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About Surgery

Managing HCM:
The following Interventions are advocated in medical management in order to control the HCM symptoms

Surgical Option:
When blood flow out of the heart is severely blocked or obstructed, and when there are severe symptoms which do not respond to medications, a surgical myectomy (removal of the portion of the muscle) may be done.

Surgical myectomy promotes long-term survival. Operated patients experience enhances longevity indistinguishable from that expected in the general population and superior to that of nonoperated patients with obstruction. This will help increase survival and cut down HCM-related mortality (heart failure and sudden death) to 99%, 98% and 95% in majority of them.

Non surgical option:
This procedure is called a 'Septal Ablation' where a small quantity of alcohol is injected into the arteries that feed the thickened part of the heart. This procedure is effective in reducing the obstruction to blood flow.

Abnormal electrical activity (arrhythmias of the heart) which results in its sudden cessation causes instantaneous death. This abnormal electrical activity is unpredictable however treatable now and death can be prevented

An implantable cardiac defibrillator (ICD) is a small electronic device installed inside the chest to prevent sudden death from cardiac arrest due to life threatening abnormally fast heart rhythms (tachycardias). The ICD is capable of monitoring the heart rhythm. When the heart is beating normally, the device remains inactive. If the heart develops a life-threatening rhythm, the ICD delivers an electrical "shock(s)" to the heart to terminate the abnormal rhythm and return the heart rhythm to normal.

How are ICDs implanted?
Implantation of an ICD is similar to that of a permanent pacemaker. The procedure, which lasts 2-3 hours, is considered minor in that it does not involve major heart surgery. Patients are typically sedated during the procedure. A local anesthetic is injected under the skin over the area where the ICD will be placed, usually in the right or left upper chest near the collarbone. The lead is then inserted into a vein located in the upper chest near the collarbone. The tip of the lead is placed on the inner wall of the heart with the visual guidance of x-rays. If there is more than one lead, the process is repeated. The other end of the lead (or leads) is connected to the defibrillator unit, which is then inserted under the skin at the incision site. Because there are no nerve endings inside the blood vessels and the heart, the patient usually does not feel the placement of the lead(s).

Heavy sedation is used during the procedure when the defibrillator is tested for proper functioning. Testing an ICD involves inducing a rapid heart rhythm and allowing the defibrillator to detect the abnormal rhythm and then terminate it with a shock (just as the device would be expected to operate in a real-life tachycardia episode).

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