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Adult
Patient Services
I. Cardiology
The Department of Cardiology
as a highly sensitive area displays the
latest in diagnostic and intensive care
technology with extremely skilled and knowledgeable
adult and Paediatric cardiologists and clinicians
with services that include:
Diagnostic and Interventional
Cardiology
Advanced methods of diagnosis
and treatment are carried out on a routine
basis with the help of the following equipment
and procedures
Preventive Cardiology & Cardiac
Rehabilitation
II. Cardiac Surgery
Progressive, passionate
and persevering, a highly skilled team of
cardiothoracic surgeons, anesthetists, intensive
care specialists and dedicated critical
care nurses operate in tandem at the Department
of Cardiothoracic and Vascular Surgery.
The department houses state-of-the-art porcelain
operating suites with separate adult and
Paediatric intensive care units. With the
ever-changing scenario of surgical techniques
and technology, the dedicated team at Frontier
Lifeline keeps up with the changing trends
in Cardiothoracic and Vascular Surgery in
order to give the best, brilliant and biggest
successes in the most intricate surgeries
for congenital and acquired heart diseases,
thoracic, vascular diseases and organ transplantation.
The surgical procedures include:
- Coronary Artery Bypass Surgery with
Endoscopic Vessel Harvesting
- On pump, including multiple endarterectomies
- Off pump
- Minimally Invasive CABG
- Mitral valve repair/replacement
- Aortic valve repair/replacement
- Aortic surgery
- Ross procedure
- Re-do Coronary and Valve surgery
- Aneurysm Repairs
- Homograft
- Xenograft
III. Vascular Surgery
Paediatric
Patient Services
I. Cardiology
- Balloon Pulmonary Valvotomy
- Ballon aortic Valvuloplasty
- Device closure of ASD, VSD, PDA
- Coil Embolisation of MAPCA
ii. Cardiac Surgery
The entire gamut of cardiac
diseases from neonates to adolescents is
skillfully and competently handled.
Dedicated operating rooms
and Post- operative ICUs with state-of-the-art
equipment and experienced staff, provide
24/7 cardiac care of the highest order.
Cyanotic and Acyanotic Heart Diseases
(Simple & Complex)
- Atrial and Ventricular septal defects,
which can also have closures with catheters
- PDA and Coarctation of aorta
- Arterial switch in neo-nates
- Truncus repair using valved conduits
(porcine or bovine valves)
- HLHS
- AV Canals
- Fontan procedures
- Adult Congenital Heart Surgeries
Transplantation
Services
In 1995, aided by the most advanced technology, cardiac care and surgical skills, Dr. K. M. Cherian performed the first heart transplant in India at his International Centre for Cardio-thoracic and Vascular Diseases in Chennai. This was made possible only after the landmark legislation for brain death which passed the law permitting transplantation of human organs in the country. With phenomenal experience and far-sightedness, he also conducted the first bi-lateral lung transplant, the first pediatric heart transplant as well as the first heart and lung transplant in India.
The
Next Generation of Cardiac Diagnostics
Every thing you should know about
64 SLICE CT Cardiac Imaging
64-slice CT coronary angiogram
is the latest non-invasive modality for
imaging coronary arteries. It is done on
a multislice CT scan which has 64 rows of
detectors to give a high sub-millimeter
resolution of 0.6X0.6X0.6mm.
What type of information
does the CT cardiovascular scan provide?
With the advent of multi-slice detectors
and high powered computer programs, we are
able to reconstruct the anatomy of the heart
arteries .We can look at the size of the
arteries, see exactly where blood flows
and determine if there is a blockage .The
number of detectors is important because
the heart, unlike other structures, is beating
and is in constant motion and hence acquisition
must be fast.
What are the possible indications for undergoing
CT cardiovascular scan?
- Borderline or inconclusive Treadmill
test
- Coronary risk assessment in patients
with abnormal baseline ECG
- High risk individuals
- Follow-up post CABG/ PTCA to study
coronary bypass grafts/ stents.
- To study aortic diseases, MAPCAs and
their course in lung, cardiac tumors
- Pre-operative risk assessment in intermediate
risk group and elderly individuals
- Triaging in patients with atypical
chest pain with high risk of coronary
artery disease
How is the CT cardiovascular
scan performed?
It is a non-invasive diagnostic test similar
to any CT scan and is performed as an outpatient
procedure. A drug like beta blocker, to
control the heart rate, is given prior to
the procedure. Iodinated contrast is injected
through a peripheral vein by a syringe pump
at a rate of 4-5ml/min. The scan is triggered
as soon as contrast opacifies the aorta.
The enire scan is completed within 5-10
seconds. CT scanner rapidly spins around
the patient about four times a second. It
obtains 64x4 i.e 256 images (slices) of
the heart in a second.
Frontier Lifeline has made
this diagnostic service available to patients
who come for our preventive cardiology clinic
as well as for routine outpatients, at an
exclusive price.
Appointments can be made at the Reception
Counter.
Digital
Pacemaker and AICD Implantation
Revolutionizing Cardiac Care :
The Next Generation of Digital Pacemakers
in Frontier Lifeline
Digital technology advances,
not only in our daily life, but also in
the field of medicine. Frontier Lifeline
has introduced digital pacemakers produced
by Vitatron, a Netherlands-based company,
which has revolutionized the field of cardiology.
Dr Joy Thomas, our eminent Senior Consultant
Cardiologist and Electrophysiologist, shares
several established advantages of digital
pacemakers as compared to analog pacemakers.
- It has the capacity to date and time–stamp
every heart beat.
- It provides better understanding and
knowledge of the patient’s heart
rhythm, which is interfaced to a computer
programme in a matter of seconds.
- Information sheets about the heart
rhythm are printed out for data retrieval
and analysis.
- The digital pacemaker can be programmed
to respond in different ways, which aids
in better care for the patient.
- Therapy Advisor – This system
provides doctors with a list of instant
suggestions for the patient, based on
what the pacemaker had documented.
- The digital pacemaker lasts longer
than the analog, with an average life
of more than nine years compared to five
years.
- Patients need not undergo minor surgery
for the change of batteries.
- It is very cost-effective, being much
cheaper than analog pacemakers are.
So far, we have implanted
more than a dozen patients with digital
pacemakers at Frontier Lifeline, of which
six of them are dual chamber pacemakers.
These pacemakers are being followed up meticulously
in an international survey, in which Frontier
Lifeline is one of the centres recognized
worldwide, to contribute towards the DIRECT
Registry.
Electro
anatomic “CARTO” Mapping for
analyzing and treating heart rhythm disorders
Introduction of 3-D Mapping System
(Ensite Nav-Ex) For Arrythmias
Frontier Lifeline has
introduced the state-of-the-art 3-D mapping
system for arrhythmias. Earlier, drugs were
the only choice of treatment for arrhythmias.
With recent advances in the field of cardiology,
and with the emergence of electrophysiology,
any intractable arrhythmia can be accurately
diagnosed and treated.
This novel system detects
the exact location of any abnormal focus,
and depicts the 3-dimensional electro-anatomic
map of the heart. Furthermore, the procedure
reduces the amount of exposure to harmful
radiation to both the patient and the operating
staff. Another added advantage of this system
is that, conventional catheters that are
routinely used can be employed along with
this system.
Pulmonary Endarterectomy
Case Scenario:
A 33 yr old obese gentleman had undergone CRT P (Cardiac Resynchronization Therapy Pacemaker) implant for idiopathic DCM (Dilated Cardiomyopathy). He also had a history of minor PE (Pulmonary Embolism). He was on anticoagulation for the same post implant. He reported 3 months after the implant with right lower limb pain, breathlessness and chest pain. He had developed DVT (Deep Vein Thrombosis) and PE. His TTE (Transthoracic echocardiograms) revealed a large thrombus in the RA (Right Atrium), precariously moving across the TV. He was taken up for removal of the thrombus, pulmonary thrombectomy and epicardial lead implantation of the CRT P leads.
Specimen - Leads with Thrombus:
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Specimen - Front View |
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Specimen - Back View |
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Intraoperatively the large thrombus was seen mangled with the 3 leads. The images show the cut leads with large thrombus.
Serious thrombotic and embolic complications are reported to occur in 0.6–3.5 % of patients with permanent transvenous pacing leads1. Right atrial pacemaker lead thrombosis has been reported, albeit infrequently. The long-term residence of permanent pacemaker leads may act as a continous nidus for the formation of thrombus although the current day polyurethane leads have less thrombogenicity.
Obesity and the propensity for DVT (deep vein thrombosis) along with low flow state due to DCM possibly predisposed him to this large burden of thrombus.
Pulmonary thrombo-endarterectomy specimen:
The figure shows the main pulmonary artery specimen along with its two main branches
(Blood vessel supplying blood to both lungs) with the intraluminal thrombus (Blood clot) and the organized fibrous peel in the artery wall.
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Specimen |
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This happens in a disease condition CTEPH (Chronic thromboembolic pulmonary hypertension) where the pressure within pulmonary artery increases with sluggish blood flow leading to clot formation and blockage of the artery, manifesting as Acute Pulmonary embolism, episodes occurring repeatedly (recurrent embolism) . This is manifested by progressive breathing difficulty with features of right heart failure.
The definitive management is by Pulmonary thrombo-endarterectomy (PEA), whereby the affected artery is removed surgically along with the clot insitu, in appropriate operative conditions, requiring skilled surgical acumen and sophisticated operative technology.
Radiology
Dr. K. M. Cherian’s Frontier Lifeline hospital has X- ray and Nuclear Imaging facilities
Nuclear medicine is a medical specialty that uses safe, painless, cost-effectuve techniques both to image the body and treat diseases.
Nuclear imaging is unique in that it documents both organ function and morphology using a state-of-the-art Dual Head Gamma Camera.
Nuclear scan:
Nuclear scan is extremely sensitive and provides accurate dynamic and quantitative information
The following are the different kind of scans performed at Frontier Lifeline Hospital.
STRESS MYOCARDIAL PERFUSION (SPECT) (Thallium Scan)
WHOLE BODY BONE SCAN:
A bone scan is a diagnostic imaging study which records the distribution of a radioactive tracer in the skeletal system. It is the most sensitive study available to detect any pathology of the skeleton, such as Primary Bone Lesions, Osteomyelitis, Sacroilitis, Avascular Necrosis, Stress Fractures and Metabolic Bone Diseases
BRAIN SPECT:
Brain Perfusion SPECT with advanced NeuroGam Analysis helps to evaluate stroke, epilepsy and dementia
RENAL SCAN:
Renal scans are performed to evaluate renal function by assessing Glomerular Filtration Rate (GFT), tubular function and cortical morphology to study diseases such as Hydronephrosis, PUJ Stenosis, Renovascular Hypertension, Transplant evaluation, Pyelonephritis, Urinary tract infection and ureteric reflux.
Gastroenterology:
Nuclear Scans help to diagnose Acute Cholecystitis, gall bladder dysfunction, cirrhosis, dysmotility, tumors, hemangiomas, GI bleeding, dysphagia, GE reflux, etc.
Other Indications:
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Thyroid scans to evaluate palpable thyroid nodule, thyromegaly, toxic goiters, thyroid cancer, midline neck & swellings |
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Lung ventilation – Perfusion can for pulmonary embolism |
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Radionuclide Ventriculography for LV function & Ejection fraction
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Isotope Vernography for DVT |
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Scinti-mammography for breast lesions |
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