Bombay Hospital

Hello,

I am doctor Krishna Prasad cardiothoracic surgeon practicing in Mumbai.

I would like to discuss with you all about valvular heart disease, so heart has four valves and valves can get affected by various diseases, especially rheumatic heart disease and also degenerative disease, which is due to aging and infection and other causes of valve disease.

So when the valve is diseased, the heart valve either become stenotic that means orifice or the opening becomes tight or it can be regurgitant or in other words leaking, so either it can be a tight lesion or can be regurgitant leaking lesion or it can be combined, so what we do? the surgical management in these cases are two options, one is valve replacement and other one is valve repair.

Replacement, we have two options by using metal valve or otherwise known as mechanical valve and other one is tissue valve. Tissue valve prepared from other animals or from cadavers, so there are various pros and cons and where to use there are guidelines so at a young age usually we put mechanical valve but the only problem with mechanical valve is patient has to be on long-term anticoagulant, but the advantage of mechanical valve is It stays longer because life is long with the metal valve.

Tissue valve is opted in old age above 65 or so, the main advantage is no need to take anticoagulation for a long time but the disadvantages is that new valve can undergo destruction early so re-surgeries are more common with tissue valve.

The other option as I told it's a valve repair, valve repair is possible especially in mitral, aortic valves when there is regurgitant lesions or stenotic lesions. We can address disease pathology and try to bring the valve near normal. The main advantage of having a repair is patient retains his own native valve and there is nothing like the natural valve, so no need for any anticoagulation and other thing is the disease may recur and may require surgery redo surgery at a later date, which can be performed whenever time is suitable and he develops the disease further. Otherwise repair is always the first option when it is possible, beyond any further details you can contact lybrate.

Thanks

Hello,

 I am Dr. Krishna Prasad, cardiothoracic surgeon. I want to discuss about coronary artery bypass surgery otherwise known as heart bypass surgery, which is a surgical management of coronary artery disease or the heart blocks, here what we do is we bypass blockages in the coronary arteries by using patient's own vessels from other parts of the body, so they are known as conduits and there are many ways to do it one is to stop the heart and do it and the other thing is to do in a beating heart without stopping the heart and also depend upon the conduit we use, the veins can be used from the legs or arteries can be used from the hand or arteries from within the chest wall .

So it can be divided or discussed in either a beating heart surgery or on-pump surgery or what we call stopping the heart and other thing is by what conduit we use, total arterial grafts or venous grafts like that. So now in the beating heart surgery with total arterial revascularization, the beating heart surgery is the more physiological we are not stopping the heart so it is a more natural way of doing it, second thing is we use total arteries so arteries have been found to stay longer than the vein grafts so patient gets a conduit which stays longer, here patency rates are very high and this has been proved in many investigations, so total arterial beating heart surgery is better and number one method for bypass surgery.

Thank you

Hello,

 I am Dr Krishna Prasad cardiothoracic surgeon from Mumbai. I would like to discuss with you all about minimally invasive cardiac surgery. Now recently minimally invasive cardiac surgery is picking up its interest and lot of surgeries can be done with a small incision. The surgery which we can do with minimal incisions are coronary artery disease, especially uncomplicated like single-vessel or double-vessel or sometimes triple-vessel disease then valve surgeries, mitral valve, aortic valve surgery and atrial septal defect.

Here what we require is a small incision to enter the particular hard cavity or surface of the heart and do the surgery and when valve surgery, open heart surgery is required the cannulations are done from the groin with a small incision, so the femoral artery, femoral veins are cannulated and the advantage of minimally invasive surgery is patient get very small incision, cosmetically very appealing and the pain is very less and the patient goes home earlier as compared to the conventional median sternotomy procedures and also the risk of infection and especially the sternal infection and all are avoided and to do this minimally invasive surgery we require lot of special instruments and sometimes the help of scopes to help make the surgery easier. Further queries and details you can contact lybrate.

Thank You.