As we know, Interventional Cardiology is a branch of Cardiology in which special techniques are used to diagnose the disorders related to blood flow, as well as, pressure in the coronary arteries and chambers of the heart. It includes various technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. To make it more clear for our audience, we had a conversation with Dr. Rajnesh Kapoor. Dr. Rajneesh Kapoor is the Vice-Chairman in the Department of Interventional Cardiology at Medanta The Medicity. He has been working with Medanta for over 10 years. At Medanta, he performs all kinds of invasive procedures which include coronary angioplasty, peripheral angioplasty, carotid angioplasty and all kinds of valvular interventions which are getting popular these days. Similarly, he is an expert in performing many other new procedures like TAVR. Before this, he has also worked with other top facilities like Apollo Hospitals.

Interview Questions Answered by Dr. Rajneesh Kapoor

Question 1: How can we address the dearth of donors concerning heart transplants? What measures are taken to preserve the health of a patient in case the donor's heart is not immediately available?Answer: Dr. Kapoor said that if we talk about the pool of end-stage heart patients, the heart failure patients, we have 'N' number of patients who come for followup, where the medicines and other treatments are not working. This is known as refractory heart failure. So now the patient is at a stage where he/she can be treated clinically only with a heart transplant. The doctor discusses this with the patients and their families. A heart transplant is not a one sitting phenomena. It requires multiple sittings with the patients and their relatives. Dr. Rajneesh Kapoor mentioned that the results of heart transplants are very good. The problem in heart transplant is that the donor is not instantly available. An ideal donor is a young individual whose blood group matches with the patient and is brain dead because of some reasons but with a functioning heart. In fact, in Northern India, if some patient is brain dead, the family is not ready to donate his/her organ because of emotional attachments. On the other hand, in Southern India, people are much more receptive in donating the organ of any family member who is brain dead. So here we need to work to enhance the awareness in the general public. We have to make people understand that donating organs of brain dead patients can save someone's life. In some cases, the patient needs a transplant but they are not receiving the appropriate donor at the right time. In that case, we must keep the patient balanced or at least keep the patient going until he/she gets the right donor. This includes some procedures, good medication and also patient's cooperation in following a good lifestyle, by restricting the salt intake or fluid intake, be very compline with the drug intake. So by utilizing either a device or appropriate drug regime or changes in lifestyle, the doctors can get the patient going till the point he receives a donor. Read: Heart Transplant - Thing You Need To Know About The ProcedureQuestion 2: What is the future of interventional cardiology? Can we expect more innovations in the catheter-based treatment that it minimizes the need for cardiac surgeries?Answer: In the past two to three decades, there has been a rapid growth in interventional cardiology. We have been doing coronary interventions and all kinds of valvular intervention. Medanta The Medicity has a different kind of expertise in handling very complex heart conditions. But the advancement in interventional cardiology is more about structural heart interventions. The cardiology procedures have moved from coronary to structural heart problems. Now structural heart problems are the valvular heart problems. Suppose, if one of the heart valves starts leaking. Normally in such situations, the surgery is the only treatment. But at times the patient's comorbidity, frailty or the age of the patient are some of the factors that add more risk during the surgery. So, in such cases, there is a need for certain procedures which can give benefits to patients and are non-surgical. This is included in the advancement which is present these days. Nowadays, we are treating aortic stenosis by a catheter-based percutaneous valve replacement popularly known as TAVR. Dr. Rajneesh said that Medanta is THE leading centre in India who has performed the maximum number of TAVR. Similarly, they are also doing percutaneous mitral valve intervention where they are replacing the valve or doing clip procedure. Question 3: In the age of technological advances, how often is open-heart surgery indicated?Answer: The advancement of interventional cardiology has reduced the number of open-heart surgery but not completely avoided. Still, there are certain subsets in which open heart surgery is the main indication of treatment. For example, Open heart surgery is indicated in the case of left main complex bifurcation disease. Open heart surgery is also required in heavily calcified arteries, calcified blockages and CTO. Other than these, many patients are suffering from valve problems like mitral valve diseases or congenital problems in kids can be treated with the help of open-heart surgery. Catheter-based treatment has become more and more advanced but still, there is a huge scope of cardiac surgery. In many cases, open surgeries are the only solution. Question 4: Approximately 200,000 children per year are born with congenital heart diseases. One-fifth of these children require clinical intervention in the first year of their life. What do you think are the main causes behind these numbers? Can expecting mothers adopt some preventive measures during their pregnancy to reduce the risk of congenital heart diseases?Answer: In many cases, the children are born with congenital heart disorders and then the doctors provide the treatments. This practice is very important and also necessary for his/her good health. But most importantly we need to understand the reason behind the congenital heart disorders. For that, we have to see the pregnancy phase. Dr. Rajneesh mentioned that pregnancy should be healthy. Make sure the mother is not suffering from malnutrition. There should be a good supply of iron and vitamins. Your family history also matters a lot and needs special investigations in such cases. There are many cardiac disorders which can be diagnosed during pregnancy. Sometimes when the condition is very critical, then we have to terminate the pregnancy. Generally, congenital disorders are common in women getting pregnant after 30 years of age or in consignors marriages, which are common in the Muslim community. In such cases, doctors recommend a simple fetal echocardiography test. This test clears whether or not the baby has any heart disorder. As mentioned in the question, 2,00,000 children are born with congenital heart diseases. Even if the children get diagnosed with heart disorders at an early stage, they can be treated completely with the help of certain procedures or surgeries. Question 5: What are the success rates of stent implantations for treating cardiac diseases? Is it possible that surgery is further indicated post stenting?Answer: Nowadays, we are into an era where the stent technology has reached the point where it is advanced. The stents are really miniaturized, very small and very refined. The chances of any failure of any stenting procedure are now less than 1%. Similarly, the chances of recurrence are not more than 3-4%. This also depends on the expertise and the hospital. The success rate of such procedures increases if the hospital is following very strict protocols and has an effective team of cardiologists like Medanta. Related read: #CrediTalk: Dr. Niraj Gupta's Take on Heart-Health and Interventional Cardiology Widely the stent success rate is very good, but at institutions where strict protocols are followed, the results are even better. There are a few segments or subsets of patients where stenting remains a risky process and needs surgery. At Medanta, multiple brains are working together at one point in time to have the best possible outcome for the patient. Check out all the article in #CrediTalk series here.

About The Doctor

Dr. Rajneesh Kapoor is a leading cardiologist and the Vice-Chairman in the Department of Interventional Cardiology at Medanta -The Medicity, Gurgaon. He has a rich experience of 23 years in his field. He has completed his MBBS from Govt. Medical College Amritsar, Punjab, Guru Nanak Dev University in 1994, MD from Govt. Medical College & Hospital Patiala, Punjabi University in 1997 and DNB from Escorts Heart Institute & Research Centre, New Delhi in 2002. He has published over 100 articles, reviews and abstracts in various national and international journals Earlier he was associated with Escorts Heart Institute and Indraprastha Apollo Hospital, New Delhi as a Senior Consultant Cardiologist.

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