Doctors at Mumbai’s Wockhardt Hospitals have given a new lease of life to 72-year-old man by carrying out a successful dual chamber Implantable Cardioverter upon him.

A team led by Dr. Ashish Mishra Consultant Interventional Cardiologist adopted a multidisciplinary approach in saving the life of a patient with a life threatening rare variant of MVP – the Arrhythmic Mitral Valve Prolapse (AMVP).

The patient resumed his daily routine after getting successful treatment and discharge from the hospital.

Mr. Shankar Shinde, a 72-year male resident from Thane, suddenly encountered palpitations (unusual and abnormal perception of heart beat) for which he was hospitalized at a local hospital.

Dr. Ashish Mishra Consultant Interventional Cardiologist, said, “The patient presented with a history of palpitations and presyncope (feel of fainting out but without actual loss of consciousness) to the emergency room (ER) at Wockhardt Hospitals, Mira Road.”

“His ECG was suggestive of monomorphic Ventricular Tachycardia (VT) – a life threatening heart rhythm which was diligently managed by the ER team. The echocardiography done by Dr. Ashish Mishra at the point of care in the emergency room revealed Mitral Valve Prolapse (MVP) with mitral annular disjunction (MAD), moderate mitral regurgitation and normal biventricular function,” he added.

Dr Ashish Mishra added, “The Cardiac MRI was done which was consistent with the echocardiographic diagnosis of MVP with MAD and multiple areas of delayed enhancement in the myocardium and both papillary muscles (overall extent of myocardial fibrosis - 13.4%) which explained the substrate for origin of life-threatening Ventricular Arrhythmia in our patient.”

The patient underwent a successful dual chamber Implantable Cardioverter Defibrillator (ICD) by Dr. Ashish Mishra and Dr. Mayuresh Pradhan. The procedure was completed over 80 minutes with a minimally invasive approach.

“An ICD is a small battery-powered device placed in the upper half of chest which continuously monitors heartbeat and delivers electric shocks to restore a regular heart rhythm with smart shock technology when life threatening arrhythmia (ventricular tachycardia or ventricular fibrillation) are detected by its pre-programmed algorithm. His life was saved due to timely treatment,” he added.

“MVP - a type of valvular heart disease wherein the leaflets of the mitral valve are floppy and bulge backward (prolapse) like a parachute into the heart's left upper chamber as the heart squeezes (contracts). MVP has a prevalence of 2-3% in the general population and is considered relatively benign with overall excellent survival,” Dr Mishra said.

He pointed out that however, sudden cardiac death (SCD) and ventricular arrhythmias are particularly linked to the rare variant of MVP – the Arrhythmic Mitral Valve Prolapse (AMVP) which occurs in only 0.2-0.4% per-year among all patients with MVP.

AMVP is usually associated with phenotype consisting of marked bi-leaflet prolapse, mitral annular dysjunction, baseline  ECG abnormalities and late gadolinium enhancement on Cardiac MRI.

“Given the rarity of arrhythmic MVP, the main clinical challenges are precisely identifying the high-risk subjects and prompt therapy to prevent sudden cardiac death (SCD)” underscored Dr. Ashish Mishra.