In a first, doctors at the State-run Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICSR) have done a tricuspid valve (on the right side of the heart) replacement using a non-surgical method on a 17-year-old boy. The surgery costing Rs.15 lakh was done free of cost with help from donors and the manufacturers.
As the boy had undergone two open heart surgeries previously, doctors said a third surgery carried highest risk and hence a non-surgical procedure was the only option. So far, this procedure has not been done on any patient in this age group in Karnataka, claimed doctors.
The patient, Karthik, was diagnosed with an infection (Endocarditis) on the right side of the heart (tricuspid valve) in 2012. Doctors found that the infection had destroyed the valve leaflet. After appropriate treatment for the infection, he was taken up for surgery and his valve was repaired, institute director C.N. Manjunath told.
However, one year later, he came back with breathlessness and an ECHO revealed severe leakage of the same valve. Subsequently, in 2017 this leak was addressed surgically by use of a graft valve extracted from a cadaveric heart donation through another open heart surgery, the doctor said.
Two years after the second surgery, the leak had gradually worsened and was again severe, which needed repair. In 2020, the boy again came back with complaints of palpitations. On evaluation, he was found to have a rhythm abnormality due to a defect in electrical conduction in the heart. He underwent a corrective procedure – Radiofrequency Ablation (a cath lab procedure) – for increased heart rate.
Meanwhile, the tricuspid valve was still leaking resulting in heart failure and the patient’s physical activity had markedly reduced. “As he had already undergone two open heart surgeries, performing a third open heart surgery carried the highest risk. Hence, we decided to replace this valve by a non-surgical method using a 19mm tissue valve called ‘MyVal’,” the doctor said.
Elaborating on the non-surgical technique, Dr. Manjunath said, “It is like an angiography. A tissue valve is mounted on a balloon and inserted through a leg vein under fluoroscopy in a cardiac cath lab. The valve is deployed at the site of the tricuspid valve within the homograft done earlier.”
A team of doctors led by Jayaranganath M. and John Joseph conducted the procedure on February 19 and the patient was discharged on February 25. Two weeks after the procedure, the boy is doing well and has resumed his normal activities.
“The boy had lost his father, a painter, a few years ago. His mother, who works as a cook, has the responsibility of Karthik and his sister. As they could not afford the cost, we pooled in Rs. 6.5 lakhs from donors. The remaining was shared by the institute and the manufacturers,” Dr Manjunath added.
