Unprecedented medical feat saves life of man

After undergoing a historic four-part surgery– sectional removal of a diseased right lung, replacement of the mitral and aortic valves and a coronary artery bypass surgery, 45-year old Seldaudu walks out of Asiri Surgical, with a new lease of life
By Mihiri Wikramanayake

Creating history, the CardiacTeam at the Asiri Heart Centre, performed a medical feat that has never been recorded previously. The team took the challenge against all odds and saved a young man’s life which would otherwise had ended within the next couple of months.

When 45-year old Seldaudu barely walked into the Asiri Surgical Hospital, he had turned an unhealthy shade of blue. His tongue, lips and extremities were visibly blue from lack of oxygen and he was gasping for breath. This had been a condition that was getting worse by the day. Other symptoms included severe breathlessness, loss of appetite, loss of hair and the inability to walk steadily.

An agriculturist from Wariyapola, Seldaudu is a father to five and the one thing he did not want was an early death leaving behind his young family. Therefore, in a bid to finding an answer to his dilemma, Seldaudu spent hours consulting doctors and undergoing numerous tests to no avail until he ended up in front of Dr. Vajira Senaratne, Consultant Cardiologist at the Asiri Surgical Hospital.

Seldaudu, surrounded by staff at Asiri Surgical

On seeing the severity of Seldaudu’s condition, he was advised to immediately do an echocardiogram which showed an alarming narrowing and calcification of the mitral and aortic valves. The mitral valve is a dual flap in the heart that lies between the left atrium and the left ventricle. It is one of four valves that helps to regulate the blood flow from the upper left chamber into the lower left chamber of the heart.

When the heart pumps, blood forces the flaps open, and blood flows from the left atrium to the left ventricle. Between heartbeats, the leaflets close tightly so that blood does not leak backwards through the valve.

The aortic valve consists of three half-moon-shaped pocket-like flaps of delicate tissue, referred to as cusps and this valve lies between the left ventricle and the aorta which is the large artery that supplies blood to the body. Therefore, functioning of these valves is necessary for blood to flow to the body when the heart chambers contract. Both these valves were severely calcified and narrowed in Seldaudu’s case and therefore his forward flow of blood to the body was initially reduced as well as the heart was under severe strain.

It was also found that the oxygen level in Seldaudu’s blood was a dangerously low 30mmHg, when the normal oxygen pressure should be between 80 – 100 mmHg. To detect this problem Dr. Senaratne ordered a chest X-ray which indicated a ‘shadow in the right lung the size of a cricket ball’.

At this point, Dr. Senaratne referred Seldaudu to the Cardiac Surgery Team. Dr. Vivek Gupta, Consultant Cardiac Surgeon at Asiri Surgical Hospital was alarmed at the severity of Seldaudu’s condition and immediately ordered for a CT scan to figure out what this lesion was. “It was at this point that we discovered that the patient was suffering from an arteriovenous malformation in the right lung,” says Dr. Gupta. In an arteriovenous malformation, the blood passes through the lung without getting oxygenated.
“We now knew that the cause of the low oxygen levels in the patient’s blood was due to this right lung fistula.”

Seldaudu also had another major problem as he was found to have a blocked blood vessel in his heart. Therefore, it was necessary for him to have Coronary Artery Bypass Surgery as well. Dr. Gupta knew that this patient’s life was in grave danger and that time was of great importance. After consultation with his Anaesthetist, Dr. Anil Perera and Thoracic Surgeon, Dr. Panna Gunaratne, they decided that the only way to save Seldaudu’s life was to operate on him immediately. However, the challenge was the four-part surgery which was critically needed for Seldaudu: the sectional removal of the diseased right lung, replacement of the mitral and aortic valves and the coronary artery bypass surgery.

“This was a huge undertaking and we knew we were taking a risk,” says Dr. Gupta. “But we knew this was the only option for the patient if he had any chance of a normal life.” Seldaudu was informed of the urgency and the gravity of the situation and he too knew that this was his only chance for survival. It was a 50/50 gamble for him because his days were numbered with his medical condition. He agreed to undergo the operation and was willing to take that risk to his life.

On June 21, Seldaudu was to create history by being the only ever recorded patient to undergo this four-part operation. On opening the chest cavity, Dr. Gupta and his team were dismayed to discover that the right lung was congenitally deformed and the entire lung had to be removed.

They did the whole operation with the support of a heart lung machine and the entire procedure was finally completed after eight grueling hours. However, the patient was still in critical condition, in grave danger and his survival extremely bleak.

According to Dr. Gupta, Seldaudu’s chest cavity had to be kept open for four days thereafter to relieve the pressure within. Seldaudu’s heart, in the meantime, was being helped by an artificial intra aortic balloon pump whilst he remained in a deep coma.

On the fifth day, the chest cavity was closed and a tracheostomy was inserted to facilitate the weaning off from the ventilator. A tracheostomy is a surgical operation that creates an opening into the trachea with a tube inserted to provide a passage for air. On the seventh day, the patient was successfully weaned off the ventilator and 20 days later, the tracheostomy was removed as well.

Ten days after the surgery, Seldaudu was given liquids and slowly introduced from semi solids to solid foods. During this time, he was also encouraged to walk slowly around the Intensive Care Unit.
“We had two nurses always by this patient’s bedside every minute of every day,” says Sister-in-Charge Kumari. With 14 years of experience in nursing, she says she has never witnessed such a complicated and critical operation. “But, despite the situation, I was sure that this patient will pull through,” she adds.

According to the doctors, it was Seldaudu’s resilience and his will to live that led to his complete recovery. Speaking to the Sunday Times, Seldaudu says he had complete confidence in his doctors and was never hesitant about undergoing such a critical surgery.

Dr. Gupta also adds that if not for Seldaudu’s will to live, the recovery or survival from such a critical procedure would have been much harder. “Although I realized the danger to this young man’s life, I knew that each procedure, individually, was feasible. It was just a matter of combining four critical procedures in one go and I was ready for the long haul.”

“For 36 hours, the medical team did not leave Seldaudu’s bedside,” says Anaesthetist Dr. Anil Perera. “We were medicating the patient with lots of medicines in excess of normal dosages and as such, we had to keep a close watch over him,” he adds.

On the 40th day, Seldaudu left the Asiri Surgical Hospital with a new lease of life. He has been assured of a ‘normal’ life ahead of him with no fear of any remissions. Meanwhile, the Team at Asiri Surgical Hospital has the honour of creating medical history.

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