Kauvery Hospital Chennai, a unit of Kauvery Group of Hospitals, a leading multispecialty healthcare chain in Tamil Nadu, successfully treated a 33-year-old woman with heart failure related to long standing blood clots in her lungs. The reason was a rare autoimmune blood clotting disorder called APLA (Antiphospholipid) syndrome. In this condition, the immune system creates antibodies that attack blood vessels. These antibodies cause blood clots to form in the arteries and veins all over the body.
Four years ago, the woman approached with complaints of swelling in the leg. There was a delay by 3 to 4 months in diagnosis of blood clots in lungs prior to the evaluation at Kauvery, and she had chronic clots in her abdomen and lungs by this time. After a thorough examination she was diagnosed with the APLA syndrome and managed with medications.
“The medication, however, was not completely effective in dissolving the existing clots. Since the blood clots blocked a significant portion (almost 70 percent) of the lung over the past few years, there was a reduction in the amount of area in which the blood flows to the lungs thereby disrupting the flow of blood, making it difficult for the right side of the heart to pump the blood into her lungs. Her condition worsened where her clots merged into the blood vessel and further made it narrow. This is called Chronic Thromboembolic Pulmonary Hypertension and occurs in 3-4% of the people after an acute blood clot in the lungs,” says Dr. Srinivas Rajagopala, Senior Consultant Pulmonology Kauvery Hospital Chennai.
The team of pulmonologists, cardiologists and surgeons who studied the condition thoroughly performed a surgical procedure (Pulmonary Thrombo – Endarterectomy) to remove a part of the inner lining of the affected artery, together with clots. This procedure is most often carried out on the carotid artery or blood vessels supplying the legs. The treatment was planned accordingly as the condition could not be resolved by just removing the blood clots but also the covering of the narrow blood vessels as well. Also, her heart was failing and had an expected survival of less than 10% up to 5 years without surgery. These figures are worse than cancer but is not recognized by people.
In an ideal scenario, the right side of the heart has lower pressures than the left as it is not naturally designed to handle higher pressure. In this particular instance, the woman’s condition was so intense that her right side of the heart was measuring a pressure of 134 mm Hg compared to the left side of the heart which was measuring 120 mm Hg. Her condition aggravated due to this where her heart and liver started failing and her kidney functions were also disturbed.
A complex surgery was initiated under anaesthesia where the woman’s heart was arrested completely and the blood was pumped through an artificial pump. She was further placed in a deep cooling condition, where the temperature was maintained at 20 degrees Celsius such that the brain function is slow and the flow of oxygen is maintained. The surgery was performed in cycles of 20 minutes where in every alternate 20 minutes, her blood flow would be cut and each side of the pulmonary blood vessels would be stripped. After each cycle, the blood flow circulation would be restarted to protect the brain. The surgery was successfully completed after 5-6 hours, after which she made a slow and steady recovery.
Speaking on the condition, Dr. Aravindan Selvaraj, Co-founder & Executive Director, Kauvery hospital Chennai, “APLA syndrome is a sporadic condition that is life-threatening and can go undetected for a long time. Time is key in treating this condition as delayed diagnosis can lead to more complications. Few studies have also shown that miscarriages and unsuccessful pregnancies are one of the symptoms to diagnose this. Unfortunately, the woman could not bear a child due to the high pulmonary pressure. A high complex surgery with advanced techniques have been used to save her life, and I appreciate Dr. Kumud Kumar Dhital and Dr. Srinivas Rajagopala at Kauvery Hospital and his team for the relentless efforts taken to save her life. She is now recovering gradually and will have to continue with anti-clot medication for the rest of her life. Her Pulmonary pressures have dropped to 1/3 of her baseline value. We are hopeful that this will normalise, after which she may experience the joy of motherhood.”