Mumbai: Doctors at Holy Family Hospital, Bandra, performed a rare combined surgical procedure on a 29-year-old woman to remove extensive blood clots and restore circulation to her legs and vital organs. The surgery, led by Cardiac Surgeon Dr. Amit Karad and supported by a multidisciplinary team, involved removal of clots from the heart and leg arteries along with a bypass from the ascending aorta to both femoral arteries.
The patient, a resident of Mahim, presented with acute pain in both legs and signs of compromised blood flow, including toe discoloration. Investigations revealed multiple thrombi in major arteries, with the most significant being a 10 cm clot stretching from the left side of the heart to the mitral and aortic valves, obstructing both inflow and outflow. The clot posed a high risk of cerebral embolism.
The patient had a prior history of myocardial infarction in 2022 but had been stable since. Her condition rapidly worsened, prompting immediate surgical intervention. Complicating the situation were her morbid obesity (110 kg, 5 feet tall) and a left ventricular ejection fraction of only 20%.
The surgical procedure involved several key steps:
- Cardiac clot removal: The team opened the left ventricle and removed the large intracardiac clot while minimizing embolic risk.
- Ventriculoplasty: Non-functional heart tissue was excised, and viable myocardium was preserved to support cardiac function.
- Arterial clearance: The abdominal aorta, mesenteric arteries, and left renal artery were all found to be occluded and were surgically addressed.
- Bypass grafting: Artificial grafts were used to create a bypass from the ascending aorta to both femoral arteries. This was done via a subcutaneous route, avoiding an abdominal incision.
- Peripheral clot removal: Additional clots measuring 15 cm and 10 cm were removed from the right and left femoral arteries respectively, restoring leg circulation.
The surgery was completed without major complications. The patient was extubated within 24 hours and has since shown signs of recovery. She is ambulatory and is expected to be discharged shortly.
“This was a complex case involving simultaneous management of cardiac and peripheral vascular clots with critical circulatory compromise,” said Dr. Karad. “We planned a combined surgical approach tailored to the patient's condition.”