Healthy Heart Volume-7 | Issue-76 | March 5, 2016 Price : ` 5/-

Honorary Editor : Diagnosis & Treatments of Venous Diseases Dr. Satya Gupta Types of venous diseases will be sitting for along time, flex and A. Chronic venous insufficiency (CVI) extend your legs, feet, and ankles and ulcers about 10 times every 30 minutes to From the Desk of Hon. Editor: keep the blood flowing in the leg veins. 1. Disorder involving stasis of blood in Artery carries oxygenated blood from lower extremities as result of If you need to stand for long periods of lungs via left side of the heart to the rest o b s t r u c t i o n & time, take frequent breaks to sit down of the body while veins brings back reflux of venous and elevate your feet. deoxygenated blood back to the lungs l valves Exercise Regularly : Walking is via right side of the heart. Arterial especially beneficial. p r o b l e m u s u a l l y b e co m e l i fe 2. L o n g s ta n d i n g l threatening and needed immediate stasis of venous Lose weight if you are overweight. attention; venous diseases are critical blood leads to l Elevate your legs while sitting and some time but may not be life poor circulation of lying down, with your legs elevated threatening. Chronicity of venous limbs resulting into above the level of your heart. problem may leads to chronic venous chronic venous l Wear compression stockings. insufficiency and of limbs, l Take antibiotics as needed to treat skin ulceration, claudication, pain, ulcers. discoloration and . infections. Treatment l Practice good skin hygiene. Lack of structured training program l Compression Stockings dedicated to veins is the main reason l Skin Care B. Varicose Veins for underdiagnosis of veins related l Sclerotherapy and endovenous 1. Irregular, tortuous veins with problem. Any venous problem and thermal ablation treatment needs close interaction incompetent valves l between interventionist, vascular Ligation & Stripping 2. May develop anywhere in body, but surgeon and radiologist. At CIMS we l Micro incision / ambulatory most develop in lower extremities have a developed team of highly skilled phlebectomy 3. Vein in legs most often affected: Long interventionist, vascular surgeon and Saphenous radiologist who are ready to take care Prevention of any problem related to vein. 4. Occurs in 1 out of 5 people; more l Avoid long periods of standing or - Dr. Satya Gupta common females > 35 sitting : If you must take a long trip and Cardiologists Cardiothoracic & Vascular Surgeons Cardiac Anaesthetists Dr. Satya Gupta (M) +91-99250 45780 Dr. Milan Chag (M) +91-98240 22107 Dr. Dhaval Naik (M) +91-90991 11133 Dr. Hiren Dholakia (M) +91-95863 75818 Dr. Vineet Sankhla (M) +91-99250 15056 Dr. Urmil Shah (M) +91-98250 66939 Dr. Manan Desai (M) +91-96385 96669 Dr. Chintan Sheth (M) +91-91732 04454 Dr. Vipul Kapoor (M) +91-98240 99848 Dr. Hemang Baxi (M) +91-98250 30111 Dr. Dhiren Shah (M) +91-98255 75933 Dr. Niren Bhavsar (M) +91-98795 71917 Dr. Tejas V. Patel (M) +91-89403 05130 Dr. Anish Chandarana (M) +91-98250 96922 Pediatric & Structural Heart Surgeons Cardiac Electrophysiologist Dr. Gunvant Patel (M) +91-98240 61266 Dr. Ajay Naik (M) +91-98250 82666 Dr. Ajay Naik (M) +91-98250 82666 Dr. Shaunak Shah (M) +91-98250 44502 Dr. Keyur Parikh (M) +91-98250 26999 Dr. Vineet Sankhla (M) +91-99250 15056 Cardiovascular, Thoracic & Congenital & Structural Heart Disease Specialist Thoracoscopic Surgeon Neonatologist and Pediatric Intensivist Dr. Amit Chitaliya (M) +91-90999 87400 Dr. Kashyap Sheth (M) +91-99246 12288 Dr. Milan Chag (M) +91-98240 22107 Dr. Pranav Modi (M) +91-99240 84700 Dr. Divyesh Sadadiwala (M) +91-8238339980 Dr. Snehal Patel (M) +91-99981 49794

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The clot can cause severe organ Treatment damage and even death within hours l Thrombolysis if it migrates to other vital organs of l Thrombosuction body . l Thrombo-fragmentation l Surgery

Presentation of venous disorders l Lower leg edema l 5. Can be due to severe damage or Itching l trauma to saphenous vein or effects Brown pigmentation/ cyanosis of skin of gravity produced by long periods of of lower leg / foot l standing Fibrosis / hardness of subcutaneous tissues l Treatment & Prevention Stasis ulcers over ankle, most often l Self care (exercise, losing weight, leg medial elevation, avoid long standing or sitting) l Compression stockings Treatment l Sclerotherapy l Local care of limb & skin l Catheter assisted radiofrequency or l Anti coagulant therapy laser energy treatment l Systemic thrombolysis l High ligation and vein stripping l Catheter directed thrombolysis (CDT) l Endoscopy vein surgery D. Ve n o u s t h r o m b o e m b o l i c C. Deep Vein (DVT) diseases (Acute pulmonary 1. Most likely to occur in deep veins of embolism, CTEPD) the calf (80%) 1. Some times thrombus from the lower 2. 25% of thrombi that occur in calf will limb may migrate to pulmonary extend to the popliteal & femoral circulation and can reach upto veins pulmonary artery called pulmonary Risk factors for venous disorder 3. PE may be the first sign of DVT embolism. l Major surgery on a hip, knee, leg, calf, 4. (DVT) occurs 2. Symptoms will depend on the size of abdomen, or chest when a blood clot forms in a vein the thrombus and the extent of l Sitting or inactivity for a long time deep inside a muscle. It usually pulmonary circulation involved. l Long plane flights or long car trips happens in legs, but can also develop Pulmonary embolism is a serious l Over weight (Obesity) in arms, chest, or other areas of body. diagnosis with high mortality rate.

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discoloration, and varicose veins. These latest equipment and technologies to symptoms can be severe, sometimes treat venous related problems. necessitating amputation. PTS occur in more than 10% of all patients with DVT at Catheter-Directed Thrombolysis 1 year with the incidence increasing over Catheter-directed thrombolysis (CDT) time. has become a pivotal adjunctive therapy in the management of both acute and chronic thromboembolic venous disease. Direct infusion of the thrombolytic agent l Current use of birth control pills or via specially designed, fenestrated patches, hormone replacement catheters results in its effective delivery therapy and leads to high local levels of drug l Smoking within the thrombosed segment, thus l An injury that reduces blood flow to increasing the likelihood of clot part of body, such as a broken hip or resolution and restoring vessel patency. leg This therapy is most likely to be l Cancer- even during treatment successful when thrombus is acute (<14 Recent Advances l A previous history of deep vein days old) and much less effective when thrombosis or pulmonary embolism Just like great advancement in arterial the clot is chronic (>4 weeks old). Such l An inherited condition that increases interventions, there are many new a c c e l e r a t e d p h a r m a c o l o g i c a l blood clotting techniques which have emerged to treat thrombolysis may be performed even l Paralysis from a spinal cord injury various complicated venous problem with a reduced dose of lytic agent l Pregnancy or having recently given effectively. At CIMS hospital, we have associated with a lower overall duration birth, especially by C-section of infusion. Various lytic agents can be l Varicose veins, which are swollen, chosen based on their individual twisted and painful biological half life, fibrin affinity and l A history of heart attack, , or specificity, time to clot lysis, and congestive respective dosing. These include alteplase, tenecteplase, reteplase, streptokinase, and urokinase. Infusion What if one does not get catheters typically consist of multiple treatment for veins problem fenestrated catheters with an occluding The most unfortunate long-term wire that allows inspissation of the lytic sequelae of DVT and other vein relate agent directly into the clot, over a period problem is post thrombotic syndrome of time, ranging from 4 to 48 hours. (PTS), which presents with chronic venous insufficiency and edema, There are studies indicate that CDT for ulceration, claudication, pain, DVT achieves more rapid lysis, reduces

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the incidence of long-term sequelae of expedite lysis. Usually, complete How team work helps to treat DVT, improves quality of life, preserves thrombus removal requires the vein problems valvular competence and more combined use of both CDT and PMT, but To understand and treat veins diseases, completely restores vessel patency as the advantages offered by PMT in the one need to get opinion and inputs both compared with standard anticoagulation immediate treatment of an acutely from the interventionalist and vascular or systemic thrombolytic therapy ischemic limb, such as when faced with surgeon. Team work always helps to treat phlegmasia cerulea dolens, trump those any types of vein disease in proper P e r c u t a n e o u s M e c h a n i c a l of CDT, especially when rapid restoration manner. Thrombectomy of flow is required. P e r c u t a n e o u s m e c h a n i c a l Thrombectomy devices generally work We have a dedicated interventionalist thrombectomy (PMT) has evolved b y s i m p l e a s p i r a t i o n , and vascular surgeon with special co n c u r rent ly w it h C DT in t h e microfragmentation, and thrombo- training and interest to treat veins related management of complex subsets of aspiration (Venturi effect). Several of problem. Over the years, we have learnt veno-occlusive disease. The attraction of these catheters have the ability to and gained experience to treat vein this modality centers on its ability to coadminister with thrombolytic agents diseases as a team. fragment, ablate, or extract thrombus to to facilitate clot extraction.

C I M S CIMS Learning Center Management of Drug Resistant Tuberculosis-Certificate Course Course Directors : Dr. Surbhi Madan / Dr. Bhavini Shah Date : April 10, 2016 (Sunday) Venue : CIMS Auditorium

Program Overview: : Program Highlights: This course is designed for physicians who are involved in Ÿ Newer diagnostics: Emphasis on molecular tests the management of patients with tuberculosis. Due to Ÿ Importance of culture and DST (Drug susceptibility testing) emergence of drug resistant tuberculosis, the approach Ÿ Define various categories of drug resistant TB Ÿ towards treatment has changed and is continuously Treatment of drug resistant TB- Program based or individualized? Ÿ Important adverse effects of second line drugs evolving. It is important to have updated knowledge about Ÿ Immune reconstitution in tuberculosis: Clinical relevance the new diagnostic strategies and treatment approaches for Ÿ Role of surgery in treatment optimal management. The aim of this course is to discuss Ÿ Newer drugs the same with the help of clinical cases. Ÿ Interactions amongst antituberculous drugs

Registration Fees : ` 1,000/- (Up to one month before course date) Visit Registration Fees : ` 1,500/- (Within 15 days before course date) www.cims.me/clc for online registration Spot Registration Fees : ` 2,000/- CLC application available > Certificate of attendance will be given at the end of the course REGISTRATION FEES REFUNDABLE AFTER ATTENDANCE For more details about course detail contact on +91-90990 66527, +91-90990 66528, +91-94268 80247 Download on the R Windows Phone CIMS CIMS Hospital : Regd Office: Plot No.67/1, Opp. Panchamrut Bunglows, Nr. Shukan Mall, Care Institute of Medical Sciences World-class practices. Trusted by doctors. Off Science City Road, Sola, Ahmedabad - 380060. Ph. : +91-79-2771 2771-75 (5 lines)

R CIMS 4 Care Institute of Medical Sciences Healthy Volume-7 | Issue-76 | March, 2016 Heart One of the only centre in India to perform all possible percutaneous cardiac interventions Only center certified in India as CIMS “ACC Center of Excellence” Transcatheter Aortic Valve Percutaneous Transluminal Structural Interventions & Replacement TAVR (TAVI) Septal Myocardial Ablation (PTSMA) Adult Congenital Intervention Balloon mitral / A minimally A minimally invasive aortic / pulmonary invasive surgical procedure (injecting valvuloplasty. A absolute alcohol into procedure to repair procedure to dilate the valve without the septal branch )to abnormal valve by removing the old, reduce the balloon. Non- damaged valve overgrowth of heart surgical closure of muscle para-valve leaks

TEVAR Thoracic Endovascular Rotablation Renal Denervation Aneurysm Repair Rotablation uses a Renal denervation system uses a technique A non surgical treatment for the abnormal tiny drill, powered by called Renal Denervation (RDN) to bulge of the arterial wall / aortic dissection compressed air, to selectively calm hyperactive renal nerves. remove calcified This causes a reduction in the kidneys' deposits in the production of hormones that raises blood pressure arteries. Since 1990 and protects the heart, CIMS Cardiology has kidneys and blood vessels one of the highest experiences in using from further damage. Rotablator in hundreds of case Electrophysiology Atrial Septal Defect (ASD), Complex Congenital Ventricular Septal Defect (VSD) & Pediatric Intervention Carto-3 System Devices Patent Ductus Arteriosus (PDA) This includes, An advanced 3- n AICD dimentional A procedure wherein an hybrid procedure n CRT mapping & imaging umbrella device is inserted in n for VSD closure, technology for Pacemaker to the hole in the septum, or accurate visualization muscular walls of the upper duct stenting or of multiple catheters chambers (ASD) & lower RVOT stenting in chambers (VSD) of the heart in a patient's heart to close it permanently. A cyanotic and pinpointing the procedure to control the extra neonates. They are effective options to exact location of flow of blood from the main artery of the surgery in small neonates / infants. arrhythmogenic focus body to the artery of the lungs Fractional Flow Reserve (FFR) & MRI - Signa Explorer & CT Scan - Revolution EVO 128 slice Intravascular Ultrasound (IVUS) coming to CIMS shortly (next month). This is a guide wire-based procedure to accurately measure blood pressure and MRI - Signa flow through a specific part of the Explorer CT Scan coronary artery to assess need for angioplasty / stent IVUS allows us to see a coronary artery from the inside-out generating real time images, such as coronary angiography, MRI model with first ever First ever installation in performed in the cath lab. CIMS has been Coronary MRI Angiography India with latest deploying the use of IVUS since many years including virtual histology. (without contrast). cardiovascular imaging R CIMS CIMS Hospital : Nr. Shukan Mall, Off Science City Road, Sola, Ahmedabad-380060. Care Institute of Medical Sciences World-class practices. Trusted by doctors. NABL For appointment call : +91-79-3010 1200, 3010 1008 Certificate No. M-0500 Ambulance & Emergency : +91-98244 50000, 97234 50000, 90990 11234 R CIMS Care Institute of Medical Sciences 5 Healthy Heart Volume-7 | Issue-76 | March, 2016

CIMSR Care Institute of Medical Sciences World-class practices. Trusted by doctors.

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R CIMS CRITICAL CARE l 24 x 7 Critical Care Intensivists & Paramedics l Best-in-class Technology CIMS l Advanced Critical Care support Systems for Kidney, Care Institute of Medical Sciences Lung & Heart l Best Peri-Operative Care for high risk patients with World-class practices. Trusted by doctors. multi-speciality requirements l Green ICUs for patient’s mental well-being

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CIMS Hospital : Regd Office: Plot No.67/1, Opp. Panchamrut Bunglows, Nr. Shukan Mall, Off Science City Road, Sola, Ahmedabad - 380060. Ph. : +91-79-2771 2771-75 (5 lines) Fax: +91-79-2771 2770. CIMS Hospital Pvt. Ltd. | CIN : U85110GJ2001PTC039962 | [email protected] | www.cims.me Printed, Published and Edited by Dr. Keyur Parikh on behalf of the CIMS Hospital Printed at Hari Om Printery, 15/1, Nagori Estate, Opp. E.S.I. Dispensary, Dudheshwar Road, Ahmedabad-380004. Published from CIMS Hospital, Nr. Shukan Mall, Off Science City Road, Sola, Ahmedabad-380060.

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