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Best Cardiologist in Delhi | Transcatheter Aortic Valve Replacement (TAVR)

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List of procedures

What is TAVI

TAVI is minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. The surgery may be called a trans catheter aortic valve replacement (TAVR) or trans catheter aortic valve implantation (TAVI).

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How does it work?

This procedure is similar to a stent placed in an artery, the TAVI approach delivers a fully collapsible replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

What is involved in a TAVI procedure?

Usually valve replacement requires an open heart procedure in which the chest is surgically separated (open) for the procedure. The TAVI procedures can be done through very small openings that leave all the chest bones in place.

The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:

  • Entering through the femoral artery called the transfemoral approach, which does not require a surgical incision in the chest
  • Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.
  • At this time the procedure is reserved for those people for whom an open heart procedure poses intermediate risk.
  • TAVI can be an effective option to improve quality of life in patients who otherwise have limited choices for repair of their aortic valve.

Leadless pacemaker

Unlike most pacemakers that are placed in the patient's chest with leads running to the heart, Leadless pacemaker is implanted directly into the patient’s heart.

  • Leadless pacemaker is placed in the heart via a vein in the leg, that results from conventional pacemakers
  • Leadless pacemaker is completely self-contained within the heart. It eliminates potential medical complications arising from a chest incision and from wires running from a conventional pacemaker into the heart.
  • Leadless pacemaker is 93% smaller than conventional pacemakers, about the size of a large vitamin capsule.
  • BENEFITS OF Leadless pacemaker
    • Permits you to safely undergo magnetic resonance imaging (MRI), a diagnostic tool doctors use to "see" inside the body
    • Adjusts your heart rate automatically by sensing changes in your body related to your activity level and adjusting your heart rate accordingly
    • Features an estimated battery longevity of 12 years

Cardiac catheterization or Coronary Angiography is an invasive diagnostic procedure that can be used to help diagnose heart conditions, help plan future treatments and carry out certain procedures. For example, it may be used:

• after a heart attack – where the heart's blood supply is blocked
• to help diagnose angina – where pain in the chest is caused by restricted blood supply to the heart
• to plan interventional or surgical procedures – such as a coronary angioplasty, where narrowed or blocked blood vessels are widened.
During the procedure, a long, thin and flexible tube called a catheter is inserted into a blood vessel in your groin (Femoral) or arm (Radial). Using X-ray images as a guide, the tip of the catheter is passed up to the heart and coronary arteries. A special type of dye called contrast medium is injected into the catheter and X-ray images are taken. The contrast medium is visible on the angiograms clearly highlights any blood vessels that are narrowed or blocked. The procedure is carried out under local anaesthesia

When to seek doctor’s help for CAG

• Chest discomfort, manifest as pain, fullness, and/or squeezing sensation of the chest
• Jaw pain, headache
• Shortness of breath
• Nausea
• Vomiting
• General epigastric (upper middle abdomen) discomfort
• Sweating
• Arm pain (more commonly the left arm, but may be either arm)
• Upper back pain

PTCA is a non-surgical procedure that helps in opening of narrow and obstructive arteries to the muscle of the heart. This allows more blood and oxygen to be delivered to the heart muscle. PTCA is now referred to as percutaneous coronary intervention, or PCI in which a small balloon catheter inserted into an artery in the groin or wrist, and reached to the narrow region of the coronary artery. Then balloon inflated to enlarge the narrowing in the artery and a stent is placed to avoid further narrowing of the artery. When successful, percutaneous coronary intervention can relieve chest pain of angina, improve the prognosis of individuals with unstable angina, and minimize or stop a heart attack without having the patient undergo open heart coronary artery bypass graft (CABG) surgery.

When to seek doctor’s help for PTCA Procedure

• Chest discomfort, manifest as pain, fullness, and/or squeezing sensation of the chest
• Jaw pain, headache
• Shortness of breath
• Nausea
• Vomiting
• General epigastric (upper middle abdomen) discomfort
• Sweating
• Arm pain (more commonly the left arm, but may be either arm)
• Upper back pain

Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. People who have severe blockage in their arteries is called coronary artery disease. CHD is a condition in which a substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Plaque can narrow or block the coronary arteries and reduce blood flow to the heart muscle. If the blockage is severe, angina, shortness of breath, and, in some cases, heart attack may occur. (Angina is chest pain or discomfort.) During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses the blocked portion of the coronary artery. This creates a new passage, and oxygen-rich blood is rerouted around the blockage to the heart muscle.

When to seek doctor’s help for Bypass procedure

• Chest discomfort, manifest as pain, fullness, and/or squeezing sensation of the chest
• Jaw pain, headache
• Shortness of breath
• Nausea
• Vomiting
• General epigastric (upper middle abdomen) discomfort
• Sweating
• Arm pain (more commonly the left arm, but may be either arm)
• Upper back pain

Blood is pumped through your heart in only one direction or single direction. Heart valves play a major role in this one-way flow of blood, opening and closing with each heartbeat. Pressure changes on either side of the valves cause them to open their flap-like "doors" (called cusps or leaflets) at the right time, then close tightly to prevent a backflow of blood. Heart Valve operations are done to repair or replace the mitral or aortic valves. These valves are on the left side of the heart, which works harder than the right. They control the flow of oxygen-rich blood from the lungs to the rest of the body.

Types of Valve repairing Surgeries

• Commissurotomy is the surgery used for narrowed valves, where the leaflets are thickened and stuck together. The surgeon opens the valve by cutting the points where the leaflets meet.
• Valvuloplasty strengthens the leaflets to provide more support and to let the valve close tightly. This support comes from a ring-like device that surgeons attach around the outside of the valve opening.
• Reshaping is done when the surgeon cuts out a section of a leaflet. Once the leaflet is sewn back together, the valve can close properly.
• Decalcification removes calcium buildup from the leaflets. Once the calcium is removed, the leaflets can close properly.
• Repair of structural support replaces or shortens the cords that give the valves support. When the cords are the right length, the valve can close properly.
• Patching covers holes or tears in the leaflets with a tissue patch.

Valve Replacement

Severe valve damage means the valve must be replaced. It is also used to treat any valve disease that is life-threatening. Few patients sometimes need more than one valve repaired or replaced.

Two kinds of valves can be used for replacement:
• Mechanical valves are usually made from materials such as plastic, carbon, or metal. Mechanical valves are strong, and they last a long time. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves will need to take blood-thinning medicines (called anticoagulants) for the rest of their lives.
• Biological valves are made from animal tissue or taken from the human tissue of a donated heart. Sometimes, a patient's own tissue can be used for valve replacement. Patients with biological valves usually do not need to take blood-thinning medicines. These valves are not as strong as mechanical valves, though, and they may need to be replaced every 10 years or so. Biological valves break down even faster in children and young adults, so these valves are used most often in elderly patients.

When to seek doctor’s help for Valve repair /Replacement

• Chest pain or palpitations (rapid rhythm or skips)
• Lightheadedness or loss of consciousness
• Swollen ankles, feet or abdomen
• Chest discomfort, manifest as pain, fullness, and/or squeezing sensation of the chest
• Jaw pain, headache
• Shortness of breath
• Nausea
• Vomiting
• General epigastric (upper middle abdomen) discomfort
• Sweating
• Arm pain (more commonly the left arm, but may be either arm)
• Upper back pain

Transcatheter Aortic Valve Implantation (TAVI) or transcatheter aortic valve replacement (TAVR)

• Transcatheter aortic valve implantation is a minimally invasive procedure to repair a damaged or diseased aortic valve. A catheter is inserted into an artery in the groin and threaded to the heart. A balloon at the end of the catheter, with a replacement valve folded around it, delivers the new valve to replace the old.
• The tissue valve is made of bovine (cow) pericardium supported by a metal stent.
• TAVI is performed while the heart is beating. For the TAVI procedure, a catheter is placed in the femoral artery (in the groin), as is done for angioplasty. The catheter is guided into the heart. A compressed tissue heart valve is placed on the balloon catheter and positioned directly inside the diseased aortic valve. Once the new valve is in position, the balloon is inflated to place the valve in place. The balloon is then deflated and the catheter withdrawn.
• The procedure is performed with general anesthesia. A team of interventional cardiologists and imaging specialists, heart surgeons and cardiac anesthesiologists work together, using echocardiography to guide the valve to the site of implantation/replacement.
• Recovery from the procedure is generally similar to that described for surgical valve replacement.

When to seek doctor’s help for TAVI

• Chest pain or palpitations (rapid rhythm or skips)
• Lightheadedness or loss of consciousness
• Swollen ankles, feet or abdomen
• Chest discomfort, manifest as pain, fullness, and/or squeezing sensation of the chest
• Jaw pain, headache
• Shortness of breath
• Nausea
• Vomiting
• General epigastric (upper middle abdomen) discomfort
• Sweating
• Arm pain (more commonly the left arm, but may be either arm)
• Upper back pain

A left ventricular assist device (LVAD) is a pump which is used for patients who have reached end-stage heart failure. It is surgically implanted, a battery-operated, mechanical pump, which then helps the left ventricle (main pumping chamber of the heart) pump blood to the rest of the body.

Who needs LVAD to be placed
• Patients with the left ventricle damaged which affects its ability to pump effectively
• LVAD can be fix temporarily to keep your heart pumping while patient is waiting for a heart transplant it is called Bridge to transplant
• LVAD can also be a permanent option. It can continue to pump for your left ventricle, if a transplant isn’t option for you. It is called destination therapy.

When to seek doctor’s help for LVAD

• Chest pain or palpitations (rapid rhythm or skips)
• Lightheadedness or loss of consciousness
• Swollen ankles, feet or abdomen
• Chest discomfort, manifest as pain, fullness, and/or squeezing sensation of the chest
• Jaw pain, headache
• Shortness of breath
• Nausea
• Vomiting
• General epigastric (upper middle abdomen) discomfort
• Sweating
• Arm pain (more commonly the left arm, but may be either arm)
• Upper back pain

A pacemaker is a small electrical device, fitted in the chest or abdomen. It's used to treat some abnormal heart rhythms that can cause your heart to either beat too slowly or miss beats.

Why do I need a pacemaker?
You may need to have an artificial pacemaker fitted if:
• you have a particular type of heart block – a delay in the electrical signals travelling through the heart, that can make the heart beat too slowly
• your heart is beating too fast and this is not effectively controlled by medication
• you have heart failure, which may cause your heart to pump out of sync.

What are the different types of pacemakers?
A pacemaker has a pulse generator – a battery powered electronic circuit – and one or more electrode leads:
• pacemakers with one lead are called single chamber pacemakers
• pacemakers with two leads are called dual chamber pacemakers
• pacemakers with three leads are called biventricular pacemakers.

When to seek doctor’s help

• Chest pain or palpitations (rapid rhythm or skips)
• Lightheadedness or loss of consciousness
• Swollen ankles, feet or abdomen
• Chest discomfort, manifest as pain, fullness, and/or squeezing sensation of the chest
• Jaw pain, headache
• Shortness of breath
• Nausea
• Vomiting
• General epigastric (upper middle abdomen) discomfort
• Sweating
• Arm pain (more commonly the left arm, but may be either arm)
• Upper back pain

An automatic implantable cardioverter defibrillator (AICD) is a small device, made up of a wire and body, used to continuously check your heartbeat. AICDs are extraordinary machines designed to help the pace of the heart and to deliver a shock, if needed. Overall, such devices can speed up or slow down your heart rate, with the ultimate goal of keeping your heartbeat as normal as possible.

Indications for AICD
Palpitations or fluttering sensations in the heart;
Lightheadedness (due to low blood pressure);
Fainting spells or loss of consciousness (due to low blood pressure);
Fatigue and weakness (due to lack of blood supply); and
A flushing sensation
Had a heart attack
Survived a sudden cardiac arrest

What is heart failure ?

Heart failure is a serious medical condition in which the heart is unable to pump blood to the body properly. It means that your blood can't deliver enough oxygen and nourishment to your body to allow it to work properly; it may cause you to feel tired or fatigued. It also means that you can't eliminate waste products - leading to a increased fluid accumulation in your lungs, legs and abdomen.
Heart failure may develop due to a medical condition affecting your heart, such as coronary artery disease, a heart attack or high blood pressure, which can damage or affects functioning of your heart. Other reasons may often include heart blood pressure, coronary artery disease, valvular heart disease, heart muscle disease and arrhythmias.
Heart failure can develop at any age but clearly becomes more common the older you get. Around 1% of people under 65 years of age have heart failure, but 7% of 75-84 year olds have heart failure and this increases to 15% in people older than 85 years of age. It’s the most common cause of hospitalisation in patients over 65 years of age.

Stages of Heart Failure
Heart failure always affects different patients quite differently, for example the affected parts of the heart, the resulting symptoms and the time course of heart failure onset. For this reason, different medical terms are used to define the different types of heart failure because it suggests appropriate treatment.

Acute heart failure develops suddenly and may follow a heart attack, which can damage an area of your heart. If you develop acute heart failure, it may be severe initially, but rather lasts for a short period of time and improve quickly

Chronic heart failure is very common. Symptoms appear slowly over time and gradually increase such as shortness of breath, get worse within a short period of time in a patient with chronic heart failure. This episode requires immediate hospitalization.

Please note that heart failure may be caused or worsened by irregular heart rhythm or a fast heartbeat because this leads to improper filling of the ventricles. It’s important to detect such important factors in order to treat them.

Left-sided heart failure means that the functionality of the left heart chamber, which pumps blood throughout the body, is reduced which leads to the left chamber must work harder to pump the same amount of blood.

There are two types of left-sided heart failure:
• Systolic failure: The left chamber efficiency is reduced to push enough blood into circulation.
• Diastolic failure: The left chamber fails to relax normally because the muscle has become stiffer and filling is impaired.

The term ejection fraction is used to describe the chambers' strength and ability to empty with each beat. It can be measured usually with echocardiography.
In right-sided heart failure, the right pumping chamber or ventricle, which pumps blood to the lungs, is reduced due to muscle injury, such as a heart attack localized to the right ventricle or may be damage to the valves in the right side of the heart or elevated pressure in the lungs. However, heart failure commonly affects both sides of the heart and is then called biventricular heart failure.

Causes of Heart Failure


Heart failure can be caused by current or past medical conditions, which causes damage or add extra workload to the heart.
This lists the different conditions that can cause or increases heart failure,

Some of the more common causes of heart failure include:


• Past heart attacks
• Coronary artery disease
• High blood pressure
• Heart valve disease
• Heart muscle disease or inflammation of the heart
• Congenital heart defects
• Alcohol / drug abuse

In some cases, Conditions that can trigger this type of heart failure include:
• Infection
• Kidney disease / poor kidney function
• Anaemia
• Abnormal heart rhythm

Signs & symptoms of heart failure
Heart failure symptoms can vary widely from person to person, depending on the type of heart failure you have. The main symptoms of heart failure are caused by fluid accumulation and poor blood flow to the body.

SYMPTOMS CAUSED BY FLUID ACCUMULATION

Shortness of breath
Coughing & Wheezing
Weight Gain
Swollen Legs or Abdomen
SYMPTOMS RELATED TO THE REDUCED BLOOD FLOW TO PARTS OF THE BODY.
Tiredness or fatigue
Dizziness
Rapid heart rate
Loss of appetite
Need to urinate at night

Medical tests available for heart failure

The most common tests are:
• Medical history and physical examination
• Electrocardiogram (ECG)
• Blood tests
• Chest x-ray
• Echocardiogram or ECHO
Additional tests may be able to find out more about your heart failure or identify the cause. These include:
• Lung function tests or LFT
• Exercise testing or Stress Echo
• Cardiac Magnetic Resonance Imaging (MRI)
• Cardiac catheterisation and angiography
• Nuclear medicines imaging techniques
• CT Angio

When to seek doctor’s help

• Shortness of breath (problem in getting a breath even when resting).
• Feeling an irregular heartbeat that lasts for a while, or a very fast heartbeat along with dizziness, nausea, or fainting.
• Foamy, pink mucus with a cough.
• Chest pain, pressure, or heavy feeling in the chest.
• Unconditional Sweating.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
• Lightheadedness and sudden weakness.
• A fast or irregular heartbeat.
• Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
• Sudden changes in vision.
• Sudden trouble in speaking.
• Sudden confusion or trouble in understanding simple statements.
• Sudden problems while walking or balance.
• A Severe headache that is different from regular headaches.