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 the heart has an operable defect but the patient does not get it treated: the defect damages the blood vessels of the lungs, the lungs become so stiff and the pressure so high that the defect can no longer be closed, and no corrective treatment is possible. The option then is a heart and lung transplant. It is a very difficult treatment, and the success rate is not very good, with only around 40 to 50% alive at five years.

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, particularly where the driveline leaves the body. Third, the device is meant to go on for about five, six or seven years, so the patient has to get their transplant done: where the patient is eligible it should be converted to a transplant 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 an intravascular stent can be placed. It is very important to review the CT angiogram of the carotid artery first. If a stent can be placed, the treatment is minimally invasive and needs hardly more than one small puncture.

Question 5

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 6

How does an artificial heart actually work?

Dr. Ajay Kaul · Accepted Answer

The heart is simply a pump. Blood travels around the body, delivering oxygen and nutrition and collecting carbon dioxide and waste; it then goes to the lungs, where the carbon dioxide is removed and the blood takes up oxygen; it returns to the heart, which pushes it out to the whole body again. The difficulty is that blood placed inside an ordinary pump and pushed along will clot. The artificial heart is therefore a special pump that took almost 50 years to perfect. It is based on magnetic levitation, like the high-speed trains in Japan that run just above the rails without touching them: the pump's rotor is magnetically levitated so that the blood is not destroyed. In India, one artificial heart costs around 1.5 crore rupees, which is a major cost.

Question 7

Is heterozygous heart transplantation possible?

Dr. Ajay Kaul · Accepted Answer

It is possible, but few doctors would be willing. The heart is a very precious organ and the waiting list is huge: with 50 patients waiting, there is no reason to transplant a heart into a patient whose outcome is uncertain. We always give the heart to the best-matching person, because we do not want to waste a heart on a recipient who then rejects it for a poor match.

Question 8

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 9

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 parent or sibling with coronary artery disease, hypertension or diabetes), age and sex. Some can be partly avoided: if you live in a heavily polluted city and can change your job, that helps, and severe stress at home or at work should be avoided, because it too can cause a heart attack. Others are entirely preventable. Smoking has no advantage at all; smoked tobacco destroys the heart and lungs, and chewed tobacco damages the heart and causes cancer of the mouth. Alcohol should be limited to two or three drinks, two or three times a week, because beyond that the liver cannot cope and cirrhosis follows. Build in compulsory exercise: get off the metro one station early and walk, and take the stairs down. Cover at least 10,000 steps every day, avoid junk food as far as possible, and remember that the best exercise is walking 3 km in 30 minutes, twice a day if possible; no gym is better. With a family history of heart disease or diabetes, have a health check-up from a doctor at 20; without one, have a proper check-up by 40. Timely check-ups prevent serious complications: someone from a diabetic family who takes care early may not develop symptoms until late in life. Finally, before any strenuous exercise, such as joining a gym, get checked by a cardiologist. The heart has so much reserve that even serious disease goes unnoticed, and a diseased heart is like a weak horse that keeps running under the whip until it drops dead. You service a new car every six months; your own body deserves the same.

Question 10

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

Dr. Ajay Kaul · Accepted Answer

Yes. Every transplant recipient, whether of a liver, lung or heart, has to stay on anti-rejection therapy. In India the cost is very low compared with the rest of the world. I cannot speak to the cost in other countries.

Live Discussion with Dr. Ajay Kaul