Advanced cardiac surgery overcomes rare anatomy and anaesthetic challenges
KOLKATA, Jan 12 (The CONNECT) — For 41-year-old businessman Arindam Sen (name changed), every heartbeat had become a quiet gamble. Born with a congenital defect and now battling a dangerously narrowed heart valve, his condition had reached a point where even a small spike in stress or blood pressure could have been fatal.
At Manipal Hospital Dhakuria, a unit of the Manipal Hospitals Group, one of eastern India’s largest healthcare networks, a highly coordinated medical team stepped in to take on what was both a cardiac and anaesthetic tightrope walk — and emerged with a life saved.
Mr. Sen was suffering from severe aortic stenosis caused by a bicuspid aortic valve, a rare condition in which the heart valve forms with just two flaps instead of three, forcing it to fail much earlier in life. Compounding the danger was a ventricular septal defect (VSD) — a hole between the heart’s lower chambers — allowing abnormal blood flow and placing immense strain on the heart.
But the most daunting challenge lay elsewhere.
Severe anxiety requiring long-term medication, coupled with an extremely restricted mouth opening of barely one finger’s width, made conventional anaesthesia almost impossible. In patients with critical aortic stenosis, even minor instability during airway management can trigger catastrophic consequences.
Recognising the risks, the cardiac surgery and anaesthesia teams planned a meticulously controlled approach. The patient underwent Awake Nasal Tracheal Intubation — a rare, high-precision technique in which the breathing tube is gently placed through the nose while the patient remains awake and breathing independently, preventing sudden stress on the heart.
Despite the anxiety and complexity, the procedure was executed flawlessly, with no drop in oxygen levels or instability in vital signs.
Once the airway was secured, the cardiac surgery team led by Dr. Kaushik Mukherjee, Consultant – Cardiothoracic Surgery, performed a successful operation to replace the damaged aortic valve and close the hole in the heart. The surgery and post-operative recovery progressed smoothly, and Mr. Sen was discharged just four days later.
Today, he is recovering steadily at home — stronger, calmer, and smiling.
“This was a rare convergence of two serious heart conditions with an extremely challenging airway,” Dr. Mukherjee said. “Severe aortic stenosis leaves no margin for error. Every movement, every response has to be precisely controlled. What made this case especially rewarding was the patient’s trust. Despite his anxiety, he placed his faith in the team, and seeing him walk out smiling made every effort worthwhile.”
Highlighting the anaesthetic challenge, Dr. Nilanjan Chakrabarty, Consultant – Cardiac Anaesthesia, said conventional intubation was simply not an option. “Awake nasal intubation allowed the patient to maintain his own breathing while we secured the airway safely. In a high-risk cardiac patient, this approach can mean the difference between life and death.”
For Mr. Sen, the journey ended where hope finally began.
“After speaking to doctors across the country, I chose Manipal Hospital Dhakuria,” he said. “I was extremely anxious, but the team explained everything patiently. Their care and compassion gave me confidence at every step. I’m deeply grateful to everyone who helped me return home with renewed strength and peace of mind.”
The case stands as a powerful example of Manipal Hospital Dhakuria’s expertise in managing complex cardiac conditions and high-risk airways — and of what becomes possible when medical precision meets empathy.
