A 58-year-old woman from Kenya experienced progressively worsening shortness of breath over several months. Even routine activities left her exhausted. Initially, the cause was unclear, as she had been living with an artificial heart valve for years without noticeable issues.
Background and Diagnosis
She had undergone tricuspid valve replacement in 2011, which stabilized her condition. However, over time, the biological valve began to deteriorate, leading to significant leakage. This placed pressure on the right side of her heart. By the time she sought medical attention, her condition had become serious. She was diagnosed with torrential tricuspid regurgitation, 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.
Limited Options
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. Eventually, she went to another hospital where doctors reviewed her case and considered a catheter-based option instead of open surgery.
The Procedure
The team decided on a transcatheter valve-in-valve procedure, which involves placing a new valve within the existing one without opening the chest. The procedure was performed under the supervision of Dr. Gautam Naik at Indraprastha Apollo Hospital in Delhi. A Sapien Ultra Resilia 29-mm valve was implanted within the prior surgical valve. Imaging during the procedure confirmed that the regurgitation had been addressed.
Post-Procedure Recovery
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 stabilize. Blood pressure improved, and there were signs of recovery in right ventricular function. Urine output also normalized. She was gradually taken off intensive care support and discharged six days later in stable condition.
Follow-Up and Outlook
Dr. Mukesh Goel, Dr. Deepa Sarkar, and the ICU team were involved in her post-procedure management. At a follow-up visit one 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.
