Chandigarh: In a very rare heart valve surgery, a 40-yr female suffering from mitral valve stenosis has operated successfully at Ojas Hospital, Panchkula recently.
The patient required mitral valve replacement with a mechanical valve. She was on treatment with steroids etc. for her Systemic Lupus Erythematosus (SLE) disease for the 5-10 years thus making her high risky for open heart surgery.
Heart surgeries are very rare in a patient suffering from an autoimmune disease SLE . In SLE heart can be affected with Coronary artery disease, Valvular heart disease or even pericardium. Left heart valves are involved more frequently.
In the literature, there are hardly 20 such case reported for mitral valve replacement in these patients since 1970 till 2014. This thus became 21st case in the world.
Dr. Virendar Sarwal Director, Dept. of Cardiothoracic & Vascular Surgery at Ojas who performed surgery said that , not many valve replacement surgeries have happened throughout the world because of the high risk involved in it mainly on 3 accounts including high infection rate post-operative, hyper coagulable state leads to clotting during surgery on heart lung machine or in the immediate post of period in the valve and renal impairment frequently
Dr Sarwal further said that angiography was done which came out to be normal. Surgery was performed using standard heart lung machine keeping activated clotting time always more than 450 seconds. She had a layer of calcium and fibrosis on interatrial septum and mitral valve annulus, he informed.
The other risk is of nephropathy which generally these patients have. Another challenge in post-operative period with mitral valve replacement patients is of maintaining proper anticoagulation which is very important for smooth functioning of the valve, said Dr Sarwal.
“So immediately within the first six hours of operation a blood thinner heparin is started to prevent clot formation on the valve. INR is maintained between 3-4 in all patients. Strict asepsis is also very important.”
This patient was thoroughly investigated to see if the SLE disease is active or not and after confirmation that it is not active she was operated for mitral valve replacement with a mechanical valve taking all precautions. She responded well to surgery and after strict post op care she was discharged on 8th day from the hospital.
Operating upon such cases is a team work where multidisciplinary approach is required which includes a Pulmonologist, an internal medicine physician, a nephrologist, and an expert critical team to monitor various parameters from time to time. We at Ojas have all in house team for all such high risk cases, maintained Dr Sarwal.