The 'desperate attempt' paid off

By Our Special Correspondent

CHENNAI, NOV. 30. The Union Industries Minister, Mr. Murasoli Maran, who returned home after a month-long hospital stay today was not the first to undergo `alcohol septal ablation,' a radical procedure on the heart, at the Apollo Hospitals here, but he was the `sickest'.

On the night of November 7, when his condition started deteriorating, the doctors at Apollo were almost at their wits' end. With the lungs burdened with almost 20 litres of fluid, he was unable to breath, his vital parameters were dropping and the kidneys were almost on the verge of a shutdown. One possible option was an open heart surgery, but the Minister was too critical to undergo the trauma.

As the bad news spread, the entire family, the entire Tamil Nadu Cabinet and friends converged at the hospital.

Dr. P.Ramachandran, senior consultant cardiologist, volunteered to take a risk. He told Dr. P.C.Reddy, Chairman, Apollo Hospitals, and the panel of doctors treating Mr. Maran that he could try `alcohol ablation' as the `last desperate attempt.' He had done it seven times before. Dr. Naidu, a veteran of more than 30,000 procedures, agreed to provide anaesthesia. Mr. Maran was rushed to the `cath-lab.' Dr. Ramachandran and his colleagues reached the affected area of the heart through a catheter and injected absolute alcohol after a trial. ``Three injections, each of 5 cc alcohol were administered''. It was 1 a.m. at night.

In the next hour itself, Maran showed improvement. But he continued to be in a serious condition. ``His oxygen saturation increased, the BP picked up and the kidneys started functioning,'' Dr. Reddy said. Mr. Maran was brought back from the brink of danger.

The blow-by-blow account of the Minister's treatment given by Dr.Reddy and the panel of doctors which treated him, at a press conference immediately after he was discharged, sounded like an engaging docu-drama. The human interest aspect of medical practice was in vivid display as doctors responded to the questions of reporters.

Mr. Maran's illness, Dr. Reddy said, was ``hypertrophic obstructive cardiomyopathy,'' in which the muscle between the left and right chambers of the heart became very thick. In Mr.Maran's case, it was three times that in a normal heart. As a result, blood flow from the heart to the rest of the body was severely affected and the mitral valve developed a leak. The solution was either open heart surgery, in which the surgeon removes the excess muscle, or ``septal ablation''.

In the latter, a cardiologist locates the arteries supplying blood to the affected part of the muscle and injects absolute alcohol. The alcohol destroys the blood vessels and hence stops supply to the thickened muscles. As a result, the muscle dies and shrinks.

Dr. Ramachandran, Dr. Sathyamurthy and Dr. Subramanyam, senior cardiologists, and Dr. M.R. Girinath, cardio- thoracic surgeon, said that after the treatment the size of the septum had reduced by almost 95 per cent.

Not willing to take chances, the hospital flew down Dr. Ulrich Sigwart, inventor of the alcohol ablation procedure. He examined Mr. Maran and opined that further ablation was not necessary. The next day, another international expert, Prof. Khun, came down from Germany. But he suggested a second procedure and injected 2.75 ml of absolute alcohol into the septal arteries on November 11.

That was the knock-out punch. The Minister showed steady improvement as days passed. His supportive management was gradually withdrawn and he was shifted out of the ICU on November 24. After a final examination on October 28 and 29, the panel agreed to discharge him.

Dr. Thanikachalm, Dean of Faculties, Sri Ramachandra Medical College and Mr. Maran's personal cardiologist, said the Minister became aware of the his heart condition only in 1989.

Since then he had been consulting experts in the US and UK and all of them advised him against any intervention. They suggested alcohol ablation, if there was any emergency.

Mr. Maran paid glowing tributes to the hospital and the doctors. In the few sound-bites extracted by TV crews today, he said: ``I have got my life back. I am really proud of this worldclass institution''.

He termed the quality of the professionals, the doctors and facilities at Apollo `worldclass'.

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