Hyderabad, (Telangana): A team of Cardiologists led by Dr Karunakar Rapolu, Consultant Cardiologist, Apollo Hospitals; performed a complex interventional procedure using Impella, IVL and OCT; on an extremely critical 61-year-old patient. The patient had 90% blockage due to high calcium deposit in the Left Main Vessel, which was jeopardizing the blood supply to already severely weakened heart. A preliminary medical evaluation found him unsuitable for a bypass surgery, due to his past history of coronary artery disease and having undergone an angioplasty three years ago. The Team had to swiftly explore for options to restore blood circulation before his condition deteriorated further and became fatal.
The patient a retired police official, presented with excruciating chest pain and symptoms of severely restricted blood flow to the heart due to calcification of the largest coronary artery, the Left Anterior Descending Artery (LAD). The LAD became narrow progressively since his previous angioplasty and manifested in the form of a massive heart attack. At the Hospital the patient was quickly wheeled into the Cath lab for an angiogram to assess the extent of heart damage. However, he developed dysfunction of the Left ventricular heart chamber, on the table, leading to sparse supply of blood to the vital organs and potential damage of those if not acted instantaneously. This episode further complicated his condition and the team had to resort to administering diuretics to rid excess fluids from the patient’s body and vasodilators to open the blocked vessels.
His perilous condition ruled out any scope of performing the risk laden bypass surgery. The team narrowed down on the most apt option considering his delicate condition, of performing a CHIP Intervention (Complex High risk Indicated Procedure) along with an Impella Heart Pump. CHIP Intervention is a highly critical procedure performed for immediate restoring of blood supply in the circulation system, while Impella replicates the work done by Left Ventricle, helps suck the oxygenated blood from the Left Ventricle and pumps it to the circulatory system. Using the infrared light guidance from OCT (Optical Coherence Tomography), the extent of occlusion was assessed, and those high-resolution images facilitated clearing of the blockage with precision. Intravascular lithotripsy (IVL) Balloon was used to crack the impregnable calcification of the blockage. IVL deploys acoustic pressure waves to break the calcium deposits. A stenting was done of the Left Main Coronary Artery using DK crush technique for the best outcome.
During the procedure the patient suffered 7-8 episodes of “Ventriculo arterial uncoupling” while inflating the balloon to clear occlusion, where the left ventricle ceased pumping the blood. Impella got into action and ensured uninterrupted supply of blood. The patient would have crashed during the procedure if Impella was not availed.
The procedure took four and half hours, patient was moved out of ICU after 24 hours of the procedure. He has since recovered and was discharged on the 4th day of admission. He needs to take regular medicines and to follow healthy life style habits like regular exercises and diet management.
Patient tolerated the procedure very well because of Impella heart pump which was working continuously to protect him, Oct guided the team to be precise, while IVL helped in the success of the procedure, says Dr Karunakar Rapolu.
