Times of India
6, March 2010
By Malathy Iyer
Mumbai, India

J J Hospital Cardiologists Go Where Few Docs Have Gone Before
Archana Shahare handles the Thermocol box placed at her bedside in J J Hospital’s maternity ward with extra care. Nestled in it is her fortnightold–daughter who had an almost miraculous birth under medically trying circumstances.

Thanks to the joint approach of four departments of the government–run J J Hospital, Archana not only underwent a high–risk Caesarean section to deliver her daughter, she also went through two angioplasties in the second trimester of her pregnancy.

Archana suffers from a rare condition called Takayasu’s Arteritis (see box) that violently affects the heart’s arteries and rapidly constricts them. “It mainly affects women in the reproductive age,” said Dr N O Bansal, who heads the cardiology department at J J Hospital. Incidentally, the damning diagnosis was made in April by a Dombivli doctor. It didn’t, however, dampen Archana’s maternal instincts. But her pregnancy aggravated her blood pressure to such an extent that her local doctor referred her to JJ’s gynaecology department in the 20th week of her pregnancy. Her blood pressure readings were 220\120 as against the normal 110\70.

“Archana was on six BP–control medications to their highest dosage,” said Dr Rekha Daver, head of the gynaecology department, who then referred her to the cardiology department. Both Archana and her husband Sandeep were not in favour of terminating the pregnancy, which the doctors told them would be the best option.

After observing that both medication and intravenous drugs had no effect on her blood pressure, cardiologists decided to do what no doctor in the world had attempted before–perform an angioplasty on a pregnant patient suffering from Takayasu’s Disease.

Dr Bansal and his associate professor Dr Bhanu Kapoor found that her descending aorta and both renal arteries had narrowed down considerably, causing her blood pressure to shoot up.

On November 12, 2009, the team shifted her to the cath lab and put a stent in her aorta. “Angioplasty is done in a cath lab that has a lot of radiation. We placed a radiation shield on her abdomen to prevent the child from getting exposed to X–rays,” said Dr Kapoor. A fortnight later, the blood pressure was lower but not completely under control. That was when Dr Bansal decided to do the second stage of the procedure. “Her renal arteries were dilated and stented,” said the doctors.

Archana’s problems didn’t end here. While the angioplasties stabilised her completely, the foetus's growth was affected. “We were staring at intra–uterine growth retardation,” said Dr Rekha Daver, who admitted the mother a month ago for observation. “We were forced to perform a C–Section on February 17 using special anaesthesia techniques,” said Dr Daver.

The low birth weight baby – barely 1.7 kg – was put in NICU for five days before being handed over to the mother. “I am just happy right now,” says the young mother. “It was the multi–disciplinary approach of J J Hospital, with efforts of the departments of anaesthesia, paediatrics, gynaecology and cardiology,” said Dr Daver.

A Rare Disease
Takayasu’s Arteritis so named after a Japanese ophthalmologist Dr Mikoto Takayasu who noticed the symptoms in young women–is a rare chronic inflammatory disease primarily of the aorta and its branches. It usually affects more females than males

Symptoms May Include | Dizziness, lowgrade fever, muscle aches, weight loss, circulatory deficit, vision problems, angina, malaise, hypertension, joint pain, stroke, etc

A Young Mother’s Battle | Archana Shahare (23) who suffers from Takayasu’s Disease developed severe hypertension during her pregnancy

Never–Before Medical Route
After observing that medication had no effect on her rising BP, cardiologists decided to do what no doctor in the world had attempted before: Perform 2 angioplasties on a pregnant patient (during the 2nd trimester) suffering from Takayasu’s Disease. The foetus's growth was affected, and doctors were forced to do a C–section using special anaesthesia techniques

All Is Well
Archana delivered a girl on Feb 17 he baby weighed barely 1.7 kg. They will be discharged on Friday