6 Sep : More than 1000 cardiac surgeries are performed every year at the Advanced cardiac centre(ACC) at PGI Chandigarh. Since its start more than a year ago average of around 100 surgeries are performed every month at ACC. One third of these are coronary artery bypass grafting and one third are cardiac surgeries for congenital heart disease of children. A number of highly complex rare cardiac surgeries are also being performed in the centre. Recently one such rare and highly complex surgery was performed on a 25yr old male from Haryana. He was diagnosed to have a huge dilatation of the Aorta (the major artery carrying the blood from aorta to the rest of the body). The Aorta was enlarged 5-6 time the normal size and the aortic valve which performs one way valve for onward flow of blood from the heart to the rest of body was also leaking badly resulting in enlargement of the heart. The enlarged aorta was also compressing the trachea ( wind pipe) and its branches (bronchi) resulting in difficulty in breathing so much so that he was not able to lie down in the bed. The hugely dilated aorta was also compressing the lungs and the vessels supplying the blood to the lungs. The surgery required not only replacement of the aortic valve but also the whole of aorta lying in the chest cavity. This required a costly graft as well as the aortic valve. Apart from these costly prosthesis it required very complex surgical skills a) first to remove the arterial branches of the aorta supplying the head neck and the upper limbs and then b) to replace these branches on to the newly formed aorta. It also required removal of coronary arteries (blood supplying vessels to heart) from the native aorta and reimplanting these on to the artificial aorta. Not only this required great surgical skills but also prolonged surgery required that some alternative arrangements for maintaining circulation (blood flow) to the head and neck as well as rest of the body. All this required a great team work of cardiac surgeon, cardiac anaestheesiogist and the perfusionist. Patient was too sick to lie down and had to be anaesthetized in sitting posture. It was difficult to maintain the breathing of the patient due to severe compression of the wind pipe. As it was difficult to approach the heart due to huge dilatation of aorta the patient was put on artificial circulation using cannulae inserted into the heart from the vessels of groin. Subsequently the patient was cooled to preserve the brain and other organs of the body during the period when the circulation to these was suspended temporarily for performing the surgery. All this while functions of all the organs of the body including the brain (using EEG) was monitored closely. and special circuits were made to selectively perfuse the brain and other organs. Whole surgical procedure took 14hrs of grueling surgery after which patient was kept in ICU for artificial respiratory support and close monitoring of all the body functions. Here the skills of cardiac intensivist and the intensive care nursing round the clock helped the patient slowly regain functions of all the organs. Subsequently he was discharged from the ICU after 2 weeks of intensive monitoring and therapy. As the surgical procedure required grafts and valves the financial support for the same was provided by different the government agencies. Poor patient fund of PGI also provided costly medicines upto Rs 30,000/ required for the treatment postoperatively. Though PGI has performed a large number of surgeries involving replacement of the aorta and the aortic valve( Bentall surgery) it was the first of its kind where whole of the aorta lying in the chest (ascending aorta, arch of aorta and part of the descending aorta) was replaced along with the aortic valve. The surgical team in the whole process was led by Prof Shyam Kumar Thingnum along with Dr Anand Misra while the Anaesthetic and intensive care team was led by Prof GD Puri assisted by Dr Bhupesh while the perfusion team was led by Ms Kanchan Ba.