Kenyan medics perform bloodless heart surgery
Medics at Nairobi’s Mediheal Hospital conducted a delicate heart surgery without a single cut.
Considering the age of an 83-year-old Catholic priest and the high rate of his heartbeat, the cardiac surgeons offered Fr Brambilla Luigi Carlo, a minimally invasive procedure to replace the narrowed aortic valve scientifically known as percutaneous transcatheter aortic valve replacement ( TAVR/TAVI) treatment.
Dr Vijaysinh Patil, the Director and Chief Interventional Cardiologist at Mediheal said Fr Carlo was unwilling to have open heart surgery because of the risk involved.
This sort of procedure, Dr Patil explained, required special training and experience to do it without complications.
“We did this procedure through the right groin, by inserting a large tube in the right femoral artery. As this was a balloon-expandable valve we mounted on a balloon navigator system and implanted an aortic valve level after pre dilatation with a 23mm mammoth balloon,” the specialist that led a team of about 20 doctors including anaesthetists explained further.
The procedure was done under local anaesthesia with conscious sedation, meaning that the patient, who heads Tuthu Parish in Kangema, Murang’a county could chat with the specialists as they went about the procedure.
“The patient was able to walk after six hours, and we are planning to discharge him on the third day, being today,” Dr Patil told journalists yesterday.
In any such operation, there are risks like bleeding in the groin, stroke from embolism, permanent pacemaker, annular rupture and urgent open-heart surgery in less than one per cent of patients operated on, he noted.
“But we were lucky that nothing happened to this patient. TAVI is a relatively safe procedure, especially on the old aged, with high-risk patients where surgery is not possible,” he said.
Dr Patil said once symptomatic aortic stenosis develops, it leads to 50 per cent mortality in five years hence the need for timely treatment.
“We did echocardiography for him which confirmed aortic stenosis with impaired heart pumping,” he said.
Sometimes in December last year, Fr Carlo was cycling uphill on the foot of the Aberdares when he lost breath and fell to the ground. This had never happened to him, and he thought it was a question of old age or being worn out after a lengthy exercise.
“Instead of resting, I decided to push myself more until I lost complete breath and fell,” he said yesterday during a media briefing in the hospital’s boardroom.
Low blood pressure
Luckily for him Good Samaritans stepped in and rushed to rescue him. They took him to his home where his pressure was found to be 80/60. Normal pressure is supposed to be around 120/80.
“It could be a heart failure and therefore come quickly,” his colleagues in Nairobi told him.
After tests, they found that the valve was not working, but delayed admitting him immediately because there was a medical preparation that had to be done before. He waited for one month before he was taken in for the operation.
“Instead of resting, I forced myself by going uphill where I lost breath completely and I lay without breaths when two women saw me and helped me go home,” Fr Carlo narrated yesterday.
One week before he lost breath, he had done a 10km walk in a flat area.
“Even there, it was a little difficult though there was a little climbing,” he said.
Fr Carlo said when the situation deteriorated; he could only do 20 meters and stop to take a rest. He had earlier thought that the loss of breath was a result of old age and inadequate physical practice.
Fr Carlo arrived in Kenya in 1966 and speaks Kikuyu fluently and with a tinge of Meru dialect.
The human heart is made up of muscles that pump blood to the lungs and around the rest of one’s body. There are four valves within a human heart, and for Fr Carlo, one had ceased to work forcing the other three to be strained.
The valves open to let blood flow in through the heart, and close to stop blood from flowing backwards. This ensures the heart is an effective pump.
When open, it allows the flow of oxygenated blood from the heart into one’s aorta, the major artery that supplies the rest of the body. Some people may experience dizzy spells when exercising, which may lead to fainting. The restriction and extra force required to pump blood also cause strain on the heart muscle.
“Open heart operation takes two and a half hours and can take up to seven days to heal,” Dr Patil said. He pointed out that having a new aortic valve inserted may improve how well the heart works, which should significantly improve the symptoms of the patient.