2. (http://www.armancare.com/heart_care.html)
Interventional cardiac procedures
Coronary angiography
Angioplasty and stenting
Balloon Valvuloplasty
pacemaker procedure
Shoulder Replacement
Cardiothoracic and vascular surgery procedures
Coronary artery bypass surgery- link should open to details
Conscious off pump coronary artery bypass surgery

3. Valve repair and replacement surgery
Thoracic and pulmonary surgeries
Adult and pediatric open heart surgeries
Angiography / Coronary Angiography
Angiography
Is a minimally invasive medical test that helps physicians
diagnose and treat medical conditions.Angiography can be used to
look at arteries in many areas of the body, including the brain, neck
(carotids), heart, aorta, chest, pulmonary circuit, kidneys,
gastrointestinal tract, and limbs.
Angiography uses one of three imaging technologies and, in some
cases, a contrast material to produce pictures of major blood
vessels throughout the body.

4. It is is performed using:
X-rays with catheters
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
In catheter angiography, a thin plastic tube, called a catheter, is
inserted into an artery through a small incision in the skin. Once
the catheter is guided to the area being examined, a contrast
material is injected through the tube and images are captured
using a small dose of ionizing radiation (X-rays).
Coronary Angiography
Itis done if a patient has symptoms of coronary artery
disease, an unexplained pain in your chest, jaw, neck or arm, a
congenital heart disease or congestive heart failure.

5. During angiography, a small incision is made in the upper thigh in
order to gain access to the femoral artery. Next, a guide wire is
inserted into the femoral artery and is threaded to the aorta. A
catheter is then inserted along the guide wire.
Once the catheter reaches the aorta, a contrast dye is injected.
When the dye flows from the aorta to the coronary arteries, an x-
ray, or angiogram, is obtained. The image taken during
angiography will show if there is any blockage, aneurysms,
narrowing or other abnormalities in the arteries.
Following the angiography, the catheter and guide wire are
removed. If treatment is necessary, the physician can recommend
appropriate therapy.
Angioplasty and Stenting
Depending on the findings of the angiography, your doctor may
advise you to undergo angioplasty/stenting or bypass surgery.

6. Both procedures restore the blood flow to the blood – deprived
areas of the heart thereby, eliminating or reducing the number of
episodes of angina pain. The choice between angioplasty/stenting
or bypass surgery for treatment of such blockages is made on the
basis of the extent and location of blockages in your coronary
arteries.
What is balloon angioplasty and stenting
During the procedure, you would be given a mild sedative
and some pain killers to ensure that you remain relaxed. Your
doctor will insert a long, thin tube called a catheter, which has a
small balloon on its tip, directed to your blocked artery via either
an artery in your leg or arm. The balloon is then inflated in your
artery, at the blockage site. This flattens or compresses the plaque
against your artery wall, thus opening up the path of blood flow
through your artery. Depending on the location and nature of your
blockage, your doctor might decide to place a stent, which is a
hollow metal tube that acts as a scaffold to keep the artery open.

7. In a small number of cases, a special catheter with a small,
diamond tip is used to drill through hard narrowing with calcium
that is causing the blockage. This is called rotational artherectomy.
What is a stent
A stent is an expandable metallic tube which is crimped on
to a thin balloon. A stent is implanted to support the artery and
keep the After the angioplasty, patient is required to stay in the
hospital for 2 -3 days. And can resume full activity within a few
days of returning home.
Angioplasty is not a cure, but a treatment to reduce the effects of
coronary artery disease. Following angioplasty, diet and
medications have to be strictly followed to reduce the risk of
recurrences.

8. Cardiac rehabilitation
Cardiac rehabilitation is a medically supervised program
to help heart patients restore their normal life after treatment of
their cardiac disease. Cardiac rehabilitation, when combined with
medicine and surgical treatments, can help you recover faster, feel
better, and develop a healthier lifestyle. Cardiac rehabilitation
often begins in the hospital after a heart attack, heart surgery, or
other heart treatment. Rehabilitation continues in an outpatient
setting after you leave the hospital.
Coronary artery bypass grafting ( CABG )
The most effective treatment forCoronary Heart Disease
(CAD) – a condition in which plaque (a substance made up of fat/
cholesterol/ calcium) builds up inside the coronary arteries thereby
narrowing them & affecting the regular flow of oxygen rich blood
to the heart. CABG significantly improves the chances of survival of
patients who are at high risk.

9. Bypass surgery or CABG is usually performed with the heart
stopped, thereby entailing the use of Heart Lung Machine. The
surgery can also be performed on a beating heart, so known as ‘Off-
Pump Surgery’.
What happens during the procedure
• Before the procedure, you will undergo some routine blood
tests, an ECG, a chest X-ray and an angiography. This will give your
doctor a clear picture of your current health status.
• In the operation theatre, you will be given general
anesthesia for a painless procedure. A heart-lung machine - referred
to as a "pump" because it continues to mechanically pump oxygen
and nutrients to the body during the surgery will ensure blood flow
through your body while your heart is stopped and being operated
upon. A graft (a long piece of vein or an artery) will be taken from
your leg or the inside of your chest wall or forearm and attached to
one end of the graft will be attached to a coronary artery below

10. your blocked area. The procedure can take from 2 to 6 hours,
depending on the number of bypasses needed.
• Off-pump or beating-heart surgery: This is another
technique for performing bypass surgery. It reduces the need for
large incisions or a heart-lung machine This procedure allows
surgery to be done on the still-beating heart using special
equipment to stabilize or quieten the area of the heart, the
surgeon is working on.
• Minimally invasive surgery: In this procedure, a surgeon
performs coronary bypass through several smaller incisions in the
chest. This technique is used only under certain conditions.
Variations of minimally invasive surgery are called port-access or
keyhole surgery.
What is coronary artery bypass graft ( CABG ) surgery
Coronary artery bypass graft surgery is an open-heart

11. operation in which arteries or veins are taken from another part of
the body to channel needed blood flow to the coronary arteries
During surgery these arteries or veins are connected directly to the
coronary arteries on the surface of the heart beyond the blockages.
This way, blood can flow through them to bypass the narrowed or
closed points. CABG operations usually last from three to six hours,
their duration depending on the number of vessels to be grafted.
Each operation varies in complexity, so its duration can only be
estimated.
What is conscious off-pump coronary artery bypass
surgery (awake bypass surgery)
Awake bypass surgery is a break through step in “Fast-track care “of
bypass surgery patients. Awake bypass surgery is the latest
advance where a patient undergoes bypass surgery while actually
awake and can converse with the operating surgeon and his team.

12. How is it performed
A new type of beating heart surgery which is performed
with epidural anesthesia, eliminating the need and risks of
generalanesthesia. The technique is a highly precisionbased
methodology, which involves injection of micro doses of local
anesthetizes only the chest region while the rest of the system is
fully awake. This enables a painless bypass surgery and makes the
surgery sage for patients who are at high risk for general
anesthesia.
Advantages of awake bypass surgery
• Avoidance of tracheal intubation
• Avoidance of Ventilation
• Avoidance of cardiac depression due to general anesthesia

13. • Avoidance of ischemic events related to intubation
• No dizziness, nausea
• Reduced ICU stay and hospital stay
Valve replacement surgery / balloon valvotomy
• Balloon valvotomy is a non-surgical procedure performed
in the cardiac catheterization laboratory. A thin flexible tube is
inserted through an artery in the groin or arm and threaded into
the heart. When the tube reaches the narrowed valve, a balloon
device located on the tip of the catheter is quickly inflated. This
relieves the obstructed valve.
• During a valve repair surgery, parts of a stenotic valve that
are stiff or hardened may be cut and separated to help

14. them open wider. If a valve can't be repaired, it may be replaced
with a prosthetic (artificial) valve.
• During valve repair or replacement surgery, the
breastbone is divided, the heart is stopped, and blood is sent
through a heart-lung machine while the valve is being replaced.
If medicines are not effective in controlling your symptoms
of mitral valve stenosis or if your doctor determines that you need
more aggressive treatment, you may need surgery to repair or
replace your mitral valve. Valve surgery is common and usually
successful. But a degree of risk is associated with this invasive
procedure. There are generally three options: a balloon valvotomy,
a closed (or open) commissurotomy surgery, or valve replacement
surgery.

15. Valve repair (balloon valvotomy)
Balloon valvotomy (percutaneous mitral balloon
valvotomy) is the method of choice for treating mitral valve
stenosis in select patients. A thin flexible tube (catheter) is inserted
through an artery in the groin or arm and threaded into the heart.
When the tube reaches the narrowed mitral valve, a balloon
located on the tip of the catheter is quickly inflated. The balloon,
pressing against the narrowed mitral valve leaflets, separates and
stretches the valve opening and allows more blood to flow
through the heart. This procedure does not require open-heart
surgery, so recovery is easier.
A balloon valvotomy is usually recommended if you have
symptoms, moderate to severe stenosis, and most of your mitral
valve is a normal shape.
A balloon valvotomy may also be used to treat people with mitral

16. valve stenosis who do not yet have symptoms (asymptomatic) if
they have:
• A higher risk of dangerous blood clots
(thromboembolism). This includes people with an irregular heart
rhythm called atrial fibrillation, as well as those who have had a
blood clot before.
• High blood pressure in the lungs ( pulmonary
hypertension ).
• Mitral valves that are still in fairly good condition.
Your doctor may recommend a balloon valvotomy if you are
planning to have another surgery (not on your heart), if you are
pregnant, or if you are planning a pregnancy.
People with signs of blood clots in the left atrium, widespread
calcification of the mitral valve structures,

17. or moderate to severe mitral valve regurgitation are not
considered good candidates for a balloon valvotomy.
The mitral valve may narrow again (restenosis) after 10 to 20 years.
Valve surgery
Depending on the amount of damage to your mitral
valve, your doctor may recommend surgery to repair or replace
your mitral valve. If the valve is damaged beyond repair, it will need
to be replaced. Mitral valve surgery may be done as an open-heart
surgery, or a minimally invasive surgery.
During open-heart surgery, your heartbeat is stopped, and you are
placed on a heart-lung machine to deliver blood to your body. The
heart-lung machine temporarily serves in place of your heart and
lungs by mixing oxygen with the blood, removing carbon dioxide
from the blood, and pumping the blood throughout your body.
During minimally invasive surgery, your doctor makes a
smaller incision than the incision made in open-heart surgery.

18. You may still be placed on a heart-lung machine. Valve repair or
replacement is similar for minimally invasive surgery and open-
heart surgery.
Valve repair
In open commissurotomy, a surgeon removes calcium
deposits and other scar tissue from the mitral valve leaflets, which
opens the valve. This procedure is used for people who have
severe narrowing of the valve and are not good candidates for
balloon valvotomy.
Valve replacement
The damaged heart valve is removed and replaced with a
new valve. This is generally done when your mitral valve is
damaged beyond repair. With improved technology, mitral valve
replacement is an important surgical option. Some doctors believe
that replacement mitral valves are now more durable.

19. Also, more of the original mitral valve and its support structure
(such as the chordae tendineae) are preserved during valve
replacement. The long-term results of surgery are generally better
when more of the original mitral valve structure is preserved.
Balloon mitral valvotomy
Balloon valvotomy is used to increase the opening of a
narrowed (stenotic) valve. It is used for:
• select patients who have mitral valve stenosis with
symptoms
• older patients who have aortic valve stenosis, but are not
able to undergo surgery
• some patients with pulmonic valve stenosis

20. This balloon valvotomy procedure can be performed on the mitral,
tricuspid, aortic or pulmonary valves.
How is a balloon valvotomy performed ?
Balloon valvotomy is a non-surgical procedure performed
in the cardiac catheterization laboratory by a cardiologist and a
specialized team of nurses and technicians.
Long, slender tubes called catheters are first placed into blood
vessels in the groin and guided into the chambers of the heart. The
cardiologist then creates a tiny hole in the wall between the upper
two chambers of the heart. This hole provides an opening for the
cardiologist to access the left atrium with a special catheter that
has a balloon at the tip.
The catheter is positioned so the balloon tip is directly inside the
narrowed valve. The balloon is inflated and deflated several times
to widen the valve opening.

21. Once the cardiologist has determined that the opening of the
valve has been widened enough, the balloon is deflated and
removed.
During the procedure, the cardiologist may perform an
echocardiogram (ultrasound of the heart) to get a better picture of
the mitral valve.
• Able to treat patients with thinner corneas
• Reduced incidence of flap complications
• Lower rate of dry eye syndrome
What should I expect before the procedure ?
• Most patients will need to have blood tests, a chest x-ray,
electrocardiogram, and an echocardiogram before the procedure.
These tests are usually scheduled the day before the procedure.

22. • Ask your doctor what medications should be taken on the
day of your test.
» If you are diabetic, ask your physician how to adjust your
medications the day of your test.
» Tell your doctor or nurse if you are taking any blood
thinning medications such as Coumadin (warfarin). An alternate
method for thinning your blood may be prescribed a few days
before the procedure.
• You will not be able to eat or drink after midnight the
evening before the procedure.
• Leave all valuables at home. If you normally wear
dentures, glasses or a hearing assist device, plan to wear them
during the procedure to help with communication.
• Tell your doctor and/or nurses if you have any allergies.

23. How long does the procedure last ?
The procedure lasts about 1 hour, but the preparation and
recovery time add several hours. Please plan on staying at The
Cleveland Clinic all day for the procedure and remaining in the
hospital overnight. Patients usually go home the day after the
balloon valvotomy procedure. When you are able to return home,
arrange for a companion to bring you home.
What should I expect during the recovery ?
• You will need to lay flat for about 6 hours after the
catheter has been removed from your groin to prevent bleeding.
You will have a tight bulky dressing on your groin area while you
are resting in bed. Do not bend your legs during this time to
prevent bleeding. A sheet may be placed across your legs to
remind you to keep them straight. Your nurse will tell you when
you may sit up and get out of bed.

24. • You should not eat anything until the catheter has been
removed from your groin.
• Notify your nurse immediately if you have a fever, chest
pain, swelling or pain in your groin or leg, or bleeding at your groin
site.
• You will have an echocardiogram the morning after your
procedure.
• Medications may be prescribed. Ask your doctor if it is safe
to continue taking the medications you took prior to the
procedure.
• Once you have recovered from the procedure and have
talked to your doctor about your follow-up appointments and
care, you will be able to go home.

25. • You will be able to return to most of your normal activities
the day after the procedure. Ask your doctor when it is safe to
drive, return to work or begin or continue an exercise program.
• Once your cardiologist has successfully opened the
narrowed mitral valve, your symptoms of valve disease should
decrease or disappear completely.
What is medical tourism?
Medical tourism, also known as health tourism or health travel, is
a term that describes travelling to a foreign country for medical,
dental, or cosmetic treatment. It involves the benefit of cost
effective treatment, private medical care, in collaboration with the
tourism industry. The concept of medical tourism is fast growing in
India and people from different part of the world are choosing
India as their desired destination.

26. Why Choose India?
Medical tourism is a rapidly growing sector in India and millions of
medical tourists from all over the world have come here to
experience a world-class healthcare service.
In 2010, about 600,000 patients travelled to India from over 30
countries for treatment, including the USA, Canada, UK, Russia, the
Middle East and Africa.
According to a study by the Confederation of Indian Industry (CII)
on healthcare, after software, the medical tourism industry is
poised to be the next big success story in India. It has predicted
that the industry will grow to earn additional revenue of $2.3
billion by 2012 and will soon account for a major share of the
country’s revenue.

27. There are several reasons behind this tremendous growth:
Patients come to India to get specialized treatments not available
in their home country. Indian hospitals excel in performing
complex cardiac surgeries, kidney transplants, bone marrow
transplants, orthopedic surgeries, infertility treatments amongst
their wide repertoire.
India provides world-class quality treatments at a fraction of the
price of developed countries. The cost of medical treatment in
India is generally one tenth of western countries and among the
cheapest in Asia.
India has state of the art medical institutes and hospitals of
international standards with highly qualified medical professionals.
These centers are backed by high quality equipment and
technology. This fusion of highly qualifiedstaff assisted by the latest
equipment gives India the edge over other countries.

28. With hospitals and clinics in every region including urban, semi-
urban, or rural parts of the country, India has ample choice in
terms of preferred destinations.
In countries such as Canada and the UK, patients almost always
have to wait weeks and sometimes months to avail of medical
treatments. In India the consultations with the doctors are prompt
and patients receive a turnaround to their treatment plan at a
quicker pace.
As English is a commonly spoken language in India, the patient will
be comfortable communicating with the doctors.
Medical tourists find that the cost of their treatment (including the
return airfare, holiday and accommodation) leaves them with a
total bill substantially less than they would have spent just on
having the procedure in the UK.

29. Why Arman
There are several concerns that flicker in the minds of the
foreigners who come for treatment to India, particularly for first
time fliers. The first among them is which hospital to choose for
their treatment.
India is flooded with hospitals, medical centers and hotels which
have their websites that attract the foreign patients. This makes
them even more confused and the complexity of decision making
becomes a challenging task.
We, at Arman can address all these concerns and issues by acting
as intermediary with hospitals, clinics, surgeons, hotels.
Arman is a healthcare facilitator that has painstakingly brought
together highly qualified professionals and hospitals of repute and
health care providers.

30. We take the responsibility of screening the hospitals by checking
their track record, accreditations, associations and have partnered
with the best internationally accredited hospitals in India.
Arman update and monitor our network of hospitals on a regular
basis and maintain a database on the hospital’s certifications, type
of facilities and other factors critical in choosing a medical center.
Arman also negotiate a lower price from the hospital which foreign
patients would not get by directly approaching the hospitals This
helps the patient to save a lot on the medical procedure costs
We provide assistance with logistics, documentations, permits and
other travel arrangements required for medical tourism.
Our coordinators are highly trained to foresee every need of the
patient and make the entire process hassle free from start to finish.

31. They help the patient plan his medical procedures before leaving
home, and schedules all his appointments, surgery, treatments
and plans for recuperation.
This in turn helps the patient to choose the hospital according to
his convenience and also get a clear picture of the cost of
treatment, accommodation beforehand that helps them to
arrange their finance.
We are aware that a lot of trust is put in our hands and ensure that
this trust is well placed by serving each patient individually with
care and comfort.
How We Work
Patient query received by the patient himself or his doctor/
hospital.

32. This query along with medical reports is forwarded to the
concerned hospitals to get expert opinions
After the hospitals respond, we create a package for the patient
which includes recommendation on the treatments, duration of
stay, and the costs involved.
The patient reviews the various options presented to him and
makes a decision based on budget and the line of treatment
recommended by the doctors. Occasionally, a patient may clarify
his concerns or questions he may have regarding the treatment
with the doctor by telephone.
In liaison with the patients, Arman representatives will make prior
bookings with the hospital, airlines, hotels.
Patient travels and checks into hospital to start the treatment. We
provide assistance through out your stay in the hospital which

33. include pre and post opeartive care.
Once fit and able to travel, the patient if wishes can enjoy the vast
tourist destinations within India before returning to their home
country fully rejuvenated. (at an additional
cost)(ebranding/mum/ts/19)
Arman Health Care Facilitators
OUR OFFICE IN INDIA
422, Bonanza, 'B' Wing,Sahar Plaza Complex, Next to Kohinoor
Hotel,
Andheri Kurla Road, Andheri East Mumbai India 4000059.
Contact: land line No: ( 022-28387433 )
Email :enquiry@armancare.com

34. OUR OFFICE IN CONGO
Arman Health care Facilitators,Gallery Saint-Pierre, 36 local
UtexAfrica Advanced ,AV 374 VolonelMondjiba,Kinshasa /
Ngaliema,DRC Mobile : +243998290384
OUR OFFICE IN KENYA
Arman Health Care Facilitators C/O Doctor Pharma Kenya Limited
Vision Tower, Muthithi Road,
Westlands, Nairobi,Kenya.Contact: Telefax:(+254)722330329
Email : doctorpharmamt@gmail.com
Web:- http://www.armancare.com/heart_care.html
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