Telemedicine Services Available for New Patients and Review Patients
Telemedicine services are available for both new patients and review patients.
Telemedicine services are provided exclusively to those patients who are unable to visit the hospital
Revisit patients please ensure that the MRD number/MRD card is with you while availing telemedicine services
Telemedicine services will not be available on Sundays and public holidays
Telemedicine services will not come under the purview of a medico-legal case.

The telemedicine service at AIMS is the first telemedicine centre in Kerala which was started in September 2002. This center was set up with the help of Indian Space Research Organization (ISRO), which selected AIMS for its pilot telemedicine project in the state of Kerala. This is to provide the best medical care to the remote corners of India, to the people who cannot afford the treatment due to their inability to travel, cost, unawareness etc. Now, more than 60 centers in India are connected from AIMS. Aside from providing consultations to the remote corners of India, AIMS uses its telemedicine link to educate doctors in remote primary centres in the latest medical advancements through seminars, workshops and teaching programs.

The Centre offers the State of Art Services
Teleconsultation
Telemedicine consultation services are provided to many geographically remote locations across the country starting from the islands of Lakshadweep to the mountains of Leh to the holy shrine of Sabarimala and to many other remote locations committed in bridging the health care gap.
Amrita telemedicine service provides primary specialist diagnosis, second opinion, recommends treatment and post treatment advice based on clinical details, appropriate radiological and laboratory investigations and consultation via video conferencing.
Remote doctor can have a teleconsultation about a patient with the specialist either with or without the presence of the patient. In the past ten years, we have so far provided over 5000 teleconsultations to the patients in remote places, which have helped them to avoid unnecessary travel to superspeciality hospitals. AIMS is by and large connected to most of the telemedicine centers across the country and also to some of the popular international centers.

Tele Health
A variety of health programs are telecasted to remote health centers having telemedicine facility for the benefit of the general public. We conduct various health awareness programs to the general mass and also health surveyors and other health facilitators. There are regular tele education classes being held by the community medicine department of AIMS to various tsunami affected areas within the state as well as outside the state.

Continuing Medical Education Programs
Continuing medical education for the doctors, specialists, and nurses which include tele-education, training, and the sharing of information and opinions through seminars, workshop, and grand rounds (multi-specialty discussion). We have done more than 700 CME programs, conferences, and case discussions. These all are broadcasted to remote medical institutes and other medical colleges. These CMEs includes regular CMEs, national and international seminars, conferences, workshops and grand rounds.

Telesurgery
A remote doctor can have a teleconsultation with an expert surgeon for conducting an operation. Though telemedicine is relatively new in India, Amrita Institute of Medical Sciences has the distinction of conducting the first telesurgery in India.

Distant Education Programs
Medical courses and classes are scheduled and conducted for students, doctors, and specialists remotely in various medical specialties.

Our Services
The telemedicine service at AIMS is the first telemedicine centre in Kerala which was started in September 2002. This center was set up with the help of Indian Space Research Organization (ISRO), which selected AIMS for its pilot telemedicine project in the state of Kerala.

The Department of Reproductive Medicine – Amrita Fertility Centre provides total fertility solution under one roof. Located at M G Road, Atlantis, Kochi with easy accessibility to patients, our team is dedicated to the cause of helping couples combat and overcome their fertility management issues. We offer comprehensive innovative evidence based fertility treatment with discretion. Our individualised treatment plans are customised to specific fertility problems at highly affordable cost without compromising on quality. The unique combination of cutting edge science and personal touch is what sets Amrita Fertility Centre apart.

Rapid changes in the lifestyles of developing economies have resulted in an unprecedented epidemic of heart disease. Along with preventive measures that involve healthcare planning, public education, and lifestyle changes, facilities to take care of the immediate consequences of heart disease have become the need of the day.
The Centre for Heart Diseases at Amrita Institute of Medical Sciences is comprised of the adult and paediatric departments for medical and surgical services and provides affordable, high-quality tertiary medical care by highly qualified as well as experienced personnel using state-of-the-art medical technology. Having evolved as a leader in the fight against cardiovascular disorders in the state of Kerala, it serves approximately ten thousand cardiovascular patients annually.
The Amrita team focuses on medical and surgical management of all types of cardiac ailments including primary and secondary prevention as well as cardiac rehabilitation.
Accordingly the program specializes in minimal access cardiac surgery and,- "beating heart" off-pump bypass surgery as well as intensifying patient health education and disease prevention, outreach programs, specialized training and research programs.

Our Departments
The department is visited by more than 25,000 patients per year. Our 24 x 7 in-hospital specialty services include emergency dialysis facility, cardiac pacing and emergency endoscopy.

Adult cardiology
Paediatric cardiology
Fetal cardiology division
Cardiovascular and thoracic surgery
Paediatric and congenital heart surgery
Amrita Hypertrophic Cardiomyopathy Center
Preventive Cardiology and Rehabilitation
Amrita Cardio-Oncology Clinic
Amrita Cardiovascular Genetics Services

The Cancer Centre at Amrita Hospital is dedicated to providing fully integrated, multidisciplinary cancer treatment under one roof with state-of-the-art technology including prevention, detection, diagnosis, treatment, rehabilitation, training & research. The Centre has assembled a wide range of experts in all disciplines related to cancer, from various parts of the country and abroad, to form an integrated team to treat the disease. We feel that this approach will provide the highest quality of scientifically guided cancer care in a modern, serene, compassionate and respectful environment and at affordable cost.
The major departments of Radiation, Medical, and Surgical Oncology are supported by community outreach programs in health awareness and education. These programs facilitate the early detection and cure of the disease. Although success is usually measured by cure, the ultimate measure of success is in the prevention of disease. This is our long-term goal.
The existing strong programs at Amrita Hospital in all the specialities and our institutional resources greatly help the management of disease in cancer patients and assure optimum care. Utilising the latest and most advanced technology, we provide precision treatment that minimises the unwanted side effects usually associated with cancer treatment.

Multidisciplinary Approach
The strength of the Cancer Centre lies in our ability to offer all treatment modalities within a single roof. Patients are seen and evaluated in multimodality clinics such as Head and Neck, Breast and Gynecology by a team of specialists in each malignancy. Treatment decisions are then made in multidisciplinary tumour boards where these specialists sit together and discuss the plan of treatment. The emphasis is on combining all modalities of treatment in the right combination to achieve the best results, while minimizing the side effects.

To facilitate multidisciplinary care of cancer patients, the Centre offers the following tumour site specific teams:
Head and Neck Oncology
Urologic Oncology
Neuro-Oncology
Paediatric Oncology
Soft tissue and Sarcoma Services
Thoracic Oncology
Hematological Malignancies
Gastrointestinal Oncology
Gynaecologic Oncology
Orthopaedic Oncology
The Centre includes the following disciplines
Radiation Oncology
Medical Oncology
Surgical Oncology
Pain and Palliative Medicine
Molecular Oncology
Blood and Marrow [Stem Cell] Transplantation
Medical Physics
Cancer Registry
Our Departments
Utilising the latest and most advanced technology, we provide precision treatment that minimises the unwanted side effects usually associated with cancer treatment.

Radiation Oncology
CyberKnife And TomoTherapy
Medical Oncology
Surgical Oncology
Clinical Haematology & Stem Cell Transplantation
Pain And Palliative Medicine
Molecular Oncology
Cancer Registry

The Centre for Digestive Diseases has state-of- the-art facilities for the early detection, diagnosis, and treatment of complex gastrointestinal, liver, gallbladder, and pancreatic diseases. The departments of imaging, interventional radiology, nuclear medicine, oncology and lab services also work closely with the Centre to provide comprehensive treatment to patients.
At AIMS, we strive to offer both patients and referring physicians a comprehensive multidisciplinary approach for disorders of the pancreas, bile ducts and gallbladder. A team of gastroenterologists, interventional endoscopists, radiologists, GI HPB and transplant surgeons, medical and radiation oncologists, work together to design a personalised diagnostic and therapeutic plan for each patient. Nursing coordinators organise and expedite patient evaluations to minimise multiple visits for testing and physician consultation.
The core units of the centre are the Department of Gastroenterology and Hepatology and the Gastrointestinal Surgery Department. The departments of Imaging, Interventional Radiology, Nuclear Medicine, Oncology and Lab Services also work closely with the Digestive Diseases group.

Areas of specialty
Gastroenterology/Hepatology
Liver centre
Centre for biliary and pancreatic disorders
Centre for luminal disorders
Diagnostic and therapeutic endoscopy and ERCP
Centre for swallowing and oesophageal disorders
Gastrointestinal haemostasis
Cancer detection and palliation unit
Paediatric gastroenterology
Intensive care services
Tele-medicine and tele-education services
Our Departments
Gastroenterology And Hepatology
Gastrointestinal Surgery

The Centre for Neurosciences at AIMS is one of the largest in Southern India, providing full facilities for investigations and treatment of neurological disorders in adults and children. The Centre caters to more than 21,000 patients in out patient services and 1500 patients as in-patient per year. In spite of the large number of patients, the Centre for Neurosciences provides quality care combining traditional clinical evaluation with judicious use of the most advanced investigation modalities that are unmatched in any hospital in India.

Our Departments
We provide quality care with judicious use of the most advanced investigation modalities

Neurology
Neurosurgery
Paediatric Neurology
Paediatric Neurosurgery
Memory Clinic
Paediatric Craniofacial Surgery
Amrita Advanced Centre For Epilepsy
Amrita Comprehensive Sleep Centre
Neuroimmunology Laboratory

The Department for Orthopaedics treats muscle, bone and joint disorders. Areas of special emphasis include arthritis, joint replacement, spine surgery, sports medicine, physical medicine, hand, foot and ankle, orthopaedic oncology, trauma, and paediatric orthopaedics.

Our orthopaedic surgeons have diverse expertise and are committed to provide effective solutions to orthopaedic problems. Specialized services include arthroscopy, musculoskeletal tumour surgery and reconstruction, rheumatology and treatment for orthopaedic trauma.

Why Choose Us
Surgeons with diverse expertise
Repair of Shoulder Impingement Syndrome and Rotator Cuff Tear
Mako Robotic-Arm Assisted Knee And Hip Replacement Surgery
Disorders Treated
Artificial Joint Replacement
Arthroscopic Surgery of Shoulder, Elbow, Wrist
Arthroscopic Surgery of Hip, Knee and Ankle
Cartilage Restoration / Transplantation
Rheumatoid Arthritis, Degenerative Arthritis
Nerve Decompression Surgery
ACL, PCL and Meniscus Repairs
Musculoskeletal Injuries
Ligament Injuries
Limb Lengthening, Deformity Correction
Rotator Cuff Repair
Scoliosis
Spinal Disc and Degenerative Surgery
Spinal Trauma, Tumour and Infection Surgery
Spinal Deformity Correction under Spinal Cord Monitoring
Minimally Invasive Spine Surgery
Disk Replacement Surgery
Repair of Shoulder Impingement Syndrome and Rotator Cuff Tear
Sports-Related Injuries
Speciality Clinics
The Centre run the following speciality clinics from Monday to Saturday:

Spine Surgery Clinic
Joint Replacement & Revisions Clinic
Arthroscopy and Sports Injury Clinic
Musculosketal Tumour Clinic
Orthopaedic Trauma Services Clinic
Limb preservation and Ilizarov surgery Clinic
Wrist, Elbow and Shoulder Arthritis Clinic

The Head and Neck Oncology Service at Amrita Hospital has always strived to be a model for comprehensive multidisciplinary care in the country. The infrastructure, clinical services offered and the outcomes of patient care are on par with the best centers in the world. Head and neck cancers comprise of tumors of mouth, throat, voice box (larynx) and the associated structures such as sinuses, salivary and thyroid gland. It is now clearly established that multimodality treatment with surgery, radiation therapy and chemotherapyalone or in various combinations offer the best chance to cure the disease and to improve the quality of life of patients. Because of the involvement of multiple specialties, the treatment decision and monitoring is best carried out through a multidisciplinary head and neck oncology team, rather than by a single physician or a specialty. The team comprises of the head and neck surgical oncologist, radiation and medical oncologists, radiologist, pathologist, medical social worker and supportive care specialists. Our weekly tumor board consisting of these experts oversees the planning and care of all head and neck cancer patients. We also have dedicated tumour boards for thyroid and skull base disorders every month where in the treatment planning is done in great detail. All the treatment decisions are based on best current evidence and universally accepted treatment guidelines.

Services Offered
Ablative cancer surgery to remove tumor from the patient body.
Reconstructive surgery to return pre-surgical state both functionally and aesthetically.
Minimal invasive surgeries – Keyhole surgery, endoscopic surgeries and Trans-oral laser surgeries.
Trans-Oral Robotic surgeries (TORS).
Robotic Thyroidectomy.
Suture less thyroid surgery (Harmonic scalpel surgery).
Skull base and sinus services including endoscopic and neuro-navigation assisted surgeries combined with expertise of neurosurgeons.
Curative surgeries for non-cancerous swellings including huge benign tumors and vascular lesions.
Virtual surgical planning with VRT Model and 3D printing software.
Patient specific implants/hardware for reconstruction of maxilla (upper jaw), mandible (lower jaw) and orbit defects.
Surgery for salivary gland cancer and non-cancer swellings.
Facial re-animation surgeries for facial palsy with free functional muscle transfer, temporalis tendon transfer, gold weight implant etc.
Secondary reconstruction of head and neck cancer ablative defects to achieve normal or near normal aesthetic and functional results.
Exclusive dysphagia unit for functional rehabilitation with tailored methods.
Dental rehabilitation in the form of dentures and implants.
Prosthetic implants for defects of face, ear and eye socket.
Dental oncology for pre and post radiotherapy care for head and neck cancer patients.
Why Choose Us?
World Class Surgical Facilities and Surgeons available in the field
Detailed workup with all sort of investigations
24-Hour availability of microvascular surgeons
Trained medical staff for hourly free flap monitoring.
Dedicated ICU integrated to the exclusive state-of-the-art operation theatre complex.
24-hour availability of expert airway intensivist and anaesthetist.
Dedicated swallowing and speech service for early rehabilitation of cancer patients.
First institution to start MCh Head and Neck Surgery/Oncology super specialty course in India.
Multi-Departmental tumor board discussion for best tailored evidence-based treatment for the patient.

The Centre for Plastic and Reconstructive Surgery features a highly experienced team adept at cosmetic, reconstructive and microsurgical procedures. The Centre has a clinical service focusing on:

All types of cosmetic surgeries
Leg and foot trauma reconstruction
Hand trauma and elective hand surgeries
Brachial plexus surgeries
Cancer reconstruction including breast reconstruction
Head and neck cancer reconstruction
Chronic and acute wound and ulcer management
Lymphoedema management
Obesity – Lifestyle management and body shaping
Correction of cleft lip, palate and congenital anomalies
Microsurgery – replantations, artery and nerve repairs, free tissue transfers
Comprehensive burn treatment
Services Offered
Cosmetic Surgeries
Hair transplant
Facial rejuvenation with Botox, fillers, etc
Fat injection
Facelift for wrinkles
Liposuction
Abdominoplasty and Hernia surgeries
Rhinoplasty (Nose shaping)
Breast reduction and augmentation
Deformity Corrections
Cancer reconstruction:
Head and neck cancer
Breast cancer
Others
Burn care, post deformity corrections
Microsurgery and Trauma
Artery repairs
Nerve repair, rehabilitation, tendon transfers
Wound coverage by micro free tissue transfer
Replantations
Brachial plexus injury treatment
Lymphoedema – comprehensive management (surgical and non-surgical)
Obesity care, management, body shaping
Our Departments
Ear Reconstruction
Cleft And Craniomaxillofacial Surgery
Burn Surgery
Hair Transplant

The Centre for Endocrinology and Diabetes is the only full-fledged endocrinology centre in the entire state of Kerala and provides advanced care for diabetes mellitus as well as complex endocrine diseases. There are full facilities for the investigation and treatment of endocrine problems in adult, paediatric, and adolescent patients and all the complications of diabetes. The Centre consists of a dedicated and well-qualified team of healthcare professionals comprising consultant endocrinologists, endocrinology specialists, diabetic foot surgeons, diabetic fellowship trainees, diabetic educators, physiotherapists, psychologists, podiatry assistants, medical social workers, dieticians and support nursing, administrative and research staff.

Features
Comprehensive Diabetes Care Program
Obesity Management Program
Thyroid Cancer Care Clinic
Paediatric Endocrinology Clinic
Osteoporosis and Metabolic Bone Disease Programme
Insulin Pump Therapy
Insulin Pump Therapy
Rhythm disorder surgery
Insulin Pump Therapy
Pituitary Diseases Clinic
Adrenal Disorder Assessment
Community Services
Diabetic awareness classes and exhibitions
Free medical camps
School health programmes for diabetic awareness
Free insulin distribution for poor patients
Publication of DIABEAT – a quarterly magazine on diabetes care for patients
Supply of glucometers and walkers on a rental basis
Documentaries for creating awareness of diabetes and its complications
Speciality Clinics
Thyroid Cancer Clinic – 1st Wednesday, 2nd Friday and 3rd Thursday of the month.
Executive Clinic – Monday to Thursday – 4:30 PM – 7:30 PM
Obesity Clinic – Every Tuesday
Our Services
Provides advanced care for diabetes mellitus as well as complex endocrine diseases

Diabetes Care Programme
The Diabetes Care Programme provides intensive management of diabetes and diabetes related problems:

Retinopathy
Nephropathy
Neuropathy
Ischaemic Heart Disease
The Programme also offers:

Management of gestational diabetes
Paediatric diabetes clinics
Psychological and social worker consultations
Assessment of family risks of developing diabetes
Diabetic Foot Care Program and Vascular Clinic
The Department of Endocrinology at AIMS is the most comprehensive one stop centre for the evaluation, treatment and rehabilitation of preventive and therapeutic aspects of diabetic foot. The diabetic foot division of the Department of Endocrinology is fully equipped with the most modern equipment to assess the function of nerves and blood vessels. The department provides all services under one roof, including special customized foot wear. The foot care programme is the only one in Asia to carry out reconstructive surgery in deformed diabetic foot – an emerging strategy for preventing diabetic foot-related amputations.

Paediatric and Adolescent Endocrine Clinic
This clinic provides specialized care for children and adolescents with growth disorders, early or delayed puberty, thyroid diseases, bone diseases, diabetes or other endocrine disorders.

Lipid Clinic
The Lipid Clinic is devoted exclusively to treating patients with high cholesterol and high triglyceride levels.

Exercise and Dietary Programme
The Exercise and Dietary Programme is aimed at full-fitness, utilizing treadmills, exercise bicycles, and other equipment under the guidance of a trained physiotherapist. The amount of exertion is gradually increased depending on each individual’s capability.

Bone Clinic
Metabolic bone diseases are a relatively less-recognized aspect of endocrinology. These diseases include osteoporosis (an age and menopause-related thinning of bones,) osteomalacia (weakening of bones due to vitamin D deficiency,) hyperparathyroidisrn (a disease with bone pains and kidney stones, caused by excess parathyroid hormone levels resulting in dangerously high calcium levels in blood) and other complex bone diseases. The Centre has the best Bone Densitorneter, the DEXA Dual Energy X-ray Absorptiometry, in the state to evaluate these complex disorders. Unexplained bone pains and early onset fractures are diseases investigated and managed by the department.

Comprehensive Diabetes Care
In addition to the routine out-patient based care of diabetic patient, the department has also initiated comprehensive diabetic care programme, focused on providing an annual diabetes check up to patients. Diabetes is known as a silent killer, and if left untreated, can cause kidney, nerve, eye, heart and foot problems. The annual checkup assesses the degree of glucose control and also measures the presence of diabetic complications. If detected early, many of these complications can be treated, and their progression can be stopped.

Obesity Clinic
A common example of an under-treated endocrine disease is obesity. In this regard, AIMS has started a multidisciplinary obesity clinic. The clinic is conducted primarily by the endocrinology team, in coordination with the departments of Gastrointestinal Surgery and Plastic Surgery. AIMS is probably the only obesity centre in the country to incorporate endocrinologists, GI surgeons and plastic surgeons working together for a common cause under the sphere of obesity management. In addition to hormonal assessment of obesity, our centre also has state-of-the-art facilities for body fat assessments, preoperative assessments and postoperative follow up for obesity patients. We have a comprehensive medical nutrition programme, exercise counselling, drug therapy and plastic surgery, as well as bariatric procedures.

Centres of Excellence Departments
Podiatric Surgery

The Centre for Psychiatry and Clinical Psychology at AIMS addresses itself to developing clinical services, training programs and research projects. Outpatient services treat all type of psychotic, neurotic, organic, psychiatric and dual diagnosis disorders. Patients with childhood behavior disorders, addiction disorders and old-age disorders are also treated. Consultation cases are also referred to our department from other clinical departments. Patients are evaluated in detail from psychiatric and behavioral perspectives. Drug treatment, psychotherapy, and psychosocial therapy are judiciously combined and used.

Our Departments
Psychiatry And Behavior Medicine
The Department of Psychiatry and Behavior Medicine provides comprehensive mental health services ranging from psycho-social treatments like counseling and psychotherapy to biological treatment modalities including pharmacotherapy and electroconvulsive therapy.

Clinical Psychology
The Department of Clinical Psychology offer services for those in need of professional psychological help across the life span – from childhood to old age. The major areas of services include assessments, diagnostic services and psychotherapies.

Transplantation of organs has been considered one of the significant advances that has occurred in medicine offering a healthy life back to numerous people all over the world. Transplants can be broadly grouped into three types, i.e., Tissue, Solid Organs and Vascularized Composite Tissues. Tissue transplants mainly include blood and marrow. Solid organ transplants include liver, heart, kidney, lung, small intestine and pancreas. Vascularised composite tissues, which are relatively new include hands, face and abdominal wall. The organs can be donated by live donors for certain organs and procured from brain-dead / deceased donors.
The first transplantation that was done at Amrita Institute of Medical Sciences was in September 04, 2001 and was that of a kidney procured from a live donor. Since then the transplant services of the institution has pioneered a lot of procedures in the state as well as the country becoming one of the largest centers in India carrying out these procedures. The center has a large experience in liver and kidney transplants and also has carried out heart, small intestine and pancreas transplants. The first and second hand transplants in India was successfully carried out in 2015. This center of excellence has a well organized transplant social worker network and has been involved in implementing the policies of the Kerala Network for Organ Sharing from its inception. The institution has led the state in deceased organ procurement and has been involved in the training of other teams from the state. The immunology department has pioneered HLA matching in the state and has been practicing state of art methods in this. The center of excellence has initiated steps to start basic science research related to immunosuppression in composite tissue transplants suitable to our country.

Supporting Services
Transplant Coordination and Social Work
Transplant Immunology
Transplant Pathology
Transplant Anaesthesiology
Blood Bank
Our Departments
Blood And Marrow Transplantation
Liver Transplantation
Small Bowel Transplantation
Pancreas Transplantation
Kidney Transplantation
Heart Transplantation
Paediatric Heart Transplantation
Lung Transplantation
Composite Tissue Allotransplantation
Corneal Transplantation

The aorta is the biggest blood vessel in the body and it carries blood from the heart to the rest of the body. A number of diseases can affect the aorta leading on to Aneurysm formation (enlargement of the aorta), Dissection (tear in the wall of the aorta) and stenosis (narrowing of the aorta). These are potentially life threatening conditions necessitating early diagnosis and appropriate treatment.
The common diseases that can affect the aorta include hypertension and atherosclerosis leading on to the above mentioned disorders. But a number of genetic and connective tissue disorders can also affect the aorta like Marfan Syndrome, Ehlers Danlos Syndrome and Loeys Dietz Syndrome among others. Connective tissue disorders affect multiple structures in the body like heart valves, blood vessels, eyes, bones and nervous system.
Thus providing a comprehensive care to these patients requires involvement of doctors across multiple specialities to provide care and long term follow up. Keeping this in mind, the Amrita Institute of Medical Sciences has started a dedicated Centre for Aortic Diseases and Marfan Syndrome. The aim of the centre is to provide a patient centric approach involving doctors from various departments with a special interest in diseases of the aorta to give patients the best possible care of their disease.
The Centre for Aortic Diseases and Marfan Syndrome at Amrita would become a referral centre for comprehensive treatment of diseases involving the aorta which include the entire spectrum of surgical interventions, key hole endovascular treatment, hybrid procedures, and percutaneous aortic valve replacement (TAVI).

The Amrita Centre for Aortic Diseases and Marfan Syndrome will provide:
Diagnosis
Genetic workup in patients with familial diseases of the aorta like Marfan syndrome
Apart from Marfan syndrome the centre will diagnose and treat other connective tissue diseases related to the aorta such as Loeys-Dietz syndrome, Ehlers-Danlos syndrome and familial aortic aneurysm
Treatment including medical management and open, hybrid and endovascular surgical treatment
Counselling for women in reproductive age group and special antenatal care for patients with Marfan syndrome who are pregnant
Periodic check-up for asymptomatic Marfan syndrome patients
Marfan Syndrome
Marfan Syndrome is an inherited genetic disorder that affects the connective tissue in the body. It affects 1 in 5000 people and it affects males and females equally. The connective tissue is basically the gel that binds the cells and tissues together and hence is essential for normal growth and development of all organs in the body. Increasing awareness among the medical and general community has led to an increasing diagnosis of this condition leading to earlier detection and proper treatment.

Genetics
Marfan Syndrome occurs due to a mutation in the gene that codes for a protein called fibrillin 1. Fibrillin 1 in turn is important in the makeup of connective tissue in various parts of the body. 75% people with Marfan Syndrome inherit it from their parents. The remaining 25% with Marfan Syndrome develop it because of a spontaneous mutation and thus do not have a family history of the disease. A patient with Marfan syndrome has a 50% chance of transmitting the affected gene to his children, as the inheritance pattern is what is termed as autosomal dominant.

Manifestations of the disease
They have hyperextensible joints meaning they have more than normal mobility at some joints in the their body. Fibrillin containing connective tissue is present throughout the body so the manifestations of Marfan Syndrome can affect various parts of the body. The most visually characteristic features of Marfan Syndrome are its affects on the skeletal system. Patients are typically tall and thin in stature with long arms and legs.
They can also have chest wall deformities like a depressed or prominent breastbone and abnormal curvatures in the spine.
This disease also commonly affects the heart and blood vessels. In the heart it can cause leaks in the valves leading on to enlargement of the heart and eventually heart failure. Also over time it causes gradual enlargement of the major blood vessel of the body, the aorta, arising from the heart causing aortic aneurysm formation and sometimes even tears in the aorta called aortic dissection. The importance of the involvement of the heart and blood vessels in Marfan Syndrome is that it is usually the cause of death in these patients.
The eyes are also characteristically affected in Marfan syndrome causing a classical lens dislocation but this does not interfere with vision. However they also develop short sight and early onset cataract and glaucoma which can affect vision.
The skin is also affected by Marfan syndrome causing stretch marks and the nervous system can also be involved and is manifested by swelling of the membrane covering the spinal cord causing lower back and leg pains.
Marfan syndrome can also affect the lungs causing emphysema or over inflated lungs, lung collapse and asthma. This disease does not affect intelligence.
Manifestations of the syndrome can occur at any age with some patients displaying signs at a young age and some only manifesting the disease later on in life. There is currently no cure for the disease. The importance of early diagnosis of the disease is for providing regular follow up of the affected organs to detect problems before they become life threatening and thus in turn provide better outcomes. Also early detection allows for genetic counseling for family members and also discussion regarding risk of transmitting the gene to their children.
Being a disease that affects various organs and has implications for family members as well it is important to get treated at a center with knowledge, experience and expertise in treating Marfan Syndrome and other related disorders.
Amrita Institute of Medical Sciences in Kochi, Kerala has a dedicated Marfan Syndrome and Aortic Center, which comprises of a team of doctors from various specialties with a dedicated interest in diseases of the Aorta. This facilitates a comprehensive care of the patient as a whole.
The procedures done for aorta related diseases include aortic valve repair and replacement, aortic root replacement (Bentall procedure), valve sparing root replacement (David Procedure), ascending aorta replacement, aortic arch surgery, and descending thoracic and thoracoabdominal aortic surgery. Endovascular (keyhole) aortic surgeries are also done in appropriate patients.
At Amrita, we have surgeons who have received specialized training in aortic diseases so that we provide all the latest surgical options in aortic diseases like valve sparing aortic root replacement, aortic arch surgery and keyhole endovascular repairs of the aorta.

The mitral valve is one of the major valves in the heart located between the two left sided chambers of your heart. It basically functions to allow uni-directional flow of blood from the upper to the lower chamber. It has two leaflets which ensure the competency of the valve. Occasionally one or both of the leaflets may abnormally bulge back into the upper chamber causing a condition called mitral valve prolapse. This can over time lead to backward leak of blood through the valve a condition called mitral regurgitation. In the initial stages mitral regurgitation is managed by your Cardiologist using a variety of available medications. However if the leak progresses to a severe degree then surgery becomes the only option as long standing severe leak will lead to harmful effects on the heart and lungs.
Surgery for mitral regurgitation should ideally be by repairing your mitral valve i.e. by retaining your own valve as it has been proven to lead to better long term results almost equal to a person who does not have valve disease. Also if the valve is repaired one does not have to take lifelong medicines to prevent blood clotting. So the quality of life is also maintained after mitral valve repair. The valve repair is done either through a conventional open technique or sometimes through a minimally invasive key hole technique.
Only in cases where it is deemed that the valve is not repairable should mitral valve replacement be done with artificial valves which may be mechanical or tissue valves.Here at Amrita, we have extensive experience with mitral valve repairs over the years and we offer it as the first choice to patients who come with mitral regurgitation.

Services Offered
The services offered at the Amrita Mitral Valve Repair Centre of Excellence are:

Advanced therapeutic options:
State of the art echocardiography including 3D and TEE
Advanced diagnostic studies:
Mitral Valve repair using various techniques like neo chordae, limited leaflet resection and leaflet sliding plasty. The surgical program is headed by Dr. Praveen Varma, Chief of Cardiovascular and Thoracic Surgery.

The Amrita Advanced Centre for Robotic Surgery at Amrita Institute of Medical Sciences was inaugurated by the Honorable Chief Minister of Kerala, Sri Oommen Chandy, on March 02, 2015.

da Vinci Surgical System
The da Vinci Surgical System is a tool that utilizes advanced, robotic technologies to assist your surgeon with your operation. It does not act on its own and its movements are controlled by the surgeon. The system is advanced robotic platform designed to expand the surgeon’s capabilities and offer an option to open surgery.
The da Vinci Surgery is a less invasive technique than traditional surgery. With da Vinci Surgery, the cuts (incisions) made in the human body by the surgeon are much smaller than the cuts made during traditional surgery. The Amrita Institute of Medical Sciences uses the da Vinci Surgical System for gastro-surgical, uro-surgical, gynaec-oncologic, cardiothoracic, head and neck cancers and liver transplant donor surgeries. Amrita Institute of Medical Sciences is one of the leading centres in Robotic Surgery in India with over 2200 surgeries performed during the last 6 years.
Compared with traditional surgery, having the da Vinci Surgery offers a shorter hospital stay, less blood loss, fewer complications, less need for narcotic pain medicine, a faster recovery and smaller incisions for minimal scarring.

Robotic Surgery in Gynaecologic Oncology
In Gynaecologic Oncology, robotic surgery is mainly used for the treatment of endometrial and cervical cancer. The surgical treatment for endometrial cancer is hysterectomy, with removal of the fallopian tubes and ovaries and also removal of the pelvic and para-aortic nodes. Surgical treatment for early cervical cancer is radical hysterectomy with removal of the pelvic nodes. Both these procedures are well suited for robotic surgery and in fact robotic surgery for endometrial and cervical cancer is advantageous over conventional as it has reduced blood loss, reduced hospital stay and reduced surgical morbidity without compromising the standard of surgery. Another advantage which the robotic platform offers is the integrated infrared imaging which allows detecting the sentinel node in endometrial and cervical cancer. This helps to reduce the surgical complications associated with lymph node dissection. At Amrita, we have completed more than 800 robotic surgeries in the gynaecologic oncology department and we are one of the leading centres in India to perform robotic gynaecological cancer surgeries. We do robotic surgeries for endometrial cancer, cervical cancer, early ovarian borderline and malignant tumors and also for isolated abdominal recurrences of gynaecologic malignancies.
Since 2017, the centre has started day-care surgical programs where patients affected with gynaecological cancers are undergoing surgery without even overnight hospital stay.
Our pioneering work in robotic surgery has been published in many national and international journals.

ROSA (Robotic Surgical Assistant)
The Amrita Institute of Medical Sciences is the first healthcare facility in India and one of the first in all of Asia-Pacific to set up robotic technology for neurosurgery.
The new generation robotic surgical technology – ROSA – will assist a broad range of surgical interventions to treat Parkinson and Epilepsy treatments, brain tumours, hemorrhagic strokes and endoscopic surgery of the brain. The robot can be used for guidance, precision and accuracy during a variety of cranial procedures. It provides a precise, mathematically correct trajectory to the destination in the brain.
Progressively, more robotic surgical machines will be inducted to set up India’s first Centre for Excellence in Robotics in the healthcare sector at Amrita Institute of Medical Sciences .

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