Author name: Anchal Negi

Paediatric Heart Surgery

What Is ASD (Atrial Septal Defect)? Can It Be Closed Without Surgery?

/ February 19, 2026

ASD — Atrial Septal Defect — is a hole in the wall between the two upper chambers of the heart, and it is one of the most common congenital heart defects found in children and adults. The good news: most ASDs can be closed completely, either with a simple catheter-based device or with surgery — and the outcomes are excellent. Dr. Ved Prakash, Director of CTVS at Yatharth Super Speciality Hospitals, Greater Noida, explains what ASD means, when treatment is needed, and what the safest, most effective option is for your child or family member. What Is ASD — Atrial Septal Defect? The heart is divided into four chambers — two upper chambers (atria) and two lower chambers (ventricles). The wall dividing the two atria is called the atrial septum. In a normal heart, this wall is completely sealed and blood cannot cross from one side to the other at this level. An ASD is a hole in this wall. Blood flows through the hole from the left atrium (where oxygenated blood returns from the lungs) to the right atrium (where de-oxygenated blood collects before going to the lungs) — because the pressure on the left side is slightly higher. This means the right side of the heart receives more blood than it should, and more blood is sent to the lungs with each heartbeat. Over years, this extra volume causes the right side of the heart to enlarge and, in severe cases, raises the blood pressure in the lungs (pulmonary hypertension) — which can become irreversible if the ASD is left unclosed for too long. Types of ASD Ostium secundum ASD: The most common type — a hole in the central part of the atrial septum. Most suitable for catheter-based device closure. Ostium primum ASD: Located in the lower part of the septum, near the heart valves. Almost always requires surgical repair — device closure is not possible. Sinus venosus ASD: Near the junction of the atria and the large veins entering the heart. Requires surgical repair. Patent Foramen Ovale (PFO): A small flap-like opening that all foetuses have and that normally closes after birth. A PFO is not a true ASD but can cause problems in some adults — particularly cryptogenic stroke. ASD Symptoms — What to Watch For Small ASDs often cause no symptoms at all — particularly in children, who compensate remarkably well. Larger ASDs may cause: Frequent respiratory infections in infancy — bronchitis or pneumonia more often than peers Reduced exercise tolerance in older children — tiring faster than classmates Breathlessness on exertion — particularly as the child grows and demands on the heart increase Heart palpitations — particularly in adults with undiagnosed ASD, often from atrial fibrillation Stroke in younger adults — a blood clot can cross from the right to the left side through a large ASD and travel to the brain Many ASDs are first discovered when a routine examination reveals a heart murmur — or when an echocardiogram is performed for another reason. Some are diagnosed in adulthood when the patient presents with atrial fibrillation or breathlessness and the cause is traced back to a previously unknown ASD. How Is ASD Diagnosed? Echocardiogram: The primary investigation — shows the location and size of the ASD, the direction of blood flow through it, and the degree of right heart enlargement Bubble echocardiogram: Agitated saline injected into a vein — bubbles crossing from right to left confirms an opening Cardiac MRI: Useful for precise assessment of the shunt volume and right heart dimensions when planning intervention ECG: May show right heart enlargement patterns When Does an ASD Need Treatment? If the ASD is significant enough to cause right heart enlargement on echocardiogram — even without symptoms If symptoms are present (breathlessness, reduced exercise tolerance, palpitations) If pulmonary blood flow is significantly elevated (Qp:Qs ratio greater than 1.5:1) If the ASD is causing atrial fibrillation Small ASDs (less than 5mm) in infants often close spontaneously by age 2–3. Larger ASDs do not close on their own and require intervention — ideally before school age if possible, though the procedure is safe at any age. Can ASD Be Closed Without Open-Heart Surgery? Yes — for the right anatomy. This is one of the most common questions parents ask. Device Closure (Catheter-Based — No Surgery) For ostium secundum ASDs of appropriate size and position, a device is delivered through a vein in the leg (femoral vein) using a catheter. The device — which looks like a small double-disc — is positioned across the hole and deployed to plug it. The procedure is performed under general anaesthesia and guided by echocardiography. The child typically goes home the next day. Suitable for: Centrally located ostium secundum ASDs with adequate tissue rims around the defect. Confirmed by echocardiogram during assessment. Surgical ASD Closure (Open-Heart Surgery) For primum ASDs, sinus venosus ASDs, and secundum ASDs that are too large or in an unsuitable position for device closure, surgical repair is performed. A patch of pericardium (the heart’s own lining) or a synthetic patch is sewn over the hole. The results are permanent and excellent — success rates exceed 99%. Device Closure Surgical Closure Incision needed? No Yes — chest incision Hospital stay 1–2 days 5–7 days Recovery 1 week 4–6 weeks Suitable for all ASD types? No — only suitable ostium secundum Yes — all types Success rate Excellent (>98%) Excellent (>99%) Frequently Asked Questions — ASD Heart Defect What is ASD and is it dangerous? ASD (Atrial Septal Defect) is a hole between the two upper chambers of the heart. Small ASDs may be harmless and close on their own. Larger ASDs, if left untreated for years, can cause right heart enlargement, pulmonary hypertension, atrial fibrillation, and stroke. Treatment before these complications develop produces excellent long-term outcomes. Will a small ASD close on its own? Small ostium secundum ASDs (less than 5mm) often close spontaneously by age 2–3. ASDs detected at birth are monitored with serial echocardiograms. Larger

Cardiac Surgery

What Is CABG? Coronary Artery Bypass Grafting Explained Simply

/ February 16, 2026

CABG — pronounced “cabbage” — stands for Coronary Artery Bypass Grafting, and it is the most commonly performed open-heart surgery in the world. If your cardiologist has mentioned CABG after your angiography, this article explains exactly what it means, how it differs from stenting, and what to expect at every stage. Dr. Ved Prakash, Director of CTVS at Yatharth Super Speciality Hospitals, Greater Noida, has performed CABG across Medanta, Narayana, and Sarvodaya with 8+ years of experience in coronary bypass surgery. What Is CABG — The Simple Explanation CABG is a surgery that bypasses a blocked coronary artery using a healthy blood vessel taken from elsewhere in your body. The blocked section of the artery is not removed or opened — instead, a new passage is created around it so blood can reach the heart muscle that was being deprived. Your coronary arteries sit on the surface of your heart and supply it with oxygen-rich blood. When plaque builds up inside them over years, they narrow. When they narrow enough to restrict blood flow significantly — or block it completely — the heart muscle is starved. This causes angina (chest pain), heart attacks, and eventually heart failure. CABG restores that blood flow permanently and reliably — which is why it remains the gold standard treatment for severe multi-vessel coronary artery disease. CABG vs Angioplasty — What Is the Difference? Feature CABG (Bypass Surgery) Angioplasty (Stenting) How it works New graft vessel bypasses the blockage Balloon opens the artery; stent holds it open Incision needed? Yes — chest incision No — catheter through groin or wrist Recovery time 6–12 weeks 2–5 days Best for Multiple blockages, diabetes, left main disease Single or simple blockages Durability LIMA graft lasts 15–20+ years Stents may re-block in 5–10 years Preferred in diabetes? Yes — strongly preferred Higher re-blockage rate in diabetics The choice between CABG and angioplasty is made based on your angiogram, your overall health, and whether you have diabetes. It is not a one-size-fits-all decision. For more detail on how this choice is made, read our full guide on what is bypass surgery. What Vessels Are Used as CABG Grafts? The graft vessel is the new “bypass road.” Three vessels are most commonly used: Left Internal Mammary Artery (LIMA) — taken from the inner chest wall. This is the best graft available. It remains open in over 90% of patients at 10 years and is used in virtually every CABG operation. It connects naturally to the most important coronary artery (LAD). Saphenous Vein — from the inner leg. Commonly used as the second or third graft. Lasts 10–15 years on average. Leg usually heals within 2 weeks with no functional limitation. Radial Artery — from the forearm. An excellent arterial graft with durability close to the LIMA. Used when total arterial revascularisation is planned. Using two arterial grafts (LIMA + radial artery) — called bilateral arterial grafting — gives the best long-term results and is increasingly preferred for younger patients. On-Pump vs Off-Pump CABG — Which Is Better? This is one of the most common questions patients ask before surgery. On-pump CABG: A heart-lung machine takes over while the heart is stopped. The surgeon operates on a still, bloodless field — which allows the most precise stitching. Standard approach for complex cases. Off-pump CABG (beating heart surgery): The bypass grafts are attached while the heart continues to beat. No heart-lung machine is used. Reduces the risk of kidney problems in patients with pre-existing kidney disease. The choice is made by Dr. Ved Prakash based on your specific anatomy, heart function, and comorbidities. Both techniques deliver excellent outcomes in experienced hands. What Does CABG Surgery Involve — Step by Step? General anaesthesia — you are fully asleep throughout Chest incision — the breastbone (sternum) is divided to access the heart Graft harvesting — the LIMA and/or vein graft is prepared Bypass grafts attached — one end to the aorta, the other to the coronary artery beyond the blockage Chest closed — sternum is wired back together; skin closed with sutures Total operative time: 3–5 hours What Happens After CABG Surgery? Cardiac ICU: 24–48 hours for close monitoring and breathing tube removal Ward stay: 5–7 days — walking, eating, and recovering Home discharge: With medications, wound care instructions, and follow-up dates Full recovery: 6–12 weeks depending on age and overall health Frequently Asked Questions About CABG What does CABG stand for? CABG stands for Coronary Artery Bypass Grafting. It is the medical term for bypass surgery — an operation that creates a new route for blood flow around a blocked coronary artery. Is CABG a major operation? Yes. CABG is major open-heart surgery requiring general anaesthesia and a hospital stay of 7–10 days. However, it is one of the most studied and standardised operations in cardiac surgery, with consistently high success rates at experienced centres. How many bypass grafts can be done in one operation? Between one and five bypasses can be performed in a single CABG operation, depending on how many coronary arteries are blocked. Triple bypass (three grafts) is the most commonly performed. Is CABG done under local or general anaesthesia? Always under general anaesthesia. You are completely unconscious for the entire operation and wake up in the cardiac ICU after it is completed. Does CABG cure heart disease permanently? CABG restores blood flow reliably and durably — the LIMA graft lasts 15–20+ years in most patients. It does not stop the underlying process of atherosclerosis. Medications, lifestyle changes, and follow-up remain essential after surgery to protect the grafts and the rest of the heart. Considering CABG? Talk to Dr. Ved Prakash First. If CABG has been recommended after your angiography, consult Dr. Ved Prakash for bypass surgery in Delhi NCR at Yatharth Super Speciality Hospitals, Greater Noida. Share your angiogram report via WhatsApp for an online pre-consultation before your visit. Dr. Ved Prakash | Director CTVS — Yatharth Super Speciality Hospitals, Greater Noida 📞 +91-9355255106  | Book Appointment →

Uncategorized

Heart Blockage Symptoms You Should Never Ignore

/ February 8, 2026

The most dangerous thing about heart blockage symptoms is that many people dismiss them — or mistake them for indigestion, muscle pain, or tiredness. By the time a heart attack occurs, the blockage has often been building silently for years. Dr. Ved Prakash, Director of CTVS at Yatharth Super Speciality Hospitals, Greater Noida, explains the key symptoms that indicate a coronary artery may be blocked — and why acting on them early can prevent a heart attack or avoid emergency surgery. What Is a Heart Blockage? A heart blockage occurs when fatty deposits called plaque build up inside the coronary arteries — the blood vessels that supply the heart muscle with oxygen. As plaque accumulates over years, the artery narrows. When blood flow is significantly restricted, the heart muscle sends out warning signals. When a plaque ruptures and a blood clot forms suddenly, a heart attack occurs. Recognising heart blockage symptoms early gives you the best chance of treatment before a heart attack — or before the blockages become severe enough to require emergency surgery. 8 Heart Blockage Symptoms That Should Never Be Ignored 1. Chest Pain or Chest Tightness During Activity This is the most classic heart blockage symptom. Patients describe it as pressure, tightness, squeezing, or heaviness in the centre of the chest — typically triggered by walking, climbing stairs, or any physical exertion. It is relieved by rest within 5–10 minutes. This pattern is called stable angina and it almost always means there is a significant coronary artery blockage. Do not ignore it. Get an ECG and see a cardiologist the same day. 2. Chest Pain at Rest or Waking at Night With Chest Pain Chest pain that occurs at rest — or wakes you from sleep — is more serious. It suggests the blockage has become critical or unstable, and the risk of a heart attack in the next 48–72 hours is significantly elevated. This requires emergency cardiac evaluation. 3. Breathlessness on Mild Exertion Unexplained breathlessness — feeling short of breath climbing one flight of stairs, walking 200 metres, or doing light housework — is frequently a heart blockage symptom. When the heart muscle is deprived of blood, it does not pump efficiently, causing fluid to back up into the lungs. Many patients — particularly women and diabetic patients — present with breathlessness as their primary or only symptom, with no chest pain at all. 4. Pain Radiating to the Left Arm, Jaw, Neck, or Shoulder The heart and these areas share nerve pathways, which is why cardiac pain often radiates outward. Pain or discomfort in the left arm (particularly the inner forearm), jaw, neck, or between the shoulder blades — especially during exertion — is a strong warning sign of coronary artery disease. 5. Unusual Fatigue That Does Not Improve With Rest A heart working against blocked arteries has to pump harder. This consumes energy and leads to persistent, unexplained fatigue — particularly in women, who frequently report feeling exhausted for weeks before a heart attack. If tiredness does not improve despite adequate sleep and rest, a cardiac evaluation is warranted. 6. Palpitations or an Irregular Heartbeat A blocked coronary artery can irritate the heart’s electrical system, causing palpitations — a sensation of the heart racing, skipping beats, or fluttering. While many causes of palpitations are benign, any palpitations combined with other symptoms on this list require urgent investigation. 7. Dizziness or Light-Headedness on Exertion When a blocked artery limits blood flow to the heart during exercise, the brain may temporarily receive less blood too — causing dizziness or near-fainting. This is particularly concerning and warrants immediate cardiac assessment. 8. Swelling in the Feet or Ankles by Evening When the heart’s pumping capacity is reduced by poor blood supply, fluid accumulates in the lower limbs. Persistent ankle or foot swelling that worsens through the day — without another obvious cause — can indicate reduced heart function from blocked arteries. Symptoms in Women and Diabetic Patients Are Often Different This is critically important. Women and people with diabetes often do not experience classic chest pain. Their heart blockage symptoms may include: Unexplained fatigue and weakness Nausea or vomiting with exertion Breathlessness without chest pain Discomfort in the upper back or jaw A vague sense that “something is wrong” Diabetic patients may have silent ischaemia — blocked arteries with no symptoms at all — because diabetic neuropathy blunts the pain signals the heart normally sends. This is why routine cardiac screening for diabetic patients over 50 is strongly recommended. What to Do If You Have These Symptoms Symptom What to Do Urgency Chest pain on exertion, relieved by rest See a cardiologist today. Get ECG and echo. Same day Chest pain at rest or waking at night Go to emergency immediately. Do not drive yourself. Emergency Unexplained breathlessness on mild activity Cardiac evaluation within 24–48 hours. Urgent Pain radiating to arm, jaw, or neck Same-day cardiology review. Same day Persistent fatigue in a diabetic patient Cardiac screening — ECG, stress test, echo. This week What Tests Diagnose a Heart Blockage? ECG (Electrocardiogram): First-line test. Shows electrical changes caused by poor blood supply to the heart muscle. Echocardiogram (Echo): Ultrasound of the heart showing how well each section of the heart wall is moving and pumping. TMT (Treadmill Stress Test): ECG recorded while exercising. Reveals blockages that only appear when the heart is under demand. CT Coronary Angiography: A non-invasive scan that shows plaque and narrowing inside the coronary arteries. Conventional Coronary Angiography: The gold standard — a catheter-based procedure that shows the exact location and severity of each blockage. Performed when intervention is likely to be needed. Frequently Asked Questions — Heart Blockage Symptoms Can heart blockage symptoms be mistaken for something else? Yes — very commonly. Chest tightness is mistaken for acidity or muscle pain. Breathlessness is attributed to fitness or anaemia. Jaw or arm pain is put down to dental issues or a muscle strain. This is why a proper cardiac evaluation is essential for anyone with recurring unexplained symptoms, particularly over the age of 40. Can

Patient Guide

Diet After Heart Surgery in India — What to Eat, What to Avoid, and the Ghee Question

/ February 7, 2026

Diet after heart surgery in India is the question that almost every patient and family asks at discharge — and the advice they receive is usually so generic (“eat healthy, avoid oil”) that it is practically useless for someone cooking Indian food at home. Dr. Ved Prakash, Director of CTVS at Yatharth Super Speciality Hospitals, Greater Noida, gives you the complete, practical India-specific guide — what to eat, what to avoid, what to do with ghee, and the most common mistakes patients make in the months after bypass or valve surgery. Why Diet After Heart Surgery in India Matters More Than Patients Realise Bypass grafts, stents, and repaired heart valves do not last forever by default. How long they last is significantly influenced by what happens to the coronary arteries and heart in the years after surgery. A poor diet accelerates plaque formation in grafted vessels, raises cholesterol, elevates blood pressure, and worsens blood sugar control. The operation buys you time and relief — your diet determines how many years that time lasts. The goal of diet after heart surgery in India is not punishment. It is making choices that protect what the surgeon created. For more on the broader picture of recovery, read about life after bypass surgery — week by week. What to Eat After Heart Surgery in India Grains and Rotis Best: Whole wheat roti (2–3 per meal), jowar roti, bajra roti, oats, daliya (broken wheat porridge), brown rice in moderate portions. These provide slow-digesting carbohydrates, fibre, and sustained energy without spiking blood sugar. Avoid: Maida-based products — puri, paratha made from maida, naan, white bread, biscuits. White rice in large quantities is acceptable occasionally but should not be the daily staple, particularly for diabetic bypass patients. Protein — Critical in the First 3 Months The sternum (breastbone) takes 6–8 weeks to heal after bypass surgery. Adequate protein is essential for this healing and for overall recovery. Indian diets are often protein-deficient — this must be corrected deliberately after surgery. Dal: 1–2 katori per day — moong, masoor, chana, toor. All excellent. The combination of dal and roti provides complete protein. Paneer: Low-fat paneer in moderate amounts — 50–75 grams per day is fine. Full-fat paneer in large quantities daily is too high in saturated fat. Curd (dahi): Plain, low-fat curd — excellent daily protein source and probiotic. Not sweetened. Eggs: 1 whole egg daily is acceptable for most patients. Egg white can be taken freely — no yolk restriction for patients whose cholesterol is controlled. Fish: Rohu, katla, sardine, mackerel — 3–4 times per week, grilled or steamed. Omega-3 rich and heart-protective. Chicken: Grilled or boiled breast, without skin — good lean protein source. Not fried. Vegetables No meaningful restriction on vegetables. Include 3–4 varieties daily — emphasis on green leafy vegetables (palak, methi, pudina), tomatoes, onions, garlic, bitter gourd (karela — helps blood sugar control). All sabzis should be cooked in 1 teaspoon of oil maximum per preparation. Fruits Two portions daily: guava, apple, papaya, orange, amla, berries. For diabetic bypass patients: avoid mango, banana, and chikoo in quantity — high sugar content. Amla deserves special mention — it is exceptionally high in vitamin C, which supports vessel integrity and wound healing. The Ghee and Oil Question — The Honest Answer This is the most frequently debated area of diet after heart surgery in India, and the most frequently over-simplified. Going completely oil-free after heart surgery is wrong. Dietary fat is essential for absorbing fat-soluble vitamins A, D, E, and K. Vitamin D deficiency — already epidemic in India — worsens after heart surgery if fat is eliminated from the diet. Patients who go oil-free often compensate by eating more refined carbohydrates, which raise triglycerides and blood sugar — both harmful to bypass grafts. The right approach to oil and ghee: Use 2–3 teaspoons total of oil per day in cooking — not per dish, per day Best oils: mustard oil, groundnut oil, rice bran oil. Olive oil is good but expensive for everyday Indian cooking and changes the flavour of dal. Avoid vanaspati (dalda), palm oil, and reused or overheated cooking oil Small amounts of homemade ghee — half a teaspoon occasionally — are not harmful for most patients. Commercially produced ghee or large daily quantities should be avoided. Coconut oil in large amounts (as used in Kerala cooking) is high in saturated fat and should be reduced after heart surgery If You Are on Warfarin After Valve Surgery — The Green Vegetable Issue Patients who have had a mechanical heart valve replacement take warfarin for life. Warfarin interacts with vitamin K, which is found in green leafy vegetables — palak, methi, sarson, dhania, pudina. The critical point: you do not need to avoid these vegetables. You need to eat a consistent amount of them week to week. If you have been eating palak twice a week and you suddenly eat it every day for a week, your INR will drop. If you suddenly stop eating green vegetables, it will rise. Consistency is the rule — not avoidance. What to Strictly Avoid After Heart Surgery in India Namkeen, papad, pickle, achar: Extremely high in sodium — raises blood pressure directly Restaurant and dhaba food: Unknown oil quality, very high sodium, very high fat — avoid for at least 6 months Fried foods of any kind: Puri, samosa, pakora, chips — eliminated for 12 months minimum Mithai and sweetened drinks: High sugar and saturated fat — particularly harmful for diabetic bypass patients. This includes packaged fruit juices. Alcohol: Avoid completely for 3 months minimum post-surgery. After that, maximum 1 standard drink per day if the cardiologist permits — and never if on warfarin without discussion with your doctor. Heart-Protective Foods to Add Daily Garlic: 2–3 raw or cooked cloves — modest LDL-lowering and antiplatelet effect Flaxseeds (alsi): 1 tablespoon ground daily — best plant-based omega-3 source in India Walnuts (akhrot): 4–5 daily — omega-3, vitamin E, anti-inflammatory Methi (fenugreek) seeds: Soaked overnight, taken in

Aortic Surgery

Aortic Dissection — Symptoms, Emergency Surgery and What Families Need to Know

/ February 7, 2026

If someone near you has sudden, severe tearing chest or back pain — call emergency services immediately and do not drive. Aortic dissection is one of the few conditions where minutes determine survival. Aortic dissection is a tear in the inner wall of the aorta that allows blood to surge between the layers of the aortic wall — and it is the most time-critical emergency in cardiac surgery. Unlike most cardiac conditions, aortic dissection symptoms have a characteristic that distinguishes them from almost everything else: the pain is at its absolute worst the moment it begins. Dr. Ved Prakash, Director of CTVS at Yatharth Super Speciality Hospitals, Greater Noida, explains aortic dissection symptoms, the classification that determines treatment urgency, and what family members need to know when every minute counts. What Is Aortic Dissection? The aortic wall has three layers. In aortic dissection, the innermost layer (intima) develops a tear — and blood under arterial pressure forces through that tear and strips the layers apart along the length of the aorta, creating a false channel (false lumen) alongside the true blood channel. As this false channel extends, it can compress the true channel — cutting off blood supply to organs. It can propagate backwards toward the heart — causing severe aortic regurgitation or cardiac tamponade. It can block the openings of coronary arteries — causing a simultaneous heart attack. And it can rupture through the outer wall — causing catastrophic internal haemorrhage. This cascade can progress from tear to death in under an hour in the worst cases. Aortic Dissection Symptoms — The Defining Characteristics Tearing or Ripping Chest or Back Pain — Maximum at Onset This is the single most important aortic dissection symptom, and what separates it clinically from almost every other cardiac emergency. Patients describe it as tearing, ripping, or like something exploding inside the chest. It is at maximum intensity from the very first second — not building gradually. Most patients describe it as the worst pain they have ever experienced in their life. It often radiates to the back, between the shoulder blades. Migrating Pain As the dissection extends down the aorta, the pain follows it — moving from the chest to the back, then toward the abdomen. Migrating pain is highly specific for aortic dissection and should always trigger immediate emergency assessment with CT angiography. Blood Pressure Difference Between the Two Arms A systolic blood pressure difference of more than 20 mmHg between the right and left arm — caused by the dissection narrowing or blocking the artery to one arm — is a clinical sign strongly associated with aortic dissection. In emergency settings, blood pressure should always be measured in both arms when dissection is suspected. Neurological Symptoms Sudden weakness, numbness, or paralysis of an arm or leg — caused by the dissection compromising blood supply to the spinal cord or carotid arteries. When aortic dissection presents with stroke symptoms, it is particularly dangerous because thrombolytic drugs (clot-busters given in stroke) are absolutely contraindicated — they would cause fatal haemorrhage in a dissection. Absent Pulse in One Limb If the dissection extends into a major branch artery, the pulse may disappear in one arm or leg. Stanford Classification — Type A vs Type B The most important classification in aortic dissection. Everything — urgency, treatment, mortality — hinges on which type it is. Type A — Surgical Emergency Any dissection involving the ascending aorta (the section of aorta rising from the heart) — regardless of where the original tear is. Mortality is approximately 1–2% per hour without surgery. Emergency surgical replacement of the ascending aorta must be performed as soon as the operating team can be assembled — ideally within 2 hours of diagnosis. This is one of the most technically demanding emergency operations in cardiac surgery. Type B — Medical Management Initially Dissection involving only the descending aorta, below the left subclavian artery, not extending into the ascending aorta. Uncomplicated Type B is managed medically — strict blood pressure and heart rate control in a cardiac ICU with IV medications. Complicated Type B — with evidence of organ malperfusion, rapidly expanding false lumen, or threatened rupture — requires urgent endovascular repair (TEVAR). What to Tell the Emergency Room Team If you suspect aortic dissection in yourself or a family member, say these specific words to the emergency team: “Sudden, severe chest or back pain that was worst immediately when it started” “The pain feels like tearing or ripping” “They have high blood pressure” (or Marfan syndrome, or a known aortic aneurysm, if applicable) This prompts immediate CT aortic angiography — the definitive test that confirms or excludes aortic dissection within minutes. Do not let the team assume heart attack and give thrombolytics without a CT scan — in aortic dissection, this would be fatal. Risk Factors for Aortic Dissection Hypertension — the most common risk factor. Poorly controlled blood pressure progressively weakens the aortic wall. Marfan syndrome — inherently weak aortic wall; dissection can occur at younger ages and smaller aortic diameters. Bicuspid aortic valve — associated with ascending aortic enlargement and dissection risk. Existing aortic aneurysm — an enlarged aorta is at higher risk of dissection; learn more about aortic aneurysm. Pregnancy — third trimester and peripartum period; rare but important cause of Type A dissection in young women. Emergency Surgery for Type A Aortic Dissection The operation is performed under general anaesthesia on cardiopulmonary bypass. The ascending aorta is replaced with a synthetic Dacron graft. If the dissection extends into the aortic arch, deep hypothermic circulatory arrest — cooling the body to 18°C and temporarily stopping circulation — allows the surgeon to repair the arch safely. If the aortic valve root is involved, it may be repaired or replaced simultaneously. Total operating time: 4–8 hours. This is among the highest-stakes operations in all of surgery — and one that Dr. Ved Prakash performs as part of the aortic surgery programme at Yatharth Hospital. Frequently Asked Questions — Aortic Dissection

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