It was midnight when Dr Atul Mathur was called for an emergency at Fortis Heart Institute in Okhla, New Delhi. A patient had just come in with aortic stenosis – a condition in which the heart weakens because an aortic valve is too narrow to pump blood. But he also had a condition called Dextrocardia or a right-sided heart.
Dr Mathur had never operated on a condition like this before. No one in the world had. But the patient had to be saved and the team had to conduct a Transcatheter Aortic Valve Replacement (TAVR) surgery. Now the patient is not only healthy and convalescing fast, Dr Mathur has a breakthrough surgery against his name.
WHAT IS DEXTROCARDIA THAT LED TO THE COMPLICATED PROCEDURE?
“Normally the heart is located on the left side of the chest. But one in 10,000 people will have their heart in the right side of the chest. This is called Dextrocardia and is a very uncommon anomaly,” explains Dr Mathur, the Executive Director of the Interventional Cardiology unit at Fortis.
There are usually two types of Dextrocardia – Mirror Image and Isolated. “In the Mirror Image condition, all the organs of the body are on the opposite side. The other type is isolated Dextrocardia where only the heart is located on the right side while other organs are in their right place. Only five per cent of Dextrocardia are the isolated type,” says Dr Mathur.
The patient, Inderpal Singh, had a narrowing of the aortic valve. The blood ejecting out of the left ventricle usually passes through the aortic valve to ensure it doesn’t return to the heart. So, the valve is a one-way process. But, in aortic stenosis, the valve is narrowed down because of degeneration or deposition of calcium with age. According to Dr Mathur, it is present in two to four per cent of the population.
Having a patient with a combination of isolated Dextrocardia and aortic stenosis is a “very rare occurrence,” according to the doctor. However, there have been three cases in the world in which a TAVR procedure was conducted on patients with Mirror Image Dextrocardia. “This was the first one outside the US. This was also the first case in the world where a patient of isolated Dextrocardia with aortic stenosis underwent a TAVR procedure,” Dr Mathur says.
WHAT IS TAVR?
TAVR is Transcatheter Aortic Valve Replacement, where an angioplasty is done on the groin with local instead of general anaesthesia. The degenerating valve can be replaced through this catheter. “We don’t need to open up the heart. We can do it non-surgically with a catheter,” says Dr Mathur. He opted for this method as his patient had severe aortic stenosis and was “too high risk for an open-heart procedure.”
Usually, a TAVR procedure costs anywhere between Rs 16 to 22 lakh. An open-heart procedure is half the cost but double the risk. So, Dr Mathur resorted to the minimally invasive surgery.
But this took meticulous planning. “We had to plan a TAVR procedure which was very different from a routine one. With the heart on the right side, all the calculations had to be rechecked on the CT scanner and the valve had to be fitted in a different way. We couldn’t talk to anyone else. No one was there to guide us and there were no reference points,” he adds.
Forty-eight hours of prep and an hour-long operation later, the patient was saved. A month later, Inderpal Singh feels healthy and happy. “I feel reborn. I used to be huffing and puffing and have sleepless nights. After the procedure, my health is improving day by day.”
A month ago, he experienced a stabbing pain in his chest and called up his friends, who took him to Dr Mathur. “There was a slight discomfort during the surgery because I was wide awake. I could hear the doctors talking. But it was very professionally done,” says Singh. He found out that he had Dextrocardia as a child but he’s lived a normal life without any complications till now. He can continue living a normal life as the valve works well for the next 15 to 20 years. “I feel unique,” he says.