Cardiac Sciences

Coronary artery bypass grafting (CABG), also known as heart bypass surgery, is a surgical procedure that improves blood flow to the heart muscle. It is used to treat coronary artery disease (CAD), a condition in which the arteries that supply blood to the heart become narrowed or blocked.

CABG is typically recommended for people with severe CAD who are not good candidates for other treatment options, such as angioplasty or stenting. These may include people with:

• Multiple blockages in the coronary arteries
• Blockages in the main artery that supplies blood to the left ventricle (the main pumping chamber of the heart)
• Blockages that are too long or severe to be treated with angioplasty or stenting

During CABG surgery, a healthy blood vessel from another part of the body is grafted, or sewn, onto the coronary artery beyond the blockage. This creates a new pathway for blood to flow to the heart muscle, bypassing the blocked area.

The blood vessels used for the graft are typically:

• One or two arteries from the chest wall
• Furthermore, the vein from the leg or
• Artery from the wrist

are harvested by minimally invasive technique , resulting in smaller scars and lesser post operative discomforts

Benefits of CABG

CABG can effectively improve blood flow to the heart muscle and relieve symptoms of CAD, such as angina (chest pain). It can also reduce the risk of heart attack and death.

CABG is typically performed under general anesthesia, which means the patient will be unconscious during the procedure.

The patient spends a few days in the hospital after CABG to recover and needs to take medication to prevent blood clots and to help the heart heal. One also needs to make lifestyle changes, such as quitting smoking and eating a healthy diet, to reduce your risk of CAD recurrence.

Aster Whitefield Hospital is a leading provider of CABG surgery in India. Our team of experienced cardiothoracic surgeons has a proven track record of success in performing this complex procedure.

Aortic valve Reconstruction and replacement procedures are aimed at addressing damage or ailments affecting the aortic valve.

The aortic valve, one of the four valves regulating blood flow within the heart, serves as a barrier between the lower left heart chamber (left ventricle) and the body's primary artery (aorta). Its function involves opening during the heart's contraction to allow blood flow from the left ventricle into the aorta and closing during relaxation to prevent backward blood movement.

A diseased or impaired aortic valve can impede blood flow, compelling the heart to exert greater effort in pumping blood to the body.

Opting for aortic valve repair or replacement can significantly enhance blood circulation, alleviate symptoms associated with heart valve disorders, and extend life expectancy. Similarly, mitral valve repair and replacement surgeries aim to rectify or substitute a malfunctioning mitral valve, situated between the left heart chambers (left atrium and left ventricle).

Depending on the severity and progression of mitral valve disease, our procedures may involve open-heart surgery, minimally invasive heart surgery, or in certain cases, catheter-based interventions to address the issue effectively. Our tailored approach prioritizes the most suitable procedure tailored to each patient's condition, ensuring optimal outcomes.

Our team of cardiothoracic surgeons is highly proficient in addressing a spectrum of heart valve issues encountered by patients. At our multispecialty hospital, our foremost approach revolves around preserving the native valve whenever feasible. However, in cases where the heart valve sustains significant damage, we resort to utilizing mechanical or tissue prostheses, including human donor tissue implantation.

Our surgeons are adept in employing minimally invasive techniques for valve repair, involving smaller incisions of two to three inches rather than the conventional major chest incision. This approach not only minimizes the risk of infection but also facilitates quicker recovery and reduces blood loss, greatly benefiting our patients.

Our surgeons also specializes in reconstructing the aortic valve with patients own tissues (Ozaki procedure)

Aneurysms affecting the aorta, the body's largest blood vessel, pose grave risks, such as rupture or dissection, requiring immediate attention. Our primary focus at Aster Whitefield Hospital is to preemptively detect and treat these conditions before they escalate into emergencies, prioritizing patient safety.

Our accomplished team, led by cardiothoracic surgeons, specializes in managing aortic aneurysms and dissections, leveraging extensive expertise to deliver exceptional care. Renowned as one of the foremost aortic surgery centers regionally and nationally, we excel in addressing complex cases, especially among elderly patients or those with intricate health issues.

Central to our success is a collaborative approach that unites diverse specialists crucial for comprehensive patient care. Alongside our proficient cardiac surgeons, our multidisciplinary team comprises interventional radiologists, anesthesiologists, critical care specialists, and seasoned nurses with specific expertise in aneurysm care. This holistic approach is vital, especially for patients contending with concurrent health concerns like diabetes, hypertension, kidney ailments, or pulmonary disorders.

Aneurysms can manifest in various sections of the aorta, from the ascending to the descending thoracic and thoracoabdominal regions, each requiring meticulous surgical attention. Notably, our proficiency extends to intricate procedures involving the repair of the aortic root, often preserving the patient's valves in valve-sparing repairs.

Our expertise further extends to complex surgeries involving the descending thoracic and thoracoabdominal aorta, areas demanding exceptional surgical precision to minimize risks.

Utilizing advanced imaging techniques such as echocardiograms, CT scans, MRI scans, and chest X-rays, our surgeons deploy specialized graft materials to repair damaged sections of the aorta. Notably, many of these interventions can be conducted via minimally invasive endovascular techniques at Aster Whitefield Hospital, minimizing surgical incisions and expediting recovery for our patients.

Left ventricular reconstructive surgery is a procedure aimed at mitigating the symptoms associated with heart failure, encompassing chest discomfort and the formation of aneurysms stemming from scar tissue. In this intricate surgery, our skilled surgeons meticulously excise the scar tissue and redefine the shape of the ventricle, empowering the heart to efficiently pump blood and improve its overall function.

This restorative approach, known as left ventricular restoration surgery, focuses on reinstating the left ventricle to its natural spherical dimensions and optimal size. This procedure is particularly beneficial for patients with compromised heart segments due to conditions like dilated cardiomyopathy or post-heart attack left ventricular aneurysms.

Aster White Hospital stands as a premier institution where our adept cardiothoracic surgeons specialize in addressing a spectrum of cardiac conditions. With a keen emphasis on treating heart attacks, congestive heart failure, and specific aneurysms, our team employs advanced techniques to reshape the left ventricle. The procedure, often referred to as the Dor procedure in honor of its creator, Dr. Vincent Dor, involves the meticulous removal of scarred or necrotic tissue from the heart chamber. This transformative approach significantly enhances the heart's capacity to propel blood efficiently throughout the body.

Moreover, our comprehensive cardiac care extends beyond left ventricular reconstruction. Often, this procedure is seamlessly integrated with other interventions like coronary bypass surgery and valve repair, ensuring a holistic and tailored approach to each patient's cardiac health.

At Aster Whitefield Hospital, our Cardiothoracic Department specializes in an array of circulatory assist devices designed to bolster heart function when it's compromised. We provide cutting-edge technology and the most advanced support options in ventricular assist devices (VAD) and total artificial hearts, catering to individuals requiring Mechanical Circulatory Support (MCS). Our commitment lies in offering innovative solutions that significantly enhance safety and efficacy.

Embracing the latest advancements, we deploy second-, third, and soon-to-arrive fourth-generation MCS devices. These newer iterations are notably more compact, efficient, and safer, ensuring easier implantation procedures. Our seasoned medical professionals possess comprehensive experience with all existing MCS devices and are adept in employing minimally invasive techniques. Moreover, our team actively engages in pioneering research to continually elevate treatment standards, driving advancements in the field.

In certain cases, our surgeons employ external devices to sustain blood circulation pre or post-surgery. Notably, the Tandem Heart implantable pump serves as a viable option, even in high-risk scenarios during percutaneous coronary interventions such as angioplasty or coronary stent procedures. This portable device, easily inserted through an artery in the groin or during open-heart surgery, serves as a pivotal support tool.

While some implantable devices are still in various developmental phases and trials, their efficacy in providing temporary heart function support has been promising, often proving lifesaving. At Aster Whitefield Hospital, our Cardiothoracic Department prioritizes staying at the forefront of innovation and implementation, ensuring our patients have access to the most advanced circulatory assist devices available, backed by our unwavering commitment to superior patient care and outcomes.

At Aster Whitefield Hospital, we specialize in addressing atrial fibrillation, an irregular heart rhythm that often leads to discomfort, dizziness, and breathlessness. If left untreated, this condition significantly heightens the risk of stroke.

While conventional treatments like medications or catheter procedures are effective for some patients, others may not respond well to these interventions. For such cases, our adept cardiothoracic surgeons offer a surgical solution utilizing radiofrequency ablation.

Our surgical approach involves administering radiofrequency waves, a form of modified electrical energy, directly onto the heart's surface. These precisely directed waves create specific scar lines, effectively blocking the erratic electrical impulses responsible for the irregular heartbeat.

This advanced technique enables our surgeons to create targeted scar tissue, which helps in restoring a normal heart rhythm and alleviating the symptoms associated with atrial fibrillation. Our goal is to provide patients with a comprehensive and effective treatment option, particularly for those who have not responded positively to conventional therapies.

At Aster Whitefield Hospital, we prioritize patient well-being and strive to offer innovative solutions for cardiac conditions. Our dedicated team of cardiothoracic surgeons is committed to delivering personalized and minimally invasive interventions, ensuring enhanced outcomes and a better quality of life for our patients dealing with atrial fibrillation.

At Aster Whitefield Hospital, our Cardiothoracic Department offers comprehensive treatment options for both benign and malignant mediastinal tumors. These growths, which can encompass thymomas, germ cell tumors, cysts, and thyroid abnormalities in the central chest region, are treatable through a combination of chemotherapy, radiation therapy, and surgical interventions.

When managing abnormalities within the mediastinum, our multidisciplinary team, consisting of surgeons, medical oncologists, radiation oncologists, and pathologists, collaborates to determine the nature of the abnormality and develop the most effective treatment plan. Typically, surgical management remains a common approach for various mediastinal tumors, involving procedures like thoracotomy or minimally invasive techniques such as thoracoscopy and mediastinoscopy.

Detection of mediastinal masses, often identified through CT scans or chest X-rays, can cause patient anxiety. However, these tumors generally grow slowly and are amenable to treatment. In some cases, these growths may invade nearby structures, necessitating surgical removal. Thymic carcinoma, a more invasive form, may require a combination of chemotherapy, radiation, and surgery for effective management.

With advancements in surgical techniques, minimally invasive robotic surgery, like video-assisted thoracoscopy (VATS) mediastinoscopy, has notably reduced postoperative discomfort and shortened hospital stays for patients. These approaches entail smaller incisions, enabling a quicker return to regular activities within a week or two post-surgery. Even larger tumors, previously requiring more invasive procedures, can now be effectively managed with robotic approaches, significantly minimizing tissue trauma and enhancing patient recovery.

At Aster Whitefield Hospital, our commitment lies in providing advanced and compassionate care for mediastinal tumors. Our specialized treatments, including minimally invasive robotic surgeries, aim to reduce patient discomfort, expedite recovery, and ensure optimal outcomes for individuals dealing with these complex conditions in the chest region.

Electrocardiography (ECG or EKG)
EKG is an essential diagnostic tool used in cardiology to detect heart conditions and abnormalities. It is a non-invasive and painless procedure that visualizes the heart's electrical activity. Interpretation of an EKG requires specialized training and expertise, and the results can provide valuable information about heart health. It records the heart's electrical activity and produces a visual representation of the heart's rhythm. The EKG machine is composed of electrodes placed on the patient's chest, arms, and legs. These electrodes detect the electromagnetic impulses generated by the heart and transmit them to the EKG machine. This displays the information on a graph. Interpreting an EKG requires specialized training and expertise. A trained healthcare professional, such as a cardiologist or a trained technician, will analyze the EKG results to determine if there are any abnormalities in the heart's rhythm or structure. The results of an EKG can provide valuable information about a patient's heart health and help guide treatment decisions.

Echocardiography-3D
Three-dimensional echocardiography (3D-echo) is a medical imaging technique that allows physicians to visualize the heart in three dimensions. Unlike traditional 2D echocardiography, 3D-echo provides a detailed and comprehensive view of the heart's structure and function. This technique uses specialized ultrasound equipment and software to create a highly detailed 3D image of the heart and its surrounding structures.3D-echo is commonly used to diagnose and monitor a variety of heart conditions, including congenital heart defects, valvular heart disease, and heart failure. By providing a more complete picture of the heart's structure and function, 3D-echo can help physicians make more accurate diagnoses and develop more effective treatment plans.

Transthoracic Echocardiograph
A transthoracic electrocardiogram is a noninvasive method of evaluating the electrical activity of the heart. A chest wall electrode is placed to record the electrical signals produced by the heart. Healthcare professionals can then analyze these signals for abnormalities by amplifying and recording them. 
Transthoracic electrocardiograms can provide information regarding a person's heart rhythm, heart rate, and overall health. Abnormalities in the test results may indicate conditions such as arrhythmias, heart attacks, or other cardiac abnormalities. This information can be used to guide further diagnostic testing or to develop a treatment plan for the patient. 

3D Transesophageal Echocardiography
Three-D Trans esophageal Electrocardiography is an essential diagnostic tool that helps doctors identify and manage a wide range of heart conditions. It is performed to assess the heart's condition and its functioning. This test is carried out by inserting a probe into the esophagus, allowing a more detailed view of the heart and its structures. During the procedure, the patient is given a sedative to relax. The procedure includes the insertion of a flexible tube with a transducer attached at the end of it. This transducer sends and receives high-frequency sound waves converted into heart images. The procedure usually takes about an hour, and the patient is monitored closely throughout. Three-dimensional Transesophageal Electrocardiography provides detailed information about heart structure and function. It is commonly used to diagnose heart abnormalities, including congenital heart disease, valve disease, and arrhythmias. This test is also used to monitor treatment effectiveness and to evaluate the results of heart surgery.

Dobutamine Stress Echo and Contrast Echocardiography
Dobutamine Stress Echo and Contrast Echocardiography are safe and noninvasive imaging tests used to examine heart conditions. They are performed by trained and skilled healthcare professionals in our Cardiology Team
Dobutamine Stress Echo is a test that combines the use of echocardiography and dobutamine, a medication that increases the heart rate and blood pressure. During the test, the patient is given dobutamine through an IV while an echocardiogram is performed. The test is used to evaluate the function of the heart and to diagnose conditions such as coronary artery disease and heart failure.
Contrast Echocardiography is a type of echocardiogram that uses a contrast agent to enhance the images of the heart. The contrast agent is injected into a vein in the arm and travels to the heart, where it makes the heart chambers and valves easier to see on the echocardiogram. This test is used to evaluate the heart's structure and function and to diagnose conditions such as heart valve disease and congenital heart defects.

Stress testing (exercise or pharmacological)
Stress testing is a valuable tool in the field of cardiology. It is used to evaluate the function of the heart during physical activity. This test is designed to detect any abnormalities or irregularities in the heart's function that may not be evident at rest. The Cardiology Department of Aster Whitefield Hospital provides the facility with exercise stress tests and pharmacologic stress tests to its patients.
Exercise stress tests involve the patient performing physical activity while being monitored to evaluate the heart's response. Pharmacologic stress tests involve the use of medication to increase the heart rate and simulate physical activity.
These stress tests are used by our doctors to diagnose coronary artery disease, a condition where the arteries that supply blood to the heart become narrow or blocked. The test can also be used to assess the severity of heart valve disease and pulmonary hypertension.

Cardiac CT scan
A cardiac CT scan is a non-invasive imaging diagnostic test usually recommended for patients with a high risk of heart disease or those who experience symptoms such as chest pain or shortness of breath. It uses X-ray technology to produce detailed images of the heart and its surrounding blood vessels. The test involves the injection of a contrast dye that highlights the blood vessels and the heart. This dye allows the doctor to see detailed images of the heart and its chambers, as well as any blockages in the coronary arteries. It also allows the doctor to assess the function of the heart valves and detect any signs of heart muscle damage.

Cardiac MRI
Cardiac MRI, also known as magnetic resonance imaging, is a medical imaging technique used to visualize the heart and its surrounding structures. This non-invasive test uses a powerful magnetic field, radio waves, and a computer to generate detailed images of the heart's anatomy and function.
Cardiac MRI is used to diagnose a variety of heart conditions, including heart disease, heart failure, and congenital heart defects. It can also be used to monitor the progression of these conditions over time and to assess the effectiveness of treatment.
Cardiac MRI is a safe and painless procedure that typically takes 30 minutes to an hour. During a cardiac MRI, the patient lies down on a table that slides into a tunnel-like machine. The machine creates a strong magnetic field around the body, which aligns hydrogen atoms. Radio waves are then used to stimulate the hydrogen atoms, causing them to emit signals that are picked up by the machine. These signals are used to create heart images.
The MRI results are reviewed by our expert and qualified radiologists or cardiologist. They can then provide detailed and accurate reports to doctors, helping them to make the best decisions for their patients.

Holter monitoring
It is a valuable tool in diagnosing and treating heart conditions. It provides a detailed analysis of a patient's heart activity over 24 hours, and doctors can make more informed decisions about their treatment plan. This test is typically used to monitor patients with irregular heartbeats or other heart-related symptoms. During the test, a small, portable device called a Holter monitor is attached to the patient's chest with sticky patches. 
The Holter monitor continuously records the patient's heart activity for the entire 24-hour period. This allows doctors to analyze the patient's heart rhythms and identify any abnormalities or irregularities. 
Patients need to refrain from any conversational behavior during the test. This includes talking directly to others or engaging in activities that may interfere with the accuracy of the test results. Patients should also avoid getting the monitor wet or removing it during the testing period. 

Event monitoring (long-term ECG monitoring)
Event monitoring, also known as long-term ECG monitoring, is a diagnostic test that records the electrical activity of the heart over an extended period. This test is used by our cardiologists to diagnose heart rhythm problems that may not be detected during a routine electrocardiogram (ECG) or stress test.
During event monitoring, a small, portable device called a Holter monitor is worn by the patient for up to two weeks. The monitor records the patient's heart rhythm and stores the data for later analysis by a healthcare provider.
Event monitoring is recommended by our doctors often for patients who experience symptoms such as palpitations, dizziness, or fainting spells that may be related to an irregular heart rhythm. The test can help identify the specific type of arrhythmia that is causing the symptoms, allowing for more targeted treatment.
Once the monitoring period is complete, the data collected by the Holter monitor is analyzed by our experts. The results of the test then help us guide treatment decisions and may indicate the need for further testing or intervention.

Ambulatory blood pressure monitoring
Ambulatory blood pressure monitoring (ABPM) is a non-invasive method of monitoring blood pressure over 24 hours. ABPM is useful for people with suspected white coat hypertension, where blood pressure readings are higher in a clinical setting than in everyday life. It can also help diagnose masked hypertension, where blood pressure readings are normal in a clinical setting but higher during daily activities. 
It involves wearing a small device connected to a cuff around the upper arm. ABPM is typically done over 24 hours and requires the person to wear the device throughout that time. They are asked to go about their normal daily routine, including sleeping, while the device records their blood pressure. After the monitoring period is complete, the data is downloaded and analyzed by a healthcare provider.
As the device records blood pressure regularly throughout the day and night, it provides a more accurate picture of blood pressure. ABPM results can help our doctors guide treatment decisions, such as adjusting medication dosages or making lifestyle changes to lower blood pressure. It is a vital tool in hypertension management and prevention of associated complications.

TMT treadmill exercise testing
TMT, or treadmill exercise testing, is an important tool used by our cardiologists in the diagnosis and treatment of many heart conditions. These conditions include coronary artery disease, heart failure, and arrhythmias. TMT is used to assess cardiovascular health, detect underlying heart conditions, and evaluate treatment effectiveness. 
This non-invasive procedure involves placing the patient on a treadmill and monitoring their heart rate, blood pressure, and ECG while they walk or run at increasing levels of intensity. 
During a TMT, the patient is connected to a series of electrodes that measure the heart's electrical activity. The electrodes are attached to the patient's chest, arms, and legs, and are connected to an ECG machine that records the heart's electrical signals. As the patient walks or runs on the treadmill, the intensity of the exercise is gradually increased to assess the heart's response to physical activity.

Tilt table testing
The tilt table test, also known as the "Passive Head-up Tilt Test" or "Head Upright Tilt Test," is a diagnostic procedure used to monitor blood pressure, heart rhythm, and heart rate in a beat-by-beat manner by adjusting the angle of a specialized table on which the patient lies. This test is commonly employed by cardiologists to evaluate patients who frequently experience fainting or exhibit symptoms such as light-headedness.
Fainting medically referred to as syncope, can be caused by various underlying medical conditions involving the heart, nervous system, or inadequate blood flow to the brain.
During a tilt table test, the patient is positioned on a table equipped with a metal footboard to support their feet. Blood pressure cuffs are then placed on one of the patient's arms and a finger, and these cuffs are connected to monitors. The finger cuff continually inflates and deflates, while the arm cuff periodically measures the patient's blood pressure, typically every four to ten minutes.
Electrodes are applied to the patient's chest using adhesive patches and connected to an electrocardiogram (EKG) machine. The EKG records the electrical activity of the heart, which is graphically represented on paper or displayed as a series of lines on a monitor. These lines depict the heart rate and rhythm throughout the test.
All in all, the tilt table test is a valuable tool utilized by our cardiologists to assess patients experiencing episodes of fainting or related symptoms. It involves adjusting the angle of a specialized table while closely monitoring the patient's blood pressure, heart rhythm, and heart rate using cuffs, finger probes, and an electrocardiogram.