The patient is a 54 year old woman who was suffering with a heart condition and was recently diagnosed with tongue cancer
Normally these operations are done 6 weeks apart, but after proper planning the team could perform these operations 10 days apart
Team of doctors at Narayana Health City successfully performed two complex surgeries for two different life threatening conditions within a span of 10 days on a 54 year old patient from Bihar. Normally these operations are done 6 weeks apart to allow for the body to recover from the impact following a major heart operation. The patient was suffering from aortic stenosis, a condition wherein the major valve of the heart is thickened and obstructs the passage of blood out of the heart. She was also recently diagnosed with stage 2 cancer of the tongue.
Hailing from Bhagalpur, Bihar, 54 years old, Mrs. Shashi Sah’s life took a turn in April when she noticed a small lump on her tongue. As the lump was paining Shashi and her husband had shown it to a local physician in their hometown who initially thought it to be a mouth ulcer. As it did not go even after medication the family visited another doctor who suggested the patient to do a biopsy. The biopsy revealed that the lump was not an ulcer but a tumor. The family’s search for a world-class medical facility led them to Bengaluru. They reached out to another hospital in the city, but as the patient was under treatment for her heart condition for 22 years, the hospital referred the patient to Narayana Health City.
The patient was admitted under the consultation of Dr. Vijay Pillai, Senior Consultant Head & Neck Surgery – Oncology, and Dr Vivek Shetty, Consultant, Head & Neck Surgery – Oncology. The team did a thorough evaluation, and it was identified that the cancer of the tongue was in stage 2. It was an aggressive cancer and surgery was the optimal mode to cure her condition. However, in order to withstand a complex cancer resection her heart function needed to be optimal. During her workup for the heart, it was revealed that she has critical aortic stenosis and needed a valve replacement surgery to replace her damaged valve. Ideally these surgeries are staggered to let the body recover in between. However, in the case of Shashi, though her tongue cancer was in stage 2 and was currently on one side of her tongue leaving it unattended or offering her sub optimal treatment modalities like radiation/ chemotherapy would have led to the progression of her cancer to stage 4. It may lead to the cancer spreading to not only the other side of the tongue but also the lymph nodes in her neck.
Both the specialities along with the family had multiple discussions. The cardiac surgery team under Dr Devi Prasad Shetty successfully performed the valve replacement surgery. Within a week’s time the patient was healthy enough to undergo the second surgery. On the 10th day of the open heart valve replacement surgery, the head and neck cancer team under the leadership of Dr Vijay Pillai and Dr. Vivek Shetty performed the Adequate Glossectomy with neck dissection and free forearm flap reconstruction on 25th of September, 2020. They removed the tumour and reconstructed the area. The 2nd surgery was also successful.
Elaborating about the case, Dr. Varun Shetty, Consultant – Cardiac Surgery, Narayana Health City said, “The patient had a critical blockage of her aortic valve which could be problematic during her cancer surgery. Hence, it was decided to perform her heart surgery first. Her native aortic valve annulus was too small to put in an appropriately sized valve based on her body size. So, we performed a root widening procedure and implanted the appropriately sized bio prosthetic heart valve. She had an uneventful recovery from the operation and was handed over to the head and neck surgery team after 7 days.“
Speaking about the case, Dr. Vijay Pillai, Senior Consultant Head & Neck Surgery- Oncology, Narayana Health City, said, “While generally the time taken for a complex surgery as this is 7 to 8 hours, but in the case of Shashi as she had underwent a major surgery under anaesthesia very recently, exposing her again to long hours of anaesthesia was a high risk one. Further, the anticoagulant that has been used to maintain the heart functioning was also a challenge. Post our detailed discussions we did a thorough planning, identified the areas that can be fastened, developed elaborate protocol to address the possible risks. With the help of our comprehensive medical team, we performed the removal of the tumour and reconstruction of her tongue within a short span of 5 hours.”
The patient is currently doing well and she was discharged on 06th October 2020.
Sharing her joy, Ms. Anubha Sah, daughter of the patient, said, “Till the time we came to Narayana Health City we were under tremendous stress. So many negative thoughts were running in our minds. But once we met the doctors we were at ease. We knew our mother was in safe hands and they would do the best to save her. In fact, they did it as well. Despite being a difficult case with two critical conditions they managed it so well. I am so grateful to the entire team of doctors. They actually saved my life and I am deeply indebted to the doctors at Narayana Health City for this.”
The case study not only stands as an example of clinical excellence of Narayana Health City, it also showcase the capability of Narayana Health City to manage complex multi-specialty issues with ease.
About Narayana Health City, Bengaluru
Narayana Health City is located in Bommasandra, Bengaluru. It is comprised of Narayana Institute of Cardiac Sciences (NICS), a superspecialty hospital for cardiology and cardiac surgery, and Mazumdar Shaw Medical Center (MSMC), a multispecialty hospital for cancer care, neurology, neurosurgery, nephrology, urology, and advanced multidisciplinary intensive care unit (MICU).
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