RabindraKalyan(S.N): The patient, Ms Neelam Deshmukh (78),was in a critical condition for nearly two weeks, when she received a new lease on life after she underwent Transcatheter Aortic Valve Implantation (TAVI) at Fortis Hospital, Kalyan. The procedure was performed by Dr Vivek Mahajan, Consultant-Interventional Cardiology and his team at Fortis Hospital, Kalyan on March 31, 2023.The success of this procedure is a medical landmark for Kalyan!
Ms Neelam Deshmukh, a resident of Nashik was experiencing breathlessness, weakness, blackouts, chest discomfort on minimal exertion, and disrupted sleep a month prior to her procedure. She was admitted to a hospital in Nashik where she underwent multiple tests; while her angiogram was normal, the 2D echocardiography reports indicated severe Aortic Stenosis. In this condition, the leaflets of the aortic valve (present at the beginning of aorta, into which heart pumps blood meant to be supplied to various body parts)do not open properly, due to an obstruction. This obstruction of blood flowresulted into tiring and weakening of the heart (as it got overworked), also known as ‘left ventricular failure’.
The patient continued to experience low blood pressure, caused by inadequate blood circulation throughout her body.This had an adverse effect on her Kidneys, leading to an increase in creatinine levels up to 2.7mg/dL,which was double than the normal levels (between 0.5 to 1.1 mg/dL). Her conditiondeterioratedrapidly, and she was shifted to Fortis Hospital, Kalyan for further treatment.The obstruction in the aortic valve and failure of the left ventricularhad resulted in blood accumulation&swelling in the lungs, resulting in low oxygen levels and extreme breathlessness.
At Fortis Hospital Kalyan, the patient was stabilisedafter the team corrected her blood pressure with medications, this reduced the swelling of the lungs&improved her creatine levels too. Now it became essential to tackle the aortic stenosis. The family was suggested two options –open heart surgery or minimally invasive TAVI. Considering her complications,TAVI was a less risky procedure, as compared toan open surgery.The patient could have lost her life if she wouldn’t have received a new valve in time.
Talking about the challenges Dr Vivek Mahajan, Consultant-Interventional Cardiology, Fortis Hospital Kalyan, said, “The patient had multiple complications and we faced challenges before &during surgery. Apart from the Kidney Dysfunction, Pulmonary Oedema and Heart Failure, her heart was pumping at only 20% against the normal 60% functioning. Also, she had a history of Stroke, that needed prolonged hospitalisation, leaving the patient psychologically affected & disoriented. We had to do an MRI to rule out new Stroke, and the reports came normal. Additionally, her ECG was abnormal, and we anticipated that she would also require a permanent pacemaker after the valve implantation.”
Dr Vivek Mahajan added, “The TAVI procedure was done successfully, and we could achieve an ideal and desired placement of the implant valve. A permanent pacemaker was placed two days after the TAVI procedure. Once both her surgeries were completed, her heart function became normal as the new valve allowed the pumped blood to reach various organs. The kidney failure resolved, and the lung congestion was cleared. TAVI gave a new lease of life to this patient with multiple complications, in whom open heart surgery would have been quite risky.”
Post surgery, the patient is doing well, and her heart’s pumping capacity has improved. She has been discharged, however as a precaution, she must take blood thinners for six months, follow a healthy diet and undergo routine check-ups for a year&annually thereafter. TAVI is a safe and life-saving procedure in critically ill patients with aortic stenosis, especially when open heart surgery carries a significantly higher risk of death and complications.
Dr Supriya Amey, Facility Director, Fortis Hospital, Kalyan, spoke proudly about this milestone, she said, “My teams’ determination to help the patient lead a quality life, and the patient’s courage to undergo these procedures are both commendable. This medical milestone showcases depth of our work in offering complex lifesaving cardiac treatments in addition to routine procedures, enabling access of care for patients across Kalyan & Dombivli. My team’s dedication and hard work has enabled us to set this landmark, which is exemplary in every aspect. Ms Deshmukh is recuperating well and is back to her daily life; we will continue to offer her care and support needed to lead a fulfilling life.”
Mr Nilesh Deshmukh, son of the patient said, “Due to my mother’s medical history and complication we opted for TAVI. Also, as the surgery was minimally invasive, her recovery wasfaster. She is now able to walk and is doing well. Most importantly, it was her grit that helped her sail through. The doctors, nurses and the support staff were very helpful during this tough time, and we are thankful to them.”
