McLEOD HEALTH 15 JANUARY 2024

Shown above from left to right: Dr. Brian Blaker, Dr. Ravi Parikh, Dr. Srivinas Kolla

The McLeod Heart and Vascular Institute combined the skills of Structural Heart Cardiologists Dr. Ravi Parikh and Dr. Brian Blaker with Cardiothoracic Surgeon Dr. Srinivas Kolla to repair a patient’s severely leaking aortic heart valve. This surgery as it was performed was a first-time procedure in South Carolina.

The patient had come to the McLeod Structural Heart Team in 2023 complaining of trouble breathing and retaining fluid. Their aortic valve had previously been replaced in 2018 with the Transcatheter Aortic Valve Replacement procedure (TAVR).

The results of a heart catheterization looked good for the patient but a transesophageal echocardiogram (TEE) test that produces pictures of the heart using high-frequency sound waves revealed the issue.

One year ago, this patient’s heart valve was functioning appropriately. The TEE test indicated the aortic valve was now leaking. This meant the leaflets on the heart valve were not closing tight enough which allowed blood to leak back into the heart.

Shortness of breath is one symptom patients can experience when this happens making everyday tasks difficult to manage. Other symptoms patients might encounter include fatigue, chest pain, fainting, or an overall feeling of weakness.

The challenge was to determine the best surgical option for the patient. At 83 years old any option that required a long extensive surgery would not have been in the patient’s best interest.

After Dr. Parikh and Dr. Kolla closely reviewed all of the imaging which included the TEE and a CT scan of the heart (routinely performed prior to TAVR procedures for planning purposes) and discussed the case with colleagues all over the country, a decision was made of the safest route to present to the patient and family – an option that combined the skills of Cardiothoracic Surgery and Structural Cardiology to minimize time for the patient on the surgical table and optimize recovery.

Removing the leaking valve would have been too extensive of a surgery. The surgical option proposed was the placement of the new valve inside the old valve. The original concern was this method did have a potential risk for heart attack because once the new valve was in place it would push the leaflets of the old valve to the side which could then block off blood flow to the arteries supplying the heart with blood. The solution to prevent this risk involved Dr. Kolla surgically removing the leaflets from the old heart valve.

Once the leaflets were removed, Dr. Parikh and Dr. Blaker implanted the patient’s new valve. When it was exactly positioned across the diseased old valve using an X-ray, the new valve was released and started working immediately.

The McLeod Structural Heart Program has been replacing diseased heart valves using the Transcatheter Aortic Valve Replacement procedure since 2017. The Structural Heart team members include Cardiothoracic Surgeons Dr. Srinivas Kolla, Dr. Cary Huber and Dr. Robert Messier; Structural Heart Cardiologists Dr. Ravi Parikh, and Dr. Brian Blaker; Anesthesiologists Dr. Daniel Fox, Dr. Robert Savage and Dr. Robert R. Casella.

Structural heart procedures, including TAVR, emphasize a team effort. This particular case could not have been accomplished without the physicians and staff working together for the benefit of the patient. All of the team members bring their experience and expertise for the best care of the patient.

The McLeod Heart and Vascular Institute offers a Valve Clinic at the office of McLeod Cardiology Associates to meet the medical needs of patients diagnosed with valve disease. In the clinic, each patient is evaluated by a team of cardiac experts to diagnose the type and severity of the valve disease and develop a treatment plan specific to the patient’s condition. For questions on the McLeod Valve Clinic, call 843-777-8258.

Dr. Ravi Parikh and Dr. Brian Blaker are Structural Cardiologists specializing in structural heart disease with McLeod Cardiology Associates. As part of the McLeod Structural Heart Program, Dr. Parikh and Dr. Blaker are also TAVR Certified Physicians. Physician and self-referrals are welcome by calling 843-667-1891.

Dr. Srinivas Kolla is a Board Certified Thoracic Surgeon with more than 20 years of surgical experience that includes cardiac, thoracic, and robotic-assisted thoracic surgery. He cares for patients at McLeod Cardiothoracic Surgical Associates.