Pacemaker implant performed on patient with ‘rare anatomical condition’ at Kolkata hospital

Kolkata, Doctors at a Kolkata hospital have successfully implanted a permanent pacemaker in a 62-year-old woman with an artificial bicaval valve system, a rare anatomical condition “reported only once before” in global medical literature.

Authorities at the Manipal Hospital in the city’s Mukundapur area claimed that this was the first such case in the country, and only the second worldwide.

Dr Soumya Patra, Senior Consultant of Cardiology and Director of the Cath Lab at the hospital, led the procedure last month with support from Dr Subhasish Deb and other team members.

The patient, Shyamali Biswas, a homemaker from Sonarpur in South 24 Parganas district, had a long history of severe heart disease, he said. In 2023, she underwent tricuspid valve replacement surgery in Vellore, after her natural valve was extensively damaged, Patra said.

Owing to advanced heart failure, she received an artificial bicaval valve system, in which valves were placed in both the superior and inferior vena cava, instead of a conventional valve repair, he said.

Earlier this year, she developed complete heart block, a serious condition in which faulty electrical signals cause the heart to beat abnormally slowly, and was admitted to the hospital on February 2. Doctors advised urgent implantation of a permanent pacemaker.

However, the presence of an artificial valve in the superior vena cava , one of the main veins returning blood to the heart, posed a significant challenge, as pacemaker leads typically pass through these veins to reach the heart, according to the doctor.

Patra said the artificial bicaval valve system “completely changes the normal anatomy of the heart”.

“The superior vena cava valve makes lead placement particularly difficult. Pacemaker implantation in the presence of an SVC valve needs precision and thorough planning, as even minor misplacement can damage the valve or compromise blood flow. It can lead to difficult pacemaker lead negotiation and placement,” he said.

While leadless and epicardial pacemaker implantation were alternative options, the former is more expensive and the latter requires surgical support, he said.

“In this case, we adopted a technique that allowed successful placement of a conventional pacemaker despite the anatomical difficulty created by the caval valve. It is important to mention and learn from such technological adaptations, as they can help others manage similar complex scenarios,” Patra said.

He said long-term follow-up, including regular pacemaker programming and echocardiography at periodic intervals, would be required.

Shyamali’s daughter Nabamita told PTI that the family was extremely anxious about her health condition, especially since she had already undergone a major heart surgery in 2023.

“My mother is currently on BiP support and under regular medical follow-up, and we are hopeful she will return to normal life very soon,” she said.

Patients with artificial tricuspid valves who later require pacemaker implantation are extremely rare. The successful intervention marks a significant milestone in advanced cardiac care, officials said.

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