Record ‘Elephant trunk’ surgery


An elephant trunk is something you usually don’t hear of in a cardiac hospital. But we are proud to say that ‘USUAL’ is not a term we can associate with AHI too often either. Over the last ten years, there have been numerous instances where patients have cardiac patients were told that their case was too complicated and they were inoperable. These are the kind of patients who are treated at AHI on a regular basis, and these patients are today living their life to the fullest and looking forward to another 20 years of a hearty life.

Here we look at another one of such cases, an extremely rare case of an aortic aneurysm, possibly the first of its kind in Mumbai. What makes this case even more interesting is that the condition seemed to be hereditary, where the patient’s father and sister suffered from the same condition.

Before we look into the details of an aneurysm, we need to know what exactly an aorta is:

The aorta is the largest vessel in your body, supplying oxygenated blood to other parts of the body through systemic circulation. The aorta is divided into five parts

  1. Ascending aorta
  2. Descending aorta
  3. Arch of aorta
  4. Thoracic aorta
  5. Abdominal aorta

The aorta supplies blood to the whole body, bifurcating into the Left Common Carotid artery (LCA), Left Subclavian Artery (LSCA) and the Innominate Artery (IA) which further branches into Right Subclavian Artery (RSCA) and Right Common Carotid Artery (RCA). All these arteries arise from the arch of the aorta and supply blood to the arms and the brain.

An aneurysm is basically a ballooning of the artery where the ballooning causes the walls of the arteries to separate into a false lumen and a true lumen. The term aortic aneurysm refers to ballooning of the aorta, which causes the walls of the aorta to swell and may eventually rupture and cause severe pain unless treated immediately.

Recently, a 36 years old female with hypertension, complained of breathlessness on exertion and climbing of stairs for the last six months. After consulting with a physician and getting an X-ray, an enlarged aortic arch was found and a 2D echo showed a dissection of the aorta starting from the root and extending up to the aortic bifurcation. The patient suffered from an aortic aneurysm with ballooning of the ascending and descending aorta, where the dilation of the root and arch of the aorta was measured to be 5.5cm x 6cm which is an extremely large aneurysm. Moreover, the RSCA was arising out of the false lumen of the descending aorta instead of the arch. In addition to this, the aortic valve was also found to be leaking and needed replacement.

The patient was admitted to AHi for a complicated procedure; Ascending aorta + arch replacement +/- AVR and +/- Coronary Re-implantation (BENTALS) and for post-operative care further management. The procedure mentioned is an extremely rare procedure and is probably the first surgery of its kind in Mumbai.

Here is a brief summary of what was done to restore the patient to her noemal condition

  1. Replacement of the aortic valve with a bioprosthetic valve.
  2. Placing the new calve at one end of the graft (a synthetic tube) while placing the other end of the graft within the aorta.
  3. Placed the second graft (elephant trunk) within the true lumen of the arch of aorta and descending aorta.
  4. The elephant trunk was then fixed to the first graft. This then directs blood flow to the true lumen.
  5. The RSCA, RCCA, LCCA and LSCA were then sewn with separate grafts onto the main ascending aortic graft restoring normal blood flow.

The patient has since recovered well and is looking forward to a hearty life.

This was just one of the many many complex cases that has been undertaken successfully at Asian Heart Institute. Please visit http://www.asianheartinstitute.org/quick-links/break-through-cases.html to read about some more of our breakthrough surgeries.

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