Question 1

Most chest abnormalities are often confused with cardiac disease. What is the major difference between the two?

Dr. Ajay Kaul · Accepted Answer

The chest includes the lungs, the esophagus, the heart, and the blood vessels. What we are discussing today covers only diseases of the heart and blood vessels, not lung disease, muscular disease, disease of the bones or spine, or even the breast, even though these are also considered part of the chest.

Question 2

What innovative treatments are available for patients with Eisenmenger syndrome?

Dr. Ajay Kaul · Accepted Answer

Eisenmenger syndrome develops when an operable heart condition is left untreated for long enough that it damages the lungs, eventually making the lungs too stiff for any treatment to help. At that stage, the only option is a combined heart and lung transplant. It is a very difficult treatment, and the success rate is only around 40 to 50 percent.

Question 3

What are the different complications of getting an artificial heart (LVAD)?

Dr. Ajay Kaul · Accepted Answer

There are three main complications. First, because the device requires blood thinners, there is a risk of bleeding. Second, there is a risk of infection. Third, an artificial heart is only designed to function for about five to seven years, so it should ideally be converted to a transplant as early as possible rather than treated as a permanent solution, though I have seen patients go 10, 12, even 15 years on the device without a transplant.

Question 4

Can the same minimally invasive technique be used for a carotid artery aneurysm?

Dr. Ajay Kaul · Accepted Answer

Yes, if the CT angiogram of the carotid artery shows that a stent can be placed, the aneurysm can be treated with an intravascular stent through a single small puncture in the leg, making it a minimally invasive procedure.

Question 5

Following up on the complications of artificial heart transplantation, what about a further concern he described as 'autonomic surgery' in this context?

Dr. Ajay Kaul · Accepted Answer

Dr. Kaul reiterated the transplant complications he had already covered, then said that there was nothing called autonomic surgery that he was aware of, and that the term appeared to be a translation error. The exchange closed with a request for Dr. Kamba to put the question in writing in the chat so it could be understood correctly.

Question 6

Are there any techniques available for treating tetralogy of Fallot?

Dr. Ajay Kaul · Accepted Answer

Tetralogy of Fallot is very well treatable, and children who are operated on go on to lead a normal life. I have patients who are now 25 to 30 years old and doing very well. Depending on the exact type of tetralogy, the results are very good.

Question 7

How does an artificial heart actually work?

Dr. Ajay Kaul · Accepted Answer

The heart is essentially a pump: blood comes in from the body, is pushed to the lungs to be purified, and is then pushed back out to the body. Building an artificial pump that does not damage or clot the blood took nearly 50 years to perfect. The device is based on magnetic levitation technology, similar to Japan's high-speed trains that run without touching the rails, so the pump's rotor never actually makes contact with the blood it is moving. In India, one artificial heart costs around 1.5 crore rupees, which is the major cost barrier.

Question 8

Is heterozygous (mismatched donor-recipient) heart transplantation possible?

Dr. Ajay Kaul · Accepted Answer

It is technically possible, but very few doctors would attempt it. A heart is a precious, scarce organ with a long waiting list of patients, so we always give it to the best-matching recipient rather than risk it in a less compatible match where rejection is more likely.

Question 9

What happens to the donor in a heart transplant?

Dr. Ajay Kaul · Accepted Answer

The donor is already dead by the time of donation. It is not a live donation, so nothing happens to the donor.

Question 10

What can someone who is currently healthy do in everyday life to keep their heart healthy?

Dr. Ajay Kaul · Accepted Answer

Some factors cannot be changed: genetics (a family history of coronary artery disease, hypertension or diabetes), age, and sex. Some factors are partially avoidable, like living in a polluted city or staying in a highly stressful job or relationship. The fully preventable factors are the most important: smoking or chewing tobacco has no offsetting benefit and damages the heart, lungs or mouth; alcohol should be limited to two or three drinks, two or three times a week; walking at least 10,000 steps a day and taking the stairs down instead of the lift helps; and the single best exercise is a 3-kilometer walk in 30 minutes, twice a day. On checkups: if there is a family history of heart disease or diabetes, get a cardiac checkup from age 20; if there is no family history, get one by age 40. And before starting any strenuous new exercise routine, such as joining a gym, get a cardiac checkup first, because the heart often gives no warning symptoms until it fails outright, the same way a car needs servicing even when it seems to be running fine.

Question 11

Does a transplant recipient have to stay on rejection-suppression therapy, and what is the average monthly cost?

Dr. Ajay Kaul · Accepted Answer

Yes, anyone who has had an organ transplant, whether liver, lung, or heart, has to remain on anti-rejection therapy. In India, that costs on average about 25,000 to 35,000 rupees a month, and can range from about 20,000 up to 50,000. I'm not able to speak to what it costs in other countries.

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