By Dr Murugu Sundara Pandian & Dr Gobu P
Wearable gadgets are being used extensively which can monitor heart rate, blood pressure and ECG with the help of apps. This helps in early detection of abnormalities and fast approach to a cardiologist for early intervention.
These gadgets can also serve to provide analysis of life style changes including fitness, diet, sleep pattern, etc which helps in prevention of Coronary artery disease,
Cardiac MRI: Recent advances enable comprehensive analysis of cardiac muscle functioning, especially in heart failure and ischemic cardiomyopathy, The revascularisation strategy depends upon the demonstration of muscle viability on MRI. It also helps in assessment of left ventricular volume and geometry and in planning surgeries such as ventricular restoration. 3D imaging and
Printing is a useful technique in complex congenital heart disease to understand the structural abnormalities, and to plan corrective surgery.
Cardiac complications in a covid patient can be of the following types –
Arrhythmias – mainly Atrial fibrillation, (irregular rapid heart rate), Sometimes ventricular arrhythmias
Ischemia – Myocardial infarction
Inflammatory – Pericarditis, Myocarditis – causing pump failure.
Pulmonary embolism and right ventricular failure.
Thromboembolic phenomena – Secondary to the cytokine storm and release of inflammatory mediators – Stroke, TIAs (Transient Ischemic Attack) and peripheral arterial embolism.
Recent cardiovascular disease seems to occur at a high incidence in young (CHO) individuals, especially among those with diabetes, metabolic syndrome, and a family history of heart disease. This disease in young patients seems to be more aggressive and of a more diffuse pattern making revascularisation a challenging task. The incidence of diabetes among Indians is also rising, especially among the younger population.
Research studies are now being published evaluating the cardiovascular complications in covid survivors as compared to non-COVID population. One such retrospective cohort study has been published in the Nov 22 edition of the Lancet journal. As per this study, Covid survivors on being followed up for a year showed a statistically significant higher incidence of cerebrovascular complications, stroke, ischemic heart disease, arrhythmias, myocarditis, and thrombo embolic phenomenon – Pulmonary embolism.
Recent Advances in Coronary Interventions
There have been major advances in coronary interventions in the last decade. Now the focus on angioplasty and stenting has moved into “precision angioplastyusing imaging techniques like Intravascular Ultrasound (IVUS) and optical Coherence Tomography (OCT). With the help of these imaging techniques, we can understand the nature and composition of the plaque (block) and estimate the exact diameter of the vessel and the length of the lesion. Also, we can assess whether the stent has expanded adequately and has opposed well to the wall. This reduces the incidence of future complications (in-stent restenosis & thrombosis) of the stents.
Another major advancement in angioplasty is the approach to calcified vessels. Calcification of the wall leads to improper stent expansion. Previously, rotational atherectomy (ROTABLATION) was used to break and cut the calcium. It is a diamond-coated burr that breaks the calcium in the vessel and facilitates the passage of stent and expansion of the stent. Recently we utilized Intravascular Lithotripsy (IVL) catheters. These catheters emit ultrasonic waves which break the calcium and facilitate the proper expansion of the stent.
Recent Advances in Non-Coronary Interventions
The major advancement has been in valvular interventions. In patients with aortic valve stenosis, surgical aortic valve replacement was the only option earlier. Now with the advent of Tran catheter Aortic Valve Implantation we can place a new valve from the femoral artery (groin vessel) without open heart surgery.
Also, in selected patients with mitral valve regurgitation (leak), Transcatheter Mitral Valve Repair (MITRA CLIP system) is possible without open heart surgery.
In selected patients, transcatheter Mitral Valve Replacement is also possible in selected patients with severe mitral regurgitation who are high-risk surgical candidates.
In certain congenital heart diseases, transcatheter pulmonary valve implantation is also possible.
Dr Murugu Sundara Pandian, Senior Cardiothoracic Surgeon & Dr Gobu P, Senior Consultant & Interventional Cardiologist, Gleneagles Global Health City
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