Recently, this lady had travelled to India seeking medical treatment. She had been diagnosed with cirrhosis of the liver and heart valve abnormalities. She had approached multiple centres in Kuwait and also a few centres in India but had been refused any form of intervention in view of the high risk it would entail. Her relatives feared that it meant the end of the road for her.
That is when she approached Dr Haresh Mehta and thus began a new chapter in her life.
His team evaluated her in detail and found that she saw suffering from anasarca (generalised swelling of the body), bleeding from the stomach, severe anaemia (Hb 6 gm%) and kidney dysfunction (S creat 2.1 mg%). The swelling was so severe that she found it difficult to move.
They found out that the main reason of Amal’s liver failure was linked with a heart valve abnormality: tricuspid regurgitation.
Leaking tricuspid valves (Tricuspid regurgitation) have been conventionally repaired with surgery ( annuloplasty or tricuspid valve replacement)
These procedures are usually performed when tricuspid regurgitation is present along with another valvular abnormality. Isolated severe tricuspid regurgitation as in this case is a rare condition.
In view of deranged liver and kidney functions, the lady was advised not to undergo this surgery, leaving her staring at a bleak future with no definitive treatment in sight.
That is when the team of doctors stepped in and offered her a unique solution.
Dr Haresh Mehta, an interventional cardiologist from Mumbai was forced to think out of the box and came up with the idea to fix her heart in order to protect her liver.
With the help of a ‘TRIC,’ the doctors gave her a new lease of life.
They proposed a novel form of treatment, TRIC valve placement. This procedure which had never been performed in western India (and only once before in entire India) was offered to the patient on a compassionate basis.
The result? Almost immediate improvement in liver functions, cessation of stomach bleeds and resolution of renal failure.
After undergoing the procedure successfully, she flew back to Kuwait on Monday, October 22.
While speaking to My Medical Mantra, Dr Haresh Mehta of Healing Hearts, said, “In this case, the valve in the right side of the heart was leaking. She was suffering from severe Tricuspid Valve regurgitation. Owing to which the blood was flowing backwards into the atrium, and was not moving forward. In a normal case, a simple heart surgery would have been helpful. But, in her case, as she was suffering from liver failure, the heart surgery was associated with a very high risk.”
Dr Mehta further said, “On the compassionate grounds, we decided to perform a novel valve mechanism which has never been tried in western India before. We had told the family that this is an investigational therapy. And after their consent, we went ahead and performed Tricuspid Valve Implantation, which is known as TRIC. We have placed the valve in both Superior Vena Cava (SVC) and the Inferior Vena Cava (IVC). During the procedure, the patient was fully awake.”
What is TRIC valve Implantation?
It is a new procedure to reduce hepatic congestion in patients deemed to be at extreme risk of surgery. It involves the placement of two stented valves in the heart at the site where the largest veins of the body drain into the right sided atrial chamber of the heart.
Unfortunately, after the procedure she bled from both groins, right wrist and into the spine. The bleed in the spinal cord compressed her nerves and caused paralysis of her lower limbs. This bleed was due to her blood thinners (which are mandatory) and the bad liver which has now started showing signs of improvement after the procedure.
Dr Mehta says, “Though the complications developed after the procedure, she has shown remarkable improvement over the past few days.”
While speaking to My Medical Mantra, the patient smiled and said, “I am feeling very good now. Earlier I couldn’t even speak, but now I can. I want to walk again, and, I will surely walk on my feet.” She profusely thanked the doctors and complimented the world class health facilities in India.
The team included Mr Sameer Saudagar, who’s the foreign recruitment person who coordinated the patient being brought here.
The other doctors involved were Dr Gopalamurugan, cardiologist from Chennai. Dr Prashant, cardiac surgeon from Coimbatore. Dr Ashish Amladi, cardiologist from Mumbai. Dr Mahesh Singh and Dr Hemant Pathare, cardiac surgeons from Mumbai. Dr Garach was the chief anaesthetist, Dr Vishal Kundnani was the spine surgeon, Dr Zeena Patel was the radiologist and not to forget the ICCU team headed by Dr Bharesh Dedhia and all the staff and management of Hinduja Healthcare Surgical.