This 21-year-old woman’s heart had enlarged to twice its size

Bengaluru: Daily chores were becoming incredibly difficult for this 21-year-old woman from West Bengal, who was diagnosed with rheumatic heart disease seven years ago. Her heart had swelled up to twice the normal size, affecting her breathing and appetite. “It was a disease which they had ignored for long,” says Dr Vivek Babu Bojjawar, Consultant Cardiothoracic Surgeon at Manipal Hospital, Whitefield, who after diagnosing her with the heart disease admitted her for surgery. 

“Gross cardiac problems lead to stomach and liver enlargement and the patient loses appetite. All the energy is used up for breathing and talking, let alone doing the regular activity. In all these cases, the valves get damaged and the heart slowly starts failing and patients succumb to heart failure," he says.

The woman patient had rheumatic heart disease with severe mitral and tricuspid valve leak with poor heart function and cardiomegaly. Her heart had enlarged to more than twice the normal size, and she also had hepatomegaly, where her liver had occupied the entire abdomen. The only cure was a high risk mitral valve replacement and tricuspid valve surgery.

Dr Bojjawar stressed that it is a rural, and not an urban, disease. “The open heart surgery on her went on for seven hours and we replaced both the valves with mechanical valves. Such cases need multidisciplinary management, including cardiac surgeons, cardiologists, anaesthetists, intensivists and physiotherapists for a good outcome. The surgery was done three days after the admission and she was under medication which was mainly to strengthen her heart for the surgery," he explains.

“Post-surgery, she was managed in the ICU for three days and she made good recovery. At follow-up, her heart size had reduced and her liver too had come back to normal size. Her breathing difficulty had reduced too, and she could eat and talk," he says. 

Reducing cases
Rheumatic heart disease is a common condition which affects various heart valves, like mitral, tricuspid and aortic valves, causing either stenosis (obstruction) or leak. This condition was very common in India earlier, but it is showing a decline in urban areas. Early diagnosis and surgical management are key to good, long-term recovery of these patients. This particular patient's condition was diagnosed 10 years ago, but due to financial crunch, they had delayed seeking surgical management leading to worsening of her health. The woman is now back with her family. 

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