September 2018, Chennai: The aorta is the largest blood vessel in the body and is the
blood vessel that carries oxygen-rich blood away from the heart to all parts of the body. The
commonest diseases of the aorta requiring invasive treatment include Aortic Aneurysm which
is an abnormal swelling of the wall of the aorta or Aortic Dissection which is a tear in the wall
of the aorta. Both these conditions can be life threatening and replacement of the diseased
aorta with a synthetic graft is the best treatment. When left untreated, such aneurysms can
rupture and majority of patients die in 3 to 4 minutes making it very unlikely for quick
treatment to be delivered in that short period.
Mr S K who hails from Vijayawada had an aortic repair done with stent grafts in 2016 for a
life-threatening condition. Over the last few weeks, he became increasingly unwell and his
family including his son and wife were very concerned and took him to various hospitals at
Vijaywada. He was diagnosed of severe renal failure and blood loss due to a leaking aortic
aneurysm. Treatment for aortic diseases is only offered by a few centres in the country.
Therefore the patient obtained opinions from various leading surgeons in Vijaywada,
Bangalore and Chennai. All concluded that no treatment can be offered for Mr S K’s critical
condition and that fatality was unavoidable.
In despair, the family contacted Dr A B Gopalamurugan, senior interventional cardiologist and
Chief of Aortic Interventions at Kauvery Hospital’s newly-opened 24-hour Aortic Department.
Dr Gopalamurugan is renowned for taking on very high risk patients for heart and aortic
diseases and is a pioneer in various cutting edge treatments in the country. The 24-hour Aortic
Department at Kauvery headed by Dr Gopalamurugan consists of various super-specialists
including Cardiovascular Surgery headed by Dr Raguram, Vascular Surgery headed by the
pioneer Prof Sekar, Renal Medicine headed by Dr Balasubramanian and Cardiac Radiology by
Dr Zeeshan. Mr S K was urgently transferred to Chennai to Kauvery Hospital for immediate
After initial assessment, Dr Gopalamurugan was shocked to observe the critical status of the
patient. He had a blood level (Heamoglobin) of 5 (normally over 10) and significant kidney
impairment. He had a CT scan within minutes in the state of the art scanner for aortic diseases
at Kauvery which revealed a massive aneurysm measuring about 10cm in the chest wall which
had slowly started to leak. Dr Gopalamurugan realised why no one in the country was
prepared to treat Mr S K as the treatment options were limited. With the possibility of only
life or death, a high risk procedure was planned and executed by Dr Gopalamurugan to
prevent death and maintain quality of life.
CT scan on arrival showing massive aneurysm of Aorta, and 3D image of the Aorta
showing the large blood leak into the aneurysm in the chest wall
The aortic team then put in their best over the next 6 hours. The plan was to treat the kidney
disease, replace lost blood immediately, perform a high risk procedure through the groin
vessels to seal the leak and most importantly perform all of these simultaneously as time was
not a luxury. The patient was anaethetsisec by the cardiac anaesthetists. Chief Renal physician
Dr Balasubramanian immediately performed dialysis for the patient. Professor Sekar and
team immediately started to expose the groin vessels. Dr Raguram, Chief Cardiac Surgeon
provided back up cardiac surgical support.
Dr Gopalamurugan then deviced an indigenous plug using a routine existing stent graft and
this is called as a “Candy Plug”. This device was designed and created in the cardiac cath lab.
This “Candy Plug” was then used to seal off the aneurysm leak by introducing it into the groin
vessel and then navigating it into the neck of the aneurysm leak. This immediately sealed off
the aneurysm and leak. The patient stabilised. The patient could come of anaesthesia on the
same day and in a day the patient started feeling better and starting walking 2 days later.
CT Scan after the procedure showing the leak completely sealed off, and 3D image of the
aorta after the “Candy Plug” technique showing no leak into the anurysm.
Mr S K and his family are extremely glad that what was deemed a mortal condition has now
been treated to have their loved family member back alive and more importantly able to have
a normal quality of life.
Diseases of the aorta require a large team of highly trained experts available 24-hours a day
and equipped with all the latest machinery to be able to deal with any eventuality as the aorta
supplies blood to almost every single organ in the body. Therefore dealing with aortic diseases
requires vast experience and skills along with attention to detail to achieve good outcomes.
Dr Gopalamurugan, head of aortic interventions feels that it is most important that patients
get to such aortic departments quickly as every minute lost can cost the life of a patient.
Awareness of aortic disease and its treatment and available centres will help patients get the
right treatment at the right time thereby saving lives and their loved ones’ hopes.