Madras Medical Mission performs two innovative Catheter-based Interventions; Published in major American journals

Chennai, June 07, 2024: Cardiologists at the Madras Medical Mission (MMM) developed two innovative procedures that were shown to be successful and now have received acclaim in highly respected international journals. These two procedures have been developed after extensive research, over years, at MMM. Their major feature is that they are both non-surgical and does away with the need for extensive invasive surgeries that are complex as well as require a much longer recovery period. 

(L to R) Dr. K. Latchumanadhas, Head – Catheterization Laboratory; Dr. Ajit Mullasari, Director – Adult Cardiology

The two procedures are for treating structural Valvular complications and for treatment of complex holes in the heart respectively.  

These two procedures and their publications are as follows:

Clinical outcomes for Percutaneous Transcatheter Release of Stuck Mechanical Mitral Valve with Cerebral Embolic Protection. Accepted for publication in Circulation Cardiovascular Interventions. Transcatheter Covered Stent Exclusion of Superior Sinus Venosus Defects. Published in Journal of American College of Cardiology, June 2024.

Procedure no.1:  Context

Mechanical heart valves have been the mainstay for treatment of valvular heart disease, especially in young patients, as their durability is superior to tissue valves. However, mechanical valve implantation is challenged by complications like thrombosis, which ranges from 0.1 – 0.6%.  This is life threatening and has been traditionally treated by redoing the surgery, which is high risk, or thrombolytic therapy which has risk of bleeding and 10 percent failure rate.

The MMM solution

The MMM team, comprising Dr. V. Nandhakumar, Consultant, Dr. K. Latchumanadhas, Head – Catheterization Laboratory and Dr. Ajit Mullasari, Director – Adult Cardiology devised an innovative technique they named PETROS (Percutaneous Transcatheter Release of Stuck Leaflets) for release of the stuck leaflets of the mechanical heart valve through a transcatheter method. These valve leaflets usually get stuck when the blood thinning medication is not taken regularly.

Dr. Ajit Mullasari said, “CT measurements are taken of the valve and accurate balloon sizing is done after which the balloon is dilated in the middle and lateral orifices of the leaflets. The technique is very challenging in these ill patients and requires protection of the brain so that strokes do not happen during the procedure.  We have completed 35 patients in the last few years and the one-year outcomes of the first 24 patients have now been accepted for publication in the lead American Journal of Cardiology – Circulation Cardiovascular Interventions. “

The patient, post this procedure, recovers within 3 – 4 days. 

Procedure No.2: Context

Birth defects of the heart affect 2.5 lakh newborns in India every year.  While a few critical life-threatening defects need early operation and some recover by spontaneous closure, most atrial septal defects become the commonest birth defect beyond childhood. They cause progressive heart enlargement, heart failure and irregularities in heart rhythm.  

Adult atrial septal defects fall under two categories: secundum defects and sinus venosus defects.  The former are successfully treated non-surgically by cardiac catheterization while the latter were traditionally remedied through open-heart surgeries, for which the recovery periods would be considerable.    

The MMM solution

An MMM team lead by Dr Sivakumar, Head of Department of Pediatric Cardiology took up a project nine-years ago to find better ways to address the sinus venosus defects.

They used imaging tools like the Transesophageal echocardiogram, CT angiogram and 3D virtual reality rendering to understand the nature of these defects. The team then designed methods of non-surgical management using long balloons and covered stents. 

The long balloons were used to do the sizing requirements for the covered stents which would be placed at the junction of the superior vena and right atrium. The outer wall of the covered stent separated the oxygenated blood outside the stent and deoxygenated blood inside the stent. 

Since this procedure is done without any surgical incisions, anesthesia, blood transfusions, the patient recovers within few hours and often get discharged from hospital within 36 hours. The patient would require to go through a CT scan or an MRI once a year, as part of the follow up to the procedure.                  

Dr. Sivakumar said, “The initial results in 24 patients were published in Circulation Journal from the American Heart Association in 2020.  Since that time, MMM went on to perform this intervention in more than 150 patients.  The June 2024 issue of the Journal of American College of Cardiology published MMM’s experience with its first 100 patients, the evolution of the procedure and the techniques adopted to make the intervention applicable across the world. This unique technique we developed has already been published in two textbooks of interventional cardiology.”

Being a relatively new technique to close a unique type of birth defect, a World registry has been formed, that has registered around 390 procedures around different institutions in the World, of which Madras Medical Mission contributed for over 150 cases.  

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