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Heart treatments made easier

health-and-fitness Updated: Dec 25, 2012 02:46 IST
Rhythma Kaul
Rhythma Kaul
Hindustan Times
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About a decade ago, none could imagine that a heart valve might be replaced without cutting open a person. Now medical science has advanced to a stage where not only the valve is replaced without surgery, but also a person is fully conscious while undergoing the procedure.

"Heart treatment procedures have come a long way, with a number of inventions and innovations having taken place to make it safer for patients, especially those who are at a higher risk and cannot afford to undergo surgery," said Dr Ashok Seth, chairman, cardiac sciences, Escorts.

Last week, at Fortis Escorts Heart Institute, Dr Seth replaced the heart valves of two of his patients without giving them anaesthesia, as both of them were high-risk patients for surgery.

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"Both had complications such as bad lungs, with severe tracheal congestion and enlarged thyroid, and would have required ventilatory support after the procedure, which we did not want. So, we performed valve replacement under local anaesthesia," said Dr Seth.

The technique was attempted for the first time in the country.

"Doctors have been doing it abroad for the past 2-3 years. But in India, this was done for the first time. It took less than an hour and replacing the valve was as safe as putting a stent in a clogged artery," said Dr Seth. Soon after the procedure, both of the patients were up and about.

Last year, Dr Seth had introduced for the first time in the country a non-surgical procedure to replace valve called Transcatheter Aortic Valve Implantation (TAVI), wherein the TAVI valve was inserted through a catheter up the groin that travelled up the aorta to the heart.

The procedure was done under general anaesthesia earlier in the cath lab. Almost two out of 10 patients requiring valve replacement are high-risk for giving anaesthesia. "Earlier we had no option but to take that risk," added Dr Seth.

The doctors, however, had a bit of convincing to do for the patients to allow the experiment. "We were aware of the uncertainty but then we trusted our doctor. Dad was high-risk for anaesthesia, so we had to take the risk. It worked well and all is well that ends well," said Pankaj Goel, whose father, SC Goel, 79, is one of the two persons who underwent the procedure at Escorts.

The procedure costs about Rs.15 lakh. Angioplasty, a technique of mechanically widening narrowed or obstructed arteries using stents, has also seen what doctors term as the fourth revolution.

Approved for commercial launch by the Drug Controller General of India last week, Bioresorable Vascular Scaffold by Abbott Vascular has changed the face of stenting.

Unlike metallic stents, this device is made of polylactic material that gets dissolved over time as it breaks into natural components like carbon dioxide and water.

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"It's programmed in a manner that supports the artery for six months, delivers the medicine and then is absorbed by the body. In two years, there is no trace of the stent in scans," said Dr Seth.

Apart from Escorts, All India Institute of Medical Sciences and Medanta are some of the hospitals that have been using these stents.

"This new method of treatment is labelled as vascular restoration therapy as it merely restores the function and gets dissolved," said Dr Seth.

The therapy, however, comes at a steep price, with a stent costing Rs.2.9lakh, as opposed to Rs.1.35 lakh that one medicated stent costs.

Organisations such as India Medtronic through its Healthy Heart for All initiative (www.healthyheartforall.org/aboutus) are providing cardiac treatment on easy monthly installments. Loans can be paid back in instalments as less as Rs.600 a month.

Heart faqs
Is there a link between smoking and heart disease?
Smoking is behind more than 25% of heart disease-related deaths worldwide. It leads to reduced oxygen supply to the heart, clotting of blood and high blood pressure.

What are the risk factors for coronary heart disease?
Some of the risk factors are: family history of a heart attack, age, gender, menopause, smoking, high cholesterol, high blood pressure, obesity and lack of exercise.

What dietary changes can I make to reduce my risk of a heart attack?
Eating right is a powerful way to reduce or even eliminate some heart disease risk factors. One needs to reduce bad cholesterol, lower blood pressure and blood sugar and reduce weight for heart to stay healthy. Also, increase intake of fruits and vegetables.

Are you at a risk of getting a heart attack? Take a quiz