Thursday, May 23, 2024

Two heart valves ( Aortic and Mitral) of a 55-year-old Canadian replaced Non-Surgically with TAVI and TMVR; the first case in Asia

Both the heart valves of the patient were severely diseased

The patient was suffering from severe aortic and mitral stenosis and severe mitral annular calcification. He was deemed extremely high risk for surgery and was denied surgery at all major hospitals in the country.

A 55-year-old Canadian patient, originally from Chandigarh underwent successful two heart valve replacement with TAVI and TMVR, without open-heart surgery by a team of doctors led by Interventional Cardiologist and structural Heart Disease specialist, Dr. Ravinder Singh Rao. The patient was suffering from severe aortic stenosis, severe mitral stenosis, and severe mitral annular calcification.  Due to the above heart problems, he was finding difficulty in doing his Daily activities and would become short of breath on minimal exertion. He was also hospitalized for heart failure at his home town. Due to the severe narrowing of both the valves, medicines were not working for his disease and the only treatment which was offered valve replacement.  Dr. Rao replaced both mitral and aortic valves by performing TAVI and TMVR, non-surgically. This transcatheter native double valve replacement in the same sitting is rarely performed worldwide and is the first case in Asia and in India. This treatment has brought a new ray of hope for the patient and his family.

 Aortic stenois refers to narrowing of the aortic valve. Aortic valve is the outflow valve which controls the oxygenated blood flow  from  heart to the body. Mitral valve controls the flow of blood from lungs to the heart. Narrowing of both the valves creates a life threatening situation called aortic stneois and mitral stenosis causing heart failure. The patient was admitted to the hospital with the condition of heart failure, a history of shortness-of-breath, difficulty in walking and carrying out the daily activities.  Traditionally such patients are treated with open heart surgery. However, due to his calcification in aorta and chest wall, he was deemed high risk for open heart surgery by more than three surgeons from all across the country. Dr Rao who specilaises in TAVI and TMVR from Mount Sinai, New York and Washington university school of medicines, St Louis, USA decided to perform TAVI and TMVR in MAC in the same sitting.

Commenting on the procedure, Dr. Ravinder Singh Rao, Director TAVI and Structural Heart Disease Programme, Interventional Cardiology at Eternal Hospital, Jaipur, said, “This was the first successful TMVR in MAC in the country and the first case of native transcatheter double valve replacement. CT angiogram was done to assess the size of the valve and also to aasess the size of groin vessels via which the valves were to be replaced.  He was to undergo: TAVI (Transcatheter Aortic Valve Implantation) and TMVR (Transcatheter Mitral Valve Repair) in MAC (Mitral Annular Calcification). The aortic valve was replaced using TAVI, and a new valve was placed inside the old valve. The new valve started functioing immediately and had no complication. Substituting the mitral valve in calcified stenosis was one of the biggest challenges. The new valve was placed by going from the Femoral vein (found in the leg) under fluoroscopic and echo visualization. The valve was then deployed under rapid pacing following which both the valves began to function. Both the valves started functioing immediately and had no complication. The patient was taken off the ventilator, immediatley post procedure and also met the family and spoke with them. He stayed in the ICU for one day. Following this he was shifted to the room and started recovering.” 

The son of the patient, said, “It felt unreal to be able to speak to my father immediately after the procedure, and he was with us in the room the very next day. Both the valves were replaced, and there was no scar on his chest. Even though we consulted multiple hospitals, the treatment for this particular condition was not available. However, when we consulted Dr Rao, he suggested TAVI and TMVR. We travelled to him and got our treatment.  Dr. Rao went on to replace both the valves as it was the only complete solution for my father’s medical condition. We are thankful to him for performing this miracle and helped save my father’s life.”

Dr Rao has experience of doing maximum TAVI procedure in India. He is also Co-prinicipal investigator for the National TAVI studies and has presented and shown live TAVI proecdure for national and international meetings. He has also protored TAVI in India, Asia and in Europe .

TAVI is a minimally invasive heart procedure conducted to replace a narrowed aortic valve that fails to open correctly and can be an option for people who are in immediate or high risk of complications from the traditional surgery. In multiple randomized trials like PARTNER 2, PARTNER 3, TAVI when compared to surgery is safer in selected patients.

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