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First heart valve replacement procedure with no anaesthetic conducted in sub-Saharan Africa

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</span><p class="MsoNormal" style="text-align: left;"><span style="font-family: helvetica;">An aortic valve replacement procedure has been conducted in
sub-Saharan Africa at Aga Khan University Hospital without the use of formal
general anaesthesia. The operation was recently conducted at the hospital on an
83 year old female patient with a narrowed aortic valve and was considered
unfit for general anaesthesia. The procedure lasted for less than two hours and
was conducted while the patient was awake, receiving only local anaesthesia
(paracetamol) with mild sedation.<span><span style="font-family: helvetica;"></span></span></span></p><p class="MsoNormal"><span style="font-family: helvetica;">Valvular heart disease affects many Africans and is commonly
related to rheumatic heart disease. While many patients can be managed with
mediation, a large number of patients will require heart surgery in order to
treat the problem. In most cases, heart valve surgery involves opening the
chest, stopping the heart, and connecting the patient to a heart-lung bypass
machine while the surgeon replaces the heat valve. The trans-catheter aortic
valve implantation (TAVI) procedure has recently been introduced to enable
patients who cannot undergo open heart surgery due to technical reasons have
this procedure performed using two punctures in the groin. </span></p><p class="MsoNormal"><span style="font-family: helvetica;">“Before the procedure, we give the patient paracetamol and
we numb the skin at the hip area where a cut of 2-3 inches will be done. We
then use a guiding wire that navigates through the artery and aorta into the
heart. Once the tip arrives at the aortic valve, it acts as a guide to the
catheter. In many patients paracetamol is the only pain relief they require”,
said Dr Mohamed Jeilan, Cardiologist and Director, Cardiac Programme at Aga
Khan University Hospital.</span></p><p class="MsoNormal"><span style="font-family: helvetica;">“The procedure involves squeezing a valve into a small
narrow tube which is delivered over a small wire introduced through the groin
to the heart.  The heart valve is made of
a memory metal, which springs back into its original shape once the tube is
removed.  The margin for error with this
kind of procedure is less than 6mm, so the level of expertise required and
technology needed is quite advanced. Conducting this procedure on a patient
while awake poses an extra challenge since the patient may move and dislodge
the valve.  Previously, the heart valve
implant gave you a single attempt but new valves and systems have developed
which allow an imperfectly positioned valve to be repositioned. Positioning of
the heart valve is key and if positioned wrongly, it causes blood leakage
causing more strain on the heart”, Dr Jeilan further notes.</span></p><p class="MsoNormal"><span style="font-family: helvetica;">So far, patients undergoing TAVI in sub Saharan Africa have
had their treatments done at Aga Khan University Hospital. Normally the
treatment requires the use of full general anaesthestic and special imaging
using an ultrasound probe introduced through the food pipe (oesophagus).</span></p><p class="MsoNormal"><span style="font-family: helvetica;">One of the challenges for this procedure has been the need
for oesophageal ultrasound, but with the development of technology and improved
expertise has, doctors have developed techniques for performing the whole
procedure guided by only the advanced x-ray images available at specialised
hospitals.</span></p><p class="MsoNormal"><span style="font-family: helvetica;">Dr Jeilan emphasised the advantages of this procedure
including no cutting of bones, almost negligible blood loss and infections are
reduced as the incision is small and the patient does not require intensive
care monitoring which means that the patient can be allowed home earlier than most
other patient.  The first lady to undergo
this procedure was discharged 3 days after the operation.</span></p><span style="font-family: helvetica;"></span></div>

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