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AWAKE HEART OPERATION ON A PATIENT WITH BOMBAY BLOOD

A RARE AWAKE HEART OPERATION ON A PATIENT WITH BOMBAY BLOOD GROUP-FIRST TIME IN INDIA


A patient by name Rukmini hailing from Sakaleshpur, aged 36 years, came to Indiana Hospital, Mangalore. Patient was investigated in the hospital. She was diagnosed to have a congenital heart disease, Atrial Septal Defect, commonly known as hole in the heart, which was present in her from the time of birth. Pure and impure blood used to get mixed in her heart.
If left alone eventually it can lead to death. She was suffering from difficulty in breathing from long time. She had severe lung disease which is high risk factor and life threatening to put her on general anaesthesia and ventilator during heart surgery. Patient was taken for series of investigations.
The cardiology team headed by Dr. Yusuf Kumble, chief interventional cardiologist and managing director, Indiana hospital, in association with Dr. Manjunath, consultant cardiologist, conducted cath-angiogram study to assess and decide about the plan of surgery.
Dr. Nisarga, chief consultant cardiac surgeon at Indiana hospital, decided to do "awake cardiac surgery" on her in view of
bad lung condition.
Patient's blood investigations revealed that she had a very very rare blood group which is called Bombay Blood Group. Patient can not be transfused with any of the common blood groups like 'A', 'B', 'AB' and 'O', which can be fatal. There are only 179 cases reported in the world to have this rare blood group. It derives its name by the city in which it was found out. But it is seen all over the world like Japan, China and Europe. After an extensive search across the country, one donor was identified in Mangalore itself with this rare blood group. He voluntarily donated the blood.
A day before surgery, an epidural catheter was introduced to her spinal canal, behind the neck to give a special form of "low cervical epidural anaesthesia". This will numb only the chest part of the body.
Heart surgery was conducted by Dr. Nisarga and his team on 11.10.2013, which lasted for about 5 hours. Patient was widely awake and conscious during the heart surgery. Her heart was cut open to correct the problem and her breathing was stopped for about four hours, still she was awake, having no pain.
Although blood was arranged, surgery was conducted successfully without any blood transfusion. Without a standby blood, her heart surgery would have been impossible.
The surgery was done free of cost under state govt. Vajapeyi Arogya Health Scheme. Now she is comfortable and can resume her normal activities after discharge. Dr Nisarga who conducted this rare operation feels that a hard work in getting the blood donor saved a life and it was challenging to perform the surgery when she was awake.
In Dr. Nisarga's cardiac surgery team cardiac anaesthetists Dr. Ronald, Dr. Nagesh, assistants Maaz and Irshad were there. "Another mile stone is reached at Indiana hospital and heart institute in treating the patients with heart diseases", opined Dr. Yusuf Kumble, managing director and chief cardiologist, Indiana Hospital.
This historical event of rare heart operation is done first time ever in South Canara District. This type of awake cardiac surgery with Bombay blood group is first of its kind in India. Mangalore city witnessed a very rare event in the history of medicine.