In a rare and highly complex cardiac procedure, Kolkata doctors have successfully implanted a permanent pacemaker in an elderly woman who had an artificial bicaval valve system, giving her a new lease of life.
It is a highly specialised treatment used in patients suffering from severe tricuspid regurgitation, a condition where a valve on the right side of the heart does not close properly, causing blood to flow backward, and congestive heart failure.
To the best of the doctors` and hospital`s medical knowledge, this is the first such case in India and has been reported only once globally.
Understanding the health condition
The procedure was carried out by Dr Subhasish Deb, consultant – Cardiology, and the dedicated cath lab team at Manipal Hospital Mukundapur in Kolkata. The woman, Shyamali Biswas, a 62-year-old homemaker from Sonarpur, had a long history of severe heart disease.
In 2023, she underwent tricuspid valve replacement surgery in Vellore after her natural tricuspid valve became severely damaged. Due to advanced heart failure, she received an artificial bicaval valve system instead of a conventional valve repair.
Earlier this year, she began feeling unwell and was admitted to the hospital in Kolkata on February 2 after being diagnosed with complete heart block, a serious condition where faulty electrical signals cause the heart to beat dangerously slowly.
Given the critical nature of her condition, doctors advised an urgent pacemaker implantation. However, the procedure was exceptionally challenging because the patient already had an artificial valve placed in the superior vena cava, one of the main blood vessels returning blood to the heart. This superior vena caval valve created significant difficulty in placing the pacemaker lead using conventional techniques, as pacemaker wires usually pass through these veins to reach the heart. Despite these challenges, the cardiology team successfully implanted the pacemaker through meticulous planning, advanced technical skills, and precise execution.
Uniqueness of the procedure
Patients with artificial tricuspid valves who later require pacemakers are extremely rare. Explaining the uniqueness of the procedure, Dr Patra said, “This was an extremely rare and technically demanding case because the artificial bicaval valve system completely changes the normal anatomy of the heart. The presence of a valve in the superior vena cava makes conventional pacemaker lead implantation particularly challenging, as even minor misplacement can damage the valve or compromise blood flow. To our knowledge, this is the first such procedure in India and only the second reported worldwide.”
Expressing her gratitude, Nabanita Biswas, daughter of the elderly woman, said, “We were extremely anxious about my mothers condition, especially since she had already undergone major heart surgery in 2023. We are deeply thankful to Dr Patra and his team for handling such a complex case with great care and precision. My mother is currently on BiPAP support and under regular medical follow-up, and we are hopeful she will return to her normal life very soon.”
