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Expert Consultant&Expert Consultant&
AdvisorAdvisorCentral Bank Of IndiaCentral Bank Of India
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Formerly:
Cleveland Clinic ,Cleveland , Ohio,USA
Royal Prince Alfred Hospital Sydney Australia
West mead Hospital Sydney ,Australia
Chief Cardiac Surgeon ,Z H S Medical college Dhaka
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I acknowledge the real Heroes of this country without whom our existence is impossible!
Anonymous
http://search.live.com/images/results.aspx?q=Indian+Army+Photo&FORM=ZZIR167/31/2019 Bombay Talk July 11
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The magnitude of problem!
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Prevalence of Coronary HeartPrevalence of Coronary Heart
DiseaseDisease 6.5-13.2% Urban6.5-13.2% Urban
1.5-7.4% Rural population (Heart 2008 :941.5-7.4% Rural population (Heart 2008 :94
;16-26);16-26)
Around :5- 10% people have CAD(Easy toAround :5- 10% people have CAD(Easy to
remember!)remember!)
6
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CVD IN INDIACVD IN INDIA
Cardiovascular disease has reached epidemic propor- tions
in India and is estimated to result in more than 3 million
deaths each year.4-6 Although CVD burden is high among
Indian urban residents, in certain regions even in rural
populations, CVD has emerged as the leading cause ofdeath.7
7
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CVD IN INDIACVD IN INDIA
Compared with Western populations, CVD occurs at arelatively younger age in Indians with a higher rate of
mortality.8,9
8
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CVD IN IndiaCVD IN India
Report from the World Health Organization (WHO) show
that by 2030, CVD will be the main cause of death
throughout India as a whole, accounting for more than
35% of mortality cases. Compared with Western
populations, CVD occurs at a relatively younger age inIndians with a higher rate of mortality.8,9
9
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CVD IN INDIACVD IN INDIA
These
premature deaths due to heart disease, stroke, and diabetes
are projected to increase cumulatively, and India's
financial losses due to CVD are estimated at US $237
billion for the period of 2005 to 2015.4 Further- more,
because the majority of these deaths are pre- mature, there
is a substantial loss of lives during the peak productivity
years as compared with other countries. The potentially
productive years of life lost due to CVD among those aged35 to 64 years was 9.2 million in 2000 and is expected to rise
to 17.9 million by 2030more than the losses predicted for
China, Russia, the United States, Portugal, and South
Africa combined (16.2 million).10 10
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EVERY MINUTE 2 PEOPLE DIE OF HEART ATTACK IN INDIA
10-15% INDIAN HAS CORONARY ARTERY DISEASE
INDIA HAS ~15 MILLION OF CAD
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Life Expectancy:1950 ~46 yr
Life expectancy:1998~66 yr
Present:?
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~15 MILLION CAD IN INDIA
~5 MILLION CASES OF RHD DIAGNOSED PER YEAR IN INDIA!
~2,LAKH CHILDREN ARE BORN WITH HEART PROBLEM EVERY YEAR IN INDIA!
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~60,000 OPEN HEART SURGERY DONE IN INDIA /YEAR
~5,000 CHILDREN HEART SURGERY IN INDIA /YEAR
PRESENT :?
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Problems in effectiveness of health care plans:
SCAMS
POPULATION
POVERTY
IGNORANCE
GOVT PRIORITIES
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A bit of Cardiac surgery!
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OPEN HEART SURGERY
CLOSED HEART SURGERY
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HENRY SOUTTAR 1925
Did First Mitral Commisurotomy
& wrote
Heart should be amenable to surgery as any other organ inthe body !
82 years back
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Main problem of heart surgery
Movement of the heart!
Solution --------
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Cardio pulmonary bypass i.e. we have to bypass the work of
heart & lung
Ways to do that:
use the parents of the patient or
controlled cross circulation or
use Machine i.e. Heart Lung Machine
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Michael Ellis DeBakeyMichael Ellis DeBakey
The legend!The legend!
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http://en.wikipedia.org/wiki/File:1783_balloonj.jpg7/31/2019 Bombay Talk July 11
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http://en.wikipedia.org/wiki/File:LeBris1868.jpg7/31/2019 Bombay Talk July 11
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AIRBUS 380
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SARNS HEART LUNG MACHINE
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Blood will clot if you use this machine!
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Heparin :1936
We should allow it to reverse i.e.Protamine
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OPEN HEART SURGERY :
CABG
VALVE SURGERY
PEDIATRIC HEART SURGERY
AORTIC SURGERY FOR ANEURYSM
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CLOSED HEART SURGERY
Closed mitral valvotomyPatent ductus arteriosus Ligation
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Bypass surgery:
We bypass the occluded coronary vessels so thatblood flows to heart
Using heart Lung Machine
by
or
Beating Heart surgery
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Two types of Valve:
1.Mechanical valve: Needs medicine ,lasts longer
2.Tissue valve :do not need medicine , does not lasts long
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Congenital heart surgery
ASD
VSD
TOF
PDA
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RESULTS OF CABG:All scientific studies done so far have provedsuperiority of this modality of treatment over other forms of treatment!
Mortality :1-2 %
Improved symptom free survival i. e No angina /Heart attack
Improved quality of life
New Block at a later date could be a problem
Morbidity:1-2%
Long lasting benefit
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Results of Angioplasty:Early results are OK But late result are less satisfactory than CABG.
Stent thrombosis(occlusion) & Heart attack are problems after some time.
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Conclusions CABG remains the standard of care for patientswiththree-vessel or left main coronary artery disease, since the
use of CABG, as compared with PCI, resulted in lower rates
ofthe combined end point of major adverse cardiac or cerebrovascular
events at 1 year. (ClinicalTrials.gov number, NCT00114972 [ClinicalTrials.gov] .)
Syntax Trial:Sept 2008
http://content.nejm.org/cgi/external_ref?access_num=NCT00114972&link_type=CLINTRIALGOVhttp://content.nejm.org/cgi/external_ref?access_num=NCT00114972&link_type=CLINTRIALGOV7/31/2019 Bombay Talk July 11
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Results :
Valve surgery
Almost normal life
Can have problems due to valve or medications (anticoagulant)
Stroke/Bleeding/clotting of valve
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Pediatric heart surgery:Results are dependent on different disease.
Results:
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Common Myth:
After heart surgery I will not be able to do all activities normally!Its nearly impossible to live normally!
C C
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Common Concerns:
1.Will I be alright for normal living?
a) Normal Physical working capacity ?
b) Normal mental capacity?
c) Normal sexual activity?
d) Normal social activity?
e) Normal traveling?
f) Do I need to take life long medicines ?
2.Is there a high chance of my death?
3.Is there a high Chance of Disability?
4.Suitability for job of choice?
5.Social acceptability?
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NEIL ARMSTRONG 1969
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NEIL ARMSTRONG
http://www.picsearch.com/info.cgi?q=Neil%25252520Armstrong&id=49pN9UGvqqdUmFX-uPITJSK7pg28D3miaK9aWmfny6Q&start=1&opt=%25252526cols%2525253D47/31/2019 Bombay Talk July 11
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NEIL ARMSTRONG
http://www.picsearch.com/info.cgi?q=Neil%25252520Armstrong&id=49pN9UGvqqdUmFX-uPITJSK7pg28D3miaK9aWmfny6Q&start=1&opt=%25252526cols%2525253D4http://www.picsearch.com/info.cgi?q=Neil%25252520Armstrong&id=49pN9UGvqqdUmFX-uPITJSK7pg28D3miaK9aWmfny6Q&start=1&opt=%25252526cols%2525253D4http://www.picsearch.com/info.cgi?q=Neil%25252520Armstrong&id=49pN9UGvqqdUmFX-uPITJSK7pg28D3miaK9aWmfny6Q&start=1&opt=%25252526cols%2525253D47/31/2019 Bombay Talk July 11
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Chandrayan I
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Negligible!
IN 2010/2011
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WHAT IS THE CAUSE OF MOST OF THE DISEASES?
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GOD ?
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YES ?
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GENETIC PREDISPOSITION !
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Persons with family history of Heart Attack!
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My golden word:
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OF COURSE!
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Avoid Smoking!
Avoid Fatty food!
Control Diabetics !
Control Blood pressure !
OF COURSE!
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CABG
ANGIOPLASTY
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Balance it!
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You decide !
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COMMON ADVISECOMMON ADVISE
1.Finance under control1.Finance under control
2.Regular exercise2.Regular exercise
3. Three monthly visit to doctor3. Three monthly visit to doctor
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Thank you !
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JAI HIND!
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