Structural Interventions

Say goodbye to blocked valves with suitable structural interventions of the heart. Live a healthy life that you deserve.

Structural interventions is a treatment type that is performed to treat structural heart diseases. SHD or structural heart disease occurs when a person has congenital (inherited) or acquired heart defects or both, lowering the functioning of heart chambers or valves.

Most structural heart problems arise at birth, but some are seen in adults due to the wear and tear of aging, an infection or some other underlying health condition.

Dr. Jagadesh Madireddi is a specialized cardiologist who diagnoses and treats structural heart diseases with structural interventions which are advanced medical techniques to repair and replace heart valves. There are different invasive treatments under structural interventions which we have explained in detail.

Conditions that need structural interventions

Your doctor will suggest undergoing a structural intervention surgery if you have any of the following structural heart conditions:

  • Mitral stenosis
  • Aortic stenosis
  • Aortic regurgitation
  • Mitral regurgitation
  • Pulmonary valve disease
  • Tricuspid valve disease
  • Defective bioprosthetic valves
  • Patent foramen ovale
  • Atrial septum defect
  • Ventricular septum defect
  • Atrial fibrillation
  • Hypertrophic obstructive cardiomyopathy
  • Paravalvular leaks

Different types of structural interventions

Based on your heart condition, the cardiologist will choose the most suitable structural intervention from the various types, such as:

Valvuloplasty

Valve Replacement

Transcatheter Aortic Valve Implantation (TAVI)

Transmyocardial revascularization (TMR)

Valvuloplasty
Also called balloon valvuloplasty, valvuloplasty is a treatment carried out to repair the narrowing opening in one of the heart valves. The narrowing of a heart valve makes the valve flaps stiff or thick and they fuse, reducing the blood flow.

With valvuloplasty, your blood flow through the heart valve will improve and it also eases out the symptoms.

The symptoms of heart valve issues include:

  • Chest pain
  • Trouble breathing
  • Fast weight gain because of fluid retention
  • Dizziness
  • Palpitations
  • Swelling of ankles, feet or abdomen
  • Various reasons for undergoing valvuloplasty are:
  • Narrowing of the mitral valve or mitral valve stenosis
  • Valve narrowing with symptoms
  • Pulmonary valve stenosis
  • Aortic valve stenosis

About the process

The cardiologist will insert a catheter having a balloon on the tip and move it into one of the arteries through your groin or arm. X-ray photographs help to guide the catheter to the defective heart valve. The balloon is then inflated to widen the valve opening and separate the valve flaps. 

After this, the balloon is deflated inside and taken out safely along with the catheter. You will be sedated but conscious throughout the treatment process. You may be observed overnight in the hospital post treatment. 

Valve Replacement
For patients with too scarred, fragile valves or any valvular heart disease, cardiologists recommend valve replacement surgery. The signs and symptoms of valvular heart disease are:

  • Dizziness
  • Fatigue
  • Cyanosis
  • Shortness of breath
  • Light-headedness
  • Fluid retention
  • Chest pain

Types of valve replacement

There are different types of valve replacement surgery carried out based on your specific heart condition, your age, overall health and ability to consume anticoagulant drugs.

Aortic Valve Replacement

The aortic valve on the left of your heart functions as an outflow valve. The valve allows the blood to go out from the left ventricle – the heart’s significant pumping chamber. After the blood leaves the left ventricle, the aortic valve closes to restrict the blood from flowing back to the ventricle. When there’s a congenital defect or heart disease of the aortic valve, such as regurgitation or stenosis, you will need to undergo a valve replacement surgery called aortic valve replacement.

Mitral Valve Replacement

The mitral valve is situated on your heart’s left side serving as an inflow valve. It enables the blood to flow from the left atrium into the left ventricle. In case the mitral valve fails to open or close completely, you will require to undergo valve replacement surgery as a narrow mitral valve will restrict the blood to flow freely.

A mitral valve that doesn’t close fully leads to the blood leaking back to the lungs, putting excess pressure on the lungs. Mitral valve defect can be a result of a congenital issue, a degenerative disease or infection.

Double valve replacement

This valve replacement surgery involves replacing both the aortic and mitral valves. In some cases, the entire left side of the heart is replaced by surgery. It is a rare type of valve replacement treatment and is only suggested in extreme cases where no other option fits well for the patient.

Pulmonary valve replacement

The pulmonary valve of your heart acts as a membrane separating the pulmonary artery and right ventricle. The pulmonary valve functions to enable the blood flow from the heart to the lungs via the pulmonary artery. Cardiologists suggest pulmonary valve replacement in cases of stenosis due to infection congenital defect or carcinoid syndrome.

The valve replacement surgery is carried out under local anesthesia using minimally invasive or conventional techniques. Conventional techniques involve making a large incision starting from your neck to the navel.

In the case of less-invasive replacement surgery, there will be a shorter incision that also reduces any risk of infection post the procedure. Throughout the surgery, you will be lying on a bypass machine to ensure blood circulation is active and your lungs keep functioning without interruption.

You will have to stay in the hospital for almost a week post surgery and follow your doctor’s advice about recovery at home. Contact your cardiologist if you notice fever, chills or any other unusual symptoms after the surgery.

Transcatheter Aortic Valve Implantation (TAVI)
TAVI is a less invasive structural intervention for serious aortic stenosis. The treatment is opted when the patient is too weak for an open-heart surgery.

During the surgery, you may or may not be completely asleep. Unlike other structural interventions, your heart will keep beating during TAVI. There are different approaches to replace a diseased aortic valve. However, the most common process is the transfemoral approach – making a small incision in the leg.

The cardiac surgeon makes a small incision in your upper leg and inserts a sheath (a short, hollow tube) into the femoral artery.

The new valve is compressed and placed in the sheath which is then pushed into the aortic valve. As soon as it reaches the diseased valve, it pushes aside its leaflets.

The new valve fits right in place of the existing valve. Your cardiologist will check if the new valve functions normally before closing the incision.

Transmyocardial Revascularization (TMR)
Transmyocardial revascularization or TMR is a surgical treatment for adults with coronary artery disease who are not eligible or didn’t respond well to cardiac procedures like stenting, angioplasty, medication or coronary artery bypass graft surgery. TMR is a treatment that helps relieve angina caused by a lack of blood and oxygen flow to the heart. 

While performing TMR, the surgeon will create a small incision in your chest’s left side. Using a special carbon dioxide laser, the doctor will make channels in your heart muscle to improve blood flow. Around 20-40 one-millimeter channels are created based on your heart condition.

A computer helps in directing laser beams to the exact location in the heart in between each beat to prevent electrical disturbances. It takes around 1-2 hours to complete the surgery and you will be under observation for a week after the treatment process.

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Yashoda Hospital, Somajiguda, Hyderabad, Telangana 500082.
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