India's first: Both right-sided heart valves treated minimally, avoiding open surgery, at Pulse Heart Super Specialty Hospital, Miyapur

New Delhi: The patient condition: A 59-year-old lady with carcinoid heart disease was referred by a senior cancer specialist for advanced treatment for her heart valves which were affected by the carcinoid syndrome. She had a severe leaking of both the right sided heart valves, i.e., Tricuspid and Pulmonary valves. With this leak (medically called regurgitation), her heart size greatly increased, her liver got damaged, she developed huge amount of fluid in the abdomen and feet and was very breathless.

She needed advanced chemotherapy for carcinoid syndrome and the senior oncologist from a corporate hospital referred her to Pulse Heart Super specialty hospital for the advanced treatment of right sided heart valves so that she can withstand the said chemotherapy. A detailed discussion of various modalities of treatment were discussed at Pulse Heart SSH with the team of cardiologists, cardiac surgeons, critical care specialists, anesthetists and most importantly, the patient attendants.

It was decided that the patient would benefit from pulmonary valve replacement and bicavalTric valve placement for the tricuspid valve. She was deemed an extremely high-riskcandidate for open heart surgery. The first of its kind treatment in India: TPVR, transcatheter pulmonary valve replacement is a very rare procedure done in only select centres in India. TRIC valve placement is even more rare procedure requiring special training and skill. Both these procedures in a single patient was an unique therapeutic challenge and was not done in India so far. The fourth such treatment done in the world: Right sided valve surgery is complicated and is needed in advanced disease which precludes open heart surgery in many patients.

Treating both right heart valves in a single patient with minimally invasive treatment presents great challenges.It was done using TPVR and Tric valve system in only three patients in the entire world. The procedure: From the right groin, a bioprosthetic pulmonary valve (Myval from Meril Life sciences) is inserted at the native pulmonary valve. This was followed after three days with implantation of the bicaval valve system (from Relisys medical devices; P+F GmbH) for the treatment of severe tricuspid regurgitation. Both the procedures were done in local anaesthesia with the patient being completely conscious throughout the treatment.

Dr M. S. S. Mukharjee and Dr Movva Srinivas led the team, comprising of Dr Vinod Unni, Dr Kranthikumar, Dr Vikas Shukla, Dr Vamsi, Dr Nanda Kishore, Dr Chandresh, and Dr Rajesh. The procedure was guided by cardiologists Dr Jayaranganath and Dr Srinivas from Bangalore and Dr Abhishek Rajpopat from Ahmedabad. The patient is stable and is walking following the treatment. Her condition is constantly being monitored by critical care specialists and cardiologists.