Dr Swarup Pal Cardiac Vascular and Thoracic surgeon

22/05/2026

An Arteriovenous (AV) Fistula is the gold standard access for hemodialysis in patients with kidney failure. It is a surgically created connection between an artery and a vein, usually in the arm, which allows the vein to become “arterialized” — stronger, larger, and capable of handling repeated dialysis sessions safely and efficiently.

Why is it needed?
Hemodialysis requires high blood flow for effective filtration of toxins from the body. Normal veins are often too small and fragile for this purpose. By connecting an artery to a vein, the increased blood flow helps the vein enlarge and strengthen over time.

An AV fistula does not work immediately after surgery. It usually takes around 6–8 weeks for the vein to mature adequately before it can be used for dialysis. During this period, the vein gradually adapts to the higher pressure and flow.

In some patients, even after maturation, the vein may remain too deep beneath the skin for easy needle access. In such cases, an additional procedure called superficialization may be required to bring the vein closer to the surface. Sometimes, the vein may also need to be repositioned or rerouted — a procedure known as vein transposition.

A well-planned and properly created AV fistula can provide durable, long-term dialysis access with fewer complications compared to catheters or grafts. This is why AV fistula creation is best performed by an experienced cardiovascular or vascular surgeon, ensuring optimal outcomes for the patient.

21/05/2026

Here s a short presentation on one of the commoner causes of infertility by Dr Ish*ta Sinha Pal , your own Gynaecologist and Obstetrician!

11/05/2026

Successful Surgery for Thymic Carcinoma in a Patient with Myasthenia Gravis

A 47-year-old patient presented with Myasthenia Gravis (MG), a condition in which the body’s immune system affects communication between nerves and muscles, leading to weakness and fatigue. During evaluation, imaging revealed a thymic mass (thymoma).

Understanding the condition

The thymus gland, located in the chest behind the breastbone, plays an important role in the immune system. In patients with Myasthenia Gravis, abnormalities of the thymus are common:

Around 10–15% of patients with Myasthenia Gravis have a thymoma (tumor of the thymus).
Nearly 30–50% of patients with thymoma may develop Myasthenia Gravis.
Thymic carcinoma is much rarer and more aggressive, accounting for only about 10–20% of all thymic epithelial tumors, with an incidence of approximately 1–2 cases per million people per year.
Why surgery is important

Surgical removal of the thymus (thymectomy) is often recommended in patients with thymoma because:

It removes the tumor completely.
It prevents local spread into surrounding vital structures.
It can improve symptoms and long-term control of Myasthenia Gravis.
Early surgery offers the best chance of cure.
The operation

The patient underwent surgery for removal of the thymic mass. During the operation:

The tumor was found to be hard and firm, suggesting a more aggressive pathology.
It was closely encasing the phrenic nerve (the nerve responsible for movement of the diaphragm and breathing).
Great care was taken to preserve the phrenic nerve, while ensuring complete removal of the mass.

The excised specimen was sent for histopathological examination, which confirmed the diagnosis of Thymic Carcinoma.

Post-operative treatment and outcome

Because thymic carcinoma can behave aggressively, the patient underwent adjuvant radiotherapy after surgery to reduce the risk of recurrence.

Today, the patient is doing very well, has recovered fully, and remains under regular follow-up.

05/05/2026

*Coronary endarterectomies and Stent endarterectomy!*

We operated close to 15 pts in the last year , all between the age of 35 to 45 yrs of age.

_What is alarming is the diffuse nature of the disease often needing an endarterectomy. This is also encountered in the other extremes of age >75 yrs of age._

In these pt subsets we have to cut open the coronary and remove the calcified plaque and do a bypass..

_Very recently we did five and seven bypasses using the Lima, Rima and Radial arteries on a beating heart 💓 . Quite often this is becoming the story in these young guys._

Hopefully , we have better preventive strategies so that the disease onset is delayed.

_Also in a certain subset ( not very uncommon) the stents they received have to be removed to make space for grafting. Stent endarterectomy,as we commonly call it, .. is also a difficult entity that we surgeons encounter and handle with care !_ This is probably the only time that a Cardiac surgeon says- I need some space! ! [ No ' pun' intended... ! (",) ]

Regards,
Dr Swarup Pal
CVTS surgeon
Gleneagles , Mumbai.

02/05/2026

It's not easy being a Heart surgeon ..

19/03/2026

Here z how one can protect themselves from the pollution around us and yet live a happy and sustainable healthy life...

For more ..meet Dr Swarup Pal at Gleneagles hospital, Mumbai and the NEW LIFE health Clinic , Matunga ( For appointment- 9833471669)!

14/03/2026

Welcome to our Clinic ..
NEW LIFE health clinic for Womens' and Heart Care !

Address - Shop no 4, Mangal CHS, R.A.Kidwai road , Central Matunga ( E), Mumbai - 400019

Phone No- 9833471669 (For Appointment)

29/01/2026

Conversations around infertility are often filled with silence, fear, and unnecessary stigma. But infertility is not a disease—it is a condition, and in many...

29/01/2026

Conversations around infertility are often filled with silence, fear, and unnecessary stigma. But infertility is not a disease—it is a condition, and in many...

14/01/2026

https://youtu.be/GRvvnEG7J1A?si=xHFVxNnbQTh4AjaO

Listen to this talk about air pollution and heart and lung damage..

Like and share with ur groups!

In this episode, we speak with Dr. Swarup Pal, Chief CVTS, MICS & Transplant Surgeon at Gleneagles Hospital, Mumbai, to understand how poor Air Quality Index...

01/12/2025

Let's learn how heart blockages develop ..
These go on to cause a major heart attack !
Prevention is always the aim...