Hospital conducts rare surgical procedure, saves 71-yr-old woman

Bengaluru: A rare and minimally invasive heart procedure, a tricuspid valve-in-valve implantation was conducted on a 71-year old patient, Shobha (name changed) suffering from rheumatic heart disease by the doctors at Aster RV Hospital. Being a very rare surgery, this procedure has only been performed once before in Karnataka.

Approximately, 70 percent of patients suffering from valve disease in India can be associated with rheumatic heart disease. It is a condition where the valves in the heart are permanently damaged because of childhood streptococcal infection and its sequela. The incidence of heart valve disease increases significantly with age affecting the longevity as well as the quality of life for elderly patients.

The patient complained of bouts of breathlessness, especially upon exertion. and doctors noted that this was a common sign for valve degeneration. "She had a bioprosthetic tricuspid valve implanted during her second open heart surgery 12 years back which had now degenerated. In such a patient, particularly because of her age and comorbidities, conducting another open-heart surgery to fix a new valve can be extremely risky. We advised her to undergo the minimally invasive percutaneous valve-in-valve procedure." said Dr S. Venkatesh, Lead Consultant, Aster RV Hospital. Shobha had already undergone two open-heart surgeries to treat her condition. Doctors felt that third heart surgery would be risky and could lead to a longer recovery time.

To determine the size of the heart and to check if there was any extra fluid in the heart or lungs, a physical examination, echocardiogram and CT Aortogram was conducted. The patient was also checked for potential damages to the heart. After successfully completing the pre-operation evaluations, the patient underwent a Tricuspid valve in valve implantation on 11 October 2021. "Through a vein puncture in the groin, we accessed her heart and implanted an MYVAL 27.5mm tricuspid valve within the previous bioprosthetic valve. This procedure typically takes about an hour to complete. She was extubated the same day and had an uneventful recovery," said Dr Venkatesh.

Within a week from surgery, the patient was also able to return to her life with normalcy.

The Aster RV is a tertiary care hospital that pioneers in percutaneous valve implantations and incidentally performed the First valve-in-valve transcatheter Aortic replacement in July 2019, the third valve-in-valve Transcatheter Mitral replacement in January 2021