Fortis Escorts Heart Institute was yet again presented a challenge with 62 year-old Mutwakil Muhamed Ahmed Abunayeb suffering from medical conditions leading to deterioration in the functioning of his heart.

Dr Yugal Kishore Mishra, Director, Cardiac Surgery, Fortis Escorts Heart Institute and Dr Atul Mathur, Director, Invasive Cardiology, Fortis Escorts Heart Institute formed the team to conduct endovascular stenting on this patient weighing 165 kg (55.4 BMI).

Mutwakil Muhamed Ahmed Abunayeb from Sudan was horse riding on his farm when felt a severe chest pain. A patient suffering also from Type 2 diabetes mellitus and hypertension, he scheduled a routine check-up for himself.

Primary investigation in Sudan revealed a problem in the descending aorta but he was unconvinced about the exact condition of his heart. He then began his pillar to post journey to various hospitals in different countries in an attempt to find a doctor to get his heart condition rectified, but met with no success. Not only was he diagnosed and informed that he was carrying a ruptured aorta since the past few months, but the treatment was impossible as his weight posed the biggest problem. Even bariatric surgery could not be conducted due to his condition. Not disheartened, he finally came to Fortis Escorts Heart Institute, New Delhi.

Further investigations at Fortis Escorts revealed complications in respiratory system and bilateral acute brain and neurovascular bundles with leaking descending aorta. His obesity presented a bigger challenge compared to his other complications, hypertension and Type 2 diabetes mellitus. His excessive weight burdened his heart with a higher ejection fraction than supply. His condition was deemed him unfit for general anesthesia as he would have required a ventilator and may not have recovered from the dependency on the machine.

Dr. Yugal Mishra said, “The leaking descending aorta of the patient was difficult to operate on due to his overweight coupled with diabetes. There was no time to wait for his bariatric surgery and weight reduction because his fast leaking aorta was causing much more damage. We had discussions on how to operate this patient without any flaws. We trusted our experience and expertise to overcome the obstacle and I am happy seeing the patient walking again.”

Dr.Mathur added, “We decided to treat the patient by non-surgical placement of covered stent graft in the aorta to seal the rupture. This was done through a cut in the groin which was a challenge. We were not able to fit the patient on the angiography table and had to place extra tables to support his arms. His excessive weight presented a significant challenge to perform the procedure through groin (blood vessel in upper thigh) through which the stent is placed inside.”

Post-surgery, the Thoracic Aorta CT Angiography showed adequately placed stent graft covering the entry point of dissection flap and no intra stent thrombus. The patient came unable to walk properly, but after the surgery, he was comfortably walking back to his home.

Abunayeb said, “I could never imagine that the aortic valve replacement which had become absolutely necessary in my case would be so simple and without any blood loss. Recovery has been very smooth and within 48 hours, I was absolutely normal. I am really very happy with the procedure and thankful to team of doctors for giving me new lease of life.

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