Baptist Health Interventional Cardiologist, Dr. Siddharth Wayangankar, MD talks about repairing instead of replacing leaky valves in a heart failure patient.
Interview conducted by Ivanhoe Broadcast News in 2022.
Can you tell me about your patient Sydney?
WAYANGANKAR: Mr. Bear was a referral to me from one of my general cardiology partners and a great guy with a wonderful family. It was disheartening to see that he’s had two open heart surgeries. The second of which was done recently to fix his mitral valve, with a mechanical mitral valve.
He’s only 57?
WAYANGANKAR: Correct. That was the other aspect of a 57 year old man looking for something to avoid a third surgery, which very few surgeons in the world would even consider. What he had was this mitral valve that was done just a year ago. When the surgeons saw the valve, they saw it around the tissue and sometimes that suture may break loose. In general, the valve is okay from inside, but the defect is around the valve between the valve and the cardiac tissue.
Is it like a plug and a drain that doesn’t hold the water in anymore?
WAYANGANKAR: That’s right. But from the outside, not the inside. The valve is working okay from inside. It’s the outside that’s leaking. When it’s leaking outside, the problem is, it is not efficient.
What is it supposed to do? Why did he need that valve in the first place?
WAYANGANKAR: The problem that happens, as you rightly said, is when it’s not working efficiently, every time the heart tries to pump the blood out of the heart into the big aorta, almost 30 to 40 percent of it is leaking through that valve and not going to the body. This causes two things. One, if the defect is big, there is a lot of considerable volume shifts that can lead to signs of congestive heart failure, what Mr. Bear had. A second problem arises where the red blood cells are going through a small orifice and the shear. When the shear, there’s destruction of the red blood cells. Eventually what you have is a hemolytic anemia. The patients eventually become anemic. It is a double vammy. You have congestive heart failure and you have destruction of the red blood cells leading to anemia.
Not a lot of people at 57 have to hear they have congestive heart failure?
WAYANGANKAR: Correct. It was very subtle, but he noticed that within one year of his surgery, he started feeling poorly very quickly. To the point that when he came to me, he had already resigned to the fact that this is the best he could be. It was a difficult dilemma for him. I’m glad that came to us because technology has changed over the last decade. Many procedures have been going on that can be done via minimally invasive techniques. We call them transcatheter therapies. One of the transcatheter therapists that you all know is the TAVR, there’s the mitral clip, and PFO closures. Very few people know that there is a minimally invasive technique we can use to close these defects around the valve. The defect is called PVL, paravalvular leak, and the procedure is called transcatheter PVL closure. The idea is simple. We have to close that defect. That is the biggest challenge because it’s a small defect. The wire always wants to go into the valve, not through the defect. You will have to do it under fluoroscopy and under 3D imaging guidance. It is a very collaborative effort that is worked on very closely with an 3D imaging specialist. They help me guide my wire through the defect. Once the wires is across the defect and we confirm it, we try to close it by stuffing devices into it. While there is no particular device that’s been designed for this, we try to take the devices from other fields of interventional cardiology, like vascular and pediatric. We try to use them to close up these defects, which is the bigger challenge. In the case of Mr. Bear, that was a bigger challenge that he had a larger hole.
How big would that be?
WAYANGANKAR: It was about one centimeter in diameter and they are crescent-shaped. You don’t have something that would particularly fit, you can’t have a circular device close that crescentic defect. We must think out of the box and use out of the box tools to close them. That is the bigger challenge with these procedures.
How did you find it?
WAYANGANKAR: When you have to do these challenging procedures where you don’t have a dedicated toolkit, it’s always good to have a Plan A through Plan C. I had that for this particular procedure. Initially I tried what we call a device called a duct occluder. This is used in pediatric interventional cardiology to close defects in the hearts of kids, but that was too small. I tried to use two of them and that didn’t work. Finally, I had to use a bigger device that’s used in a bit of a bigger kids to close the defect. That worked great. I’m glad it did because otherwise my options were limited because of the way his defect was. Some of the other vascular plans that we use wouldn’t have been an option too.
Will he have to have this replaced and done again?
WAYANGANKAR: I hope not. We had a great result and it is completely closed now. His valve is working great. If something future comes up, I always hope that technology is ahead of the problems that we have in the society. I’m confident that science and technology are progressing faster than us.
Do you just feel like sometimes surgeries are very the same thing all the time?
WAYANGANKAR: That’s what I love about interventional cardiology because it’s a very rapidly expanding field. There are procedures that are coming up that don’t have set guidelines. They don’t have a set algorithms. I think the advantage I have is unlike other operators, I do all three. I do coronary interventions, which is interventions in the heart. I do all peripheral interventions from carotids, to toes, any artery that’s in the body, I can help re-vascularize. I do all structural procedures including TAVR’s, mitral clips, and WATCHMEN’s. When you have a diverse training and diverse skill set, you have a better ability to think out of box solutions for rare problems or niche problems.
Then when you see someone like Sid, who you’ve changed his life. You’ve saved his life.
WAYANGANKAR: Absolutely. Sid saved Sid’s life. I feel these are the moments in your life where you feel that all these years of training and advanced training was worth it.
Are we able to talk about what might come in the future from this specifics?
WAYANGANKAR: The future is very good. This technique has been there for a decade, but very few operators do it. The toolkit is very limited. One of the good things that have come out of this is that, we are being recognized as a center around the region to do this. I get a lot of referrals from at least 300 to 400 miles away to do these procedures. The bigger impact is there is a clinical trial going on that is looking at a dedicated device to treat these problems. We are being considered for that trial. I think when you do procedures like this, people, society, and industries, all notice what we’re doing. Then they are more willing to share their latest technology with us as a part of research trials.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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