BENGALURU: Fortis Hospital Bannerghatta Road successfully treated a 64-year-old male from Madagascar, suffering from Triple Vessel Coronary Artery disease (blockage in three major arteries), an enlarged prostate, and multiple co-morbidities. A multidisciplinary team of Doctors – Dr. Sudarshan G T, Senior Consultant – Cardio Thoracic Vascular Surgery, Dr Srinivas Prasad, Senior Consultant – Interventional Cardiology and Dr Mohan Keshavamurthy, Senior Director – Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant & Robotic Surgery along with a Vascular Surgeon, ENT Specialist, Endocrinologist, Nephrologist and a Pain & Palliative Specialist treated the patient.

Patient Ramesh (name changed), a cancer survivor and a double amputee, faced a dire health crisis a month ago when he complained of chest pain and shortness of breath. An angiogram – a crucial imaging test that reveals the condition of blood vessels, was performed in Madagascar, which revealed reduced blood flow to the heart (Acute Coronary Syndrome) leading to heart attack and reduced blood flow to the rest of the body (Acute Left Ventricular Failure) highlighting an urgent need for a bypass surgery. However, the conventional bypass surgery was not feasible for Ramesh due to the amputation of both his legs, which meant he lacked viable veins for grafting. Additionally, his severe mobility restrictions, relying entirely on an electric wheelchair, further complicated the matter. Faced with these challenges and the lack of advanced medical technology in his country to address such a complex case, Ramesh sought the expertise of doctors at Fortis Bannerghatta Road for advanced treatment and a chance for improved health.

Upon admission at Fortis Bannerghatta, a comprehensive diagnostic evaluation revealed multiple co-morbidities including triple vessel coronary artery disease, diabetes, acute kidney failure, and an enlarged prostate. Due to financial constraints, hemodynamic-assisted angioplasty – a minimally invasive procedure to improve blood flow through blocked or narrowed arteries was not a viable option. Consequently, Dr Sudarshan and Dr Srinivas recommended a hybrid surgical approach combining traditional open surgery with minimally invasive techniques. The treatment plan involved a robot-assisted minimally invasive bypass grafting (MIDCAB, or Minimally Invasive Direct Coronary Artery Bypass Surgery), followed by a Rotablation atherectomy assisted Angioplasty with Percutaneous Coronary Intervention (PCI). Dr Mohan

Keshavamurthy suggested a UroLift procedure to address the enlarged prostate, while diabetes and kidney failure were managed by the respective specialists.

Explaining the procedure, Dr. Sudarshan G T, Senior Consultant – Cardio Thoracic Vascular Surgery, Fortis Hospital, Bannerghatta Road said, “Given the patient’s complex cardiovascular condition and the high risks associated with traditional open-heart surgery, which requires a large incision in the chest, we opted for a minimally invasive approach called Robot-Assisted Minimally Invasive Direct Coronary Artery Bypass (MIDCAB). This innovative treatment included a surgery designed to tackle one or more blocked arteries using tissues through small surgical cuts. It reduces both recovery time and surgical risks. The surgery took approximately 2 hours and once the patient was stabilized, he was scheduled for rotablation assisted angioplasty with Percutaneous Coronary Intervention – a non-surgical procedure to treat the blockages in the artery.”

Dr Srinivas Prasad, Consultant- Interventional Cardiology, Fortis Hospital, Bannerghatta Road “We performed Rotablation assisted angioplasty with Percutaneous Coronary Intervention on the patient, during which a tiny, diamond-coated tool that rotates at high speed was used to grind away hard, calcium deposits inside arteries. After the calcium deposits are cleared, a catheter with a balloon at the tip is guided to the site of the blockage in the artery, thereby widening the artery and improving blood flow. A drug-releasing stent was then placed in the artery to keep it open after the balloon was removed. This drug is slowly released into the artery wall over time, preventing the regrowth of tissue within the artery. The procedure lasted for around 45 minutes to an hour. Following the procedure, the patient was monitored in the hospital for 3-4 days and then underwent a week of physiotherapy to aid in his recovery. This timely intervention significantly contributed to the patient’s recovery and overall health improvement. In the absence of these surgical interventions, in case the patient suffered another heart attack it would have been difficult for the patient to survive.”

Dr Mohan Keshavamurthy, Senior Director – Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant & Robotic Surgery at Fortis Hospitals, Bengaluru said, “Following the successful cardiac surgery, we proceeded with the UroLift procedure to address the patient’s enlarged prostate also known as Benign Prostatic Hypertrophy (BPH). BPH is a common condition that affects over 70% of men in their 60s. Although benign and unrelated to prostate cancer, BPH can significantly impact a man’s quality of life. As the prostate enlarges, it presses on and blocks the urethra (the tube through which urine leaves the body), potentially leading to permanent bladder damage if left untreated. To address this, we opted for the minimally invasive UroLift technique where 4 small implants were placed to gently lift and hold the enlarged prostate tissue away from the urethra preventing blockage. This approach improves urine flow and preserves ejaculatory function without the need for more invasive surgery. Given the complexity of the patient’s medical condition, this technique was particularly well-suited and crucial to his overall recovery and well-being.”

Akshay Oleti, Business Head, Fortis Hospitals, Bengaluru said, “At Fortis Hospitals, our mission is to provide world-class medical care tailored to the unique needs of each patient. We are proud to have offered a comprehensive and innovative approach to Ramesh’s complex health challenges. By leveraging our advanced medical technologies and the expertise of our multidisciplinary team, we were able to deliver a seamless treatment experience. This case exemplifies our commitment to combining cutting-edge techniques with compassionate care to achieve the best possible outcomes for our patients.”

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Indus Health Plus study further revealed that 90% of people have a high genetic risk of Vitamin D deficiency and 57.55% of people have a high genetic risk for Vitamin B12 deficiency as per their genetic makeup which can also contribute to overall cardiovascular health.  

Mr. Amol Naikawadi, Preventive Healthcare Specialist, Indus Health Plus says, “Genetic testing is gaining popularity among people to get an understanding of the predisposition of various lifestyle conditions along with other health check-ups. This does not only help in better health assessment but also improves disease management, particularly for individuals with a family history of CAD or other risk factors. In addition, it enables people to plan an effective diet and efficient fitness regime. This will also guide an individual to personalize their medication for treatment in consultation with the doctor and make appropriate lifestyle choices.” 

In the Indian context, where the population is genetically diverse and faces unique healthcare challenges, genetic testing can have significant implications. India has a high burden of lifestyle-related diseases, such as diabetes and cardiovascular diseases, along with a growing prevalence of genetic disorders. It can help identify the genetic risk of developing such diseases, enabling early interventions and management strategies. Genetic testing can provide valuable information to manage these risks effectively, personalize medication and guide lifestyle choices, diet, and fitness regimens that are culturally relevant.  Saliva-based genetic testing is non-invasive, painless, and can be easily done at home, making it more convenient for individuals who prefer to collect their DNA samples in the privacy of their own homes. 

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