Mumbai: Dipesh Shah suffered from a major heart problem and doctors described his case as ‘extremely rare’ with a risk of developing permanent infections. But 39-year-old Shah's heart valve was successfully repaired without serious repercussions after a first-of-its-kind surgery.
Shah suffered severe aortic valve leakage in his heart, but secured a new lease of life when a team of medicos led by Ramakant Panda successfully operated on him.
Panda described the case as ‘extremely rare’. This was the ‘first time in India that a unique surgery of this nature’ was conducted at the Asian Heart Institute (AHI).
Shah, who did not have any previous complaints of heart trouble, had gone to AHI for a routine check-up in January. Though all his investigations were fairly normal, his 2D Echo revealed leakage in the aortic valve.
“A heart valve helps control the flow of blood in and out of the heart. The leakage is caused due to damage to the aortic valve and results in backward flow of blood from the aorta. Shah's CT coronary and aortic angiogram showed different tubular dilation (bulging) of the ascending aorta,” Panda told IANS.
Finally, on March 12, as Shah's anxious wife Jigisha, 14-year-old son Mounil and 78-year-old father prayed, he was wheeled into the operation theatre for surgery that lasted over 12 hours.
He first underwent Trans Esophageal Echocardiogram (TEE), a procedure in which the probe instrument is inserted through the mouth and passed into the food pipe to view the heart and its functioning.
This was followed by opening the aorta, an examination of the aortic valve and the decision to repair it, said Panda, who shot to fame after he successfully operated on Prime Minister Manmohan Singh last year.
“Generally, when the valve gets damaged, it is replaced with a mechanical or biological valve. However, in this case the valve was repaired, not replaced,” he explained.
Accordingly, the dilated portion of the ascending aorta was replaced with a 34-mm woven polyester vascular prosthesis, reinforced with bovine collagen. The right and left coronary arteries were re-implanted on the vascular prosthesis.
“TEE was repeated on Shah, which showed mild aortic leakage, indicating good repair. The patient was absolutely stable and discharged a week later (March 19),” Panda said.
Explaining the challenge, Panda said that when the valve does not function properly, it is either repaired or replaced with a new valve, especially the aortic valve.
“Replacement involves a lot of post-surgical care. Since the new valve is a foreign object, it tends to produce clots and gets blocked, compelling the patient to take blood thinners for the rest of his/her life,” he added.
Added to this is the risk of the patient developing permanent infections in the replaced valve.
However, if it is repaired - as in Shah's case - the patient retains his own valve, doesn't need long post-operative care and quality of life is much better,” Panda said.
Aortic valve repair is a rare thing. In Shah's case, because of the 7-8 cm bulging of the aorta, the gap between the flaps of the valve had increased
considerably, making it near-impossible to repair it, which resulted in its dysfunction, though the flaps had not torn. Jigisha said that the Shah family would be forever indebted to Dr. Panda and his team, for giving a new lease of life to her husband.
“He has come home now and is feeling quite normal. Yes, there are severe dietary and other restrictions, some minor side-effects after the surgery, but he is cheerful,” said Jigisha.
The total cost of the operation would work out to over Rs.1 million (US $22,205) Jigisha said adding that her husband is expected to go back to his routine within two months.