Too risky for open surgery, this patient’s heart was treated without opening the chest

For several months, a woman aged 58, in Kenya, had been experiencing increasingly severe shortness of breath. Even minor, regular activities drained her energy. Initially, the reason behind the transformation was unclear. After all, she had been living with an artificial heart valve for years without any noticeable issues.


It was 2011 when she received tricuspid valve replacement, which contributed to stabilising her condition. Regardless, as time passed, the valve started to deteriorate, as biological valves inevitably do. The significant leakage resulted in exerting pressure on the right side of the heart.


By the time she returned for medical care, her condition had become serious. She was diagnosed with torrential tricuspid regurgitation, along with significant valve gradients and severe right ventricular dysfunction. In simple terms, her heart was no longer coping well, and the risks of another open-heart surgery were extremely high.



She visited multiple hospitals, but the response was largely the same. The case was considered too risky for repeat surgery. With each consultation, her options narrowed.


She later went for a check up at another hospital, where doctors reviewed her case again. Given the risks of another open-heart surgery, the team considered a catheter-based option instead.


They decided on a transcatheter valve-in-valve procedure. The plan was to place a new valve within the existing one without opening the chest.


The procedure was carried out under the supervision of Dr Gautam Naik at Indraprastha Apollo Hospital. A Sapien Ultra Resilia 29-mm valve was implanted within the prior surgical valve. Doctors said imaging during the procedure showed that the regurgitation had been addressed.


The days after the procedure were critical. Her heart function was already weak, and she developed low blood pressure along with reduced urine output. She was moved to intensive care and required inotropic support. Fluids were managed carefully.


Over the next few days, her condition began to stabilise. Blood pressure improved, and there were signs of recovery in right ventricular function. Urine output also normalised. She was gradually taken off intensive care support.


She was discharged six days later in stable condition.


Dr Mukesh Goel, Dr Deepa Sarkar and the ICU team were involved in her post-procedure management. At a follow-up visit a week later, doctors noted improvement in her symptoms. Breathlessness had reduced, and she was able to return home.


Dr Naik said such procedures are being used more often in patients who are not suitable for open surgery, especially in complex valve cases.