Jaipur: In a remarkable milestone for high-risk cardiac care, an Impella – assisted complex angioplasty performed in Jaipur has transformed the life of a 78-year-old mechanical engineer and businessman from Nepal who had been deemed “untreatable” across multiple medical centers due to his complicated cardiac history and severely weakened heart.
A Month of Suffering and Sleepless Nights
Mr. Maru, 78, had been battling severe chest heaviness and breathlessness for over a month. Every night, the moment he lay down, breathlessness and chest pain would worsen, forcing him to sit upright. He spent weeks sleeping in a seated position and relying on sorbitrate tablets to ease the discomfort.
Despite consultations with several doctors in Nepal and India, he was turned away due to the high risk associated with his condition. His cardiac history was extremely complex:
- Bypass surgery in 1992
- Angioplasty 10 years later at Narayana Hospital, Bangalore
- Another angioplasty in New Delhi
- Heart function reduced to just 20%
With his symptoms worsening rapidly, he sought an online consultation with Interventional Cardiologist Dr. Ravinder Singh Rao, who recognized the urgency of his condition.
Dr. Rao noted, “Mr. Maru had a complex and extremely high-risk history. With a prior bypass, multiple angioplasties and a heart efficiency of only 20%, the treatment demanded the highest level of precision and protection.”
Flying to Jaipur on Oxygen for Life-Saving Care
The patient flew from Kathmandu to Jaipur on oxygen support and was evaluated at RHL Hospital. An urgent angiography revealed alarming findings:
- He was surviving solely on one bypass graft — the LIMA to LAD
- This graft had a critical 99% blockage
- The graft also had a stent at its junction, which had severely narrowed
- All other bypass grafts were completely closed
With only one nearly-blocked graft supplying blood to his heart, his condition was deteriorating rapidly, leaving him bed-bound.
Impella: The World’s Smallest Artificial Heart Pump Becomes the Lifeline
Dr. Rao decided to perform an Impella-assisted angioplasty — the safest option in such a high-risk scenario.
The Impella device, the world’s smallest artificial heart pump, is inserted through the femoral artery in the groin. It supports the heart by pumping 3.5 liters of blood per minute, protecting the heart and vital organs throughout the procedure.
Once the Impella was positioned, Dr. Rao and his team performed the delicate angioplasty through the old bypass graft:
- The previous stent in the graft was cut open
- A new stent was precisely placed
- The 99% blockage was fully opened
- IVUS (Intravascular Ultrasound) confirmed perfect stent expansion and positioning
- Full blood flow to the heart was restored
The Impella pump was kept in place for 24 hours and removed the next day when the heart function began improving.
A Dramatic Recovery
Dr. Rao shared,
“The patient showed dramatic improvement. His chest pain and breathlessness disappeared. He walked in the ICU the next day, was shifted to his room, and finally slept peacefully after two months.”
Within days, he regained strength, spent quality time with his family from Nepal, and was able to walk comfortably. He safely returned home and is now living a healthy, stable life.
Expertise Makes the Impossible Possible
Dr. Rao added,
“Such angioplasties are extremely delicate and leave little room for error. Our extensive experience with complex angioplasty helps ensure safe outcomes in even the highest-risk patients. Impella provides an additional safety layer, and studies show that IVUS-guided angioplasty delivers the best long-term results in complex cases.”
About the Treating Specialist
- Dr. Ravinder Singh Rao, MD, DM, FACC
- Vice Chairman, RHL Hospital, Jaipur
- Interventional Cardiologist, Lilavati Hospital, Mumbai
- Interventional Cardiology Fellowship, Mount Sinai Hospital, New York
- Structural Heart Disease Fellowship, Washington University School of Medicine, St. Louis
