83-year-old female patient from Kenya undergoes Watchman device implantation without open heart surgery.

About the Patient and condition

An 83-year-old female, resident of Nairobi, Kenya, presented at the Apollo International clinic at Nairobi for the management of anticoagulation for her atrial fibrillation, which was diagnosed two years back. The patient had a history of hypertension and was receiving the required treatment. Owing to high risk of thromboembolic phenomenon, as judged by CHADS2VASc score, she was advised regular anticoagulation. It was expected that the anticoagulation will prevent the formation of clots in the left atrial appendage.

Case Scenario

The anticoagulation had unpredictable effects and the 83-year-old patient suffered 2 episodes of intracranial bleed (IC) while on anticoagulation. Considering the life threatening events of IC bleed, continuation of anticoagulation became problematic. At the same time, stoppage of anticoagulation increased her risk for life threatening atrial fibrillation related ischemic strokes. Hence, closure of LAA (left atrial appendage) by innovative percutaneous technique with the help of a device seemed to be an ideal solution. The patient was further referred to Apollo Hospitals, Navi Mumbai for detailed evaluation and closure of LAA. The patient was assessed with Transesophageal Echocardiography (TEE) for the feasibility of the LAA device closure (LAA-DC). After confirming suitability, the procedure was carried out though right femoral venous access. LAA was accessed through trans-septal puncture. The ‘Watchman’ or LAAC device with maximum evidence was chosen, which is a parachute-shaped, self-expanding device used to close the LAA percutaneously. It was deployed successfully under fluoroscopic and TEE guidance. The patient tolerated the procedure well, after which the anticoagulation eventually stopped, at the same time keeping her at a low risk for ischemic stroke.

Worldwide Scenario

Atrial fibrillation is the most common heart rhythm abnormality which affects more people in the world. Left Atrial Appendage can become a source of problem for such patients. Irregular heartbeats and inefficient pumping of heart can cause blood to pool in the LAA; instead of being pushed out of heart. In some cases, these clots may travel to the brain resulting to ischemic stroke, putting patients with Atrial fibrillation at a higher risk of stroke and bleeding. Watchman device is considered as one of the best treatment options for left atrial appendage closure.

Expertise at Apollo Hospitals

The left atrial appendage (LAA) is a small, ear-shaped outpouching in the left atrium. It is the most common site of clot formation in patients with atrial fibrillation and closure of LAA is required to save life. However, considering the patient’s age and the life threatening events of IC bleed she suffered; it was a high-risk case for the team. Dr Sanjeev Kumar Kalkekar, Consultant, Interventional Cardiology and his team at Apollo Hospitals, Navi Mumbai accepted the challenge and meticulously performed the procedure on this octogenarian patient, without even opening the heart. This was also the second case reported in Mumbai and third in Maharashtra.

Apollo Hospitals – Touching Lives

Apollo Hospitals is the pioneer of heart care in India. We have leading Cardiologists and Cardiothoracic Surgeons who are highly experienced and have handled many challenging cases which other centres decline. Apollo Hospital has been known to introduce cutting edge technologies like Mitra Clip, Trans-catheter mitral valve replacement etc. We have given patients new lease of lives by successfully performing heart transplantation surgeries and beating heart surgeries.

Patient’s testimonial

The patient was very satisfied and found the ambience friendly. She was glad that she chose Apollo Hospitals for her cardiac surgery and thanked the entire team at the Department of Cardiology.