Mumbai: A 29-year-old woman narrowly escaped a devastating stroke when a massive blood clot in her heart broke loose. Instead of travelling to her brain, it moved downward, blocking blood flow to her legs, spleen, kidney, and uterus.
Faced with severe obesity (110 kg) and damage to multiple organs, doctors at Holy Family Hospital made a high-stakes decision: to combine two procedures into one lifesaving operation.
The clot, known as a left ventricular thrombus, formed because her heart was functioning at just 20% following a previous heart attack.
“The thrombus was 10cm long and 3cm thick. We don’t fully understand why it went to her lower body instead of the brain, which is what we typically see,” said Dr Amit Karad, a cardiothoracic surgeon who led the operation.
Cardiologist Dr Yash Lokhandwala, who was part of the procedure, said such a massive clot is unheard of, stretching all the way from the lowest point to the exit of the left ventricle, curled like a hockey stick and throwing off pieces into the bloodstream. “She was really fortunate that a piece did not go towards the brain; she would have been in a coma or paralysed,” he said.
To save her, surgeons first opened her heart and removed the clot from the main pumping chamber. They then repaired the heart wall to normalise her heart function. Next, rather than opening her abdomen—considered too risky due to her weight and organ injury—they created a new path for blood to flow by connecting an artificial vessel from the largest artery in the chest to both leg arteries, bypassing the blocked section of her main artery.
Finally, they cleared large clots from both legs, restoring blood supply to her feet. Dr AB Mehta, Senior Cardiologist at Jaslok Hospital, said, “It was a good strategy to perform multiple procedures simultaneously. Such procedures have been done before—at least 10 by Dr Arun Mehra at Jaslok—but they are still highly uncommon.”