Heart Valve Repair or Replacement Surgery Hospitals in India

Overview

Heart valve surgery is a procedure to treat heart valve disease. In heart valve disease, at least one of the four heart valves that keep blood flowing in the correct direction through your heart doesn’t function properly.heart_valve_replacement03

These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps called leaflets, for the mitral and tricuspid valves, and cusps, for the aortic and pulmonary valves. These flaps open and close once during each heartbeat. Sometimes the valves don’t open or close properly, disrupting the blood flow through your heart to your body.

In heart valve surgery, your surgeon repairs or replaces the affected heart valves. Many surgical procedures may be used to repair or replace heart valves, including open-heart surgery or minimally invasive heart surgery.

Your treatment depends on several factors, including your age, health, the condition of the heart valve that is affected and the severity of your condition.

Your treatment depends on several factors, including your age, health, the condition of the heart valve that is affected and the severity of your condition.

Signs and Symptoms of Heart Failure

In the early stages, Heart Failure may not have any symptoms. In the later stages, the patient may have severe symptoms because the weakened heart is unable to pump enough oxygen-rich blood with each contraction to satisfy the body.

The most common symptoms are

  1. Difficulty in Breathing – Fluid back up into and around the lungs can cause shortness of breath with exercise or difficulty in breathing at rest. Some people with Heart Failure must prop themselves up with extra pillows to breathe more easily.
  2. Chronic Cough – The build-up of fluid in the lungs causes the lungs to work harder. Patients may have a persistent cough or wheezing (a whistling sound in the lungs, or labored breathing).
  3. Edema – Less blood to the kidneys causes fluid and water retention, resulting in swollen ankles, legs and abdomen and weight gain. Symptoms may cause an increased need to urinate during the night.
  4. Loss of Appetite – Bloating in the abdomen may result in loss of appetite or nausea. Patients have the feeling of being “full,” even when they have not eaten for a long time. Their abdomen may become swollen or distended.
  5. Fatigue – Less blood to major organs and muscles makes one feel tired and weak.     Patients find even walking difficult.

Heart valve surgery risks may include:

  • Bleeding
  • Heart attack
  • Infection
  • Valve dysfunction in replacement valve
  • Irregular heart rhythm (arrhythmia)
  • Stroke
  • Death

Diagnosis for Heart Failure

There is no single test that can diagnose Heart Failure. The patient may have to go some of the following tests –

  1. EKG (Electrocardiogram) – This test is used to measure the heart’s electrical activity. It may show if the patient has had a heart attack or if there is thickening of the walls in the heart’s pumping chambers (ventricles) or if the heart rhythms are abnormal.
  2. Chest X-ray – A chest X-ray shows if the heart is enlarged or if there is fluid in the lungs, or any lung disease.
  3. BNP Blood Test – This test checks the level of a hormone called BNP (B-type natriuretic peptide) that rises in Heart Failure.
  4. Thyroid Function Tests – These tests reveal whether an overactive or an under-active thyroid is responsible for Heart Failure.
  5. Echocardiogram – Echocardiogram enables the doctor to evaluate the size, thickness and pumping action of the heart, as well as evaluate how well the heart valves are functioning. A stress echocardiogram may also be useful in assessing how well the heart is functioning at rest and during exercise.
  6. Coronary Angiography – This test, usually performed along with cardiac catheterization, helps the doctor see the flow of blood to the heart muscle.
  7. Magnetic Resonance Imaging (MRI) – MRI shows detailed images of the structures and beating of the heart, enabling the doctor to assess if parts of the heart are weak or damaged.

BEFORE THE PROCEDURE

How long the operation takes depends on how much heart disease is present. Your surgeon will discuss this with you before the operation.

To help you learn about the procedure, your doctor may suggest a number of actions, including:

  • Talking with different members of the surgical team, such as the anesthesiologist, surgeon, cardiologist, respiratory therapist, and nurses
  • Discussing with family members the details of the operation
  • Visiting the intensive care unit (ICU) where you may be sent for postoperative recovery

DURING THE PROCEDURE

During the operation, the surgeon opens your chest to get to your heart and the problem valve. You will be asleep during the operation and will feel no pain.

During the majority of procedures, your heart will be temporarily stopped, and you’ll be put on a heart/lung machine that takes over your breathing and blood circulation. Alternatively, there are procedures that may be performed on a beating heart. Your surgeon will decide which type of procedure is best for your particular needs.

Procedures that let the surgeon get to the damaged valve through a small incision in the “breastbone” (sternum) or under the right pectoral muscle in your chest are called minimally invasive procedures.mitral_valve_repair123

With recent advances in technologies and procedural techniques, more cardiac surgeons are using minimally invasive procedures to repair heart valves. These procedures may potentially reduce pain, scarring, and your recovery time. You and your doctor will decide if this is a practical procedure for your condition.

Heart valve repair is performed with one of the three types of incisions shown in this illustration. Minimally invasive surgery uses a “mini” incision in the sternum or under the pectoral muscle in your chest to access the heart valve.

Your surgeon may perform one or several of these procedures as he or she repairs your heart valve:

  • Resize the valve by removing extra tissue
  • Remove calcium deposits that may have built up around the valve leaflets
  • Repair the cords that control the movement of the valve leaflets
  • Reattach the valve to its cords
  • Add support to the base of the valve (annulus) by adding tissue or by sewing an annulus band or ring around the outside of the valve

AFTER THE PROCEDURE

When the heart valve has been repaired and the surgery is completed, your heart will be beating and all incisions will be closed.

Following the surgery, you’ll spend some time in the intensive care unit (ICU) where you will be closely monitored to make sure there are no complications. After that, you’ll be moved to another room where your family and friends will be able to visit you.

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Heart Valve Repair or Replacement Surgery Hospitals in India

Most Advanced Heart Valve Repair or Replacement Surgery With Best Hospitals in India

Overview

Heart valve surgery is a procedure to treat heart valve disease. In heart valve disease, at least one of the four heart valves that keep blood flowing in the correct direction through your heart doesn’t function properly.

These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each544 valve has flaps called leaflets, for the mitral and tricuspid valves, and cusps, for the aortic and pulmonary valves. These flaps open and close once during each heartbeat. Sometimes the valves don’t open or close properly, disrupting the blood flow through your heart to your body.

In heart valve surgery, your surgeon repairs or replaces the affected heart valves. Many surgical procedures may be used to repair or replace heart valves, including open-heart surgery or minimally invasive heart surgery.

Your treatment depends on several factors, including your age, health, the condition of the heart valve that is affected and the severity of your condition.

Your treatment depends on several factors, including your age, health, the condition of the heart valve that is affected and the severity of your condition.

Signs and Symptoms of Heart Failure

In the early stages, Heart Failure may not have any symptoms. In the later stages, the patient may have severe symptoms because the weakened heart is unable to pump enough oxygen-rich blood with each contraction to satisfy the body.

Heart valve surgery risks may include:

  • Bleeding
  • Heart attack
  • Infection
  • Valve dysfunction in replacement valve
  • Irregular heart rhythm (arrhythmia)
  • Stroke
  • Death

Diagnosis for Heart Failure

There is no single test that can diagnose Heart Failure. The patient may have to go some of the following tests –

  1. EKG (Electrocardiogram) – This test is used to measure the heart’s electrical activity. It may show if the patient has had a heart attack or if there is thickening of the walls in the heart’s pumping chambers (ventricles) or if the heart rhythms are abnormal.
  2. Chest X-ray – A chest X-ray shows if the heart is enlarged or if there is fluid in the lungs, or any lung disease.
  3. BNP Blood Test – This test checks the level of a hormone called BNP (B-type natriuretic peptide) that rises in Heart Failure.
  4. Thyroid Function Tests – These tests reveal whether an overactive or an under-active thyroid is responsible for Heart Failure.
  5. Echocardiogram – Echocardiogram enables the doctor to evaluate the size, thickness and pumping action of the heart, as well as evaluate how well the heart valves are functioning. A stress echocardiogram may also be useful in assessing how well the heart is functioning at rest and during exercise.
  6. Coronary Angiography – This test, usually performed along with cardiac catheterization, helps the doctor see the flow of blood to the heart muscle.
  7. Magnetic Resonance Imaging (MRI) – MRI shows detailed images of the structures and beating of the heart, enabling the doctor to assess if parts of the heart are weak or damaged.

How you prepare

Before surgery to have your heart valve repaired or replaced, your doctor and treatment team will explain to you what to expect before, during and after the surgery and potential risks of the surgery.

Your doctor and team will discuss with you concerns you may have about your heart valve surgery. Discuss with your doctor and treatment team any questions you may have about the procedure.

You’ll need to have your hair shaved at the location of your body where the procedure will take place.

Before being admitted to the hospital for your surgery, talk to your family about your hospital stay and discuss help you may need when you return home. Your doctor and treatment team may give you specific instructions to follow during your recovery when you return home.

Heart valve replacement:-

If your heart valve can’t be repaired, your doctor may recommend heart valve replacement. To replace a heart valve, your doctor removes the heart valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

Biological valves often eventually need to be replaced, as they degenerate over time. If you have a mechanical valve, you’ll need to take blood-thinning medications for the rest of your life to prevent blood clots. Doctors will discuss with you the risks and benefits of each type of valve and discuss which valve may be appropriate for you.

A minimally invasive catheter procedure may be conducted to replace certain heart valves. For example, a catheter procedure may be performed to insert a replacement valve into a biological replacement valve in the heart that is no longer working properly.

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Most Advanced Heart Valve Repair or Replacement Surgery With Best Hospitals in India

Best Heart Valve Repair or Replacement Surgery Hospitals in India

What is heart valve repair or replacement surgery?

The heart is a pump made of muscle tissue. The heart has four pumping chambers: two upper chambers, called atria, heart12and two lower chambers, called ventricles. To keep the blood flowing forward during its journey through the heart, there are valves between each of the heart’s pumping chambers:

  • Tricuspid valve. Located between the right atrium and the right ventricle
  • Pulmonary valve. Located between the right ventricle and the pulmonary artery
  • Mitral valve. Located between the left atrium and the left ventricle
  • Aortic valve. Located between the left ventricle and the aorta.

Why might I need heart valve repair or replacement surgery?

Valve repair or replacement surgery is done to correct the problems caused by one or more diseased heart valves.

If your heart valve(s) becomes damaged or diseased, you may have the following symptoms:

  • Dizziness
  • Chest pain
  • Breathing difficulties
  • Palpitations
  • Edema (swelling) of the feet, ankles, or abdomen (belly)
  • Rapid weight gain due to fluid retention

There may be other reasons for your healthcare provider to recommend heart valve repair or replacement surgery.

What are the risks of heart valve repair or replacement surgery?

Possible risks associated with heart valve repair or replacement surgery include:

  • Bleeding during or after the surgery
  • Blood clots that can cause heart attack, stroke, or lung problems
  • Infection
  • Pneumonia
  • Breathing problems
  • Arrhythmias (abnormal heart rhythms)

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider prior to the procedure.

During the Procedure

To help you learn about the procedure, your doctor may suggest a number of actions, including:

  • Talking with different members of the surgical team, such as the anesthesiologist, surgeon, cardiologist, respiratory therapist, and nursesheart123
  • Discussing with family members the details of the operation
  • Visiting the intensive care unit (ICU) where you may be sent for postoperative recovery

Treatment Options

Heart Valve Repair

Heart valve repair is a surgical or minimally invasive procedure that corrects a heart valve that is not functioning properly. Heart valve repair usually involves the heart valve leaflets that open and close to pump blood through the heart. In some cases, your doctor may find that repairing your heart valve is the best way to treat your heart valve disease.

Heart Valve Replacement

When repair is not an option, replacing your damaged heart valve may be the most effective treatment for your condition. Heart valve replacement is a surgical procedure that replaces a damaged heart.

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Best Heart Valve Repair or Replacement Surgery Hospitals in India

Most Advanced Heart Valve Replacement Surgery in India

What is Valve Replacement Surgery?

Heart valve replacement surgery is a procedure by which surgeons remove a damaged heart valve and substitute it with grafts or parts from body tissues or with synthetic heart valves to restore the normal functioning of the heart.valve-replacement13

Heart valve replacement surgery is done under general anaesthesia and takes about four to five hours. The surgery is done either as an open-heart surgery where in the patient is put on a heart lung machine or rarely as beating heart surgery without the use of heart lung machine, while the patient’s heart is normally beating.

There can be various reasons for heart valve replacements like:

  • Mitral valve regurgitation is a condition where the oxygenated blood flows backwards into the lungs as opposed to flowing through. Patients have angina arrhythmia and shortness of breath.
  • Narrowed valve is one more reason for valve replacement in cases like aortic stenosis or mitral stenosis.
  • When the valve is leaky, like in aortic regurgitation or aortic insufficiency, the condition requires valve replacements. Left untreated it may lead to heart failure.

Valve defects can be congenital that is a birth defect or can be a result of degenerative mechanism. Other causes for valve damage can be infections such as bacterial endocarditis or ischemic heart disease.

Aortic and mitral are the most commonly replaced valves whereas pulmonary and tricuspid are not commonly replaced. The replaced valves can be made either of tissues from animals or humans and mechanical valves made of man-made material.

  • Tissue valve where animal or human donor is used
  • Mechanical valve is made of durable materials

What is the Diagnosis for Valve Replacement Surgery?

The following tests may be done to conclude and diagnose valve diseases

  • Echocardiography
  • Transesophageal echocardiography
  • Cardiac catheterization (also called an angiogram)
  • Radionuclide scans
  • Magnetic resonance imaging (MRI)

Procedure of Heart Valve Surgery

Heart valve surgery means repair or replacement of the diseased valves. In the surgery, some valves are repaired or mended to do its work properly. Replacement means removal of the diseased valves by a new valve. The procedures of heart valve surgery are :

  1. Valve Repairing : In the valve repair surgery, a ring is sewn around the opening of the valve to make tighter. The surgeons may cut the other parts or may separate and shorten it to help the valve open and close right.
  2. Valve Replacement : Sometimes by mending the valves, it is not possible to cure the unhealthy valve, and then replacement is required to get back its normal function. A prosthetic valve is used to replace. There are two types of prosthetic valves.
    1. Mechanical valves : These types of valves are made from man-made materials. While heart surgeons’ use this valve, lifetime therapy with an anticoagulant is prescribed to the patient.
    2. Biological (tissue) valves : The surgeons take biological valves from pig, cow or human donors. The longevity of biological valves is less than the mechanical valves.

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Most Advanced Heart Valve Replacement Surgery in India

RadioFrequency Catheter Ablation Treatment in India

Radiofrequency catheter ablation may be a procedure that’s performed to correct a disturbance in heart rhythm. a short review of however a normal heart rhythm happens and a description of a number of the rhythm issues that are treated with this procedure can help within the understanding of radiofrequency catheter ablation.

How will the heart usually work? — heart muscle cells area unit stimulated by electrical impulses that cause them to go for a homogenous manner and with an everyday rate. This contraction produces the heartbeat, that causes blood to be pumped out of the heart into arteries and so to all or any parts of the body. The flow of blood into arteries are often measured by feeling the pulse, that corresponds to the heartbeat.

In the normal heart, electrical impulses arise from an area of specialized cells called the sinus node, which is the heart’s normal pacemaker. The sinus node is located in the right atrium, the upper right chamber of the heart . After leaving the sinus node, an impulse spreads across the upper heart chambers (right and left atria) and reaches the atrioventricular (AV) node located near the center of the heart between the atria and the lower chambers, or ventricles, and then to conduction fibers that spread across the ventricles, which are the heart’s main pumping chambers. As the impulse moves along the conduction fibers, cardiac muscle cells are stimulated and contract, producing a heartbeat.

Sometimes, the electrical impulses “short circuit” the normal pathway and travel across the heart in an abnormal way. Abnormal pathways, or routes, for the impulses can develop, causing irregularities in the heartbeat, or arrhythmias. In other cases, arrhythmias arise when areas other than the sinus node become active and begin to send out impulses that either compete with or take over the pacemaker function of the sinus node. Typically, the result of these abnormalities is a heartbeat that is too fast. This may develop in any location within the atria, AV node, or ventricles. When the fast rhythm requires tissue from the upper part of the heart, it is known as supraventricular tachycardia. When it requires tissue from the lower chambers only, it is known as ventricular tachycardia.

What is RadioFrequency Catheter Ablation ?

Radiofrequency ablation is a procedure that can cure many types of fast heart beats. Using special wires or catheters that are threaded into the heart, radiofrequency energy (low-voltage, high-frequency electricity) is targeted toward the area(s) causing the abnormal heart rhythm, permanently damaging small areas of tissue with heat. In some cases, cryoablation, which damages tissue by freezing rather than heating, may be used rather than radiofrequency energy.

The damaged tissue is no longer capable of generating or conducting electrical impulses. If the procedure is successful, this prevents the arrhythmia from being generated, curing the patient.

A pacemaker is a small electrical device that stays in the body and is connected to the heart with wires that stimulate the heart to contract in a regular way. In some patients, insertion of a pacemaker is a planned part of the procedure. In other cases, the need for a pacemaker is a complication of the ablation procedure.

Use of RadioFrequency Catheter Ablation in Cardiology

Radio frequency catheter ablation is a procedure that is performed to correct a disturbance in heart rhythm (cardiac arrhythmia or irregular heartbeat).

It`s most often used to treat supraventricular tachyarrhythmias which are rapid, uncoordinated heartbeats starting in the heart`s upper chambers (atria) or middle region (AV node or the very beginning portion of the heart`s electrical system). In cardiology, RF ablation is used to correct:

  • recurrent atrial flutter.
  • atrial fibrillation (AF).
  • supraventricular tachycardia (SVT).
  • some types of ventricular arrhythmia.

Advantages of RadioFrequency Catheter Ablation

 Radiofrequency ablation has been around for years. It works by killing a very small amount of the abnormal heart muscle that is causing the heart to beat irregularly.

  • Catheter ablation has more success rate with low risk of complications.
  • Minimal side effects allowing the patient to resume normal activities in just a few days.
  • There are no long-term effects on the heart muscle once this procedure is done.

Radiofrequency ablation is popular because it has proven effective for patients with heart arrhythmias of many kinds.

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RadioFrequency Catheter Ablation Treatment in India

Interventional Cardiology Treatments for Angioplasty in India

What Is Angioplasty?

Angioplasty could be a procedure used to open blocked or narrowed coronary (heart) arteries. The procedure improves blood flow to the heart muscle. Over time, a fatty substance known as plaque (plak) will build up in your arteries, causing them to harden and narrow. This condition is called  atherosclerosis will have an effect on any artery within the body. once atherosclerosis affects the coronary arteries, the condition is termed coronary heart {disease|heart condition|cardiopathy|cardiovascular disease} (CHD) or coronary artery disease.cardiac-heart-surgery

Angioplasty will restore blood flow to the heart if the coronary arteries became narrowed or blocked thanks to CHD.

 

 

Angioplasty is a common medical procedure. It may be used to:

  • Improve symptoms of CHD, such as angina (an-JI-nuh or AN-juh-nuh) and shortness of breath. (Angina is chest pain or discomfort.)
  • Reduce damage to the heart muscle caused by a heart attack. A heart attack occurs if blood flow through a coronary artery is completely blocked. The blockage usually is due to a blood clot that forms on the surface of plaque. During angioplasty, a small balloon is expanded inside the coronary artery to relieve the blockage.
  • Reduce the risk of death in some patients.

Most Advanced Interventional Cardiology Procedures for Treatment of Heart Diseases

Balloon Angioplasty – Balloon angioplasty is a medical procedure that is performed to open up arteries that have been narrowed by plaque. Balloon angioplasty is a safe and commonly performed procedure, and is now considered standard PAD treatment. For many types of PAD, a balloon angioplasty procedure has replaced a standard surgical procedure as first line treatment.Angioplasty1
The principle of balloon angioplasty is to insert a small balloon into a narrowed section of an artery where the balloon is inflated, opening up the artery and improving blood flow.

Stents – A stent is a small mesh tube that’s used to treat narrowed or weakened arteries in the body. Arteries are blood vessels that carry blood away from your heart to other parts of your body.You may have a stent placed in an artery as part of a procedure called angioplasty (AN-jee-oh-plas-tee). Angioplasty restores blood flow through narrowed or blocked arteries. Stents help prevent the arteries from becoming narrowed or blocked again in the months or years after angioplasty.

You also may have a stent placed in a weakened artery to improve blood flow and to help prevent the artery from bursting.Stents usually are made of metal mesh, but sometimes they’re made of fabric. Fabric stents, also called stent grafts, are used in larger arteries. Some stents are coated with medicines that are slowly and continuously released into the artery. These stents are called drug-eluting stents. The medicines help prevent the artery from becoming blocked again.

Rotablation (Percutaneous Transluminal Rotational Atherectomy or PTRA) –   A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of narrowing in your coronary artery. The tip spins around at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed away in your blood stream and filtered out by your liver and spleen. This process is repeated as needed to allow for better blood flow. This procedure is rarely used today because balloon angioplasty and stenting have much better results and are technically easier for the cardiologist to perform.

  • Drug Eluting Stents- A drug eluting stent commonly called DES, slowly release a drug which prevents fibrosis & clots which could block the stented artery. The stent is usually placed by interventional cardiologist during angioplasty and one of the most preferred treatments.

Absorbable / Dissolvable Stent – the most recent development in interventional cardiology is the use of dissolvable or absorbable stents. Doctors are now using this revolutionary device made of dissolvable material.

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Interventional Cardiology Treatments for Angioplasty in India

Affordable Pediatric Cardiac Surgery in India

What is Pediatric Cardiac Surgery ?

Paediatric heart surgery in India with the most effective paediatric Heart surgeons in India is what you’d wish if your little one is suffering from any heart ailment. MyMedOpinion affiliate paediatric heart surgeons in India are among the highest medicine heart specialists and provide best in paediatric heart care. reasonable pediatric heart surgery in india|Bharat|Asian country|Asian nation} at the best cardiac Hospitals with prime pediatric cardiac Surgeons in India with MyMedOpinion.

Sometimes heart surgery in kids is needed for repairing defects within the heart that a baby might need born with (known as congenital heart defects) and heart diseases that he gets when birth, that need surgery. pediatric cardiac Surgery deals with operative procedures within the newborn and unborn kids and kids suffering from cardiac dysfunctions, structural, purposeful and rhythm-related problems with the guts additionally.pediatrics-congenital-heart-surgery2
Pediatric cardiac Surgery usually deals with heart issues in kids, the cause of innate heart diseases that are common heart ailments among new born kids and involves deficiencies like structural defects, congenital arrythmias and cardiomyopathies, that end in completely different varieties of abnormalities associated with the heart. innate heart disease may be a cause of improper growth of the heart or blood vessels before birth.

Heart Treatment in India for Major Heart Ailments in Children

The most common cardiac defects in children are the following:

  •    Atrial Septal Defect
  •    Ventricular Septal Defect
  •    Fallot’s Tetralogy
  •    Valvular defects

 

Why the Procedure is Performed

Some heart defects need repair soon after birth. For others, it is better to wait months or years. Certain heart defects may not need to be repaired.In general, symptoms that indicate that surgery is needed are:

  • Blue or gray skin, lips, and nail beds (cyanosis). These symptoms mean there is not enough oxygen in the blood (hypoxia).
  • Difficulty breathing because the lungs are “wet,” congested, or filled with fluid (heart failure).
  • Problems with heart rate or heart rhythm (arrhythmias).
  • Poor feeding or sleeping, and lack of growth and development of the child.
Additional risks of heart surgery are:

  • Blood clots (thrombi)
  • Air bubbles (air emboli)
  • Pneumonia
  • Heartbeat problems (arrhythmias)
  • Heart attack
  • Stroke

Before the Procedure

If your child is talking, tell them about the surgery. If you have a preschool-aged child, tell them the day before what will happen. Say, for example, “We are going to the hospital to stay for a few days. pediatric-cardiac-surgery-indiaThe doctor is going to do an operation on your heart to make it work better.”If your child is older, start talking about the procedure 1 week before the surgery. You should involve the child’s life specialist (someone who helps children and their families during times like major surgery) and show the child the hospital and surgical areas.Your child may need many different tests:

  • Blood tests (complete blood count, electrolytes, clotting factors, and “cross match”)
  • X-rays of the chest
  • Electrocardiogram (EKG, or ECG)
  • Echocardiogram (ECHO, or ultrasound of the heart)
  • Cardiac catheterization
  • History and physical

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Affordable Pediatric Cardiac Surgery in India