Dr Purshottam Lal is one of the most well-known doctors in the country who holds the world record for performing the maximum number of angioplasties and angiographies. Trained in the UK, Germany and the US he is perhaps the only practising medical professional who has been the recipient of the Padma Vibhushan and the Dr B.C. Roy National award. He had earlier been conferred the Padma Shri and Padma Bhushan as well. At present, he is the chairman of the Metro Group of Hospitals and recently performed a path breaking procedure. Some excerpts from an interview to The Sunday Guardian:
Q. You have performed a breakthrough procedure for the first time in the world with a specialised catheter and angioplasty with stenting of the main artery at the same time.
A. This is indeed a very interesting procedure, especially for the elderly population who run either a high risk for open heart surgery or are unfit for open heart surgery. There is a condition called as aortic stenosis in which the aortic valve gets calcified and restricts the blood flow from the left ventricle to the whole body. If not treated, the patient can have a heart failure or even death. Due to old age, the patient, particularly after the age of 75, cannot undergo an open heart surgery due to advanced age, poor general condition and other co-existing conditions like bad lungs, kidney problems, cancer etc. For such patients, we introduced non-surgical replacement of the aortic valve with Core Valve on 12 July 2004 at Metro Heart Institute, Noida, for the first time in the world and we published the research paper of our first case in the medical literature. Now, close to two lakh Core Valves have been used around the world. In India, this valve is very expensive and costs the patient close of Rs 18 lakh, making it accessible to rich people only. To tackle many of the limitations of the currently available valves, an innovative catheter pre-loaded with valve was used along with angioplasty with stenting of the major artery in the same sitting. This hybrid procedure happens to be the first case reported so far in the world.
Q. How will this new catheter prove to be better than the already existing valves and what will be the cost implications for the patients?
A. In the current valve system like Core Valve, it has two components — the valve and the catheter. This valve is prepared by rinsing in the liquid, crimping it and loading on the catheter. After it is being loaded, the procedure is performed. It is thought that rinsing and preserving in the chemical called glutaraldehyde may be making it less durable and more prone to calcification and contamination. It also requires more time and more radiations for the patient. This new valve system, known as Venibri Aortic Valve System, has a dry tissue which is very strong and durable and less prone to calcification. It is pre-crimped, pre-loaded, pre-packaged, pre-sterilised and ready to use self-expandable stent. The time taken from taking the valve out of package and deployment is not more than 15 minutes which is an unbelievable breakthrough. We are trying to bring its cost to less than 50% of the existing cost.
Q. If you can explain us about your patient who underwent this unique procedure. How is she doing now?
A. Our patient is 76-year-old Mrs. Rama Dhamani from Jaipur, having a past history of hypertension for the past 15 years, hypothyroidism since 10 years, COPD (bad lungs), severe osteoarthritis of both knees. Her echocardiography showed severe and calcific aortic valve stenosis. Her coronary angiography revealed critical block of its main artery. Neither this patient was fit for surgery nor was the family ready for open heart surgery at any cost. To the extent when we took her in Cath Lab, the family told us categorically that we are not ready even for emergency surgery in case you require for some reason during the procedure. The patient underwent a successful implantation along with angioplasty with stenting. She came for follow-up after three weeks and is doing very well. Now, we are planning to get her surgery done for bilateral knee replacement so that she can walk comfortably and make her quality of life much better.
Q. You have the unique distinction of performing over 20 procedures of Interventional Cardiology like diamond drilling, stenting, Inoue balloon valvuloplasty, heart hole closure etc. I am sure there must be some memories about these procedures. Could you share these with us?
A. Actually, I have memory of each procedure. However, I recall few of these like in 1990-91 there was one lady, the wife of a tailor master, who used to bring her 19-year-old son Suresh Babu who had a hole in his heart, a condition called ASD. Whenever I visited Apollo Chennai from the US, she used to come and request: “Please close the hole in my son’s heart without surgery.” She had so much hope and confidence in me and this encouraged me to close his son’s heart hole without surgery with a mono-disc device in which I was involved in its clinical development. This happens to be the first case in the world with this device. Similarly, one Ahmed, a 33-year-old male, came to me while I was at Apollo, Chennai, in 1992 with tight mitral valve. He had only Rs 5,000 in his pocket. Those days, the cath lab charges for the procedure use to be Rs 40,000. I took this patient to my residence and kept him along with his one attendant during the night. I took him to the hospital at 04:00 a.m. and opened his valve with echo guidance without the cath lab. The patient did well and was discharged the same day.