Heart Specialist Department

A 67-year-old male patient with a history of dyspnoea of exertion since 1 month which worsened since 15 days. He was diagnosed with severe Aortic Valve Stenosis.

On Examination

Vitals Stable

CVS – EFM Systolic Murmur

Management/ Progress in Hospital

He underwent TAVI (Trancatheter Aortic Valve Implantation) under local Anaesthisia + Sedation by Dr. Ankur Phatarpekar and his team through right femorial artery.

Post procedure was shifted to ICU with stable Haemodynamic for observation.

Post procedure ECG sinus rhythm no ST-T changes.

After 24hrs left femorial sheaths were removed.

He was mobilised out of the bed.

Beta Blockers with held in view of Borderline Bradycardia.

Post Procedure Echo Screening.

Investigation

Pre-Operative

2D-Echo – Gross Concentric LVH. All chambers normal size. Mild and distal septum mildly hypokinetic. Heavily calcified Aortic valve with reduced opening with peak by mean gradient of 86/53 mm of Hg suggestive of Severe AS with Grade ¼ AR. Grade ¼ MR, Grade ¼ AR. No evidence of PR/TR. No significant gradient across LVOT/RVOT. Normal LVEF – 61%

Post- Operative

2D-ECHO- Normal LV systolic function. k/c/o degenerative Severe AS , s/p TAVI with normally functioning of Aortic valve. Mild Concentric LVH. All chambers normal size.

Bioprosthetic Aortic valve in situ, opening well. No e/o paravalvular leak.

Grade I MR. No evidence of AR/PR/TR. Peak by mean gradient across Aortic valve is 28/16 mm of Hg. AVA by continuity is 1.43 sq.cm.

LVEF 65%.

Operative Notes

Right femorial and left femorial artery venous punctured.

Left femorial side 6-F sheath introduced in both venous and artery.

Right common femorial artery 10-F sheath introduced.

23 size balloon used for commissurotomy and inflated for 3 seconds.

Ventricle with pacing at 180 beats/min gradiant aortic valve – nil.

Following commissurotomy 23 size MyVal pericardial, bioprothes crimpel introduced and implanted across aortic valve with ventricular pacing of 180 beats/min.

Result – Valve position intra-annular

No para valvular leak.

Good result.

Right femorial cannulation closed with proglide.

2 proglide used.

Good haemostasis.

Patient tolerated procedure well.

58 years male was admitted for PTCA with a highly calcified LAD artery showing 90% blockage and another 90% blockage in its side branch.

Highly calcified artery makes angioplasty very challenging as calcium present in the arteries doesn’t allow the stent to expand. The patient underwent Rota Ablation with a OCT Guided PTCA by Dr Ankur Phatarpekar.

Rota Ablation is a technique in which a burr rotating at very high speed drill is used to pulverise calcium unblocking the artery.

To know the right position of the stent we use a technique called OCT (Optical Coherence Tomography) which helps us to decide the exact placement, sizing and apposition to ensure proper expansion of stent providing long term result.

With the availability of both the technologies & experienced doctors we could achieve a very challenging Angioplasty at our Hospital.

A 70 years old male was admitted under Dr. Ankur Phatarpekar with a history of Rheumatic Heart Disease with Mitral Valve Stenosis with PAF Since 2004. In 2010 he underwent Mitral Valve Replacement through open heart surgery.

Medical History

Known case of Rheumatic Heart disease with Mitral Valve Stenosis since 2004. Under went mitral valve replacement surgery.

2D Echo Report

Pre TMVR

Peak by mean gradient across prosthetic mitral valve from 15/6mm of hg to 19/7mm of hg

Grade 1/4 AR

Pasp by tr jet 43 mm of hg

Mitral valve diameter varies from 39.8 mm and 43.7 mm

LVEF 45%

Post TMVR

Well functioning bioprosthetic valve in mitral position no turbulence and laminar flow noted

Mitral peak by mean gradient pht = 9/2 mm of hg

Mitral valve area = 2.0 sqcm

Mildly sclerotic aortic valve with peak gradient 20 systolic

Psp by tr jet 35 mm of hg

LVEF 50-55%

Management/Progress in Hospital

Post procedure shifted to ICU for Cardiac Monitoring. ICU stay was uneventful with no fresh complaint hence shifted to ward and discharged with stable hemodynamic.

A 3 years baby was admitted with history of breathlessness for 1 year with no weight gain. She was a pre-term baby (7 months LSCS) and was diagnosed to have Congenital Heart Disease (Acynotic) with moderate to severe pulmonary stenosis. After detailed evaluation she underwent Balloon Pulmonary Valvuloplasty.

Procedure

The pulmonary valvuloplasty was performed with 14 X 40 mm balloon, which was inflated (twice) at nominal pressure at the valve plane level, with the formation and disappearance of the hourglass image.

Post Procedure

Post-Pulmonary valvuloplasty pressures were: RA = 9, Pulmonary gradient: 20 mm of Hg (Pre Procedure gradient — 50 mm of Hg), RV = 60/4 (Pre Procedure 48/4) with no significant gradient post procedure . Therefore, the procedure was considered very successful.