Doctors replace valve, insert pacemaker without opening up heart

Risk reduction:79-year-old S. Arunachalam along with doctors A.B. Gopalamurugan, V.V. Bashi and Raju (Vice President).— PHOTO: L. SRINIVASAN

S. Arunachalam was awake and talking during a surgery, which involved replacing his aortic valve and putting a pacemaker into his heart.

Doctors at SRM Institutes for Medical Science found the 79-year-old resident of Arumbakkam at high risk for an open heart surgery, and so, decided to do both procedures under local anaesthesia.

“The aortic valve is the main valve through which blood goes to the rest of the body. As you get older, the aortic valve can become severely narrowed, causing breathlessness and chest pain. This is the commonest heart valve disease in the elderly and if not dealt with, can be fatal. There are no medications for this disease – the only option is to change the valve,” said A.B. Gopalamurugan, chief of the department of percutaneous valves at the hospital.

On Monday night, a team began the four-hour procedure.

The valve, imported from Netherlands, was placed inside a catheter, entered into the femoral artery (in the groin) and pushed all the way to the point of the aorta where the valve needed to be replaced. The new valve squashes the existing diseased valve behind it, Dr. Gopalamurugan explained. The catheter is then removed.

Since the patient also had electrical system abnormalities in his heart, a pacemaker was also placed during the procedure.

In three days Mr. Arunachalam was ready to be discharged.

“As you grow older, apart from the heart developing blocks, you could also have kidney ailments, diabetes, lung or other problems. Often, such patients are high risk for open heart procedures, and so we have to keep innovating for procedures that are least traumatic to the body,” said V. V. Bashi, senior consultant cardiothoracic and vascular surgeon at the hospital. While the technology is about 15 years old, it is only recently that it is being used in India, Dr. Gopalamurugan said.

Chandra Arunachalam, the patient’s wife said that while he had no symptoms, doctors had said the narrowing of his valve was severe. “He also has diabetes and hypertension and had undergone a knee surgery a few years ago,” he said. The valve alone costs Rs. 15 lakh and along with disposals, the cost could be higher. The family has already paid Rs. 20 lakh, said Chandra Arunachalam, the patient’s wife.