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A multidisciplinary medical team has successfully performed a rare and highly complex six-hour surgery to simultaneously treat early-stage breast cancer, severe aortic valve stenosis, and critical coronary artery disease in a 65-year-old woman. The combined procedure eliminated three life-threatening conditions in a single operation, preventing delays in cancer treatment while averting a potentially fatal cardiac event.
The coexistence of all three conditions in one patient is exceptionally rare, making it one of the first documented cases of its kind in the Delhi NCR region.
Hidden Cardiac Risks Discovered During Cancer Screening
The patient, Mrs. Iyer, a retired media professional, initially sought medical attention after noticing a lump in her right breast. She was diagnosed with early-stage right breast carcinoma and was scheduled for breast-conserving surgery, to be followed by radiotherapy.
However, during routine pre-operative evaluation, doctors at ShardaCare HealthCity detected an abnormal heart murmur. While Mrs. Iyer had experienced no cardiac symptoms, further investigations were ordered out of caution.
A 2D echocardiography revealed severe aortic valve stenosis caused by a congenital bicuspid aortic valve (having only two leaflets instead of the normal three). The narrowing significantly obstructed blood flow, placing her at high risk of sudden cardiac death. Subsequent coronary angiography uncovered an additional threat: a 90% blockage in the Left Anterior Descending (LAD) coronary artery, often called the "widow-maker" artery. Remarkably, both severe cardiac conditions had remained entirely asymptomatic.
Pivot in the Treatment Strategy
Faced with three conditions requiring urgent intervention, specialists from surgical oncology, cardiology, cardiac anesthesia, and cardiothoracic surgery convened to formulate a safe strategy. Because breast-conserving surgery requires postoperative radiotherapy, which would be highly risky alongside untreated severe heart disease, the team modified the surgical plan in consultation with the patient and her family.
To address all three issues at once, surgeons performed a Modified Radical Mastectomy for the breast cancer, an Aortic Valve Replacement using a prosthetic valve, and a Coronary Artery Bypass Grafting (CABG) using a single graft-all within a single six-hour operative window.
The patient recovered without complications. Follow-up imaging showed excellent heart function and a normally operating prosthetic valve. She has been discharged in stable condition and continues her regular oncology follow-up.
The Value of Comprehensive Pre-Operative Screening
Medical experts note that the procedure represents one of the most technically demanding combined surgeries.
"We had to simultaneously perform cancer surgery, replace a severely narrowed aortic valve, and bypass a critically blocked coronary artery," said Dr. Akhil Kumar Rustagi, Senior Director & Head, Department of Cardiothoracic & Vascular Surgery, ShardaCare HealthCity. "Successfully completing this combined procedure prevented a potentially fatal cardiac event and ensured the cancer treatment was not delayed. It also underscores the importance of careful clinical examination, as these silent cardiac conditions would have otherwise gone undetected."
Dr. Hemkant Verma, Senior Consultant & Unit Head - Surgical Oncology, ShardaCare HealthCity, emphasized how the unexpected cardiac findings forced a complete change in strategy.
"Instead of proceeding with cancer surgery alone, a joint plan allowed us to address all major health concerns in a single session," Dr. Verma explained. "This spared the patient from undergoing multiple major surgeries and prolonged recovery periods. It highlights the necessity of integrated care and comprehensive pre-operative assessments before any major surgery."
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