Structural Heart Disease Treatment in Bangalore: TAVI, TMVR, MitraClip, Shunt Closure and LA Appendage Closure

Heart Team Assessment Comes First

Choosing between a transcatheter procedure and surgery is never a single-test decision. Echocardiography, often with a transoesophageal study, CT scans for exact measurements, the patient’s age, frailty, other illnesses and expected surgical risk are all reviewed together. Cardiologists, imaging specialists and cardiac surgeons discuss the options, and the patient and family are part of that conversation.

TAVI and TAVR: Aortic Valve Replacement Without Open-Heart Surgery

TAVI (transcatheter aortic valve implantation) and TAVR (transcatheter aortic valve replacement) are two names for the same procedure. It treats aortic stenosis, in which the valve that carries blood out of the heart narrows and calcifies. Breathlessness, chest pain, dizziness or fainting on effort are the usual signs, and once such symptoms appear, severe stenosis needs timely treatment because medicines cannot reopen the valve.

After CT scans size the valve and map the blood vessels, a new valve mounted on a catheter is usually guided through the artery in the groin and expanded inside the diseased valve. The procedure is often done under sedation, and many patients walk the next day and go home within a few days. Transcatheter valves were first used in patients too frail for surgery and are now an option across a wider group of older patients. In younger and low-risk patients, surgery often remains preferred because long-term valve durability data are still accumulating, and the heart team weighs age, anatomy and life expectancy individually.

TMVR: Transcatheter Mitral Valve Replacement

The mitral valve controls flow between the upper and lower chambers on the left side of the heart. When it leaks or narrows severely, patients experience breathlessness, fatigue and swelling, and the heart gradually enlarges. Transcatheter mitral valve replacement places a new valve through a vein in the groin and across the wall between the upper chambers. It is considered for patients who are not good candidates for surgery, most established when a previously implanted surgical valve or ring has failed, while use in native valves is evolving and depends closely on anatomy.

MitraClip: Edge-to-Edge Repair for a Leaking Mitral Valve

MitraClip is a transcatheter repair rather than a replacement. A small clip is delivered to the mitral valve through the same vein and joins the edges of the two leaflets, reducing the leak while preserving the patient’s own valve. Three-dimensional echocardiography guides every step. It is considered for severe, symptomatic mitral regurgitation that persists despite medicines, especially when surgery carries high risk. In selected patients with heart failure and functional regurgitation, it can reduce hospital admissions. Valve anatomy decides whether a clip can be used.

Closing Holes in the Heart: PFO and ASD

Patent foramen ovale (PFO)

A PFO is a flap-like opening between the upper chambers that remains after birth in about one in four people, and in most it is harmless. Closure is considered when a younger patient has had a stroke without any other cause being found, or in certain high-risk anatomy. It is not routinely recommended for migraine. A small device is placed through a vein in the groin under imaging guidance, and antiplatelet medicines are continued for a period afterwards.

Atrial septal defect (ASD)

An ASD is a true hole between the upper chambers. Over the years it makes the right side of the heart work harder, which can lead to breathlessness, palpitations and raised pressure in the lungs. In India the diagnosis is often made late in adulthood. When the shunt is significant and the rim of tissue around the hole is adequate, a device can close it through a vein without a chest incision. Larger or unusually shaped defects may require surgery.

Left Atrial Appendage Closure

In atrial fibrillation, blood in the left atrium can pool and form clots, most of which arise in a small pouch called the left atrial appendage. Anticoagulant medicines remain the first choice for stroke prevention. For patients who cannot take them long term, for instance after a brain bleed, recurrent gastrointestinal bleeding or with a high risk of falls, a device can seal the appendage and reduce the chance of clots reaching the brain. It is placed through a vein under imaging guidance, followed by a short course of antithrombotic medicines and scans to confirm complete sealing.

Recovery and Follow-Up

Most transcatheter procedures involve a short hospital stay, avoidance of heavy lifting for a few days, and regular echocardiography afterwards. Patients with new valves also need guidance on dental hygiene and antibiotic cover. Because follow-up is lifelong for valve patients, many families from Whitefield, BTM Layout and JP Nagar prefer to coordinate reviews at the centre that is easiest to reach from home.