A first in Maharashtra: Mitral vale in heart replaced through minimal invasion

THANE: It was the third time that the 70-year-old former first lady of Thane underwent a cardiac surgery, but it was only this time that the medical team led by Dr Vijay Surase here junked the open-heart procedure and instead successfully accessed the heart to implant the mitral valve through a minimally-invasive incision from the groin.

Pratibha Pradhan, wife of Thane’s first Mayor Satish Pradhan, who was operated last Tuesday here and recovering fast, is all smiles as the life-saving surgery by Dr Surase, interventional cardiologist at the Jupiter hospital, and his team got rid of the sudden breathlessness and acute chest pain that she was suffering.


"She was suffering from cardiac ailment as the blood supply to the two chambers of the heart was interrupted. It was primarily due to degeneration of the mitral valve which was inserted during the earlier two open-heart operations. We had diagnosed the reason and that the cure lied in removal of the earlier mitral valve. However, considering her age and fragile health condition an open-heart surgery was ruled out and so we decided to do the mitral valve replacement procedure using Indian Meril Myval product,’’ Dr Surase told TOI.

Mitral valve is a part between the upper left and lower left chamber of the heart and its function is to pump blood.

Pradhan’s daughter Ashwini Kotwal said the family was worried as another the surgery would be extremely cumbersome for her mother. "She was in Pune when she started feeling breathless and was unable to sleep and complained of unease. We rushed her to Thane and after diagnosis the doctors assured us that they will not conduct an open-heart surgery and but would replace the mitral valve using another procedure where we would insert the new Indian-made valve in the existing degenerated valve,” Kotwal said.


This was the first time in the state that a mitral valve was inserted in an already existing mitral valve and that the Indian-made valve costs Rs. 12 lakh, which is half the cost of a valve sold by international firms, Dr Surase claimed.

“We conducted the percutaneous mitral valve replacement procedure, in which the mitral valve was inserted in a tube and the tube went directly to the heart through the fermoral vein. Then we fit the new valve it in the heart, so the old valve was crushed due to the new one and this one was positioned in its place,” said Dr Surase.

The size of the mitral valve is of the diameter of a striker, in a carom board game and it is made of a tissue. The surgery took around an hour and the patient was lying in a 40 degree position as she could not lie down completely during the operation. Along with Dr. Surase was his team- Dr. Jayesh Dhareshwar, cardiovascular surgeon, Dr. Nitin Burkule, interventional cardiologist, Dr. Ravinder Singh Rao, interventional cardiologist, Dr. Sneha Vaswani, anaesthetist.


"It was important for the mitral valve to be placed in the right position and for the same we were using fluoroscopy, that is similar to an x-ray machine and also Transesophageal Echocardiography (TEE), which is like an ultrasound. A surgery was not done on the patient as she was a high-risk patient. Also, in open heart surgery there are 50 per cent chances of survival wherein in this procedure there are around five per cent chances of death,” said Dr. Jayesh Dhareshwar, cardiovascular surgeon.


Percutaneous mitral valve replacement procedure:-

The mitral valve was inserted inside a tube. The tube was then inserted inside the fermoral vein, which was near the groin and as it connects near the heart, the tube went till the heart. When the tube reached the heart, it went in the upper right chamber then it went into the upper left chamber and then in the lower left chamber. When it reached near the previous valve which was there, the new one was fixed in its place, due to which the earlier one tore.