TAVR is a minimally invasive cardiac procedure recommended for patients with severe Aortic stenosis who cannot go for open heart surgery because of high risk involved with the surgery. TAVR involves placement of new aortic valve through a catheter inserted in the femoral artery.It is also referred to as TAVI (Transcatheter Aortic valve Implantation) since this procedure does not remove the old damaged aortic valve,instead the new valve is positioned in its place to restore normal blood flow across aortic valve.
During this procedure:
A tiny incision is made in the groin
Through this incision, a flexible tube(Introducer sheath)is placed into the femoral artery(a blood vessel in the thigh which is main source for providing oxygen rich blood to the lower limb) to provide access point for passing other surgical tools through it.
Guide wire is inserted through Introducer sheath as mentioned above and guided till the aortic valve and pushed through it into the left ventricle.
Now a balloon tipped catheter is inserted into the femoral artery with the help of the guide wire and guided till the aortic valve.
Once the catheter reaches the aortic valve, balloon at its tip is inflated in order to expand the narrowed valve and push the damaged valve leaflets to the side.
Balloon is then deflated and catheter is removed.
Another catheter with the replacement valve placed at its tip is inserted into the femoral artery. This replacement valve is a tissue valve with a wire mesh called stent around it.The replacement valve is compressed and then placed.
Once this catheter with replacement valve at its tip reaches the aortic valve,the balloon beneath the stent is inflated and the stent with the tissue valve is positioned effectively. The stent helps to fix tissue valve in place and provides stability.
Subsequently, the balloon will be deflated and catheter and guidewire would be taken out.
Once all the surgical instruments are removed the insion is closed with stitches.
Likewise another incision, that was made in the other groin to insert instruments in order to monitor the heart, is closed too.
Aortic valve is one of the 4 heart valves that ensure smooth flow of the blood through the heart and out of it in one right direction. Itis located between the left ventricle(lower left heart compartment)and Aorta. It ensures one way blood flow from the left ventricle to the largest artery in the body, Aorta. Aorta takes the oxygen rich blood from the heart to the whole body. At the time of ventricular contraction during each heart beat, 3 cusps or flaps of tissue that forms the aortic valve are flexible and open wide to allow oxygen rich blood to pass through it. When ventricle relaxes, the cusps of the Aortic valve close effectively to prevent flow of blood back into the left ventricle.
Aortic stenosis is a medical condition in which the aortic valve becomes narrow or tight. Calcium may get deposited on the cusps of the valve making them stiff and thick and rendering them ineffective(Calcific Aortic stenosis). The cusps of the valve, under such circumstances, do not open wide, making the valve opening narrow resulting in restricted blood flow across the valve from the left ventricle to the aorta.
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Mitral valve is located between left upper chamber(Left atrium)and left lower chamber(Left ventricle) of the heart that ensures one way blood flow through the left atrium to the left ventricle. During ventricular relaxation, the Mitral valve opens, allowing the blood to flow through left atrium into the left ventricle. Blood fills the ventricle only to be emptied into the great artery or aorta during the contraction of the ventricle and this blood reaches the body tissues to oxygenate them.
During the ventricular contraction, the mitral valve closes preventing backflow of the blood into the upper left chamber or left atrium. This rhythmic opening and closure of the valve happens with each heart beat in a cardiac cycle.
Mitral valve has two flaps, also known as cusps or leaflets (in lay man’s terms, can be thought as doors) that are flexible and are attached to the papilary muscles located in the inner wall of the ventricle, through strong chord like tendons or fibrous strings referred to as Chordae tendinae. During left ventricular contraction (Systole), the papillary muscles contract and the strings like tendons of the papillary muscles attached to the cusps prevent prolapse or ballooning of these flaps into the left atrium (Mitral prolapse) when the Mitral valve closes and prevent back flow of blood.
Mitral Valve once diseased or damaged, can be dysfunctional in the following two ways:
Valve does not close effectively leading to the backflow of the blood, which is a wrong way.This condition is referred to as Valve insufficiency or Valve incompetence.
Valve does not open widely, it becomes narrow and blood does not flow through it easily and smoothly. This condition is known as Mitral stenosis.
It puts stress on the heart and the function of the heart is compromised. Under such conditions the diseased or damaged valve needs to be repaired or replaced. Valve may be repaired, which means it is reshaped or trimmed to make it function properly or replaced. Replacement of the valve means that the diseased or damaged valve is removed altogether and a new valve is put in its place.
The new valve that has been put in place of the diseased or the damaged valve may be of the following two types:
Made up of metallic alloy
The patient needs to be on the blood thinning medication(Anti coagulants) for the rest of his/her life.
Likelihood of its failure is extremely less.
Lifestyle after surgery has to be adjusted to a large extent to accomodate for the usage of blood thinning medication.
Taken from human or animal(generally pig) tissue
No requrement for blood thinning medication.
Can last for 10 to 15 yrs.
May fail,after all it is a biological tissue.
Life style is simple with minimal changes post surgery
Traditional heart surgery involves cutting through the middle of the breast bone or sternum to reach the heart. The incision is 6 to 8 inches long.There is another minimally invasive mitral valve surgery wherein the sternum is untouched. An incision is made on the right side of the chest between the ribs. The most advanced and least invasive technique currently being employed is Robotically assisted Mitral valve surgery.It involves few small(around 2 cm) key hole incisions between the ribs.
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Roux-en-Y Gastric Bypass Surgery- Gold standard for weight loss surgery
Roux-en-Y Gastric Bypass surgery, most commonly performed bariatric surgery, works on the principle of
1. Restriction of the size of the stomach so that the person feels satiated early with less intake of food and hence less calories consumption at a time.
2. Bypassing that part of the intestine where the absorption of nutrients and calories take place.
In order to achieve the above, the stomach is divided into two parts, upper small pouch of the size of the walnut that can hold only 30 ml of food and the lower remaining big part of the stomach which would be bypassed, in this surgery. The surgeon separates these two parts of stomach by putting surgical staples in between.
Similarly, the small intestine is also divided into two parts, the upper, duodenum which remains attached to the stomach like before and will be bypassed too and the Jejunum, lower part of the small intestine, which will now be attached directly to the upper small stomach pouch.
Your must be wondering where do the stomach acid and various digestive enzymes that are normally secreted, go! The larger remaining part of the stomach continues to make digestive juices and enzymes. However, the food does not pass through it.
The digestive juice with digestive enzymes is directed to the lower part of the intestine by reattaching the free end of the bypassed part of the intestine which is still connected to the remaining larger part of the stomach, to the lower part of the jejunum resulting in their mixing with the food eventually. This whole new arrangement of the intestine is in the shape of “Y” and hence the name of the surgery and “Roux” name has been taken after the name of the surgeon who invented this procedure.
Roux-en-Y surgery can be done either through Open surgery wherein 8 to 10 inches long incision is made in the middle of the abdomen. At times, Gall bladder is also removed during this surgery as the probability of Gall bladder stones becomes high when a significant amount of weight is lost in short time, say initial 4 to 6 months post surgery.
Other minimally invasive surgical approach is Laparoscopic Roux-en-Y Gastric Bypass Surgery, that involves, few (4 to 5) small key hole incisions in the abdomen through which specialized surgical instruments and an endoscope(laparoscope) is passed to view, access the surgical site and perform the surgery. Laparoscope has a tiny video camera at its end that helps in the projection of the images from inside onto the monitor.
Roux-en-Y Gastric Bypass Surgery has several benefits, such as
Long term considerable weight loss
Cause changes in the gut hormones resulting in decreased appetite and early satiety.
Maintenance of weight for a long period
Improvement in the health conditions such as Diabetes, High blood pressure, Sleep Apnea post surgery
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CABG or Open heart surgery is performed to restore normal blood flow to the heart. It is indicated in severe coronary heart disease. CABG or Coronary Artery Bypass Grafting, also known as Bypass surgery involves sewing a graft or substitute healthy blood vessel (artery or vein) from leg, arm or chest, around the coronary arteries in such a way so as to bypass the blockage in the coronary arteries. One end is sewn before the blockage and the other end beyond it. In other words, the blood to the heart is detoured by way of a substitute vessel or graft. This restores the normal blood flow to the heart.
Benefits of CABG(Coronary Artery Bypass Grafting)surgery in India
Most affordable cost coupled with quality.
World class hospitals with state of the art infrastructure.
No waiting period.
Globally trained Cardiologists with decades of experience in carrying out the procedure with competence and ease.
Compassionate staff to look after
Hospitals accredited with international organizations such as JCI(Joint commission International) for quality standards.
Language no barrier. English speaking people and if required, translators are available for your convenience.
Most economical accommodation available at a walking distance from the hospital. Wide range of options starting from guest house, service apartments to five star hotels, best suited to your budget and choice.
Good flight connectivity
India has a diverse and rich cultural heritage. You can witness its beauty and uniqueness. It offers most conducive environment for recuperation.
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Breast cancer surgery that involves the removal of the entire breast tissue including the skin, nipple, areola,along with most lymph nodes (Axillary Lymph nodes) from the under arm. The muscles beneath the breast tissue is spared.
With advancement in the medical technology, other treatment modalities for breast cancer such as Breast conservation surgery have gained a strong foothold as the treatment of choice for breast cancer patient. However, mastectomy is still considered a viable option in breast cancer patients, as determined by your team of medical experts. It is indicated in early stage breast cancer that has spread to the axillary lymph nodes. Over all surgery has always been the integral treatment modality for breast cancer.
In contrast to the Traditional Radical Mastectomy surgery, Modified Radical treatment surgery compromises less with the appearance of the breast and the outcome of the surgery is comparable to that of the traditional breast removal surgery.
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