provide blood to the heart and thus restore normal blood flow to
the heart. This procedure is officially known as a “Coronary Artery Bypass Graft” (CABG).
Y Graft Procedure
However, given the patient’s unique condition, he was referred to Dr Prateek as the standard bypass surgery could not be done.
Having practiced since 1990, Dr Prateek is one of the experts in cardiothoracic surgery in the country.
“The problem with taking the man up for a traditional bypass is that normally the aorta will be involved, but this couldn’t be done with him since his aorta is placed in an abnormal way,” said Dr Prateek,
“So we opted to take him up for a Y Graft procedure.”
He further explained that this particular procedure would entail the use of the internal mammary arteries and would not involve the aorta, so it could be done irrespective of the placement of this patient’s heart.
“I have opted to use the Y Graft technique for patients before, and had the confidence in taking him up for the same,” said Dr Prateek, “We wanted to make sure that the patient was doing well before we drew attention to it. This was the first time such a procedure was done for a patient with this condition.”
The doctors kept a close watch on the man post-operatively. A year after he underwent the procedure, a CT-Angiogram scan was done which showed that the graft was functioning well.
“The patient was also symptomatically fine. He is leading a healthy, active lifestyle today, and so we have been able to document these findings, which will be able to help other surgeons and patients
around the world.”