Heart treatments when surgery is not the choice
In this program, we will be covering heart valve disease and its treatment options and live experience sharing of patients to empower us with the right and the latest information. Today, we are joined by eminent interventional cardiologist Dr. Rajneesh Kapoor
He is working as Vice-chairman at the Department of interventional cardiology at Medanta Hospital Gurugram, India
Dr. Rajneesh Kapoor has been honored with the prestigious Punjab Ratan award and is one of the top cardiologists in India with expertise in performing specialized heart treatments as such transcatheter aortic valve replacement, also popularly known as the TAVR or TAVI.
Dr. Rajneesh Kapoor says “we are trying to create a big awareness amongst people who would require such a procedure and amongst doctors also, because still, I feel, you know, this is relatively a newer procedure. And there are many people who can benefit from this, but probably because of ignorance or because of lack of awareness, they're not getting proper benefit of this procedure as a whole”
Role of valves in the heart and what can possibly go wrong with them?
Dr. Rajneesh Kapoor:
“Heart has four valves, two on the left side and two on the right side. There are two chambers, upper chamber and lower chamber there is one valve between these chambers and then the main exit valve which is aortic valve. The valve which is in between the upper chamber and the lower chamber is called the mitral valve and this main exit valve, through which actually the heart pumps all the blood to the body is known as aortic valve.”
So, now, how these valves can go wrong?
“There are many diseases which can affect and implicate the valves. It can be some infections, which happen during the childhood stage and can implicate the valves. They can deform the valves and they can make it narrower & then valves can start leaking. These put a huge strain on the heart. So, this childhood infection which leads to these deformities in the valves is known as rheumatic heart disease.
This main exit aortic valve can become diseased or deformed with advancing age. So, this is known as degenerative aortic valve disease. This disease happens usually, after 60 years of age.
We can actually see the valve deformities in the form of either narrowing which is called stenosis, or leakage which is called regurgitation. Both are very bad for the heart, and they put a huge strain on the heart and the heart starts to fail. So once this happens and heart dilates and starts to fail, it's it leads to a lot of miserable symptoms to the patient.”
What are the most common symptoms that hint at the possibility of heart valve disease and what are the tests needed to confirm them?
Dr. Rajneesh Kapoor:
“Many patients come to us with a symptom of breathlessness. Now, breathlessness can be an expression of this valvular heart disease. So, it's very important to pick up this breathlessness and get oneself investigated whether all the valve functions and the heart function is fine, whether it is attributed to heart disease or valvular heart disease at an earlier stage.”
“Patients come to us that this breathlessness is happening for the last four or five years and we thought that it could be exercise incapacity or some anemia or some other things, but they do not get investigated. From our point of view and this is a very awkward scenario because, at times if we don't do that, the heart disease becomes really advanced.”
“So, as you have asked the symptoms of valvular dysfunction could be the first symptom could be breathlessness, whether it is narrowing, whether it is to stenosis, whether it is leakage, the expression, the first expression could be breathlessness, and initially effortlessness happens on exertion only, but slowly as the disease advanced as there is more strain on the heart, the breathlessness starts to happen at rest also, and especially on lying down.”
“The second symptom then comes is that there could be a transient loss of consciousness, the patient may feel a lot of giddiness or patient may lose transient consciousness if the main aortic valve which is main exit valve is shrunken.”
How do we get diagnosed?
“Now i think this is again very important to emphasize here that it's a very very simple test to diagnose the vulvar dysfunction, that is simple echocardiography. which is an ultrasound of the heart, it can clearly give us a picture”
Line of treatment in patients who have been confirmed with heart valve diseases
Dr. Rajneesh Kapoor:
“Normally the opening of the aortic valve is four to six centimeters care, but if it goes less than one cm, I think that is one point where we can't ignore because patient becomes at very high risk of sudden cardiac death and heart failure.”
“Treatment strategies could be one that surgically we need to go with a full chest surgery and replace the valve surgically, that is one time tested method but off late for last 10 years or so we have a very good modality where any high risk patient, who has a high risk for cardiac surgery, we can replace the valve non surgically just via a percutaneous method and this modality is popularly known as TAVR”
Transcatheter aortic valve replacement or TAVR - please tell us more about it what is this procedure and how it is done as you mentioned it's relatively new?
Dr. Rajneesh Kapoor:
“Historically up till say 15 years back we had only one way to treat the valves that was a surgical replacement or surgical repair of the valve. The repair of the valve is not possible with the aortic valve but repair of the valve is possible with the mitral valve where the leakage is there in some subsets and not in all subsets. There were a lot many subsets who were highly vulnerable and are at very high risk for a surgical valve replacement, so we were not able to offer a surgical valve replacement.
So those patients are actually dying and we didn't have any option. So then this procedure came, which is known as TAVR.”
“The whole procedure is done through access in the artery, which is usually taken from the groin, no surgery, no cut on the chest, no incision done no blood loss. It has to be done with proper expertise and proper steps”
“We go across the valve with a wire, then the first balloon dilates the valve. And then the valve has to be deployed at a proper place with precise placement, that needs to be a certain time and again and properly it has to be done. Once this valve is deployed, it crushes the diseased well beneath, the new valve starts functioning immediately. Now it is a big relief to a patient.”
We have been talking a lot about TAVR. But then to know more about, how does it feel after TAVR treatment, we bring to you a live experience sharing from Mr. Kanhaiya Lal. He is 83 years of age and today he's right here at this live session.
Mr Lal says “I had a heart problem right from at the age of 21, but it did not affect my daily costs. In the month of May June, after this pandemic, I developed this breathing problem, acute problem, became so ill that once in the bathroom I couldn't come out, I collapsed. So immediately went to Medanta, contacted Dr. Kapoor. I had to thank him for treating me the way he did. And also educating me about my disease and the stage at which I am now.
TAVR patient experience - Dr. Rajneesh Kapoor
Mr. Lal has been really wonderful. guy, I would say, and, you know, it's privileged treating him. And as he mentioned, you know, it's a good 90% and maybe 95% improvement in the symptoms, he's back to his lifestyle, although he's adjusting a bit because of his age, but he's doing quite good. And thankfully, he is a very good patient, he's following all the things. And I think the major, major message which comes out of this is that, you know, there are many patients who have this disease of aortic stenosis, but somehow if you keep lingering on and sitting on this disease, which keeps on amplifying that strain on the chamber, it can be really risky and life-threatening, and the quality of life can be really bad. So now the treatment is there. Obviously, there are some logistics involved as to the cost of this treatment. But if somebody can afford one can really come back to a good quality of life, no symptoms and the survival also gets along significantly. So all these things are in favor of this procedure. And this is Mr. Kanhaiya Lal is giving a real example of that.
Dr. Rajneesh Kapoor is an eminent Indian interventional cardiologist and renowned expert in performing TAVR / TAVI has a 100% valve deployment success rate and 98% treatment success rate. He can be contacted for further advice on TAVR at 09971991740.