Novel method used to fix leaky valve without open-heart surgery
By Poon Chian Hui, The Straits Times, 20 Apr 2012
FOR 10 agonising months, retiree Anthony Cher waited for a solution to his failing heart.
After two heart operations, doctors had told the 72-year-old that it was too risky to go for a third one.
The solution came in February this year, in the form of a new minimally invasive procedure to fix faulty heart valves.
This 'valve in valve' procedure, as its name suggests, involves fitting a new implant within the older, worn-out one - without having to cut open the heart.
It is suitable for people who have had conventional open-heart surgery before, and are deemed high-risk for another similar operation.
Mr Cher is the first person in Asia to undergo this novel operation, performed by the National Heart Centre Singapore.
'I was in such bad shape that I was prepared to accept anything,' said the former air cargo transport officer.
His feet had swollen and it was difficult to get around.
'I was so surprised that just four or five days after the operation, I could walk again,' he said.
Only 21 cases like Mr Cher's have been reported worldwide. The first such procedure was done in Canada in 2007.
Heart valves direct blood flow by opening and closing with every beat.
Mr Cher had a problematic mitral valve, which regulates the flow of blood between the top and bottom chambers on the left side of the heart.
He had an animal valve implanted in 2005 via open-heart surgery. But this has worn out, causing blood to leak between the heart chambers.
Unlike open-heart surgery, which is still considered the gold standard in treating valve problems, the procedure makes use of a newly approved artificial heart valve secured within the worn-out implant with the help of a balloon device.
This is how it works: A ring-shaped implant, mounted on a balloon, is delivered inside the heart using a tube through a small cut in the chest.
When the implant - made of a stable metal and cow tissue - is seated inside the faulty valve, the balloon is inflated.
This expands the implant such that it pushes against the walls of the old valve, allowing the old valve to hold it in place.
Imagine putting a layer of waterproof material in the inside of a faulty pipe to prevent leakage.
The procedure was originally used to fix another heart valve, the smaller aortic valve. It was then adapted in 2007 to service the bigger mitral valve.
Dr Soon Jia Lin, who led Mr Cher's surgical team, said patients like him have little recourse: Either take medicine, or risk another open-heart surgery.
But open-heart surgery in these cases would have involved 'major plumbing work' that includes temporarily stopping the heart, said Dr Soon.
'We can now offer this as an alternative to a high-risk repeat operation,' said the consultant cardiothoracic surgeon.
'With a small incision, we can fix this problem without stopping the heart, and without cutting the old valve out.'
More people are expected to benefit from this procedure as Singapore's population ages. Life expectancy here has increased from 78 years in 2001 to nearly 82 years in 2010. By 2030, one in five Singaporeans will be 65 and above.
Some of the elderly would have had heart valve operations before and because of their age, may not be suitable for another one, said Dr Soon.
This new procedure can offer them a way out. 'It is a technology that is changing the game,' he added.
In 2010, the centre treated 120 people with mitral valve problems. One third had to have their valves replaced.
Meanwhile, two months after the procedure, Mr Cher says he is back to his active self, although he still attends rehabilitation sessions twice weekly.
'Now, every morning I go to the park for a walk, sometimes for up to 1km,' he said beaming.
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