– Doctors at Gleneagles Global Health City perform a high-risk cardiac surgery on a patient with repeated heart valve infection using a human heart valve
Chennai, India: Gleneagles Global Health City (GGHC), a leading multi-speciality centre in Chennai, successfully replaced an infected heart valve of a 39 year old patient, from Oman, with a homograft aortic heart valve from brain dead patients.
Mr. Hilal, an Arabic teacher from Oman, underwent 3 complicated heart surgeries to clear the infection in his heart valve that were identified due to an unexplained fever and a dental procedure. Despite these surgeries, he developed recurrent infection around the mechanical valve inside his heart. As an additional complication, he developed ballooning of his aorta due to infection which is known as pseudo aneurysm of the aorta.
While facing these complications, Mr. Hilal was referred to GGHC for treatment of the heart valve infection. The multi-disciplinary team of doctors evaluated his condition to understand the best possible treatment for the patient. In view of repeated infection of the mechanical heart valve, which is made of metal and covered with fabric, the team decided to replace his infected heart valve with a homograft aortic valve. A homograft is an aortic or pulmonic valve that has been removed from a donated human heart, preserved, antibiotic-treated, and frozen under sterile conditions. This homograft aortic valve is derived from hearts donated by brain dead patients that are harvested and stored at -70 degrees in liquid nitrogen.
In the first week of September, Mr. Hilal underwent a complex and meticulously planned heart surgery for the 4th time. The procedure involved cooling down the patient’s body down to 18°C to allow pausing of his blood circulation for 8 minutes to open and control his pseudo aortic aneurysm. During this period, where there was no blood flow to his body, his brain was perfused blood by a special tube placed in the carotid artery (selective antegrade cerebral perfusion). The previously infected heart valve was removed and the infection surrounding it was thoroughly cleaned. A new aortic valve (Cryopreserved homograft) was implanted in the centre of the aorta.
Dr. R. Anto Sahayaraj, Senior Consultant – Cardiothoracic and Vascular Surgery, Gleneagles Global Health City, Chennai, said, “Upon arrival, the patient showed severe infection in his heart valve and was taken into emergency. The main challenge was to get to the centre of the patient’s heart in a setting of a densely scarred chest, due to previous performed multiple cardiac surgeries and with a pseudo aneurysm ready to burst, sitting right under the breast bone. This warranted a detailed discussion in arriving at a safe and comprehensive treatment strategy.”
Dr. Subramanian Swaminathan, Director – Infectious Diseases, Gleneagles Global Health City, Chennai, said, “The recurrent heart valve infection did not respond well to conventional treatment. At GGHC, we had designed a new regimen which is more potent when combined with surgery. During the procedure, the patient was under close monitoring of our team.”
Dr. Susan George, Senior Consultant – Cardiology, Gleneagles Global Health City, Chennai, said, “Upon evaluation by echocardiogram, the patient was found to have a severe leak of blood from the aorta into the left ventricle by the side of the mechanical prosthetic valve medically known as paravalvar leak and an abscess cavity secondary to the infection of the valve. There was also a false aneurysm of the ascending aorta which made the situation extremely challenging to perform a surgery. With the patient having undergone 3 surgeries in the past, it was extremely crucial for us to ensure that the patient was safe from any further risk of infection.”
The patient recovered and flew black home after 2 weeks of post-operative care with a wide smile and heart full of gratitude, only to get back to teaching Arabic.
Praising the team on the accomplishment of the case, Dr. Alok Khullar, CEO, Gleneagles Global Health City, Chennai said, “We are truly happy with the outcome of this complex procedure. It is a commendable effort taken by our team of experts to ensure that quality care and specialized treatment is provided to extremely challenging cases as well.”