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Heart Care

( Interventional cardiac procedures Coronary angiography Angioplasty and stenting Balloon Valvuloplasty pacemaker procedure Shoulder Replacement

Cardiothoracic and vascular surgery procedures Coronary artery bypass surgery- link should open to details Conscious off pump coronary artery bypass surgery Valve repair and replacement surgery Thoracic and pulmonary surgeries Adult and pediatric open heart surgeries

Angiography / Coronary Angiography

Angiography Is a minimally invasive medical test that helps physicians diagnose and treat medical conditions.Angiography can be used to look at arteries in many areas of the body, including the brain, neck (carotids), heart, aorta, chest, pulmonary circuit, kidneys, gastrointestinal tract, and limbs. Angiography uses one of three imaging technologies and, in some cases, a contrast material to produce pictures of major blood vessels throughout the body. It is is performed using: X-rays with catheters Computed Tomography (CT) Magnetic Resonance Imaging (MRI)

In catheter angiography, a thin plastic tube, called a catheter, is inserted into an artery through a small incision in the skin. Once the catheter is guided to the area being examined, a contrast material is injected through the tube and images are captured using a small dose of ionizing radiation (X-rays). Coronary Angiography Itis done if a patient has symptoms of coronary artery disease, an unexplained pain in your chest, jaw, neck or arm, a congenital heart disease or congestive heart failure. During angiography, a small incision is made in the upper thigh in order to gain access to the femoral artery. Next, a guide wire is inserted into the femoral artery and is threaded to the aorta. A catheter is then inserted along the guide wire. Once the catheter reaches the aorta, a contrast dye is injected. When the dye flows from the aorta to the coronary arteries, an x-ray, or angiogram, is obtained. The image taken during angiography will show if there is any blockage, aneurysms, narrowing or other abnormalities in the arteries. Following the angiography, the catheter and guide wire are removed. If treatment is necessary, the physician can recommend appropriate therapy. Angioplasty and Stenting Depending on the findings of the angiography, your doctor may advise you to undergo angioplasty/stenting or bypass surgery. Both procedures restore the blood flow to the blood deprived areas of the heart thereby, eliminating or reducing the number of episodes of angina pain. The choice between angioplasty/stenting or bypass surgery for treatment of such blockages is made on the basis of the extent and location of blockages in your coronary arteries. What is balloon angioplasty and stenting During the procedure, you would be given a mild sedative and some pain killers to ensure that you remain relaxed. Your doctor will insert a long, thin tube called a catheter, which has a small balloon on its tip, directed to your blocked artery via either an artery in your leg or arm. The balloon is then inflated in your artery, at the blockage site. This flattens or compresses the plaque against your artery wall, thus opening up the path of blood flow through your artery. Depending on the location and nature of your blockage, your doctor might decide to place a stent, which is a hollow metal tube that acts as a scaffold to keep the artery open. In a small number of cases, a special catheter with a small, diamond tip is used to drill through hard narrowing with calcium that is causing the blockage. This is called rotational artherectomy. What is a stent

A stent is an expandable metallic tube which is crimped on to a thin balloon. A stent is implanted to support the artery and keep the After the angioplasty, patient is required to stay in the hospital for 2 -3 days. And can resume full activity within a few days of returning home. Angioplasty is not a cure, but a treatment to reduce the effects of coronary artery disease. Following angioplasty, diet and medications have to be strictly followed to reduce the risk of recurrences. Cardiac rehabilitation Cardiac rehabilitation is a medically supervised program to help heart patients restore their normal life after treatment of their cardiac disease. Cardiac rehabilitation, when combined with medicine and surgical treatments, can help you recover faster, feel better, and develop a healthier lifestyle. Cardiac rehabilitation often begins in the hospital after a heart attack, heart surgery, or other heart treatment. Rehabilitation continues in an outpatient setting after you leave the hospital. Coronary artery bypass grafting ( CABG ) The most effective treatment forCoronary Heart Disease (CAD) a condition in which plaque (a substance made up of fat/ cholesterol/ calcium) builds up inside the coronary arteries thereby narrowing them & affecting the regular flow of oxygen rich blood to the heart. CABG significantly improves the chances of survival of patients who are at high risk. Bypass surgery or CABG is usually performed with the heart stopped, thereby entailing the use of Heart Lung Machine. The surgery can also be performed on a beating heart, so known as Off-Pump Surgery.

What happens during the procedure

Before the procedure, you will undergo some routine blood tests, an ECG, a chest X-ray and an angiography. This will give your doctor a clear picture of your current health status. In the operation theatre, you will be given general anesthesia for a painless procedure. A heart-lung machine - referred to as a "pump" because it continues to mechanically pump oxygen and nutrients to the body during the surgery will ensure

blood flow through your body while your heart is stopped and being operated upon. A graft (a long piece of vein or an artery) will be taken from your leg or the inside of your chest wall or forearm and attached to one end of the graft will be attached to a coronary artery below your blocked area. The procedure can take from 2 to 6 hours, depending on the number of bypasses needed. Off-pump or beating-heart surgery: This is another technique for performing bypass surgery. It reduces the need for large incisions or a heart-lung machine This procedure allows surgery to be done on the still-beating heart using special equipment to stabilize or quieten the area of the heart, the surgeon is working on. Minimally invasive surgery: In this procedure, a surgeon performs coronary bypass through several smaller incisions in the chest. This technique is used only under certain conditions. Variations of minimally invasive surgery are called portaccess or keyhole surgery.

What is coronary artery bypass graft ( CABG ) surgery

Coronary artery bypass graft surgery is an open-heart operation in which arteries or veins are taken from another part of the body to channel needed blood flow to the coronary arteries. During surgery these arteries or veins are connected directly to the coronary arteries on the surface of the heart beyond the blockages. This way, blood can flow through them to bypass the narrowed or closed points. CABG operations usually last from three to six hours, their duration depending on the number of vessels to be grafted. Each operation varies in complexity, so its duration can only be estimated.

What is conscious off-pump coronary artery bypass surgery (awake bypass surgery)

Awake bypass surgery is a break through step in Fast-track care of bypass surgery patients. Awake bypass surgery is the latest advance where a patient undergoes bypass surgery while actually awake and can converse with the operating surgeon and his team. How is it performed A new type of beating heart surgery which is performed with epidural anesthesia, eliminating the need and risks of generalanesthesia. The technique is a highly precisionbased methodology, which involves injection of micro doses of local

anesthetizes only the chest region while the rest of the system is fully awake. This enables a painless bypass surgery and makes the surgery sage for patients who are at high risk for general anesthesia. Advantages of awake bypass surgery Avoidance of tracheal intubation Avoidance of Ventilation

Avoidance of cardiac depression due to general anesthesia and premedication drugs Avoidance of ischemic events related to intubation No dizziness, nausea Reduced ICU stay and hospital stay

Valve replacement surgery / balloon valvotomy

Balloon valvotomy is a non-surgical procedure performed in the cardiac catheterization laboratory. A thin flexible tube is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed valve, a balloon device located on the tip of the catheter is quickly inflated. This relieves the obstructed valve.

During a valve repair surgery, parts of a stenotic valve that are stiff or hardened may be cut and separated to help them open wider. If a valve can't be repaired, it may be replaced with a prosthetic (artificial) valve.

During valve repair or replacement surgery, the breastbone is divided, the heart is stopped, and blood is sent through a heart-lung machine while the valve is being replaced. If medicines are not effective in controlling your symptoms of mitral valve stenosis or if your doctor determines that you need more aggressive treatment, you may need surgery to repair or replace your mitral valve. Valve surgery is common and usually successful. But a degree of risk is associated with this invasive

procedure. There are generally three options: a balloon valvotomy, a closed (or open) commissurotomy surgery, or valve replacement surgery.

Valve repair (balloon valvotomy)

Balloon valvotomy (percutaneous mitral balloon valvotomy) is the method of choice for treating mitral valve stenosis in select patients. A thin flexible tube (catheter) is inserted through an artery in the groin or arm and threaded into the heart. When the tube reaches the narrowed mitral valve, a balloon located on the tip of the catheter is quickly inflated. The balloon, pressing against the narrowed mitral valve leaflets, separates and stretches the valve opening and allows more blood to flow through the heart. This procedure does not require open-heart surgery, so recovery is easier.

A balloon valvotomy is usually recommended if you have symptoms, moderate to severe stenosis, and most of your mitral valve is a normal shape.

A balloon valvotomy may also be used to treat people with mitral valve stenosis who do not yet have symptoms (asymptomatic) if they have:

A higher risk of dangerous blood clots (thromboembolism). This includes people with an irregular heart rhythm called atrial fibrillation, as well as those who have had a blood clot before. High blood pressure in the lungs ( pulmonary hypertension ). Mitral valves that are still in fairly good condition.

Your doctor may recommend a balloon valvotomy if you are planning to have another surgery (not on your heart), if you are pregnant, or if you are planning a pregnancy.

People with signs of blood clots in the left atrium, widespread calcification of the mitral valve structures, or moderate to severe mitral valve regurgitation are not considered good candidates for a balloon valvotomy.

The mitral valve may narrow again (restenosis) after 10 to 20 years. Valve surgery Depending on the amount of damage to your mitral valve, your doctor may recommend surgery to repair or replace your mitral valve. If the valve is damaged beyond repair, it will need to be replaced. Mitral valve surgery may be done as an open-heart surgery, or a minimally invasive surgery. During open-heart surgery, your heartbeat is stopped, and you are placed on a heart-lung machine to deliver blood to your body. The heart-lung machine temporarily serves in place of your heart and lungs by mixing oxygen with the blood, removing carbon dioxide from the blood, and pumping the blood throughout your body. During minimally invasive surgery, your doctor makes a smaller incision than the incision made in open-heart surgery. You may still be placed on a heart-lung machine. Valve repair or replacement is similar for minimally invasive surgery and open-heart surgery.

Valve repair

In open commissurotomy, a surgeon removes calcium deposits and other scar tissue from the mitral valve leaflets, which opens the valve. This procedure is used for people who have severe narrowing of the valve and are not good candidates for balloon valvotomy.

Valve replacement

The damaged heart valve is removed and replaced with a new valve. This is generally done when your mitral valve is damaged beyond repair. With improved technology, mitral valve replacement is an important surgical option. Some doctors believe that replacement mitral valves are now more durable. Also, more of the original mitral valve and its support structure (such as the chordae tendineae) are preserved during valve replacement. The long-term results of surgery are generally better when more of the original mitral valve structure is preserved. Balloon mitral valvotomy

Balloon valvotomy is used to increase the opening of a narrowed (stenotic) valve. It is used for:

select patients who have mitral valve stenosis with symptoms

older patients who have aortic valve stenosis, but are not able to undergo surgery some patients with pulmonic valve stenosis

This balloon valvotomy procedure can be performed on the mitral, tricuspid, aortic or pulmonary valves.

How is a balloon valvotomy performed ?

Balloon valvotomy is a non-surgical procedure performed in the cardiac catheterization laboratory by a cardiologist and a specialized team of nurses and technicians.

Long, slender tubes called catheters are first placed into blood vessels in the groin and guided into the chambers of the heart. The cardiologist then creates a tiny hole in the wall between the upper two chambers of the heart. This hole provides an opening for the cardiologist to access the left atrium with a special catheter that has a balloon at the tip.

The catheter is positioned so the balloon tip is directly inside the narrowed valve. The balloon is inflated and deflated several times to widen the valve opening. Once the cardiologist has determined that the opening of the valve has been widened enough, the balloon is deflated and removed.

During the procedure, the cardiologist may perform an echocardiogram (ultrasound of the heart) to get a better picture of the mitral valve.

Able to treat patients with thinner corneas Reduced incidence of flap complications Lower rate of dry eye syndrome

What should I expect before the procedure ?

Most patients will need to have blood tests, a chest x-ray, electrocardiogram, and an echocardiogram before the procedure. These tests are usually scheduled the day before the procedure. Ask your doctor what medications should be taken on the day of your test.

If you are diabetic, ask your physician how to adjust your medications the day of your test. Tell your doctor or nurse if you are taking any blood thinning medications such as Coumadin (warfarin). An alternate method for thinning your blood may be prescribed a few days before the procedure.

You will not be able to eat or drink after midnight the evening before the procedure. Leave all valuables at home. If you normally wear dentures, glasses or a hearing assist device, plan to wear them during the procedure to help with communication. Tell your doctor and/or nurses if you have any allergies.

How long does the procedure last ?

The procedure lasts about 1 hour, but the preparation and recovery time add several hours. Please plan on staying at The Cleveland Clinic all day for the procedure and remaining in the hospital overnight. Patients usually go home the day after the balloon valvotomy procedure. When you are able to return home, arrange for a companion to bring you home.

What should I expect during the recovery ?

You will need to lay flat for about 6 hours after the catheter has been removed from your groin to prevent bleeding. You will have a tight bulky dressing on your groin area while you are resting in bed. Do not bend your legs during this time to prevent bleeding. A sheet may be placed across your legs to remind you to keep them straight. Your nurse will tell you when you may sit up and get out of bed. You should not eat anything until the catheter has been removed from your groin. Notify your nurse immediately if you have a fever, chest pain, swelling or pain in your groin or leg, or bleeding at your groin site. You will have an echocardiogram the morning after your procedure.

Medications may be prescribed. Ask your doctor if it is safe to continue taking the medications you took prior to the procedure. Once you have recovered from the procedure and have talked to your doctor about your follow-up appointments and care, you will be able to go home. You will be able to return to most of your normal activities the day after the procedure. Ask your doctor when it is safe to drive, return to work or begin or continue an exercise program. Once your cardiologist has successfully opened the narrowed mitral valve, your symptoms of valve disease should decrease or disappear completely. What is medical tourism? Medical tourism, also known as health tourism or health travel, is a term that describes travelling to a foreign country for medical, dental, or cosmetic treatment. It involves the benefit of cost effective treatment, private medical care, in collaboration with the tourism industry. The concept of medical tourism is fast

growing in India and people from different part of the world are choosing India as their desired destination. Why Choose India? Medical tourism is a rapidly growing sector in India and millions of medical tourists from all over the world have come here to experience a world-class healthcare service. In 2010, about 600,000 patients travelled to India from over 30 countries for treatment, including the USA, Canada, UK, Russia, the Middle East and Africa. According to a study by the Confederation of Indian Industry (CII) on healthcare, after software, the medical tourism industry is poised to be the next big success story in India. It has predicted that the industry will grow to earn additional revenue of $2.3 billion by 2012 and will soon account for a major share of the countrys revenue. There are several reasons behind this tremendous growth: Patients come to India to get specialized treatments not available in their home country. Indian hospitals excel in performing complex cardiac surgeries, kidney transplants, bone marrow transplants, orthopedic surgeries, infertility treatments amongst their wide repertoire. India provides world-class quality treatments at a fraction of the priceof developed countries. The cost of medical treatment in India is generally one tenth of western countries and among the cheapest in Asia. India has state of the art medical institutes and hospitals of international standards with highly qualified medical professionals. These centers are backed by high quality equipment and technology. This fusion of highly qualifiedstaff assisted by the latest equipment gives India the edge over other countries. With hospitals and clinics in every region including urban, semi-urban, or rural parts of the country, India has ample choice in terms of preferred destinations. In countries such as Canada and the UK, patients almost always have to wait weeks and sometimes months to avail of medical treatments. In India the consultations with the doctors are prompt and patients receive a turnaround to their treatment plan at a quicker pace.

As English is a commonly spoken language in India, the patient will be comfortable communicating with the doctors.

Medical tourists find that the cost of their treatment (including the return airfare, holiday and accommodation) leaves them with a total bill substantially less than they would have spent just on having the procedure in the UK. Why Arman There are several concerns that flicker in the minds of the foreigners who come for treatment to India, particularly for first time fliers. The first among them is which hospital to choose for their treatment. India is flooded with hospitals, medical centers and hotels which have their websites that attract the foreign patients. This makes them even more confused and the complexity of decision making becomes a challenging task. We, at Arman can address all these concerns and issues by acting as intermediary with hospitals, clinics, surgeons, hotels. Arman is a healthcare facilitator that has painstakingly brought together highly qualified professionals and hospitals of repute and health care providers. We take the responsibility of screening the hospitals by checking their track record, accreditations, associations and have partnered with the best internationally accredited hospitals in India. Arman update and monitor our network of hospitals on a regular basis and maintain a database on the hospitals certifications, type of facilities and other factors critical in choosing a medical center. Arman also negotiate a lower price from the hospital which foreign patients would not get by directly approaching the hospitals This helps the patient to save a lot on the medical procedure costs We provide assistance with logistics, documentations, permits and other travel arrangements required for medical tourism.

Our coordinators are highly trained to foresee every need of the patient and make the entire process hassle free from start to finish. They help the patient plan his medical procedures before leaving home, and schedules all his appointments, surgery, treatments and plans for recuperation. This in turn helps the patient to choose the hospital according to his convenience and also get a clear picture of the cost of treatment, accommodation beforehand that helps them to arrange their finance. We are aware that a lot of trust is put in our hands and ensure that this trust is well placed by serving each patient individually with care and comfort.

How We Work Patient query received by the patient himself or his doctor/ hospital. This query along with medical reports is forwarded to the concerned hospitals to get expert opinions After the hospitals respond, we create a package for the patient which includes recommendation on the treatments, duration of stay, and the costs involved. The patient reviews the various options presented to him and makes a decision based on budget and the line of treatment recommended by the doctors. Occasionally, a patient may clarify his concerns or questions he may have regarding the treatment with the doctor by telephone. In liaison with the patients, Arman representatives will make prior bookings with the hospital, airlines, hotels. Patient travels and checks into hospital to start the treatment. We provide assistance through out your stay in the hospital which include pre and post opeartive care. Once fit and able to travel, the patient if wishes can enjoy the vast tourist destinations within India before returning to their home country fully rejuvenated. (at an additional cost)(ebranding/mum/ts/19) Arman Health Care Facilitators OUR OFFICE IN INDIA 422, Bonanza, 'B' Wing,Sahar Plaza Complex, Next to Kohinoor Hotel, Andheri Kurla Road, Andheri East Mumbai India 4000059. Contact: land line No: ( 022-28387433 ) Email OUR OFFICE IN CONGO Arman Health care Facilitators,Gallery Saint-Pierre, 36 local UtexAfrica Advanced ,AV 374 VolonelMondjiba,Kinshasa / Ngaliema,DRC Mobile : +243998290384 OUR OFFICE IN KENYA Arman Health Care Facilitators C/O Doctor Pharma Kenya Limited Vision Tower, Muthithi Road, Westlands, Nairobi,Kenya.Contact: Telefax:(+254)722330329

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