A multidisciplinary team of doctors in Delhi NCR successfully treated a 65-year-old woman diagnosed with early-stage breast cancer, severe aortic valve disease and a critical coronary artery blockage through a single six-hour surgery.
According to doctors at ShardaCare HealthCity in Greater Noida, the coexistence of these three major conditions in one patient is extremely rare, making this the first reported case of its kind in the Delhi NCR region.
The surgery, performed by specialists from multiple departments, not only ensured timely cancer treatment but also prevented a potentially fatal cardiac event.
The patient, Mrs. Iyer, a retired media professional, had recently noticed a lump in her right breast and was diagnosed with early-stage carcinoma of the right breast. She was initially scheduled for breast-conserving surgery, a procedure that preserves the breast and is typically followed by radiotherapy. However, during routine pre-operative evaluation, doctors detected an abnormal heart sound, or cardiac murmur, a finding that often indicates an underlying heart valve disorder. Although the patient had no significant cardiac symptoms, the clinical finding prompted further investigations.
A two-dimensional echocardiogram revealed severe aortic valve stenosis caused by a bicuspid aortic valve, in which the valve opening had narrowed significantly. If left untreated, the condition could have resulted in heart failure or sudden cardiac death.
Further coronary angiography uncovered an additional critical finding—a 90 per cent blockage in the left anterior descending (LAD) coronary artery, one of the heart’s most important blood vessels. Remarkably, both life-threatening cardiac conditions had remained completely silent, with the patient experiencing no major warning symptoms.
With the patient simultaneously battling three serious conditions—early-stage breast cancer, severe aortic valve disease, and critical coronary artery disease—a multidisciplinary team comprising specialists from surgical oncology, cardiology, cardiac anaesthesia, and cardiothoracic and vascular surgery held detailed discussions to determine the safest treatment strategy.
As breast-conserving surgery would have required postoperative radiotherapy and the patient urgently needed open-heart surgery, the team revised the treatment plan after obtaining informed consent from the patient and her family.
The patient subsequently underwent a modified radical mastectomy for breast cancer, aortic valve replacement with a prosthetic valve, and a coronary artery bypass grafting using a single graft. All three procedures were successfully completed during a single six-hour surgery.
The patient’s postoperative recovery was uneventful. Follow-up echocardiography showed a normally functioning mechanical aortic valve, excellent cardiac function, and no evidence of valve leakage or other complications. She was discharged in stable condition and advised to continue oncology follow-up.
Commenting on the case, Dr. Akhil Kumar Rustagi, Senior Director & Head, Department of Cardiothoracic & Vascular Surgery, ShardaCare HealthCity, said, “This was one of the most technically demanding surgeries because we had to simultaneously perform cancer surgery, replace a severely diseased aortic valve, and bypass a critically blocked coronary artery. The aortic valve was extremely narrowed, making the procedure particularly challenging. Performing all three surgeries together required meticulous planning and seamless coordination across multiple specialties.”
He added, “Had the treatment been delayed, the patient would have faced a substantial risk of sudden cardiac death due to severe aortic stenosis and critical coronary artery disease, while the untreated breast cancer could have progressed to a more advanced stage or spread to other organs.”
Dr. Hemkant Verma, Senior Consultant & Unit Head – Surgical Oncology, ShardaCare HealthCity, highlighted the importance of comprehensive pre-operative assessment before any major surgery.
“Cases like these demonstrate the value of integrated cancer care, where specialists across disciplines work together to deliver the most effective and patient-centric treatment plan. This case highlights why comprehensive pre-operative assessment is essential before any major surgery,” he said.
(L–R) Dr. Akhil Kumar Rustagi and Dr. Hemkant Verma
