Indraprastha Apollo Hospital's Innovative Procedure

New Delhi: Indraprastha Apollo Hospital has successfully performed a rare transcatheter mitral and tricuspid clip procedure, providing an alternative to open heart surgery for a 58-year-old female with severe mitral and tricuspid valve regurgitation.

This innovative procedure, conducted by Dr. Vanita Arora, Senior Consultant, Cardiac Electrophysiologist & Interventional Cardiologist at Apollo Hospital, along with a team of specialized doctors and nurses, resulted in a significant reduction in regurgitation and a rapid recovery for the patient, who was discharged in stable condition within 48 hours.

Patient's Medical History

The patient had been experiencing palpitations for the past 2-3 years. She previously underwent radiofrequency ablation (RFA) for atrioventricular nodal reentrant tachycardia (AVNRT) in 2020. Despite the procedure, she continued to suffer from atrial fibrillation with fast ventricular response (AF with FVR), as well as symptoms of weakness, fatigue, and breathlessness.

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Diagnosis and Treatment

Upon admission, the patient was diagnosed with severe mitral regurgitation (MR) and severe tricuspid regurgitation (TR), along with an increase in the size of the left atrium (LA) and right atrium (RA). Additionally, her left ventricular ejection fraction (LVEF) had fallen to 35%, with mild dilation of the left ventricle. Given these conditions, the patient was presented with the option of open-heart surgery for mitral and tricuspid valve repair/replacement. However, she opted for the Transcatheter Mitral and Tricuspid Clips.

Procedure Details

During the procedure, the team of doctors successfully reduced the mitral regurgitation from Grade IV to Grade I by placing the mitral clip in the 12-6 o'clock position. The tricuspid clip was then placed, reducing the tricuspid regurgitation from Grade IV to Grade I. Both procedures were guided by transesophageal echocardiography (TEE) and fluoroscopy, ensuring precise placement of the clips.

The patient was discharged in stable condition 48 hours after the procedure, with a 2D echocardiogram showing both clips in place and regurgitation reduced to Grade I. This case demonstrates that carefully selected patients can benefit from this minimally invasive technique, allowing for quicker recovery times and reducing the need for open heart surgery.

Expert Opinion

Dr. Vanita Arora, Senior Consultant, Cardiac Electrophysiologist & Interventional Cardiologist at Apollo Hospitals said, “This patient, who presented with complex cardiac conditions, could have required open-heart surgery, but our minimally invasive approach using transcatheter clips provided a safer alternative. The use of transesophageal echocardiography (TEE) and fluoroscopy ensured precise placement, resulting in a significant improvement in the patient's condition and a faster recovery.

I am extremely proud of our team of Cardiologists and Cardiac Surgeons:

• Dr. Gautam Naik
• Dr. Mukesh Goel
• Dr. Rekha Mishra
• Dr. Vikas Singh
• Dr. Deepa Sarkar
• Sr. Anu (Nursing Incharge)
• Sr. Pui B
• Mr. Shyam, Head cath lab Technician

for their collaborative efforts in making this procedure a success. This case is a clear example of how teamwork and advanced technology can lead to innovative healthcare solutions, allowing patients to recover quickly without major surgery. Indraprastha Apollo Hospital is committed to continuing this approach, offering effective treatments with minimal recovery times.”

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