I am Doctor Rajiv Agarwal. today I am going to talk to you about some advances which are there in the treatment of valvular heart disease and I think the general public should also be aware of this that what new facilities are now available to treat disease which has sometimes been considered to be inoperable and very dangerous to life.
So as you know that the most important heart disease that we keep talking about is a heart attack, which happens because of blockage in blood vessels. In addition the heart also has four valves, which handle the flow of blood which goes to the entire body, two on the right side of the heart and two on the left side of the heart and disease in these valves could be considered to be the second most important heart disease, so these valves can have disease which ranges from a narrowing of the valve opening which leads to back pressure, to severe leakage of the valves. In either case, there is a problem of the forward flow of blood and it leads to problems which might be troublesome to life-threatening.
So the main two valves we will talk about will be mitral valve and the aortic valve and in many cases we are able to treat disease in these valves without surgery, so in regard to the mitral valve, balloon dilatation of the mitral valve has been around now for more than two decades and in fact if there is narrowing of the mitral valve, so-called mitral stenosis then the first treatment which we offer is a balloon mitral valvotomy and this procedure is highly successful.
In some cases where the valve is extremely damaged, often it happens in elderly people, in redo procedures, in that case, we may have to go for an open heart mitral valve replacement, otherwise we are able to handle this in a safe and economical manner by doing balloon mitral valvotomy which is done in the cardiac cath lab.
More recent is the increasing problem of aortic stenosis. Aortic valve is the valve which takes the blood from the heart to the entire body and with increasing age the incidence of narrowing of the aortic valve has been increasing and often these people by virtue of being elderly, by virtue of having many other diseases they are considered to be very high risk for surgery, they may be having associated lung disease or even other associated heart problems which makes it nearly impossible to do a safe open heart surgery for them.
Plain simple ballooning often does not work for the aortic valve because often these valves are highly deformed and calcified, so now help is at hand we have advanced in technology whereby artificial valve can be inserted into the aortic valve in a completely non-surgical method called TAVR (Transcatheter aortic valve replacement) or TAVI(Transcatheter aortic valve implantation). So big catheters are placed usually through an artery in the thigh and under the guidance of X-Ray the catheter is passed up to the patient’s aortic valve position in the upper part of the chest and this valve is deployed under X-ray vision and this is a highly successful procedure.
It is technologically demanding and it requires collaboration between the cardiologist and cardiac surgeon as well as a radiologist. We often have to take the help of our kidney specialist and nephrologist also in order to get a safe procedure with minimum dye usage, but the fact is that something which with open heart surgery carries a risk of 25-30% we are able to do at a risk of hardly 2% by doing this transcatheter aortic valve implantation procedure. Cost no doubt is more than with the surgical procedure but these costs are also coming down with more and more innovation.
So I think many of our no hope valvular heart disease patients should consider this and certain other techniques whereby we can save the lives of many of our patients. So thank you for your kind attention, have a good day.