Most Advanced Minimally Invasive Heart Valve Replacement or Repair Surgery Techniques in India

The four valves inside the heart must swing open easily and then click shut tightly—about 60 times per minute—to keep blood pumping smoothly in the proper direction. But these hard-working, one-way valves often break down. The most common problems are leaks (regurgitation) and narrowing (stenosis).

Heart disease can produce these valve problems. For example, patients with an aortic aneurysm, a heart attack, or high blood pressure may develop aortic valve regurgitation. In this condition, also called insufficiency, the valve flaps (leaflets) do not close completely. This allows leakage of blood backward into the left ventricle after each heartbeat. Infection, inherited conditions, or other problems may also cause valve problems. 

If untreated, a faulty heart valve can trigger serious problems elsewhere in the heart. For example, patients who have mitral valve regurgitation (where the leaflets leak blood backward into the atrium) are at risk of arrhythmias, heart failure, or stroke. Mitral valve stenosis can cause heart failure or lung problems due to the backflow pressure.

Surgery is often the best solution for valve problems.|

Common Types of Valve Surgery

Your surgeon may recommend surgery to repair a damaged or diseased valve. Surgery is most often needed for the mitral valve or aortic valve on the more powerful left side of the heart. But some people need surgery on the tricuspid valve or pulmonary valve. Many valve procedures can be done with minimally invasive or robotic-assisted techniques that may limit pain and speed recovery.

we offer a full range of minimally invasive approaches (totally endovascular, mini-thoracotomy, port access, keyhole, and robotic-assisted) as well as standard open surgical procedures. All these terms describe how the surgeon reaches the heart valve to make the necessary repair—not the exact surgical repair itself. Learn more about robotic and minimally invasive 

Aortic Valve Surgery or Mitral Valve Surgery.

The purpose of valve surgery is to help your existing valve work better—either opening more fully or closing more completely. The most common valve surgeries performed include:

Valve Repair andRreshaping

·     Your surgeon can use a variety of tools and methods to repair, reshape, trim, or otherwise modify the valve flaps to create a tighter seal or to enlarge the opening.

·     Any tears or holes in your valve can be patched or sewn back together to prevent leakage.

·     In another common technique to improve valve function, your surgeon may shorten or repair the cords or tendons inside the heart that attach to the valves. These cords, called papillary muscles and chordae tendineae, are sometimes ruptured or weakened by a heart attack or infection.

·         One or more of these repair procedures might be used to limit stenosis or regurgitation.

Annuloplasty

·         If the base of a mitral or tricuspid valve becomes enlarged, dilated, or damaged, your surgeon can strengthen this ring of tissue (called the annulus) by sewing in an O- or C-shaped annuloplasty ring at the valve base.

·         This synthetic ring provides a firmer foundation for the valve.

·         It also cinches up the loose opening, allowing the valve to seal more tightly and prevent regurgitation of blood into the atria. 

·         Annuloplasty can now be accomplished using minimally invasive techniques.

Mitral Prolapse Repair

·      

   If your mitral leaflets are weak or thickened, they may bulge backward with every heartbeat. In some cases, blood spills backward through the ballooning valve into the left atrium.

·         If prolapse is starting to cause symptoms, or if tests indicate future risks, your surgeon can remove a section of one or more leaflets to "tighten up" the leaflet(s) and prevent mitral regurgitation.

·         Another option for a floppy mitral valve is to insert an annuloplasty ring to strengthen the valve's base.

Mitral Balloon Valvuloplasty

·         If you have a certain type of mitral stenosis, your surgeon can guide a balloon-tipped catheter into the mitral valve and gently inflate it to force open the valve and improve blood flow.

·         The catheter is a wire-like tube that can be inserted through a leg artery and guided up to the heart, thus avoiding open surgery.

·         This procedure, called balloon valvotomy or valvuloplasty, is usually for milder stenosis with no regurgitation or calcification.

·         A valve replacement is often needed for more severe stenosis.

Repair or Replacement ofBicuspid Aortic Valve

·         About 1% to 2% of the population is born with two of their three aortic valve leaflets (cusps) fused together.

·         For many people this "bicuspid" aortic valve is no problem. But if your bicuspid valve is causing stenosis, your surgeon may recommend repair to separate the fused cusps.

·         If the problem is severe, you may need a valve replacement.

Aortic, Mitral,Pulmonary, or Tricuspid Valve Replacement

·         In severely diseased or damaged valves, replacement with a new mechanical or tissue (from pig, cow, or human donor) valve is sometimes recommended.

·         Your surgeon will provide details about the benefits of repair versus replacement and the trade offs between mechanical and tissue (biologic or bioprosthetic) valves.

·         Some valves can be replaced using minimally invasive techniques.

MedWorld India Affiliated Best Heart Hospitals in India offer: - The ultimate destination for international patients who want World Best, Affordable Heart Surgery

• Latest and best available techniques globally like Robotic Heart Surgery, Minimally Invasive Valve & coronary Heart Bypass Surgery, Primary and complex Coronary Angioplasties and Stenting. Percutaneous Valvular interventions including aortic valve replacement need a special mention..
• Many of the world's finest heart hospitals are located in India with 98-99 % success rate for most procedures.
• Cost of Surgery just 1/6th of cost in USA, UK or Europe with finest quality implants, prosthesis and consumables imported from Leading International Companies.
• The highly trained team of Electrophysiologists have tremendous experience in doing all kind of radiofrequency ablations, device implantations, electrophysiology studies, and pacemaker and resynchronization therapy.
• Computer Navigation Surgery System for excellent outcomes and use of finest quality implants, prosthesis and consumables imported from Leading International Companies.
• Specialized Physiotherapy and Rehabilitation services for quick rehabilitation after cardiac surgery in India.
• India’s leading hospital for children’s heart surgeries performs almost 3 times as many surgeries as Children’s Hospital, Boston, the leading children’s hospital in the USA

India offers great value proposition to patients looking for affordable Heart surgery or Cardiac surgery abroad as not only the cost of valve replacement in India is very low, the facilities and infrastructure is most modern and is counted among the best heart hospitals in the world. Cardiac surgeons now use most advanced minimally invasive heart valve replacement or repair surgery techniques for eligible patients.

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How does an Angioplasty procedure treat Heart Disease? : Best Cardiac Hospitals in India

What is an angioplasty (PCI) procedure?

Percutaneous Coronary Intervention (PCI) is a specialized procedure to open up a coronary artery which is narrowed due to plaque build-up. A fine tube, or catheter, is threaded from the artery in the groin, up to the site of the blockage in the heart. The balloon-tip of the catheter is inflated to press the plaque back against the wall of the artery. When the catheter is removed, the artery remains open wider than before, allowing more blood and oxygen to get to the heart muscle.

In some cases, a tiny wire coil, or stent, is inserted with the catheter to help stabilize the newly opened area of plaque. Stents are not necessary for all patients and the Cardiologist makes the decision during the procedure.

Who performs an angioplasty procedure?

Specialized Cardiologists perform PCI procedures. They receive extensive training in both General Cardiology and Invasive Cardiology (performing angiograms and angioplasties). Cardiac surgeons are trained differently, for surgical procedures, and do not perform PCI.

  

How long does an angioplasty procedure usually take?

The average PCI takes approximately one hour to perform, followed by a recovery phase of 12-16 hours. Most patients remain in hospital overnight and go home the following day.

How does an angioplasty procedure treat heart disease?

PCI does not treat heart disease, which is a chronic disease process related to genetics, lifestyle, diet and other factors. However, it effectively treats the symptoms which result from the narrowing of arteries such as extreme fatigue, chest pain and shortness of breath. Patients usually are able to resume their regular activities quickly following their PCI procedure, then follow-up with their physicians to ensure that they control the underlying factors which contributed to their disease process.

  

What does Stand-Alone Angioplasty mean?

Stand-Alone angioplasty means that the service is provided in Centres without Cardiac surgery. In these cases, Centres must make arrangement for surgical backup within a short time-frame and reasonable distance. TBRHSC in partnership with the air and land ambulance systems has emergency back up in Duluth, Minnesota.

  

When is cardiac surgery recommended over angioplasty?

A number of patients cannot be effectively treated with PCI and require long-term medications or a coronary bypass operation. This could be due to the extensive nature of their disease or the location of a single narrowing in an artery. Also, some patients have other medical conditions which could make surgery a better option.

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Benefits of Having Pediatric Heart Surgery in India : Pediatric Cardiothoracic Surgery in India

Sometimes heart surgery in children is required for repairing defects in the heart which a child might have born with (known as congenital heart defects) and heart diseases which he gets after birth, which require surgery. Pediatric Cardiac Surgery deals with operative procedures in the newborn and unborn children and youngsters suffering from cardiac dysfunctions, structural, functional and rhythm-related issues of the heart also.

Pediatric Cardiac Surgery often deals with heart problems in children, the cause of congenital heart diseases which are common heart ailments among new born children and involves deficiencies like structural defects, congenital arrythmias and cardiomyopathies, which result in different kinds of abnormalities related to the heart. Congenital heart disease is a cause of improper growth of the heart or blood vessels before birth.

Pediatric Cardiology Facilities

The Paediatric cardiology department of any hospital offers all non-invasive diagnostic and paediatric cardiac interventional services. The diagnostic modalities are inclusive of foetal echocardiography, transthoracic and transesophageal echocardiography, round the clock Holter, CT and MR angiography as well as diagnostic cardiac catheterisation. Cardiologists, cardiovascular surgeons, anesthesiologists and other specialists work closely together to care for newborn as well as unborn children suffering from cardio-vascular disorders who provide exceptional pre and post operative services.

Pediatric heart surgery in India is performed by specialized cardiac surgeons who are known internationally for their medical expertise. The level of education and expertise of the cardiac surgeons and medical staff in India is very high and their extra ordinary performance has become a daily routine for them. As a result, their expertise and capabilities are frequently sought after on a world-wide scale. Significant efforts in quality management, accreditations and national and international benchmarking are employed to maintain and even further improve quality of care in India. Exceptionally short waiting time for surgeon’s consultations, short waiting lists for surgeries, direct access to surgeon’s and the outstanding medical results has pushed India into the top position for pediatric heart surgery.

Pediatric heart surgery often deals with cases of congenital heart disease. Congenital heart disease is a common heart ailment among new born children and involves deficiencies like structural defects, congenital arrythmias and cardiomyopathies. This leads to different kinds of abnormalities related to theheart. Congenital heart disease is a cause of improper growth of the heart or blood vessels before birth. Pediatric heart surgery deals with operative procedures dealing with newborn and unborn children and youngsters suffering from cardiac dysfunctions.

Pediatric Cardiothoracic Surgery in India

There are a number of Pediatric Cardiology Surgeries such as balloon atrial septostomy, Valvuloplasty/Angioplasty, Patent Ductus Arteriosus, Ventricular Septal Defect and Atrial Septal Defect, Tetralogy of Fallot, Total Anomalous Pulmonary Venous Return, Double Outlet Right Ventricle etc. The major ones are:

Balloon Atrial Septostomy (BAS) : This technique, also known as the Rashkind procedure used for enlarging a hole between the right atrium and the left atrium. It is often used to manage patients with transposition of the great arteries. Here the larger hole improves oxygenation of the blood.

Valvuloplasty/Angioplasty : Valvuloplasty is that process where a small balloon is inserted and inflated for stretching and opening a narrowed (stenosed) heart valve. On the other hand, angioplasty is a non-surgical process which can be used for opening blocked heart arteries.

Patent Ductus Arteriosus : This is a kind of defect in infants where vessel (the ductus arteriosus) fails to close soon after birth which results in abnormal blood flow, between the pulmonary artery and aorta, which takes the blood from the heart to the lungs and to the rest of the body. To treat it, an incision is made under the chest through which tubes are inserted to regulate the flow of blood supply.

Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD) : Both of these are congenital defects. In ASD, the wall that separates the upper heart chambers (atria) does not close completely. The surgery here involves a placement of an ASD device into the heart through catheters, which is inserted by making a tiny incision in the groin area. While in VSD, happens at the time of birth. It is explained as one or more holes in the wall that separates the right and left ventricle of the heart. In pre-natal stages, the right and left ventricles of a heart are not separate. As the fetus grows, a wall is formed for separating the two ventricles but if the wall does not form completely, a hole remains. This can be treated by inserting cardiac catheterization.

Tetralogy of Fallot (ToF) : Another congenital heart defect, it is a constellation of four abnormalities, which result in insufficient oxygen in the blood. In this case, a surgery is needed for restoring these defects which are caused, main; paid at the time when the infant is young.

Cost of HeartSurgery in India.

The cost of heart surgery in India is perhaps the lowest in the world Some comparisons show that patients in the USA can save 90 per cent of the treatment cost by having their heart surgery in India. The cost of heart treatment in India is also very much cheaper compared with Thailand, Singapore, etc which also attract medical tourists.

Hospitals in India have a success rate of between 98 to 99% for heart surgery in India Heart surgery in India is performed by cardiac surgeons of great experience, in terms of both number of surgeries, diversity of procedures and complexity of heart conditions This experience is built on top of the outstanding academic qualifications of heart surgeons in India.

India’s hospitals have world-class cardiac catheterisation labs for diagnosis of heart diseases and performance of angiograms and angioplasties They also have state-of-the-art operation theatres that enable safe and successful heart surgery in India.”

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How is the Pacemaker Implanted : Pacemaker Implantation at World Best Hospital in India

Pacemaker Implantation at World Best Hospital in India 

Heart rhythm disorder is a serious medical condition and could lead to problems ranging from simple palpitations to sudden death. But the modern Electrophysiology has provided great solution to the patients suffering from heart rhythm problems. The newer techniques and developments in Electrophysiology have enhanced the quality of life in these patients to a great extent. Heart hospitals in India have now the best electrophysiology teams to offer the best treatment for patients with heart rhythm disorders.

What is a Pacemaker?

A pacemaker is an electrical device that is used to regulate and normalise the rhythm at which the heart works. The rate at which the heart works and the rhythm at which it works are triggered by electrical impulses generated from within the heart. Abnormalities in these electrical impulses result in arrhythmia, where the heart rhythms are too slow, too fast or irregular.

 A pacemaker has two components to it: the electric leads which are connected to the heart and a pulse generator/computer which detects abnormality in the heart's rhythm and delivers an electrical impulse to the heart to normalise the rhythm.

Different types of Pacemakers:

• Permanent (internal) Heart Pacemaker - This kind of Heart Pacemaker is implanted in a small pocket under your skin and is meant to be left in there for the rest of your life.
• Temporary (external) Heart Pacemaker - This is used for initial stabilization of the patient during a cardiac crisis.
• Demand Heart Pacemaker - This kind of Heart PacThis kind of Heart Pacemaker has an inbuilt sensing device which senses when the heart beat is too slow and turns the signal on. Once the heart beat is above a certain level, it automatically turns the signal off..
• Single Chamber Heart Pacemaker - This kind of device has one lead to carry signals to and from one chamber of your heart, either the right atrium or, more commonly, the right ventricle.
• Dual Chamber Heart Pacemaker - This kind of Heart Pacemaker has 2 leads and can monitor and deliver impulses to either or both of the heart chambers.
• Adaptive-Rate Heart Pacemaker or Rate-responsive Heart Pacemaker - This kind of Heart Pacemaker automatically increases the pacing rate to meet the body's changing need.

          Medical conditions when a Pacemaker is Needed

• BradycardiaAtrial fibrillation
• Heart Block
• Heart muscles problems
• Aging or heart disease damages

How is the Pacemaker Implanted?

The pacemaker is implanted, normally in the upper chest, as part of a surgical procedure performed under local anaesthesia. The electrophysiologist / cardiologist assisted by fluoroscopy imaging, implants the leads at the designated locations within the heart, by threading them through veins leading to the heart. The other end of the leads is connected to the pulse generator unit which is implanted in the chest region. This procedure will take upwards of one hour and can sometimes take several hours.

Once the leads are attached to the heart as well as the pacemaker, the cardiologist would test the device to make sure that electrical impulses are flowing from the pacemaker to the heart and that the heart rate and rhythm are being read accurately by the pacemaker.

          Medical conditions when a Pacemaker is Needed

• An effective approach to control the bradycardia (slow heart beat)
• It will give relief from irregular heart beat.
• Keep the heart beating at a rate that allows you to continue living a normal life and meet your body's demand for oxygen whatever your activity level may be
• Allows you to enjoy a better normal quality life

Tetralogy of Fallot is the most common heart defect in children : Fallot's Tetralogy Surgey in India

Tetralogy of Fallot is the most common heart defect in children. The condition causes mixing of oxygen-poor blood with the oxygen-rich blood being pumped out of the heart and into the circulatory system of blood vessels.

·         The blood leaving the heart has less oxygen than is needed by the organs and tissues of the body, a condition called hypoxemia.

·         Chronic (ongoing, long-term) lack of oxygen causes cyanosis, a bluish color of the skin, lips, and membranes inside the mouth and nose.

The normal heart works as follows:

·         The heart is made up of 4 chambers: 2 upper chambers called atria and 2 lower, larger chambers called ventricles. Each atrium is separated from its paired ventricle by a valve.

·         The heart has a left and a right side. The left and right sides of the heart are separated by a septum (wall). The right side of the heart receives oxygen-depleted or blue blood returning by veins (superior vena cava and inferior vena cava) from the body.

·         The blood flows from the right atrium through the tricuspid valve into the right ventricle, which pumps it through the pulmonic valve into the pulmonary artery, the main artery to the lungs.

·         In the lungs, the blood absorbs oxygen and then returns to the left atrium through the pulmonary veins.

·         From the left atrium, the blood is pumped through the mitral valve to the left ventricle. The left ventricle pumps the blood out of the heart into the circulatory system via a large artery known as the aorta.

·         The blood moves throughout the body, supplying oxygen and nutrients to organs and cells.

·         Organs cannot work properly if they do not receive enough oxygen-rich blood.

The 4 abnormalities (tetralogy) of the heart described by Fallot include the following:

·         Right ventricular hypertrophy: Narrowing or blockage of the pulmonary valve and/or muscle under the pulmonary valve coming out of the right ventricle. This restriction to blood outflow causes an increase in right ventricular work and pressure, leading to right ventricular thickening or hypertrophy.

·         Ventricular septal defect (VSD): This is a hole in the heart wall (septum) that separates the 2 ventricles. The hole is usually large and allows oxygen-poor blood in the right ventricle to pass through, mixing with oxygen-rich blood in the left ventricle. This poorly oxygenated blood is then pumped out of the left ventricle to the rest of the body. The body gets some oxygen, but not all that it needs. This lack of oxygen in the blood causes cyanosis.

·         Abnormal position of the aorta: The aorta, the main artery carrying blood out of the heart and into the circulatory system, exits the heart from a position overriding the right and left ventricles. (In the normal heart, the aorta exits from the left ventricle.) This is not of major importance in infants.

·         Pulmonary valve stenosis (PS): The major issue with tetralogy of Fallot is the degree of pulmonary valve stenosis, since VSD is always present. If the stenosis is mild, minimal cyanosis occurs, since blood still mostly travels to the lungs. However, if the PS is moderate to severe, a smaller amount of blood reaches the lungs, since most is shunted right-to-left through the VSD.

Tetralogy of Fallot Symptoms

Most infants with tetralogy of Fallot develop cyanosis in the first year of life.

·         The skin, lips, and mucous membranes inside the mouth and nose take on a noticeably dusky blue color.

·         Only some infants with very severe obstruction of the right ventricle outflow turn blue at birth.

·         A small number of children with tetralogy of Fallot never turn blue at all, especially if the pulmonary stenosis is mild, the ventricular septal defect is small, or both.

·         In some children, the cyanosis is quite subtle and may go undetected for some time.

The following symptoms suggest tetralogy of Fallot:

·         Growth and development are slower, especially if the pulmonary stenosis is severe. Puberty may be delayed if the tetralogy is untreated.

·         The child usually tires easily and begins panting with any form of exertion. He or she may play for only a short time before sitting or lying down.

·         Once able to walk, the child often assumes a squatting position to catch his or her breath and then resumes physical activity. Squatting increases the pressure transiently in the aorta and left ventricle, causing less blood to move into the left ventricle, more out the pulmonary artery to the lungs.

Medical Treatment

Surgery is the primary way to correct the heart problem. Your child may be prescribed medication for tet spells. You will also be given information for dealing with future tet spells.

·         The child will be placed on his or her back in the knee-to-chest position to increase aortic resistance. The increased aortic and left ventricular pressure reduces the rush of blood through the septal hole from the right ventricle and improves blood circulation to the lungs, so more red blood reaches the tissues.

·         The child may be given oxygen through a face mask to increase the amount of oxygen in the blood.

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