Lung patient Kravchenko Igor with Dr K R Balakrishnan

Fortis Hospital, Malar team conducted a successful bilateral lung transplant on a patient, Kravchenko Igor from Ukraine. This is the first case of endobrochial stenting for a lung transplant patient in India.

Overview of Team

The challenging surgery of implanting new lungs was performed by the team led by Dr K R Balakrishnan, Director, Cardiac Sciences, Fortis Malar Hospital and Dr Suresh Rao, Senior Cardiac Anaesthiologist and Critical Care Specialist.

 Patient Condition

In 2009, 39-year-old Igor started feeling weak and found it difficult to walk at his home town Odessa, Ukraine.  Due to lack of accurate diagnosis of the problem, he continued treatment for the symptoms of breathlessness and fatigue. Only in 2014, later in the year 2014, it was diagnosed that he had an Interstitial Lung Disease (ILD), wherein he had developed extensive fibrosis of his lungs which prevented them from functioning properly.

Due to this, the oxygen saturation in his blood circulation had dropped below 70%, despite oxygen support, which in turn made him very weak, making his lungs deteriorate further. Igor was advised to undergo a lung-transplant.

Challenges Before Surgery

• The initial condition of the patient was considered not fit for the surgery.
• Soon, his condition deteriorated, needing mechanical ventilation, and became septic with low blood pressure.
• Despite a ventilator, his oxygenation was very poor sand he was placed on a Veno-Venous ECMO (Extracorporeal Membrane Oxygenation) where his blood stream was diverted from the veins to an external machine that would oxygenate the blood outside of the body. The purified blood was then sent back to the vein itself from where it reached the heart and pure oxygenated blood was supplied to the entire body via the arteries.
• On ECMO and ventilation, he was barely alive and three times had a near cardiac arrest due to machine clotting.

Challenges Post Surgery

• Though the expert team made sure the transplant was successful, his weakened respiratory muscles were not able to support normal breathing.
• As another attempt towards saving his life, a tracheotomy was performed and he was made to breathe through an incision made in the wind pipe through the neck.
• Igors problems did not end there as another challenge was thrown at the doctors, a dehiscence (leakage) developed between his bronchi and the newly implanted lung. The doctors immediately performed an Endo-Bronchial Stenting to repair the air leakage. The first ever incidence of stenting performed on an implanted lung in India.
• The patient remained in the ICU for another month and finally at the end of July he was weaned of the oxygen support. The 46-year-old man finally breathed on his own after almost 10 months and breathed freely after 7 long and painful years.
• Gradual physiotherapy and nutrition ensured that he gained his strength back and let his new set of lungs take over their job properly. Igor has started to move and even started to climb stairs with a smile which loudly announces I have defeated my bad fate.

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