Advancement in Interventional Heart Therapy

Kolkata, December 6, 2017: A 23-year old lady from Tripura with a 3-year history of effort dyspnea and palpitations was referred for evaluation. Cardiovascular examination revealed continuous murmur at left upper parasternal area. She underwent a successful catheter-based intervention, where the team of doctors put an umbrella- shaped special device called Amplatzer Vascular Plug (AVP) instead of carrying out a surgery correction, at a city hospital recently. Patient Umrao Bano (name changed on request), had an abnormal vascular channel connecting the right coronary artery and right atrium called congenital (inherited) aortocameral fistula. Umrao consulted the Medica Heart Team doctors comprising Interventional Cardiologists and Cardiac Surgeons together. The doctors met the patient together at-the-same-time and collectively advised her family that the catheter-based intervention would be a safer and best option than a surgical procedure, a hospital release said here today.

The team of doctorsinclude renowned Cardiac SurgeonDr. Kunal Sarkar, Senior Vice-Chairman, Medica, Prof. (Dr.) Rabin Chakraborty,Senior Vice-Chairman, Cardiology Services, Medica, consultants Dr. SoumyaPatra, Dr. Sumanto Mukhopadhyay and Dr. Arindam Pande. “When she wasadmitted at Medica, she compliant of shortness of breath and palpitation, whichshe actively felt from last 2-3 years,” said the team of doctors. “It was a structuraldisorder of heart which is very rare in nature. Since we ensure patient-centredtreatment plans, we neither recommended surgical operation nor bloodtransfusion. Heart care is in the midst of a transformation," said Cardiac Surgeon Dr.Sarkar.

It was indeed a gooddecision on part of Medica Heart Team. The procedure was initiated with localanaesthesia by putting a special umbrella-shaped device called ampletzervascular plug inside heart. The patient is recovering fast. "Withoutsurgery, the patient is doing well now. Bearing children in future would benormal for her, considering that she is just 23 years old," said Dr. Rabin Chakraborty. This is a rarecongenital abnormality from birth and in such cases the blood is to be shuntedfrom aorta to right side of the chamber of the heart. Management of this typeof congenital (inherited) aortocameral fistula is generally done by surgicalcorrection but non-surgical device intervention has recently been introduced asa safe alternative,explained Dr. RabinChakraborty.

The aorto-atrialfistula is a rare variant of congenital aorto-cameral fistula, most frequentlyoriginating from left coronary sinus. This case emphasizes the role ofpercutaneous closure of this congenital cardiac anomaly. “To our bestknowledge, it was the first case of aorto-RA fistula where AVP was used. Largeavailable sizes and easy antegrade deliverability made this device appropriatein this large fistula.  It is a rare manifestation of aorto-rightatrial fistula successfully closed by AVP and this device is used for the firsttime for this kind of case, said Dr.Soumya Patra elucidating further.

The entire proceduretook around 2 hours and the patient was discharged happily after 2 days.

After investigatingthe patient, the Heart Team doctors came to a consensus on the line oftreatment, ensuring a rational approach with evidence-based medicine for betteroutcomes. "Skill and efficiency are the examples of this case,” concluded Dr. Alok Roy, Chairman, MedicaGroup of Hospitals. 

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