Our experienced specialists at Shankar Surgery manage a wide range of problems for both children and adults.
We manage Coronary Artery blockages in both children and adults
All procedures are performed on a "BEATING" Heart a technique we started in 1997
We prefer Arterial Conduits.
We manage heart valve problems in all age groups.
Heart valve repair is preferred in most patients.We believe a LESS INVASIVE APPROACH, a technique we started in 2015 as the way to go. We also perform Concomitant electrophysiological resetting of the Heart rhythm
WE offer Surgery for patients with Aortic aneurysm in the thoracic and abdominal aorta.
We offer Valve Sparing Aortic Root repair. We are experienced in REDO-Aortic Surgery.
We manage patients with Lung disease including Malignancy and Mediastinal tumours preferring a Less invasive approach to their care..
We have wide experience in managing patients with Lung failure on ECMO which is to support breathing while the lung recovers. We have experience in managing chest wall defects.
We offer Antenatal counselling and alsocreate individualised algorithms of care. (Since 1987)
We have extensive experience Surgery for patients with complex heart defects. We specialise in Minimally invasive approach to surgery especially in patients who need Re-operative or REDO--Surgery.
We are experienced in managing CHEST WALL defects in CHILDREN.
We have performed Tracheal surgery both for Tracheal stenosis and Trachomalacia.
We manage congenital lung malformation's.
Sometimes heart defects are diagnosed later in a child's life. These are usually 'Holes' in the heart in the atrial or ventricular septum.
we now offer repair using
MINIMALLY INVASIVE TECHNIQUES'.
We provide long term follow-up care for patients with congenital defects.
We spend a lot of Time in Health Education that will help Parents and patients understand the underlying condition. and the way forward.
If you have been diagnosed with a Cardiovascular or Lung condition and want clarification of the way forwards.
We are happy to provide an EXPERT opinion in health care disputes
If you have been diagnosed with a Cardiovascular or Lung condition and want clarification of the way forwards.
We are happy to provide an EXPERT opinion in health care disputes
The assessment phase : the defect is diagnosed, investigations are reviewed and clinical decisions are made on the need for intervention.
Chest Xray is reviewed carefully:
1. to look at the lie of the rib spaces and determine the best approach to the aorta and the vena cave and the right atrium, all of which provide access for cardio-pulmonary bypass.
2. to identify the surface marking of the underlying defect Occasionally we do a CT Scan.
1. To explain and help patients understand the defect and the need for intervention if need be.
2.The choice of surgical approaches between “conventional” and “less invasive”.
Patient and family then decide on the preferred approach to be taken.
Surgical Access :: Surgical procedure :: Post Procedure Assessment
We first create an axillary incision at the anterior axillary fold and develop it to enter the chest via an appropriate intercostal space. We use a soft tissue retractor to open up the incision. We then retract the edges of the ribs with a metal retractor. The right lobe of the thymus is dissected away carefully and pericardial sac inside which the heart lies is opened. The pericardial edges are carefully stayed back to expose the heart well. Cardiopulmonary bypass is established by cannulating the Common femoral artery and vein. Heart stopped by clamping the ascending aorta and infusing the heart with cold Blood rich in potassium. The appropriate chamber is then opened and the planned surgery effected. Heart is de-aired and the aortic clamp removed. The patient is then fully rewarmed and the heart-lung machine weaned off. The surgical procedure is checked and Local anaesthetic infiltration for Pain relief done and the wound closed appropriately. The patient then goes to intensive care for recovery.
Procedures where LIS is offered:
Atrial septal defect both simple and with partial anomalous pulmonary venous drainage, Ventricular septal defect,
Atrial myxoma,
MItral valve repair : simple and complex, mitral valve replacement,
Tricuspid valve repair or replacement,
Pulmonary valve implantation,
Aortic valve repair or replacement, Valve sparing aortic root repair,
Hypertrophic cardiomyopathy resection of Subaortic stenosis
Pericardial : Window, Pericardectomy
single vessel Coronary artery bypass grafting,
Pulmonary thrombectomy/ thromboenedartrectomy.
Surgical Access:
We first create an axillary incision at the anterior axillary fold and develop it to enter the chest via an appropriate intercostal space. We use a soft tissue retractor to open up the incision. We then retract the edges of the ribs with a metal retractor. The right lobe of the thymus is dissected away carefully and pericardium is opened. The ascending aorta is exposed and we go around the Superior Vena Cava for subsequent snaring. A second incision is made in the infra-mammary area to enter the chest via the fourth interspace. The pericardial incision is extended to the diaphragm and retained . We then go around the Inferior Vena Cava for subsequent snaring.
Procedure :The Patient is then heparinised and placed on cardiopulmonary bypass with single aortic and bi-caval cannulation.The aorta is cross clamped and heart is infused with cold blood cardioplegia. The cave are snared, and atrium is opened . The atrial septal defect or Ventricular septal defect be accessed via a right atriotomy either from the upper or the lower incision depending on its location and repaired. The Cardioplegia needle is then connected to suction and the heart is de-aired, cross clamp is removed and the heart is re-perfused. Bypass is terminated once the heart has recovered, patient is de-cannulated, the heparin is reversed with Protamine, and chest is closed with drains and pacing wires as appropriate. All patients receive an intercostal block at completion of surgery and appropriate analgesia post-surgery.
Assessment :: Pre and postoperative echocardiography is done to assess the defect and the adequacy of repair. It is either trans oesophageal or trans thoracic depending on the surgery. Transthoracic echocardiography is typically used to assess atrial septal defects .4. ICU: Patients are transferred to ICU and are extubated a few hours later.
Procedures where LIS is offered:
Atrial septal defect in all locations
Partial anomalous Pumonary venous drainage,
Ventricular septal defect, right ventricular outflow reconstruction,
resection of Subaortic stenosis in
aortic stenosis both supravalvar and subaortic stenosis,
Repair : aortic valve , Aortic root (valve sparing ) .
repair of aneurysm of Sinus of Valsalva, amongst others.
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#02-03, Gleneagles medical Centre,
6 Napier Road
Singapore 258499
Phone: +65 64797718