Jaslok Hospital Doctors perform complex aortic valve replacement surgery in patient with Dwarfism

Mumbai: Jaslok Hospital and Research Centre, is proud to announce the successful completion of a complex aortic valve replacement surgery in a 39-year-old male patient with achondroplasia, highlighting the power of teamwork, innovation, and patient-centred care.

Born with achondroplasia, commonly referred to as dwarfism Mr. Kapil Gala had multiple leg deformities and underwent eight surgeries on his feet to enable independent walking. Employed in the financial industry and managing a family independently, he faced a sudden onset of paraplegia a year ago, threatening his mobility and independence.

Kapil was then admitted under the care of Dr Raghvendra Ramdasi & Dr Manish Kothari, spine surgeons & Dr Nihar Mehta, Associate Director of the Structural Heart Department at Jaslok Hospital. Kapil was diagnosed with severe aortic stenosis during the pre-operative workup for spinal surgery. His bicuspid aortic valve, a congenital defect, necessitated urgent intervention before any spinal surgery could be considered.

After a thorough review of echocardiograms, blood tests, CT scans, and MRI reports, the team identified several key concerns during the consultation. Kapil's bicuspid valve lacked the necessary calcium for a minimally invasive TAVI procedure. Additionally, contractures and small arteries in his feet made TAVI a less suitable option. His lung function, however, was deemed capable of handling surgery with pre-surgery exercises. Anaesthesia posed significant risks; extending his neck for intubation could lead to spinal compression and quadriplegia. Furthermore, the surgical team faced the challenge of operating without affecting his spine or legs, necessitating continuous monitoring of muscle and nerve signals throughout the procedure.

The team concluded that an open-heart surgery to implant a mechanical (metal) valve, which could last approximately 15-20 years, was the safest and most effective option. Dr. Nihar Mehta performed a coronary angiography to ensure no blockages were present. With careful planning and the use of a flexible video laryngoscope and conscious sedation Patient was anaesthetised. The Aortic valve replacement surgery was successfully conducted by Dr. Upendra Bhalerao.

Commenting on this case, Dr. Nihar Mehta said, "Our primary concern was the patient's safety and long-term health. We knew that TAVI was not the best option due to the anatomical challenges. It was crucial to provide a solution that ensured his survival and quality of life. We are delighted that Kapil trusted us and chose to proceed with the open-heart surgery."

Dr. Upendra Bhalerao added, "Performing open-heart surgery on a patient with such unique challenges required meticulous planning and execution. This was high risk surgery and posed considerable technical challenges due to anatomical variations and neuromuscular deformities. The successful outcome is a testament to our team's dedication and expertise."

Dr. Manish Kothari remarked, "It was a complex case, but seeing Kapil recover and regain his mobility is incredibly rewarding. His journey exemplifies the importance of interdisciplinary collaboration in medicine.” Jaslok Hospital is honoured to have played a part in enhancing Mr. Kapil’s quality of life. This case exemplifies the dedication and compassion of our medical team and reaffirms our commitment to delivering exceptional patient care."

Thrilled Kapil said that “ Dr Nihar was like a brother to me who gave me the correct advice of not getting a TAVI done despite being a TAVI specialist to ensure my safety and long-term quality life . Dr Upendra Bhalerao, Dr Manish Kothari, Nurses and entire team of Jaslok Hospital treated me as a family. I am standing so comfortably today is because of the hardwork of Jaslok team”

Kapil's surgery was a success. He was off life support within 12 hours, walking with crutches by the second day, and discharged on the seventh day. This case underscores the importance of cohesive, methodical teamwork in achieving optimal patient outcomes. Kapil’s positive attitude and trust in the medical team were pivotal to his recovery. He continues to support his family and live a fulfilling life. The new valve will not hinder any future surgeries, including potential spinal surgery to further improve his mobility.