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Heart Surgery: MVR+TVRr for Sev MR, Sev TR, Massive Cardiomegaly, Extreme Cardiac Cachexia

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• published: 21 Aug 2012
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Rheumatic Heart Disease is not uncommon in developing nations and certain parts of the world like India, Nepal, Bangladesh, Pakistan and some Latin American countries. Low socioeconomic conditions and unhygienic living standards are the main cause. Usually the adolescent catches a sore throat or a skin infection by a bacteria called Streptococcus. The body reacts against it but it attacks the cardiac tissues thinking to be bacteria (the m protein part)! Rheumatic fever then sets in and when it becomes chronic most commonly it affects the heart valves! With the advent of Penicillin prophylaxis and early detection patients can get good therapy and has chance of recovery. This particular patient is a case of Chronic Rheumatic Heart Disease affecting two heart valves (Mitral and Tricuspid). Both her valves were leaking badly and she developed massive cardiac enlargement which pressed upon the left lung to make it almost nonexistent. As she developed the disease in her growing period, she had significant changes in her body morphology. She was suffering from extreme cardiac cachexia and severe growth retardation so much so that at 23 years of age now she looks like a 10 year old kid! Her thigh was the size of my two fingers! She could hardly breathe and due to fast heart rate (Atrial Fibrillation) and gross cardiac enlargement (LA measured 10 cms)she develops bouts of pulmonary oedema and frequent heart failure; she was in NYHA Class IV. She was repeatedly getting admitted at different hospitals. She went to Bengaluru (Bangalore) in 2002 but the surgeons refused to operate her as she was having severe growth retardation. She somehow pulled along like that till 2009 when she went to Kolkata (Calcutta) for her check up and possible operation. due to her gross changes in chest wall due to massive cardiac enlargement, the surgeons advised against her surgery. When she came to us in 2012, she came in distress. Almost dying she miraculously recovered with our treatment, but she had to get admitted two times more as she was developing heart failure! Finally when I told about surgery the family was surprised as everybody gave up on her long back. But she was a fighter. She held my hands and told, she wants to live, she wants to complete her education and take up geography as a subject. I told frankly as this is an extremely risky surgery, but as there is no option left surgery is the only chance we can take. We took her up for Mitral Valve Replacement (PML preservation) using #27 St Jude Medical Mechanical prosthetic Valve. The severe Tricuspid Valve leak was managed by using Tailor St Jude Flexible Ring (partial). She did a wonderful recovery, she was off ventilator by 15 hrs and she was discharged after 10 days! Listen to her interview at the end of the video to see her zest for life and her message to the world!