Suggested Treatment
Centers
1. Narayana Hrudayalaya
Hospital, Bangalore
Located in
Bangalore’s Bommasandra Industrial area on Hosur road, Phase 1 of the
hospital is spread over 25 acres. Presently, it has 500 beds with 10
operating rooms with the capacity to perform 25 heart surgeries in a
single day. With the onset of Phase 2 NH will sprawl over an
impressive 100 acres. The structure will accommodate 780 beds, 30
operating rooms to perform 75 heart surgeries every day. Besides the
hospital, it will also accommodate a teaching institute for
cardiologists, cardiac surgeons, cardiac anaesthetists, nurses, health
technicians and healthcare specialists. Once completed, the entire
project will have 5000 beds called the Health City with specialty
hospitals for every disease.
We at Narayana Hrudayalaya Foundation, Bangalore and the Asia Heart
Foundation, Kolkata have a dream. A dream of making sophisticated
healthcare available to the masses, especially in a developing country
like our own.
When set up, Narayana Hrudayalaya was
envisioned as the largest hospital in the world, state-of-the-art in
every aspect, and capable of handling every surgical procedure of the
heart. To make this feat achievable no constraints were set in terms
of size, equipment or finance. The best in every field were employed
with the aim of providing quality patient care. Narayana Hrudayalaya
has become synonymous with the best in cardiac care and services for
adults and children alike, around the world. The Cardiac service is
just one such area where Narayana Hrudayalaya believes it can extend
specialized and competent services. Today, Narayana Hrudayalaya plays
host to areas of Neurosciences, organ Transplants, Gastroenterology,
Total Pediatric Care in Narayana Children’s Hospital and much more. It
is the one of the many steps NH is taking to provide complete, expert
and holistic treatment to the millions of afflicted individuals in
need of treatment by super specialists at an affordable cost.
DOCTORS
Some of the world’s most experienced in their respective fields are
with Narayana Hrudayalaya to join in the mission of caring. Needless
to say, they have graduated, practiced at the best hospitals of India
and from US, UK, Australia, and other parts of the world.
- DR. DEVI PRASAD SHETTY
- DR. COLIN JOHN
- DR. PRAVEEN KUMAR
- DR. P.V.RAO
- DR. RAJESH SHARMA
- DR.JAIRAJ.P.S
- DR.SHEKAR RAO
CENTERS OF EXCELLENCE
CARDIOLOGY
- Cardiology
Interventional Cardiology
Our interventional cardiologits strongly believe in primary
interventions on an acute heart attack with medicated stent for all
victims. They have vast experience in treating the victims of heart
attack. We also conduct post-doctor courses in Cardiology,
Interventional Cardiology & Paediatric Cardiology in association with
National Board of Examinations, Delhi.
Electrophysiology
Our team is one of the most experienced in the field of electro
physiology of the heart which treats rhythm disturbances of the heart
commonly called as 'palpitation'. Their special interest is AICD
implantation for serious rhythm disturbances of the heart and
bi-ventricular pacing for terminal heart failure. We conducts training
programs for young cardiologists in the field of electro physiology.
Endovascular Interventions
More and more aneurysms of the aorta are getting amendable from
endovascular stent grafting rather than a major surgery. Our team is
one of the most experienced in the field of treating complex aneurysm
of the aorta with endovascular stent grafting. Narayana Hrudayalaya in
association with various hospitals conducts joint discussions via
telemedicine for individual patient management.
Pediatric Cardiology & Interventions
Narayana Hrudayalaya has a very well rounded, well trained and
active Pediatric Cardiac team. Our Pediatric Cardiologists are adept
at complex echocardiograms as well as non surgical interventions in
the catherterization lab such as ASD, PDA and VSD closures. It is
their good clinical acumen and outstanding echo and cath lab skills
that have helped build us into a world class referral center for
children with heart disease.
- Cardiac Surgery
Coronary Artery Bypass Grafting (CABG) & Redo Coronary Artery
Bypass Grafting
Indians are genetically three times more susceptible than Europeans to
have an attack on the heart. In India, usually the breadwinner of the
family is the victim of attack. At Narayana Hrudayalaya 60% of the
surgeries carried out are, coronary artery bypass grafting and redo
coronary artery by pass grafting.
Having carried out over 13,000 coronary bypass grafting and redo
coronary artery bypass grafting operations, the team of experts at
Narayana Hrudyalaya are one of the most experienced in the world when
it comes down to performing CABG, redo CABG's and mainly coronary
artery bypass grafting without heart lung machine. The team of our
cardiac surgeons also have a special interest in complete arterial
graft using internal mammary artery and radial arteries.
DOR's Procedure (Left Ventricular Volume Reduction Operation) and
Carotid Enderactectomies :
The team of cardiac surgeons at Narayana Hrudayalaya strongly believe
that terminal heart failure, mainly due to ischaemic cardiomyopathy,
can be corrected by our favourite technic called DOR's Procedure with
coronary artery bypass grafting operation. With over 200 Dor's
procedures to the team's credit, our team is one of the most
experienced in the world in this rare procedure. We also conduct a
large series of carotid enderactectomies to improve the blood supply
to the brain with bypass grafting operation.
Blue Babies :
India produces the largest number of children in the world. So, going
by the incidence of congenital heart disease we produce the largest
number of children with heart diseases in the world (approximately 3
lakh children every year). Our team of paediatric cardiac surgeons is
one of the most experienced in the world in terms of specializing in
operating on children, especially children suffering from this complex
heart problem.
Transposition of Great arteries
Heart Surgeries on New Born Babies: Narayana Hrudayalaya gets
referrals from 21 countries for surgeries in complex heart diseases
especially in newborn babies who are barely few hours old. Our team of
neonatal cardiac surgeons are perhaps few in the world who routinely
performs switches and double switches for complex heart problem called
Transposition of Great Arteries in newborn babies.
The Ross Procedure
The Ross Procedure, also known as Pulmonary valve translocation,
was developed by Donald Ross in 1967.This operation uses the patients
own pulmonary valve and part of the main pulmonary artery as a unit to
replace the aortic valve and ascending aorta. A homograft valve is
harvested from a cadaver, is then placed in the pulmonary position.
The pulmonary valve is identical in shape, size, and in fact stronger
than the aortic valve and is therefore an ideal replacement for the
diseased aortic valve. Narayana Hrudayalaya has a full fledge
functioning homograft heart valve bank for the benefit of the needy
patients. The surgeons of the Narayana Hrudayalaya have a large
experience in successful valve replacements using homografts and Ross
operations. These operations are being done only in very few centers
in our country. Surgeons at Narayana Hrudayalaya have performed about
100 of this procedures with excellent results. They are perhaps one of
the most experienced surgeons in the World in performing operations
like Bental Procedure for Aortic Aneurysm and Aortic Arch replacement
surgery for dissecting Aneurysm of Aorta.
- Paediatric Cardiology
- Critical Cardiac Surgeries
Narayana Hrudayalaya is located close to the Electronics City of
Bangalore covering 26 acres of land with a building to accommodate
1000 beds, 26 operation theaters, infrastructures to perform 70 heart
surgeries a day. Within the first 5 years of commissioning this
institution, currently 25 heart surgeries are done on a daily basis,
out of them about 30% are on children with heart problem. Rest of them
is adult open-heart surgeries.
Institution is attracting patients from 22 countries primarily because
of its expertise in the area of complex heart problems. To enumerate
them;
Pulmonary Thrombo Endarterectomy for pulmonary Embolism
Pulmonary embolism is a dreadful conditions and its advanced stage
only
Treatment for this is a lung transplant, which carries extremely high
risk
And poor prognosis. Narayana Hrudayalaya is one of the very few
centers in the World today performing Pulmonary thrombo
endarcterectomy (PTE) for pulmonary embolism (PE).
Aneurysms of the Aorta
Surgery for Aneurysms of the Aorta including Aortic Arch Replacement
and Replacement of Total Thoraco Abdominal Aorta with Re-implantation
of Visceral
Arteries.
Aneurysms are fairly common problem, which are fatal if not treated.
Narayana Hrudayalaya does large number of aneurysm surgeries on a
regular basis.
Dor’s procedure
Remodeling Procedures (Dor’s procedure) for Left Ventricular
Aneurysms:
Terminal Heart Failure is a common problem affecting most of the
ischaemic
heart patients. Left ventricular remodeling procedure called Dor's
procedure
has a really transformed the lives of these patients and over 200 of
these
Procedures are done at Narayana Hrudayalaya.
Double Switches Corrected Transposition of Great Arteries
This is a rare heart problem, which can be corrected by performing
complex
Procedure called Double Switch to re-route blood through the heart.
Pulmonary Atresia
Pulmonary Atresia is a condition in which blue babies are born
with absent
Main pulmonary arteries. Narayana Hrudayalaya is one of the few
institutions
in the world where unifocalisation procedures are done to treat this
dreadful problem.
One Stage Operation for Swiss Cheese VSDs
Traditionally Swiss Cheese VSDs in which there are multiple holes in
the heart are corrected in two stages. However, Narayana Hrudayalaya
has performed over over 200 operations on children with Swiss Cheese
VSDs in one stage by closing all the holes in the heart.
Mitral Valve Repair in New Born Babies and Infants
Mitral Valve leakage is a dreadful condition affecting small
percentage of children suffering from congenital heart disease. Only
option for these children is repair of the valve, which is done on a
regular basis at Narayana Hrudayalaya.
Ross's Procedure for Aortic Stenosis
Best treatment option for Aortic Stensosis is Ross's Procedure in
which the patient's own pulmonary valve is used to replace the aortic
valve and in the place of pulmonary valve a homograft taken from a
dead body is replaced.
Coronary Artery Neo-Roofing Procedure
There are thousands of patients especially Diabetics, who develop
diffuse coronary artery disease, which cannot be grafted surgically.
For these patients, Narayana Hrudayalaya perform an innovative
procedure called Neo-roofing.
- Cardial Rehabilitation
Cardiac rehabilitation services are designed to help patients with
heart disease recover faster and return to full and productive lives.
Cardiac rehabilitation includes exercise, diet pattern, education,
counseling and support, and learning new ways to live a healthier
life.
You can benefit from cardiac rehabilitation if:
• You have heart disease, such as angina or heart failure, or have had
a
heart attack.
• You have a chronic heart problem.
• You had coronary artery bypass surgery or a valve replacement.
• You have an implanted defibrillator
• You have had a balloon catheter (angioplasty), a stent, or other
cardiac
procedure
You can also benefit from cardiac rehabilitation if you are at risk of
heart disease. Cardiac rehabilitation can make a difference. It is a
safe and effective way to help you:
• Feel better faster, emotionally and physically.
• Get stronger
• Get to know how to reduce stress
• Adjust to your condition
• Become confident to care for your health and return to former
activities
• Reduce the risk of further heart problems
• Enjoy life more
Almost everyone with heart problems can benefit from some kind of
cardiac rehabilitation. No one is too old or too young. Women can
benefit from cardiac rehabilitation as much as men. When you have
heart disease, breaking old habits and learning new ones can be
difficult. Wondering about your future health can be worrying too. The
support of family and friends, as well as health care providers, can
make a big difference to how well you adjust to these changes. Share
this information with others so they will learn about cardiac
rehabilitation and how they can help you.
Rehabilitation Team:
Cardiac rehabilitation services can involve many people. Your team may
be made up of one or more of the following people:
• Doctor (a heart specialist)
• Exercise specialist/physiotherapist
• Dietician
• Psychologist
• Yoga/Meditation teacher
• Your family
The most important member of your cardiac rehabilitation team is you.
No one else can make you exercise, or quit smoking, or eat a more
healthy diet.
- Cardiac Imaging – 64 slice CT for Non
Invasive angiogram and other
investigations – Myocardial Perfusion, etc.
2.
Shroff Eye Hospital, Mumbai
Shroff Eye Hospital is an expansion of the nationally recognized ISO
9002 accredited Shroff Eye Clinic (Marine Lines, Mumbai). The new facility
ideally located in Bandra (Mumbai) is a fulfillment of its endeavor to
provide patients with one of the most advanced eye hospitals, a space that
blends the highest surgical skills with instrumentation comparable to the
finest in the world.
The Shroff name stands for distinction in eye care since 1919. Today,
Shroff Eye Hospital is dedicated to delivering high quality, affordable
healthcare to patients in India and abroad.
State-of-the Art Technology
Our patient-centric philosophy has resulted in the hospital
acquiring the finest instrumentation from Carl Zeiss (Germany), including:
++ Lasers
++ ICG and Fluorescein Digital
angiography and imaging systems and Fundus photography
++ Glaucoma early diagnosis with
Automated and Applanation Tonometry.
++ Visual Field Analysis
++ Laser systems [IOL Master] for
intraocular lens power calculation for
cataract surgery
++ Automated Spectacle analysis and
computerized vision testing.
++ Automated corneal topography and
contact lens software
++ B Scan Ultrasonography
++ Photo Dynamic Therapy
++ Synaptophore for Squint Analysis
These enable our surgeons to diagnose with precision and offer the best
treatment options, particularly for most modern surgeries for cataract [phacoemulsification],
the retina and vitreous, LASIK, glaucoma, squint, keratoplasty, cornea, and
oculoplasty.
Modern technology ~ yet a humane touch!
"Patient Satisfaction" always comes first at Shroff Eye Hospital.
With this aim in mind, Shroff Eye Hospital is equipped with the finest
talent of doctors and staff and with the latest diagnostic and surgical
instrumentation.
Observing internationally accepted protocols and standards of medical
hygiene and patient comfort, the five story Shroff Eye Hospital is proud to
be considered at par with the best eye hospital in the world.
Superiority is visible in every aspect of the hospital. The Operation
Theatre Complex is built to stringent international design standards. The
HEPA filtered air-conditioning system and laminar air flow maintains an
absolutely sterile surgical environment.
NEW
KERATOCONUS (cone shaped cornea)
What is keratoconus?
Keratoconus is a common bilateral corneal condition, occurring in more than
1 in 1000 people. The condition typically starts in adolescence and early
adulthood.
Keratoconus is a disease with an uncertain cause, and its progression
following diagnosis is unpredictable. If afflicting both eyes, the
deterioration in vision can affect the patient's ability to drive a car or
read normal print. Further progression of the disease may lead to a need for
surgery.
Despite its uncertainties, keratoconus can be successfully managed with a
variety of clinical and surgical techniques, and often with little or no
impairment to the patient's quality of life.
SYMPTOMS
At early stages, the symptoms of keratoconus may be no different from just
having the need for spectacle correction. As the disease progresses, the
vision deteriorates. Visual acuity becomes impaired at all distances, and
night vision is sometimes quite poor. Some individuals have vision in one
eye that is markedly worse than that in the other eye. Some develop
photophobia (sensitivity to bright light), eye strain from squinting in
order to read, or itching in the eye. There is usually little or no
sensation of pain. Keratoconus can cause substantial distortion of vision,
with multiple images, streaking and sensitivity to light.
DIAGNOSIS
This is usually done by an ophthalmologist with a detailed eye examination.
Diagnosing early keratoconus can be tricky, since mild disease often does
not show any identifiable signs on slit-lamp examination; however, recent
and a more definitive diagnosis can be obtained using corneal topography, in
which an automated instrument projects an illuminated pattern onto the
cornea and determines its shape from analysis of a digital image. The
topographical map reveals distortions or scarring in the cornea, with
keratoconus revealed by a characteristic steepness of curvature which is
usually below or around the centre of the cornea. The topography record of
the degree and extent of the deformation is used for assessing its rate of
progression. Unilateral cases tend to be uncommon. Sometimes it’s a mild
condition in the better eye, below the limit of clinical detection. It is
common for keratoconus to be diagnosed first in one eye and not until later
in the other.
At our hospital, we use a very sensitive Topography instrument called the
‘Topolyser’ from Wavelight Inc.
PROGRESS
However good the vision may be with the use of contact lenses, vision may be
difficult to maintain at times as the condition progresses and contact lens
tolerance varies. Contact lenses are used as temporary measures of
treatment, but do not, unfortunately, slow down the rate of progression of
the cone. In about 10% to 20% of keratoconus patients the cornea may become
extremely steep, thin and irregular or the vision cannot be improved
sufficiently with contact lenses. The cornea may then need to be replaced
surgically with a corneal transplant or graft. Visual recovery after a
transplant takes a long time - sometimes as long as a year to 18 months - to
settle down and there is a strong possibility that the eye will still need
to be fitted with a contact lens afterwards in order to see properly.
Surgery is therefore not a shortcut to perfect vision and nor is it a way of
avoiding contact lens wear.
There is also a risk of the transplant rejecting afterwards, although a
majority of corneal transplants done for keratoconus are successful.
TREATMENT
Treatment of mild keratoconus is geared towards eliminating or reducing the
myopia and astigmatism.
Temporary :
- Contact Lenses
Permanent :
New modality of treatment:
- Corneal Collagen Crosslinking with Riboflavin (C3-R®*)
Contact lenses :
Initial management is tried with rigid contact lenses
by our contact lens specialist. In very early stages of keratoconus,
spectacles can suffice to correct minor astigmatism. As the condition
progresses, spectacles may no longer provide the patient with a satisfactory
degree of visual acuity, and most doctors will move to managing the
condition with contact lenses.
Rigid gas permeable contact lenses for keratoconus improve vision by means
of tear fluid filling the gap between the irregular corneal surface and the
smooth regular inner surface of the contact lens, thereby creating the
effect of a smoother cornea.
Many specialized types of contact lenses have been developed for
keratoconus, and our contact lens expert helps you with the best fit. The
irregular cone needs expertise to produce a contact lens with optimal
contact, stability and steepness. Some trial-and-error fitting might be
necessary.
Traditionally, contact lenses for keratoconus have been the 'hard' or rigid
gas-permeable variety, although manufacturers have also produced specialized
'soft' or hydrophilic contact lenses. A soft contact lens has a tendency to
conform to the conical shape of the cornea, thus diminishing its effect.
These do not however prove effective for every patient.
Some patients also find good vision correction and comfort with a
"piggyback" contact lens combination, in which gas permeable rigid contact
lenses are worn over soft contact lenses, providing clarity of vision and
comfort.
Precaution with contact lenses: There is a small risk of infection when
wearing contact lenses and the risk becomes much greater if the contact
lenses are not kept clean, so it is important to strictly follow the hygiene
instructions given when the contact lenses are fitted.
A NEW PERMANENT NON SURGICAL TREATMENT: CORNEAL COLLAGEN CROSSLINKING WITH
RIBOFLAVIN (C3-R®*)
So far there has been not one successful way to stop the
progression of keratoconus.
With current methods using rigid contact lens or intra corneal ring
segments, only the refractive error (spectacle numbers) can be corrected,
but it has very little effect on the progression of keratoconus. It is
estimated that eventually 21% of the keratoconus patients require surgical
intervention to restore corneal anatomy and eyesight. A new non surgical,
non invasive treatment, based on collagen cross linking with Ultraviolet A (UVA,
365nm) and riboflavin (Vitamin B 2), a photosensitizing agent is now
available. This changes the intrinsic biomechanical properties of the
cornea, increasing its strength by almost 300%. This increase in corneal
strength has shown to arrest the progression of keratoconus in numerous
studies all over the world.
What is collagen cross-linking?
A new treatment for keratoconus which has shown great success is Corneal
Collagen Crosslinking with Riboflavin (C3-R®*),
a one-time application of riboflavin eye drops to the eye. The riboflavin,
when activated by approximately 30 minutes illumination with UV-A light,
augments the collagen cross-links within the stroma and so recovers some of
the cornea's mechanical strength.
C3-R®*,
developed at the Technische Universität Dresden, Germany has been shown to
slow or arrest the progression of keratoconus, and in some cases even
reverse it, particularly when applied in combination with intracorneal ring
segments.
How is the treatment done?
The treatment is performed in our operation theatre under complete
sterile conditions. Usually, only one eye is treated in one sitting. The
treatment is performed under topical anesthesia (using anesthetic eye
drops). The surface of the eye (cornea) is treated with application of
Riboflavin eye drops for 30 minutes. The eye is then exposed to UVA light
for 30 minutes. Hence, the treatment takes about an hour per eye. After the
treatment, antibiotic eye drops are applied; a bandage contact lens may be
applied, which will be removed by our doctor during the follow up visit.
Protective eye wear, such as sunglasses (also given by us) is to be worn for
a few days until complete healing takes place.
Who can benefit from this treatment?
Collagen cross-linking treatment is not a cure for keratoconus,
rather, it aims to slow or even halt the progression of the condition. This
is important to understand. Patients may need to continue to wear spectacles
or contact lenses (although a change in the prescription may be required)
following the cross-linking treatment but it is hoped that it could limit
further deterioration in the patient's vision and reduce the case for
keratoplasty.The main aim of this treatment is to arrest progression of
keratoconus, and thereby prevent further deterioration in vision and the
need for corneal transplantation.
What are the risks and consequences involved?
Very few potential risks associated with this treatment have been reported
so far. The Ultraviolet light dose used is designed to prevent damage to the
cells that line the back of the cornea or the other structures within the
eye.
No lens opacities (cataracts) have been attributed to this treatment in
European trials.
The treatment involves the outer layer (epithelium) of the cornea. There is
therefore discomfort and a short-term haze.
Other lesser but more common risks include:
- Inability to wear contact lenses for several weeks after the
treatment
- Changes in corneal shape necessitates fitting of a contact lens or a
occasional change in
spectacle correction.
As is the case with any treatment, there may also be long-term risks that
have not yet been identified. The increased corneal rigidity induced may
wear off over time and further periodic treatments may be required.
How does Cross Linking arrest keratoconus?
Until recently, there was no method to change the integrity and
strength of the cornea itself for keratoconus patients. The non-invasive
treatment C3-R®*
(corneal collagen cross-linking riboflavin) treatment has been proven to
strengthen the weak corneal structure in keratoconus. This method works by
increasing collagen cross-linking, which are the natural "anchors" within
the cornea. These anchors are responsible for preventing the cornea from
bulging out and becoming steep and irregular (which is the cause of
keratoconus).
Issued in public interest by
ShroffEyeHospital, Mumbai, India
India’s first LASIK Centre to launch
the 400 Hz Wavelight laser
India’s first EyeHospital to be awarded
the JCI- Joint Commission International certification (USA), the Gold
standard of Healthcare Internationally.
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