India: A 63 years old Rukminamma reported shortness of breath and was diagnosed with dilated cardiomyopathy. Usual medicines were tried but she could not tolerate them, her BP went too low and she started feeling giddy. There were only two options for her – a heart transplant or a Ventricular Assist Device (VAD). The heart transplant was ruled out considering her age. So the only option she had was to have a VAD inserted. After counseling her and her family, she was convinced that a VAD will help in improving her quality of life and will extend her life as she was otherwise fit and all other organs were functioning fine.
Heartmate III VAD was implanted to help her left ventricle, which is the main pumping chamber, and hence the procedure she underwent is called LVAD (Left Ventricular Assist Device). The device was implanted successfully at Medicover Hospitals, Hyderabad, by a team of Cardiologists headed by Sr. Consultants DR. Ramagiri Balaji, Dr. Krishna Prasad, Dr. Pramod Kandukare, Dr Nithin Annarapu, and Dr Mithilesh in a procedure that took 6 hours. This is the first time a Heartmate III device has been implanted in a small patient (body surface area of 1.34).
It happens to be the 1 among 100 cases implanted in India so far. It is the sixth device implanted in both Telugu-speaking states. The device was fixed in her chest despite the lady being a small-sized one and a single wire comes out of the chest which is attached to a small computer device which the patient can carry with them. It is battery operated device, the battery can run for 17 hours, and covers for most of the daily activities. The patient was discharged home after 2 weeks of hospital stay.
She is currently walking by herself and is no longer short of breath. The distance walking ability doubles in the immediate post-operative period because of the device. Medicover Hospitals runs an active Heart Failure Clinic, where patients with poor heart pumping are identified, and appropriate medication is commenced.
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If patients do not respond to medical treatment then a heart team (comprising of senior cardiologists and Cardiac surgeons) decides whether the patient will benefit with VAD, or transplant. What is Ventricular Assist Device (VAD)? A device that is unique and weighs around 200gms (slightly more than an average mobile phone), and is small enough to fit in palm of a person.
The implantation technique is also much easier and has better performance that its predecessors. It works as a centrifugal pump, and complete magnetic levitation technology, and pumps blood by spinning a churning device placed in blood stream. This technology reduces the intake of more medication. It has become as simple as valve replacement procedure, and can be performed anytime without waiting for a donor etc. it can be used as a temporary or a permanent device. VADs can be used for 1 chamber failure LVAD/RVAD) or these can support both chambers (BiVAD).
The doctors who performed the surgery are Dr. Mithilesh – Critical Care , Dr. Pramod Kandukare – Cardiothoracic Surgeon, DR. Ramagiri Balaji -Cardiologist, Dr Nithin Annarapu- Cardiologist , Dr Krishna Prasad- Cardiothoracic Surgeon.
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