A team of cardiologists of the Christian Medical College (CMC) Hospital, Vellore, has used a novel percutaneous route to implant a pulmonary valve in a 54-year-old woman from Puducherry. The doctors implanted the new heart valve through the jugular vein, a blood vessel in the neck.
The patient had undergone open heart surgery for “Tetralogy of Fallot”, a condition in the heart that causes oxygenated blood and deoxygenated blood to mix with not enough blood reaching the lungs, when she was 9, at CMC. She had recently approached the hospital with progressive fatigue and trouble in doing her household activities.
At CMC, doctors found that one of her valves in the right side of the heart — pulmonary valve — was defective and was allowing reverse flow of blood into the heart.
This caused her pulmonary artery, the blood vessel that carries blood to the lungs, to enlarge significantly. If left untreated, this could lead to progressive deterioration of the heart function, according to a press release.
After a detailed evaluation, the structural heart team was of the view that she needed a new valve. Considering that she had undergone an open heart surgery in the past, a repeat surgery would carry higher risks and require prolonged hospital stay.
Non-surgical implant
Doctors pointed out that recent technological advancements in interventional cardiology allowed for implantation of new valves non-surgically. Over the past four years, they have been following a low-cost non-surgical or percutaneous valve implantation programme. By avoiding an open-heart surgery, the percutaneous procedure helped in reducing hospitalisation time and led to quicker recovery, doctors said.
For this patient, doctors used a made-in-India artificial heart tissue valve that was increasingly used in European countries such as Germany and the Netherlands.
With the patient’s pulmonary artery becoming exceptionally large, the largest portion of 32 mm of artificial valve was utilised for the procedure.
A team of cardiologists of cardiology unit-2 John Jose, Paul V. George and Harsha Teja — implanted the valve in the pulmonary position through the jugular vein under anaesthetic support by the cardiac anaesthetic team Raj Sahajanandan, Balaji and Kirubakaran.
“We have previously done valvuloplasties through the jugular vein. In some patients, inserting the catheter through the femoral vein (in the groin) and taking it to the heart can be technically challenging due to normal anatomical angulations and distortions due to disease pathology. In this patient, we had to take a large valve of 32 mm that required a puncture of about 8 mm in the jugular vein. This was the biggest challenge in the procedure,” Dr. Jose, professor of cardiology, said.
