Heart: a new TAVI valve implant was performed in Misiones at the Institute of Cardiology and Surgery of the Boratti Sanatorium

It was done to a 70-year-old patient, affiliated with the provincial social work IPS. It is a complex, but minimally invasive procedure, where the aortic valve is replaced, called TAVI, whose first intervention had been done by the same medical team in 2019. The professionals who carried it out highlighted the commitment and effort of both specialists, such as the local health system.

Doctors José Luis Lazarte, a specialist in interventional cardiology, and Griselda Doxastakis, a specialist in echocardiography, who are part of the team that carried out this intervention, explained everything from how the diagnosis is made to the practice.

“We have four valves in the heart and the aortic is the one that gets sick the most, over time it degenerates, and therefore it is the one with the highest prevalence of valvular pathologies in the heart. However, it should be noted that it is a valve that is easy to diagnose. The doctor places a stethoscope on him and can make the diagnosis of this pathology based on the murmur,” Lazarte indicated.

What years ago could only be solved with surgery, now adds the option of a percutaneous implant

The professional explained that “the valve must open and close for the passage of blood, and that opening and decrease is altered in the opening, it is called stenosis, which makes the area narrow, and the patient with the decrease in that opening develops symptoms, when that happens, it is very likely that it is already in a context of significant stenosis or narrowing, and it makes medical treatment no longer sufficient, so the alternative that existed some time ago was a valve replacement, that it was through open surgery, which is a major operation on the heart.”

The problem that arises, the doctor clarified, is that many times elderly patients (over 70 years old) did not have the possibility of receiving this open surgery, due to the risk of age or the presence of other pathologies, which made that a surgery of that importance, they were not going to tolerate it. So they had to resign themselves to the natural history of the disease, because surgery was a higher risk. This is where minimally invasive interventions appeared a few years ago, such as this percutaneous aortic valve implantation.

Diagnosis through routine studies with the cardiologist

Dr. Doxastaquis said that today, having the possibility not only of the technique known as Echo Doppler, but also three-dimensional ultrasound, the study of this pathology can be expanded. “Every day one sees people who come with suspicious symptoms of this condition, among which shortness of breath, precordial pain and in some cases syncope, that is, sudden fainting, can be the triggers for the diagnosis of this pathology. . But on many other occasions the person is asymptomatic, and the doctor in the office hears a murmur, which is the sound generated by the blood passing through a closed valve, then he arrives at an echocardiography office, where the detection of the pathology can be seen in people who do not have symptoms and from there it is possible to see what is the real risk of that person, to be able to determine which procedure is going to solve that problem, if we are going to go to a general surgery or a procedure TAVI. Ultrasound allows us to approach this pathology that, in younger people, with low risk, such as with bicuspid valves, or people with chronic kidney failure, who get sick much before the age of 70.”

Once the problem is diagnosed comes the definition of the treatment

Dr. Lazarte explained once the diagnosis is made, and severe aortic valve stenosis is detected, from Boratti, they have formed a medical team that allows the patient’s risk to be evaluated and to see which is the best alternative for treatment, since all patients are indicated for one or another option (surgery or percutaneous implant).

“Today, defining it and also carrying it out, with the commitment of the team (trained many times abroad) and the health system to face this type of effort and prioritize local health, is what we want to highlight,” said Lazarte.

The doctor recalled that the first aortic valve in the world was placed in 2002, while in Argentina it was in 2009. In Misiones it happened in 2019, with a high-risk patient. But last week another one was already done in a low-risk patient. “Being able to do it in low-risk patients is an effort that has come to an end and gives us great satisfaction.”

The patient operated on a week ago is 70 years old, is a member of the IPS and is blind. That the next day, he went to his house with the valve implanted, he was controlled seven days later and he was already walking perfectly.

“I highlight the effort of the group, and the health system, in this case the IPS, which bets on local health, because not all (social or prepaid works) do it in the same way. It takes us a lot of time and effort to train ourselves, and many times we cannot develop that training. Being able to do it in our field is a great satisfaction” he closed.

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