Times of India
27 May 2010
By Santosh Andhale

In a first–of–its–kind procedure in the country, doctors treat Andheri resident Dinah D’Souza who had a 40 mm hole in her heart –without a bypass surgery
It was unfortunate for 29–year–old Dinah D’Souza that she had been born with the rare condition of a hole in the heart. What made matters worse for her was that, as time passed, it developed into a 40 mm hole which is rather unusual. To treat a hole of this size, so far there was no option but bypass surgery. However, in the first–of–its–kind endeavour, doctors at Nanavati Hospital managed to successfully correct the defect in Dinah’s case –without any surgical intervention.

Generally, in patients with atrial septal defect (ASD), the size of the hole in the heart is around 20–35 mm and treatment involves a costly surgically invasive bypass operation. Andheri resident Dinah consulted three high profile cardiologists, all of whom suggested the routine bypass surgery. But Dinah was afraid of undergoing invasive surgery and kept exploring options. In time, a friend led her to renowned cardiologist Dr Bharat Dalvi, who said he would treat her without a bypass.

To correct ASD, doctors use an ASD closure device which resembles an umbrella, and is generally suitable for a hole of 35 mm. As Dinah’s case was an exception, a device to fit the size of the hole in her heart was not available in the market. A special 44 mm custom–made device had to be ordered from abroad. And, when it arrived a fortnight later, the procedure was successfully done at Nanavati Hospital.

“I was confident of the procedure and everything worked out fine. We were concerned about the size of the hole in the heart. But after observing the patient for a month and a half we are confident that she is doing well. This is the only case of its kind that I have handled,” said Dr Dalvi, who runs a clinic at Matunga.

“I was aware of my disease since I was a teenager, but didn’t have a problem till I had a daughter. After her birth, I began getting bouts of breathlessness and decided to seek treatment,” Dinah told Mumbai Mirror. She added, “I was unaware that the size in my case was rare, but the doctors counselled me well. I’m now doing fine with just two tablets a day which I have to take for a year.”

“We had full faith in Dr Dalvi who explained the whole process to me. His assurance that he would conduct the bypass free of cost if the device did not work really helped, and we went ahead with his suggestion,” said Ronald, Dinah’s husband.

What is ASD
ASD is a form of congenital heart defect that allows blood to flow between the left and right atria via the interatrial septum. The interatrial septum is the tissue that divides the right and left atria. Without this septum, or if there is a defect in this septum, it makes it possible for blood to travel from the left side of the heart to the right side, or vice–versa.

Expert Speak
“Treating such a huge hole in the heart without surgery is really commendable. This could have only been done by a cardiologist with exceptional skill,” said Dr Ramakant Panda, Senior Cardiac Surgeon, Asian Heart Institute, Bandra.

“Patients with such an ASD size are generally recommended bypass surgery because it’s difficult to treat this condition otherwise. This is indeed a rare procedure which all cardiologists will look forward to using,” said Dr Harish Mehta, Cardiologist, Khar.