Dr K K Aggarwal

Good news for ageing Indian patients with aortic valve disease

This year’s WHO slogan focuses on ageing and health. The title is important to India in view of its increasing ageing population.  More and more people are toady crossing the age barrier due to advancements in medical fields.

Recently India saw 2 advancements in elderly population with heart disease called aortic stenosis where one of the valves gets narrowed and reduces the life span.
Firstly Padamshri Professor Jagdish Prasad, Chief Cardio Thoracic Surgeon & DGHS implanted a tissue bovine pericardial artificial aortic ‘Trifecta’ valve successfully to a patient at Safdarjang hospital. The valve is the most advanced pericardial aortic stented tissue valve design available by St. Jude Medical, a global medical device company.
The newest Trifecta valve is a clinically proven replacement valve designed for patients with diseased, damaged or malfunctioning aortic heart valves. The next-generation tissue valve has a tri-leaflet stented pericardial design that offers excellent hemodynamic performance (circulation and flow of blood through the valve) and long-term durability.
We have been eagerly anticipating the launch of the Trifecta valve in India and pleased to report the first successful implant of the same said Dr Prasad. The valve will offer numerous benefits to the patients including a durable design that reduces stress on the valve and allows it to last longer, and exceptional hemodynamic performance that allows the valve to perform more like a natural heart valve, which will allow patients to live a more active life.
The valve is constructed using a polyester and tissue-covered titanium stent, or base, to ensure structural integrity of the valve. The valve features leaflets manufactured from pericardial tissue attached to the exterior of the valve stent. This design allows the leaflets to open more fully and efficiently, mimicking the performance of a healthy aortic heart valve, while also mitigating tissue abrasion through tissue-to-tissue (stent-to-leaflet) contact, said Dr Yugal Mishra from Fortis Escorts Heart Institute.
Also for those who are not fit for surgery India now has another alternative. A few weeks back Fortis Escorts Heart Institute launched replacement of the valve without surgery via a catheter.

Mythology and Medical Ethics

 A medical doctor is accorded a status next to God as he or she has a duty to heal the sick irrespective of their caste, creed, race or financial status. The classical description of the duty of a doctor was depicted in the Hindi film ‘Achanak’ by Gulzar in 1973.

 In the movie, Vinod Khanna plays the character of an army man who loves his wife intensely. He returns home after the 1971 war to find his wife, actress Lily Chakravarti, involved with his close friend. In a fit of emotion, he kills his wife and her lover. He is sentenced to death but is wounded in an attempt to escape the police. At the hospital he is looked after by a team of doctors (Om Shivpuri, Asrani) and a nurse (Farida Jalal). They work hard day in and day out to save him from the lethal injury only to hand him over to the police chief (Iftikhar) for the due capital punishment. The story ends with the message that the duty of the doctor is to save the dying man and the duty of the policeman is to award the due deserved capital punishment.

 Historically, the first known example of medical ethics comes from the story of Ramayana. During the war between Lord Rama and Ravana, Meghnath shot a Brahmastra shakti baan (arrow) that hit Laxmana and he became unconscious.

 Vibhishana informed Sri Rama about a physician, Sushena, who lived in Lanka. Hanumana was asked to bring him. He brought Vaidya Sushena, together with his house. Vaidya Sushena, well aware that he was a physician attached to the kingdom of Ravana, and that treating Lakshmana could end up annoying Ravana, took a conscious ethical decision of treating the wounded Lakshmana. He said that only the ‘Sanjivani Booti’ (an herb found only on Sumeru Hill) could save Laxmana. But that herb grew on Himalayas at a great height and needed to be brought before day break. Then Jambavanta reminded Hanumana that only he could bring back the ‘booti’ before sunrise. He said, “Fly across the ocean to Himalaya Mountains and bring back herbs Mritha Sanjivani, Vishalya karani, Savamakarani and Sandhanakarani.”

 Hanuman went to Sumeru Hill, which was far, far away from the battlefield. There he found several herbs that looked similar to the ‘Sanjivani Booti’. Confused, Hanumana immediately lifted Sumeru Hill in his right hand and flew back to the battlefield in Lanka. Thus, Laxmana was saved by Vaidya Sushena who waited by Lakshaman’s side till Hanuman returned with the remedy.

 Both the above depictions relate to the true message later described in the classical Hippocratic Oath, traditionally taken by physicians pertaining to the ethical practice of medicine. But today many doctors are ruining the image of the medical profession. They indulge in indiscriminate sex determination, carry out illegal abortions, making people beggars by cutting their hands, making males eunuchs by castrating their private parts, illegal organ trade or getting involved with the criminals and helping them in torturing their captive persons. The classical example is what happened in Iraq.

 We should take lessons from the movie ‘Achanak’ and from Vaidya Sushena who stood by his professional duty and acted according to what was right and ethical.

 About the author : Padmashri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal is a Senior Consultant, Physician, Cardiologist at Delhi based Moolchand Medcity; President Heart Care Foundation of India; Chairman Ethical Committee Delhi Medical Council and has served as the Research and Academic Wing Heads of National Indian Medical Association.

It’s safe to watch lunar eclipse

It’s safe to watch total lunar eclipse today said Padmashri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India. Dr Aggarwal was interacting with the audience in a discussion organized in Manthan and Aradhana program by Zee Network. Unlike solar eclipse watching total lunar eclipse does not damage the eyes. It’s safe for pregnancy as per alllopathy but Ayurveda restricts it to be watched by pregnant ladies. On lunar eclipse day there is “full moon” present in an atmosphere of “new moon”. The full moon effect on the environment also reflects on the mood and mind of a person. The high tides in the ocean reflect in the mind as mood disturbance. These mood changes may occur in every full moon and that is the reason why in India mythology it is advised to control the mind by observing fast either on ekadashi ( 3 days before full moon) or on the day of full moon.

The ‘sutak’ (nine hours period before the lunar eclipse starts) is also observed in Indian mythology as a period of physical and mental fast so as to avoid the effect of eclipse on the mind. During this period one is required not to eat cereals, if possible nothing by mouth and do pranayama and meditation. Ten percent of the society at any given time is affected with anxiety or depression. The full moon as per Ayurveda is said to effect and exacerbate symptoms of anxiety or depression. The fluctuations in the mind can also be associated with fluctuations in upper systolic blood pressure.

In an Institute of Psychiatry & Human Behavior, Goa study a significant trend was observed for greater numbers of patients with non-affective psychoses on full moon days and on days of visible lunar eclipse, but no pattern was observed for mania or depression. [Indian J Psychiatry. 1999 Jan; 41(1):60-5.

If one believes in Indian mythology then one should observe the rituals as the fear of harmful effects of the mind for example in a pregnant lady can harm the fetus based on a common Vedic saying and principle “ you are what you think”