Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Oct 27, 2026 · View LinkedIn profile

When a doctor says “you need an ICD”, most families hear only one thing: a machine that gives shocks. The fear is understandable. This guide explains in plain words what the device does, who benefits from it, and what life looks like afterwards.

What is an ICD?

ICD stands for implantable cardioverter defibrillator. It is a small metal box, about the size of a large pocket watch, placed under the skin below the collarbone. One or more thin wires run from it through a vein into the heart.

The ICD watches every heartbeat, all the time. Mostly it does nothing. If the heart suddenly goes into a very fast, dangerous rhythm, the kind that causes cardiac arrest, it acts within seconds. First it may try a series of quick, painless pulses to bring the rhythm back. If that does not work, it gives one strong shock that resets the heart.

Cardiac arrest is not a heart attack. A heart attack is a blocked artery; in cardiac arrest the heart’s electrical system fails and pumping stops. See heart attack vs cardiac arrest.

How is an ICD different from a pacemaker?

The two look alike and are fitted the same way, but they do different jobs.

• A pacemaker helps a heart that beats too slowly. It sends small signals to keep the beat from dropping.
• An ICD protects a heart that may suddenly beat dangerously fast. It can also work as a pacemaker when needed.

So every ICD can pace, but a pacemaker cannot shock. If your doctor has advised a pacemaker instead, our pacemaker guide covers that device. For a side-by-side comparison of a pacemaker, an ICD and a CRT-D in Hindi, read ICD aur Pacemaker mein kya fark hai.

Who needs an ICD?

There are two broad groups of people.

People who have already survived a dangerous rhythm. If your heart has stopped once and you were revived, or a dangerous fast rhythm was caught on an ECG, it can happen again. An ICD is usually advised, unless the cause was temporary and has been fixed.

People whose heart is at high risk, even though nothing has happened yet. The most common reason is a weak heart muscle. Doctors measure how well the heart pumps with an echo test; the report calls it ejection fraction, or EF. In a healthy heart, the EF is usually above 50%. When the EF stays at 35% or below despite the right medicines, the risk of sudden death goes up.

Two large trials tested ICDs in this group:

• In MADIT-II, people with an old heart attack and an EF of 30% or less lived longer with an ICD. Over about two years, 14 in 100 died with the device against 20 in 100 without it.
• In SCD-HeFT, people with heart failure and an EF of 35% or less had about a quarter fewer deaths with an ICD. A heart-rhythm medicine tested alongside it did not help.

Some inherited heart conditions raise the risk in young people even when the pumping strength is normal. The NIH guide on who needs a defibrillator lists these situations.

When is an ICD not the right answer?

Not everyone with a weak heart needs one, and timing matters.

Right after a heart attack. The heart muscle often recovers in the weeks that follow. The DINAMIT trial fitted ICDs 6 to 40 days after a heart attack and found no fall in deaths. So doctors usually wait, give medicines, and then check the pumping strength again.

When the weakness has a cause that can be fixed. Blocked arteries can be opened. A badly narrowed aortic valve can be replaced, often without open surgery through TAVI. After that, the heart sometimes pumps much better, and the ICD question changes. Before an ICD decision, I ask whether the EF was measured again after the medicines had time to work.

When the heart failure is not from blocked arteries. In the DANISH trial, people with this type of heart failure who got an ICD had half as many sudden deaths, but overall deaths did not fall by a clear margin. For them, the decision depends on age, other illnesses and how they respond to treatment. It is a case by case discussion, not a rule.

When other illness limits life. For a very frail person, or someone with a serious illness that will shorten life, the device may add little. Discuss this honestly with your cardiologist.

Good heart failure treatment comes first in every case.

What happens during ICD surgery?

It is a smaller operation than most people imagine. As the US patient guide MedlinePlus describes it:

• You stay awake. The skin below the left collarbone is numbed, so you do not feel pain.
• The doctor makes a small cut, makes a pocket under the skin for the box and guides the wire into the heart using X-ray pictures.
• The whole thing usually takes two to three hours.
• Most people go home the next day.

For a few weeks, do not lift heavy things with that arm or raise it above your shoulder, so the wire can settle. Full recovery takes about four to six weeks. You will get a wallet card with your device details; keep it with you always.

Another type, the subcutaneous ICD, has its wire under the skin of the chest instead of inside the heart. It cannot pace, so it suits only some patients.

What does an ICD shock feel like?

This is the question families ask me most often in OPD.

The small pulses an ICD uses to correct a fast rhythm are not painful, and many people never notice them. A full shock is different. It lasts less than a second, and people describe it as a sudden hard kick or thump in the chest. It can hurt, and it can be frightening.

What to do after a shock, as advised by the NIH:

• One shock, and you feel fine afterwards. Sit down and rest. Call your doctor the same day or the next day.
• Several shocks in a short time, or you feel unwell. Go to the hospital emergency at once.

Sometimes an ICD shocks when it is not needed, for example because of a damaged wire or a very fast heartbeat during heavy exercise. This is more common in the first weeks, and changing the device settings or medicines usually stops it.

Many people live with an ICD for years and never get a single shock.

What is daily life like with an ICD?

Most people go back to work and normal family life. A few precautions matter.

• Mobile phone. Keep it at least 15 cm (6 inches) from the device. Hold it to the ear on the opposite side, and do not keep it or earphones in a shirt pocket over the device.
• Airport security. Show your ICD card and ask for a hand search if you prefer.
• MRI scan. Many newer ICDs allow MRI with special precautions. Always tell the scan centre first.
• Driving. Rules differ by country, and a shock can make you faint at the wheel. In the US, the NIH notes waits of about one week for a preventive ICD and up to six months after a cardiac arrest or a shock, and no driving of commercial vehicles. Ask your doctor before you drive again, especially if driving is your work.
• Exercise. Walking and most sports are fine. Avoid contact sports where the device can take a hit.
• Engines and tools. Do not lean over a running car engine, and keep electric power tools away from your chest.

You will need a device check at least every six months. The doctor reads the ICD with a small wand held over the skin.

How long does the ICD battery last?

The NIH puts ICD battery life at about 5 to 7 years. It runs out faster if the device has to pace a lot or give many shocks. Your check-ups show how much battery is left, so a replacement is planned well in time.

Changing the battery means changing the box. This is quicker than the first operation, because the wires are usually kept.

What should you ask before saying yes?

The cost of an ICD in India depends on the type of device, the hospital and the length of stay. Ask for a written estimate that lists the device, the procedure and the follow-up checks, and ask what a battery change will cost later.

Also ask:

• Is it because of a dangerous rhythm I have had, or to prevent one?
• What is my EF now, and was it checked again after medicines?
• Who will check my device every six months?

If you want a second opinion on whether you need an ICD, you can book a consultation with Dr. Prem Ratan Degawat in Jaipur. Please bring your echo reports and ECGs, with a list of your medicines.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

Book a consultation

FAQs

Is ICD surgery painful?

The surgery itself is done under local numbing medicine, so you feel pressure but not sharp pain. The area below the collarbone is sore for a few days afterwards, and simple painkillers usually control it. Most people go home the next day and return to light daily activity within a week.

Can I live a normal life with an ICD?

Yes, for most people. You can work, travel and exercise, and family life carries on as before. The main changes are keeping your phone away from the device, carrying your device card, telling doctors before any scan, and going for a device check at least every six months.

What is the difference between an ICD and a pacemaker?

A pacemaker helps a heart that beats too slowly by sending small signals to keep it going. An ICD watches for dangerously fast rhythms and stops them with quick pulses or a shock. An ICD can also work as a pacemaker, but a pacemaker cannot give a shock.

How long does an ICD battery last?

Usually about 5 to 7 years, according to the NIH. It runs down faster if the device paces often or gives many shocks. Regular device checks show how much battery is left, so the replacement is planned in advance. The wires in the heart are usually kept, and only the box is changed.

Can an ICD be removed or switched off?

The shock function can be switched off without surgery, by reprogramming the device from outside the body. This is sometimes chosen near the end of life, when shocks would only cause distress. Removing the device itself needs a procedure and is usually done only for infection or a damaged wire.

The post ICD Implant: Who Needs One and What Life Is Like After appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Oct 22, 2026 · View LinkedIn profile

Lipoprotein(a), or Lp(a), is a cholesterol-carrying particle in your blood. Its level is set almost entirely by your genes, and a high level raises your risk of heart attack, stroke and narrowing of the aortic valve. A routine lipid profile does not measure it, which is why most people have never had the test.

Guidelines now say every adult should have the lipoprotein(a) test at least once. If yours is high, no approved medicine yet lowers it in a way that protects the heart. What helps is controlling every other risk factor harder and earlier.

These cut-offs come from the 2022 European Atherosclerosis Society (EAS) consensus statement. Labs differ a little at the edges.

What is lipoprotein(a)?

Your blood carries cholesterol inside small particles. LDL, the “bad cholesterol” on a normal report, is one of them. Lp(a) is an LDL particle with an extra protein, called apolipoprotein(a), attached to it.

That extra protein makes Lp(a) more harmful than plain LDL. It helps cholesterol settle in artery walls and drives inflammation there. It is also linked with calcium build-up on the aortic valve.

The EAS statement says more than 90% of the difference in Lp(a) between people comes from genes. Your adult level is usually reached by about age 5 and then stays roughly the same for life. You cannot guess it from your weight, diet or LDL. A slim, fit person with a perfect LDL can still have a very high Lp(a).

Why does it matter for Indians?

South Asians carry high Lp(a) often, and they seem to pay a high price for it.

In the INTERHEART Lp(a) study, researchers led by Paré compared 6,086 people after a first heart attack with 6,857 people without one, across seven ethnic groups. An Lp(a) above 50 mg/dL raised the odds of a heart attack by about 48%, even after allowing for other risk factors such as diabetes or smoking. The share of heart attacks linked to high Lp(a) ranged from 0% in Africans to 9.5% in South Asians.

A 2019 review in the Indian Heart Journal by Enas and colleagues estimated that about one in four Indians has an Lp(a) of 50 mg/dL or more.

I see this in the OPD. A man in his thirties comes in after a heart attack. He does not smoke, his sugar is normal, and his LDL is only a little high. In that patient, Lp(a) is one of the first tests I ask for.

It matters for heart valves too. The EAS statement treats the Lp(a) gene as a major contributor to aortic valve narrowing, and high Lp(a) is linked with calcium on the valve. Our guide to aortic valve sclerosis and stenosis explains how that narrowing starts. When I find a calcified aortic valve in someone younger than I would expect, I ask whether Lp(a) has ever been checked.

Who should get the lipoprotein(a) test?

The short answer is every adult, once. The 2026 ACC/AHA dyslipidemia guideline and the EAS statement both recommend measuring Lp(a) at least once in adulthood.

It matters most if:

• You had a heart attack, stent, bypass or stroke at a young age
• A parent, brother or sister had one at a young age
• Your LDL cholesterol is very high, or runs in the family
• Your heart disease keeps progressing even though your LDL is well controlled
• You have aortic valve calcium earlier in life than usual

Most people need the test only once. The ACC/AHA guideline notes that lifestyle changes Lp(a) very little, so repeat testing is generally not needed. A level measured in childhood is the exception, because Lp(a) can still rise until adulthood.

How do you read your Lp(a) result?

First, check the unit on your report. Lp(a) is reported either in mg/dL or in nmol/L, and the EAS statement is clear that one cannot be converted to the other with a simple formula. A result of 60 means very different things in each unit.

Then compare it with the table at the top. Below 30 mg/dL, Lp(a) is not your problem. Above 50 mg/dL, it adds to your risk. Between the two, it depends on the rest of your risk profile, including your age and family history. When a patient shows me a report, I check the unit before anything else.

The exact line is still being settled. The 2025 ESC/EAS dyslipidaemia update says it is reasonable to treat Lp(a) above 50 mg/dL (above 105 nmol/L) as a reason to reassess risk, especially in people close to a treatment decision.

Can you lower lipoprotein(a) with diet or exercise?

Not much.

According to the EAS statement, exercise has little or no effect on Lp(a), and lifestyle changes in general move it very little. No supplement, juice or herbal product has been shown to bring it down in a way that protects the heart. I tell patients not to spend money on anything that promises to.

Exercise, a better diet and stopping smoking will barely change your Lp(a), but they cut your overall risk. Our guide to daily habits that prevent heart disease covers the changes worth making.

Statins are a common worry. A statin does not lower Lp(a), and the EAS statement notes it may raise it slightly. I do not stop a statin because of a high Lp(a). It still lowers your LDL, and that still lowers your risk.

What lowers your risk if your Lp(a) is high?

You cannot fix the number yet, so you fix everything around it. The EAS statement recommends early and intensive control of every other risk factor in people with high Lp(a).

In practice, that means:

• LDL cholesterol. With a high Lp(a), I aim for a lower LDL than I would otherwise accept.
• Blood pressure and sugar. Both are treated earlier rather than watched.
• Smoking. It has to stop completely.

If you already have heart disease, our guide to life after angioplasty covers the medicines and habits that protect a stent. If you have diabetes, the diabetes and heart disease guide explains why sugar control matters twice over.

PCSK9 inhibitors, injections used to bring LDL down, also lower Lp(a) by 15% to 30%, though they are not approved for Lp(a) itself. Niacin is not recommended, because two outcome trials showed no benefit. Lipoprotein apheresis, a dialysis-like filtering of the blood, is kept for very high Lp(a) with disease that keeps progressing. Do not start aspirin on your own because of a high Lp(a); the EAS statement found no data to support that.

Where do the new Lp(a) drugs stand?

Several drugs that sharply lower Lp(a) are in large trials. The first outcome result has been disappointing.

Lp(a)HORIZON tested pelacarsen in 8,323 people who already had heart disease and a high Lp(a). On 4 September 2026, Novartis announced that the drug lowered Lp(a) but did not meet its main goal. In the overall trial group, it did not reduce major heart and stroke events, the trial’s main measure. The full results have not been published yet. The honest answer today is that nobody has yet shown that lowering Lp(a) itself prevents heart attacks.

Two other drugs are still being tested. Olpasiran is in the OCEAN(a)-Outcomes trial, with results not expected before 2028. Lepodisiran is in the ACCLAIM-Lp(a) trial, expected to finish in 2029.

As of October 2026, no medicine is approved specifically to lower Lp(a) in India or elsewhere. If anyone offers you one, ask what trial result it is based on.

Should your family be tested?

Yes, if your level is high. Lp(a) is inherited, so your children and siblings may carry the same high level without knowing it. The EAS statement calls it reasonable to test anyone whose parent or sibling has a markedly high Lp(a).

That is often the most useful thing a high result does. A son or daughter in their twenties finds out early, with decades to keep LDL and blood pressure in check.

What does the test involve?

It is a simple blood test. The EAS statement lists fasting as having no effect on Lp(a), so you can give the sample at any time unless a fasting lipid profile is drawn with it.

Most routine lipid profiles in India do not include it, so ask for lipoprotein(a) by name. The price differs from lab to lab; ask for the current rate before you go.

If your result is high, you can book a consultation with Dr. Prem Ratan Degawat in Jaipur. Bring your lipid reports and a note of any heart problems in your family. For a wider check, see how to know if your heart is healthy.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

Book a consultation

FAQs

What is a normal lipoprotein(a) level?

There is no single normal value, because risk rises steadily with the level. The European Atherosclerosis Society uses below 30 mg/dL (75 nmol/L) as low risk and above 50 mg/dL (125 nmol/L) as high. Levels in between are read alongside your other risk factors, such as LDL cholesterol and family history.

Can lipoprotein(a) be reduced naturally?

Not in a meaningful way. Lp(a) is more than 90% genetic, and exercise and diet change it very little. No supplement has been shown to lower it and protect the heart. Healthy habits are still worth it, because they lower your overall risk, which is what high Lp(a) adds to.

Does a statin lower lipoprotein(a)?

No. A statin does not lower Lp(a) and may raise it slightly. You should still take your statin if your doctor has prescribed one, because lowering LDL cholesterol reduces your risk of heart attack and stroke. With a high Lp(a), your doctor may set an even lower LDL target.

Do I need to repeat the Lp(a) test?

Usually not. Your adult level is set early in life and stays about the same, so one test is enough for most people. A repeat may be useful if the first test was done in childhood, if the result was close to a cut-off, or if a different lab reported it in a different unit.

Does high lipoprotein(a) cause any symptoms?

No. High Lp(a) causes no symptoms on its own. It shows up only through what it leads to over the years: a heart attack, stroke or a narrowed aortic valve, sometimes at a young age. That is why the blood test is the only way to know your level.

The post Lipoprotein(a): The Cholesterol Test Most Indians Have Never Had appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Oct 20, 2026 · View LinkedIn profile

TMT यानी treadmill test, heart की वह जांच है जिसमें आप treadmill पर चलते हैं और साथ-साथ आपकी ECG, BP और धड़कन लगातार देखी जाती है। इसका मकसद यह पता लगाना है कि मेहनत के समय heart की मांसपेशी तक पूरा खून पहुंच रहा है या नहीं। TMT positive आने का मतलब है कि मेहनत के दौरान ECG में ऐसे बदलाव दिखे जो heart की नसों में रुकावट की ओर इशारा करते हैं। यह रुकावट का पक्का सबूत नहीं है, और negative report भी रुकावट को पूरी तरह खारिज नहीं करती।

TMT test में क्या देखा जाता है?

Heart को खून पहुंचाने वाली नसों को coronary arteries कहते हैं। अगर किसी नस में आंशिक रुकावट है, तो आराम के समय उतना खून भी अक्सर काफ़ी होता है। इसीलिए आराम की ECG कई बार सामान्य आती है।

मेहनत करते ही heart की खून की मांग बढ़ जाती है। तब रुकावट वाली नस उतना खून नहीं दे पाती और ECG में बदलाव आने लगते हैं। TMT इसी बदलाव को पकड़ने के लिए मेहनत को धीरे-धीरे बढ़ाता है।

ECG के साथ चार और बातें दर्ज होती हैं: आप कितनी देर चल पाए, BP कैसे बढ़ा, धड़कन कितनी तेज़ हुई और उसकी लय कैसी रही, और कोई लक्षण आया या नहीं।

TMT किसे करवाना चाहिए, और किसे नहीं?

TMT आमतौर पर इन स्थितियों में लिखा जाता है:

• चलने, सीढ़ी चढ़ने या भारी काम पर सीने में दर्द, भारीपन या जलन, जो आराम करने पर ठीक हो जाए
• मेहनत पर बिना वजह सांस फूलना
• पहले से heart की बीमारी हो, और यह देखना हो कि आप कितनी मेहनत सुरक्षित रूप से कर सकते हैं

कुछ स्थितियों में TMT नहीं किया जाता, क्योंकि मेहनत खतरनाक हो सकती है। Carluccio और साथियों की 2026 की गाइड में इनकी सूची है। इनमें मुख्य हैं: पिछले दो दिनों में heart attack, आराम में भी होने वाला सीने का दर्द, बेकाबू heart failure, heart की झिल्ली या मांसपेशी में ताज़ा सूजन, और लक्षण वाला severe aortic stenosis।

आखिरी बात मेरे काम से सीधे जुड़ी है। Severe aortic stenosis में heart का valve बहुत संकरा हो जाता है, और ऐसे मरीज़ को treadmill पर दौड़ाना जोखिम भरा है। इसलिए TMT लिखने से पहले मैं आराम की ECG देखता हूं और सीने पर murmur की आवाज़ सुनता हूं। Murmur मिले तो पहले echo होता है। Echo report में valve की गंभीरता कैसे पढ़ी जाती है, यह हमारे echo report गाइड में है।

कुछ मरीज़ों में TMT हो तो सकता है, पर उसकी ECG पढ़ी नहीं जा सकती। आराम की ECG में LBBB हो, pacemaker लगा हो, WPW pattern हो, या ST segment पहले से 1 mm नीचे हो, तो मेहनत वाले बदलाव पहचानना मुमकिन नहीं रहता। Digoxin लेने वालों में भी report झूठा positive आ सकता है। ऐसे मरीज़ों के लिए stress echo या CT coronary angiography बेहतर रास्ता है।

TMT की तैयारी कैसे करें?

• जांच से दो-तीन घंटे पहले भारी खाना न खाएं। पानी पीते रहें।
• जांच से पहले चाय, कॉफ़ी, शराब और तंबाकू से बचें।
• आरामदायक कपड़े और चलने लायक जूते पहनें।
• अपनी सभी दवाओं की सूची और पुरानी reports साथ लाएं।

दवाओं पर अपने मन से फैसला न करें। Beta-blocker जैसी दवाएं धड़कन को धीमा रखती हैं। अगर डॉक्टर बिना दवा के असर वाली जांच चाहते हैं, तो वह इन्हें 24 घंटे पहले रोकने को कह सकते हैं। अगर heart की बीमारी पहले से पता है, तो दवा अक्सर चालू रखी जाती है।

TMT test कैसे होता है?

सबसे पहले सीने पर ECG के electrodes लगाए जाते हैं। फिर आराम की ECG और BP दर्ज होता है।

इसके बाद आप treadmill पर चलना शुरू करते हैं। आमतौर पर Bruce protocol इस्तेमाल होता है, जिसमें हर तीन मिनट पर treadmill की गति और चढ़ाई बढ़ती है। Carluccio की गाइड के मुताबिक कोशिश यह रहती है कि मेहनत आठ से बारह मिनट चले।

चलते समय ECG लगातार चलती है और BP हर दो मिनट पर नापा जाता है। लक्ष्य अक्सर आपकी उम्र के हिसाब से अनुमानित सबसे तेज़ धड़कन का 85% छूना होता है। जांच पहले रोकी जा सकती है अगर सीने में दर्द हो, ECG में गंभीर बदलाव दिखें, धड़कन की लय बिगड़े या BP गिरने लगे। थक जाएं तो बताएं, ज़बरदस्ती चलने की ज़रूरत नहीं।

रुकने के बाद भी कुछ मिनट ECG और BP देखे जाते हैं। जांच डॉक्टर की निगरानी में होनी चाहिए, और कमरे में defibrillator और आपात दवाएं रहनी चाहिए। ठीक से चुने गए मरीज़ों में गंभीर दिक्कत का जोखिम कम है।

TMT report कैसे पढ़ें?

Negative report. पूरी मेहनत तक ECG में खून की कमी वाले बदलाव नहीं आए। इसका भरोसा तभी है जब आप लक्ष्य वाली धड़कन तक पहुंचे हों। अगर बीच में थककर रुक गए, तो report पर submaximal या inconclusive लिखा हो सकता है, और उसे negative मानना ठीक नहीं।

Positive report. मेहनत के दौरान या बाद में ST segment कम से कम 1 mm नीचे गया, और यह गिरावट सपाट या नीचे की ओर झुकी हुई थी। बदलाव जितनी जल्दी आए और recovery में जितनी देर टिके, रुकावट की आशंका उतनी ज़्यादा होती है।

कई reports पर Duke treadmill score भी लिखा होता है, जो चलने के मिनट, ST की गिरावट और सीने के दर्द को मिलाकर बनता है। Mark और साथियों की 1991 की स्टडी में 613 मरीज़ों में से करीब दो-तिहाई का score कम जोखिम वाला (+5 या ज़्यादा) था, और चार साल बाद उनमें से 99% जीवित थे। ऊंचे जोखिम वाला score (-10 से कम) 4% मरीज़ों का था, और उनमें यह आंकड़ा 79% रहा।

अब सबसे अहम बात: TMT गलत भी हो सकता है। Gianrossi और साथियों ने 147 स्टडी के 24,074 मरीज़ों का विश्लेषण किया। रुकावट वाले मरीज़ों में से औसतन 68% में ही TMT positive आया, यानी लगभग तीन में से एक में रुकावट छूट गई। बिना रुकावट वाले लोगों में से 77% का TMT negative आया, यानी करीब चार में से एक को झूठा positive मिला।

महिलाओं में यह गड़बड़ी और ज़्यादा है। Kwok और साथियों के विश्लेषण में महिलाओं में TMT 61% रुकावटें पकड़ पाया, और बिना रुकावट वाली 30% महिलाओं का report positive आया। उसी विश्लेषण में exercise echo दोनों पैमानों पर बेहतर रहा। इसलिए सीने के दर्द वाली महिला मरीज़ों में मैं अक्सर stress echo या CT coronary angiography को पहले रखता हूं। महिलाओं में heart attack के लक्षण भी अलग हो सकते हैं।

Positive TMT के बाद आगे क्या होता है?

हर positive TMT का मतलब angiography नहीं है, और हर positive मरीज़ को मैं सीधे cath lab नहीं भेजता। आगे का कदम तीन बातों पर निर्भर करता है: आपके लक्षण कैसे हैं, TMT कितनी जल्दी और कितना positive हुआ, और आपका कुल जोखिम कितना है।

• हल्का या देर से positive, लक्षण कम. अक्सर stress echo या CT coronary angiography से पुष्टि की जाती है।
• जल्दी और साफ़ positive, या मेहनत पर सीने में दर्द. सीधे coronary angiography पर विचार होता है।
• Positive के साथ BP गिरना या लय बिगड़ना. इसे गंभीर संकेत माना जाता है और जांच जल्दी आगे बढ़ती है।

Negative report के बाद भी अगर मेहनत पर सीने में दर्द या सांस फूलना बना रहे, तो जांच वहीं न रोकें। मैं ऐसे मरीज़ की बात को report से ज़्यादा वज़न देता हूं। कुछ लोगों में heart की बीमारी बिना साफ़ दर्द के भी बढ़ती है, जिसे silent heart attack में समझाया गया है।

TMT, echo और angiography में फ़र्क

कौन-सी जांच किस स्थिति में पहले की जाती है, इसकी पूरी तुलना हमारी heart की जांचों वाली गाइड में है। TMT सस्ती, आसानी से मिलने वाली और बिना सुई वाली जांच है, पर रुकावट पकड़ने में यह imaging वाली जांचों से कमज़ोर है। इसकी असली ताकत यह बताने में है कि मेहनत पर आपका heart कैसा बर्ताव करता है।

Jaipur में TMT test का खर्च

TMT का खर्च सेंटर के हिसाब से अलग होता है। कीमत इस पर भी निर्भर करती है कि साथ में cardiologist से मुलाकात और report पर सलाह शामिल है या नहीं।

अगर आपको TMT करवाने की सलाह मिली है, या आपके हाथ में positive report है और आगे का रास्ता साफ़ नहीं, तो आप Jaipur में Dr. Prem Ratan Degawat से सलाह ले सकते हैं। मौजूदा दर और समय के लिए +91-8960594076 पर संपर्क करें। अपनी पुरानी ECG, echo और TMT reports साथ लाएं।

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

Book a consultation

अक्सर पूछे जाने वाले सवाल

TMT test में कितना समय लगता है?

Treadmill पर चलने का हिस्सा आमतौर पर आठ से बारह मिनट का रखा जाता है। इससे पहले electrodes लगाने और आराम की ECG में कुछ समय लगता है, और बाद में कुछ मिनट recovery की निगरानी होती है। पूरी जांच में कितना समय लगेगा, यह सेंटर से पहले पूछ लें।

क्या TMT test खाली पेट करना होता है?

पूरी तरह भूखे रहने की ज़रूरत नहीं है। जांच से दो-तीन घंटे पहले भारी खाना न खाएं, उससे पहले हल्का खाना ले सकते हैं और पानी पीते रहें। चाय, कॉफ़ी, शराब और तंबाकू से बचें। अपनी दवाएं डॉक्टर से पूछे बिना बंद न करें, खासकर BP और heart की दवाएं।

TMT positive आने का मतलब क्या heart में blockage है?

ज़रूरी नहीं। TMT positive का मतलब है कि मेहनत पर ECG में खून की कमी के संकेत दिखे। 147 स्टडी के एक बड़े विश्लेषण में बिना रुकावट वाले लगभग चार में से एक व्यक्ति का TMT positive आया। इसलिए positive report के बाद cardiologist आमतौर पर stress echo, CT coronary angiography या angiography से पुष्टि करते हैं।

TMT negative आने का मतलब क्या heart बिल्कुल ठीक है?

हमेशा नहीं। Negative TMT से उस समय गंभीर रुकावट की संभावना कम हो जाती है, खासकर जब आप पूरी मेहनत तक पहुंचे हों। फिर भी यह लगभग तीन में से एक रुकावट को पकड़ नहीं पाता। अगर मेहनत पर सीने में दर्द या सांस फूलना जारी है, तो cardiologist को ज़रूर दिखाएं।

क्या महिलाओं में TMT भरोसेमंद है?

महिलाओं में TMT का झूठा positive आना ज़्यादा आम है। एक बड़े विश्लेषण में बिना रुकावट वाली करीब 30% महिलाओं का report positive आया। उसी विश्लेषण में exercise echo ज़्यादा सटीक रहा। इसलिए सीने के दर्द वाली महिलाओं में stress echo या CT coronary angiography अक्सर बेहतर विकल्प होते हैं। फैसला लक्षण और जोखिम पर निर्भर करता है।

The post TMT Test क्या होता है: Treadmill पर Heart की जांच, Positive और Negative Report का मतलब appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Oct 8, 2026 · View LinkedIn profile

Aortic valve sclerosis means the aortic valve has thickened or picked up some calcium, but it still opens well and blood flows through it normally. It is not aortic stenosis, and it does not need a valve procedure. It does deserve attention, for two reasons: a small share of sclerotic valves narrow over the years, and sclerosis is linked with a higher risk of heart attack and stroke.

If your echo report says “aortic valve sclerosis”, “sclerosed aortic valve” or “AV thickened, opening normal”, this article explains what it means and what to do next.

What does aortic valve sclerosis actually mean?

The aortic valve sits between the heart’s main pumping chamber and the aorta, the large artery to the body. Its three thin flaps, called leaflets, open with each heartbeat and close to stop blood flowing back.

With age, these leaflets can thicken. Small deposits of calcium settle on them. On an echo, they look brighter and thicker than a young person’s valve. That is sclerosis.

The key word is “still”. The leaflets are thicker, but they still swing open fully. The echo measures how fast blood moves through the valve, and in sclerosis that speed stays close to normal. Nothing is blocked.

It is very common. In the Cardiovascular Health Study, which followed older Americans for years, Otto and colleagues found sclerosis in 29% of 5,621 people aged 65 or above. A 2014 review of 22 studies by Coffey and colleagues found it in 9% of people in a study with an average age of 54, rising to 42% in a study with an average age of 81.

How is it different from aortic stenosis?

Aortic stenosis is the next stage. The leaflets become stiff enough that they no longer open fully. Blood has to squeeze through a smaller opening, so it speeds up, and the heart has to push harder.

The echo draws the line using that speed, the pressure difference across the valve and the area of the opening. When those numbers move out of the normal range, the report changes from “sclerosis” to “mild aortic stenosis”. Our Hindi guide to reading an echo report for aortic stenosis lists the exact cut-off for each grade.

Sclerosis is the early, silent stage of the same disease. Not everyone moves on from it, and those who do usually take years.

Is aortic valve sclerosis dangerous?

On its own, no. The valve is working, and sclerosis does not cause breathlessness, chest pain or fainting. If you have those symptoms, the cause lies elsewhere and still needs finding.

The concern is what sclerosis signals. There are two separate risks.

Risk 1: it can progress to stenosis

Most sclerotic valves never become a problem. Some do. The Coffey review found that 1.8% to 1.9% of people with sclerosis developed aortic stenosis each year.

In a study by Cosmi and colleagues of 2,131 patients with a thickened valve, 15.9% developed aortic stenosis. Severe stenosis developed in 2.5%.

Those numbers cut both ways. A small yearly rate is reassuring. Over 10 or 15 years it adds up, so one reassuring echo at 65 is not the end of the story.

Risk 2: it is a marker of heart and artery disease

In the Otto study, people with sclerosis had about a 50% higher risk of dying from heart disease and of having a heart attack over five years than people with normal valves. That held even after allowing for age and sex, and again after allowing for other risk factors.

The Coffey review found the same pattern: a 68% higher risk of coronary events, 27% higher risk of stroke and 69% higher risk of death from heart disease.

Why would a working valve carry that risk? The calcium on the valve builds up through a process much like plaque in the arteries. The valve is not causing heart attacks. It is a visible sign that the same process may be at work in the coronary arteries.

What raises the chance of progression?

In the Cardiovascular Health Study, Stewart and colleagues found that the factors linked with sclerosis look a lot like coronary risk factors:

• Age, with roughly double the risk for every 10 years
• Male sex, about twice the risk
• Current smoking, about 35% higher risk
• High blood pressure, about 20% higher risk
• High LDL cholesterol and high lipoprotein(a), a genetic form of cholesterol

Lipoprotein(a) is inherited and is not part of a routine lipid profile. Our guide to the lipoprotein(a) test explains who should have it checked.

The Cosmi study added one echo finding: calcium in the ring of the mitral valve (mitral annular calcification) was the only factor that independently predicted progression to stenosis in that group.

Two other causes of a “thickened” valve matter in India. A valve with two leaflets instead of three, a bicuspid aortic valve, tends to thicken and narrow 10 to 20 years earlier than a normal one. Old rheumatic fever can also thicken the aortic valve, usually alongside changes in the mitral valve. In Rajasthan I still see both. When a report mentions sclerosis in someone under 50, I check whether the valve has two leaflets or three, and whether there are rheumatic changes.

What should you do if your echo shows aortic sclerosis?

No medicine is needed for the valve itself. Look after the rest of your heart, and keep an eye on the valve.

Treat the risk factors that matter for your arteries. Keep blood pressure in the range your doctor sets. Stop smoking completely. Control diabetes. Get your cholesterol checked. I do not prescribe a statin for the valve, but I do prescribe one when the overall heart risk calls for it.

Get a repeat echo. There is no single guideline interval for sclerosis alone. When the valve is otherwise fine and the person has no symptoms, I usually repeat the echo after about two to three years. I bring it forward if the doctor hears a new or louder murmur, or if the valve has two leaflets.

Know the symptoms that should bring the visit forward. Do not wait for the scheduled echo if you notice:

• Breathlessness on walking or climbing stairs that is new or getting worse
• Chest tightness or heaviness during effort
• Dizziness, light-headedness or fainting during or just after effort

I do not ask patients with sclerosis alone to cut back on walking or exercise. The valve is not narrowed, so there is no reason to restrict yourself.

When I see a patient with sclerosis in the OPD, the valve is usually the shortest part of the conversation. I listen for the murmur and look at the echo for the leaflets and the mitral ring. Then I spend most of the time on blood pressure, cholesterol, sugar, smoking. That is where the real risk sits.

What does not work?

Nothing reverses calcium on a heart valve. No diet, supplement or ayurvedic preparation has been shown to dissolve it. Be wary of anyone who promises otherwise.

Statins are the obvious question, and they have been tested. In the SALTIRE trial, 155 patients with calcific aortic stenosis took high-dose atorvastatin or a placebo. LDL cholesterol fell by more than half on the statin, yet the valve narrowed at the same speed in both groups.

The larger SEAS trial gave 1,873 patients with mild or moderate stenosis either simvastatin plus ezetimibe or a placebo. Valve replacement was needed just as often in both groups. But the treated group had fewer heart attack-type events (148 against 187 patients).

That is the honest summary. A statin will not protect your valve. It may protect your arteries, which is the reason to take one when your doctor advises it. These trials were in stenosis, not sclerosis, and no trial has shown any medicine stops sclerosis from progressing.

When should you see a structural heart specialist?

Sclerosis alone does not need a TAVI specialist. I tell patients this plainly: you will not be offered a valve procedure for sclerosis, and you should not be.

See a structural heart cardiologist if:

• A later echo shows the valve has moved into mild, moderate or severe aortic stenosis
• The valve has two leaflets, or there are rheumatic changes
• You develop any of the symptoms listed above

If stenosis does develop and becomes severe, the treatment options include surgical valve replacement and TAVI, a valve replacement through a tube in the leg artery. Our guide to aortic stenosis symptoms and treatment covers that stage in detail, and the TAVI eligibility guide explains who qualifies. Most people with aortic valve sclerosis will never need either.

To have your echo reports reviewed, you can book a consultation with Dr. Prem Ratan Degawat in Jaipur.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

Book a consultation

FAQs

Is aortic valve sclerosis dangerous?

The sclerosis itself does not harm the heart, because the valve still opens normally. It matters for two reasons. A small share, about 2% a year in pooled studies, progress to aortic stenosis. It is also linked with a higher risk of heart attack and stroke, so your other heart risk factors need attention.

Can aortic valve sclerosis be reversed?

No. Calcium on the valve does not dissolve with diet, supplements or medicines. Statins lower cholesterol but did not slow valve narrowing in the SALTIRE and SEAS trials. What you can change is your overall heart risk, which is where most of the danger linked with sclerosis lies.

Does aortic sclerosis need surgery or TAVI?

No. Surgery and TAVI are for severe aortic stenosis, usually with symptoms. Sclerosis means the valve still opens normally, so there is nothing to replace. If a later echo shows the valve has narrowed to a severe degree, the question of valve replacement comes up then.

How often should I repeat the echo?

There is no fixed guideline interval for sclerosis alone. For a three-leaflet valve with no symptoms, I usually repeat the echo after two to three years. It should be sooner if a new murmur is heard, the valve has two leaflets, or you develop breathlessness, chest tightness or dizziness on effort.

What is the difference between aortic sclerosis and mild aortic stenosis?

In sclerosis the leaflets are thickened but open normally, and blood moves through the valve at near-normal speed. In mild stenosis, the opening has started to narrow and the speed of blood through it has risen above normal. The echo report states which one it is, based on measured numbers.

The post Aortic Valve Sclerosis vs Aortic Stenosis: When a Thickened Valve Becomes a Problem appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Sep 27, 2026 · View LinkedIn profile

There is no fixed upper age limit for TAVI. People in their late 80s and 90s have the procedure when the valve is the main thing holding them back. What decides it is frailty, memory, other illnesses and whether the procedure can realistically give back good years, not the date of birth.

That is also the honest answer to the question families ask most often in clinic: “Is my father too old for this?” Sometimes the answer is no. Sometimes the answer is that the valve is not his biggest problem any more.

Why is age the wrong question?

Two people aged 84 can be completely different patients. One walks to the market every morning and manages her own medicines. Another has been mostly in bed for a year after a stroke. The birth certificate is identical; the likely result of a valve procedure is not.

Guidelines have also moved. The 2025 ESC/EACTS valve guidelines lowered the age from which TAVI is generally recommended over surgery from 75 to 70. That is a lower threshold, not an upper one. Nothing in these guidelines closes the door at 80 or 85.

For the general criteria, our TAVI eligibility guide covers who qualifies. This article is about the older end of that range.

What does frailty actually mean?

Frailty is a loss of physical reserve. A frail person copes with daily life, but a fall, an infection or a hospital stay can tip them into a lasting decline. It is measured, not guessed from how someone looks in a wheelchair at the OPD door.

The largest study on this, the FRAILTY-AVR study by Afilalo and colleagues, followed 1,020 patients with a median age of 82 who had TAVI or surgical valve replacement. Depending on the scale used, between 26% and 68% of them were frail.

A short four-item tool, the Essential Frailty Toolset, predicted outcomes best. It checks:

• Leg strength, by timing how quickly the person can stand up from a chair several times
• Memory and thinking, with a brief bedside test
• Anaemia, from a routine blood count
• Albumin, a blood protein that falls with poor nutrition

Frail patients on this tool had about 3.7 times the odds of dying within a year of the procedure, and higher odds of worsening disability. That does not mean frail patients should never have TAVI. It means frailty has to be part of the conversation, with numbers rather than impressions.

Other checks commonly used alongside it include walking speed over a short distance, recent weight loss, and whether the person needs help with basic daily tasks.

What happens if severe aortic stenosis is left untreated?

Once severe aortic stenosis causes symptoms, it does not stay still. Breathlessness, chest pain on effort and fainting are signs that the heart is struggling to push blood through the narrowed valve.

The clearest evidence comes from the PARTNER trial cohort reported by Leon and colleagues in 2010. It enrolled 358 patients with severe aortic stenosis whom surgeons judged unsuitable for open surgery. At one year, 50.7% of those given standard medical treatment had died, compared with 30.7% of those who had TAVI. Among survivors, 58.0% of the medically treated group still had severe symptoms, against 25.2% after TAVI.

The same trial also recorded more major strokes and vascular complications at 30 days in the TAVI group. Devices and techniques have changed since 2010, but the basic point holds: untreated symptomatic severe aortic stenosis carries a high risk within one to two years. Medicines can ease fluid build-up, but they do not open a narrowed valve.

How is an 80- or 85-year-old assessed?

The valve tests are the same as for any TAVI patient, starting with an echo and a CT scan. Our guide to reading an echo report (in Hindi) explains the numbers. For an older patient, the conversation around those tests matters as much as the tests.

Beyond the valve itself, the assessment looks at five things:

1. Daily function. What the person could do a year ago and what they can do now. A decline caused by the valve may reverse. A decline caused by something else usually will not. 2. Memory. Mild forgetfulness is common. Moderate or advanced dementia changes the likely benefit and the recovery plan. 3. Other illnesses. Kidney function, lung disease, previous stroke, cancer and nutrition. 4. Support at home. Someone needs to help with medicines, meals and follow-up visits for the first few weeks. 5. The patient’s own goals. Some want to walk to the temple again. Some mainly want to breathe comfortably at home. Both are reasonable, and they lead to different decisions.

The question the Heart Team is trying to answer is simple to state: will this procedure add good years, or only add a procedure? When the answer is unclear, a second opinion is a fair request.

What does recovery look like for a fit patient versus a frail one?

The two patients below are hypothetical examples, used only to show the difference.

A fit 84-year-old who walks daily and lives with family is often up and walking within a day. Most go home within a few days. Breathlessness usually improves over the following weeks as the heart works against a normal valve.

A frail 78-year-old with weight loss, low albumin and early memory problems may have a technically perfect procedure and still recover slowly. There is more risk of delirium in hospital, muscle loss and readmission. Some regain function with physiotherapy and nutrition support. Some do not.

Neither outcome is predictable from age. That is why the frailty assessment happens before the decision, not after. If the family is travelling from outside Rajasthan, our guide for outstation families explains how to plan the stay.

When is comfort care the right answer?

Sometimes the valve is severe but the person is near the end of life for other reasons. The 2021 ESC/EACTS guidelines advise against valve intervention in patients with severe other illnesses when it is unlikely to improve quality of life or extend survival beyond a year.

In practice, this includes advanced dementia, bed-bound patients whose immobility has another cause, and advanced cancer. Comfort care is not “doing nothing”. It means medicines to ease breathlessness and fluid build-up, managing pain, and planning care at home with the family.

Saying no to a procedure is a medical decision like any other, and it should be explained just as carefully as saying yes.

A World Heart Day message: do not call it “just old age”

The meta-analysis by Osnabrugge and colleagues pooled data on 9,723 people over 75. About 12.4% had some aortic stenosis and 3.4% had severe aortic stenosis. Among those with severe, symptomatic disease, 40.5% were not treated surgically.

A common story behind a late diagnosis is breathlessness or tiredness that the family put down to age. If a parent over 75 has become breathless on stairs, stopped walking as far, or fainted, ask for an echo. It is a painless test, and the answer changes what is possible.

You can read about others who went through this in our TAVI patient stories. To discuss a parent’s reports, arrange a TAVI consultation with Dr. Prem Ratan Degawat in Jaipur.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

Book a TAVI consultation

FAQs

Is there an upper age limit for TAVI?

No fixed upper age limit exists in the guidelines. People in their late 80s and 90s have TAVI when the valve is the main cause of their symptoms. The decision depends on frailty, memory, other illnesses and the person’s goals. Age alone neither qualifies nor disqualifies someone for the procedure.

Is TAVI safer than open surgery for someone over 80?

For most people over 80 with severe aortic stenosis, TAVI avoids opening the chest and usually means a shorter recovery. It still carries risks, including stroke, bleeding, vascular injury and the need for a pacemaker. The Heart Team weighs these against the risks of surgery for each patient.

How is frailty checked before TAVI?

Frailty is measured rather than judged by appearance. Common checks include timed standing from a chair, walking speed, a brief memory test, blood tests for anaemia and albumin, recent weight loss and independence in daily tasks. Together they help predict how well someone will recover after the procedure.

Can medicines alone treat severe aortic stenosis in an elderly patient?

Medicines can ease breathlessness and fluid build-up, but they cannot open a narrowed valve. In the PARTNER trial, half of patients with severe aortic stenosis treated without valve replacement died within a year. When a procedure is not appropriate, medicines become part of comfort-focused care.

My father has mild memory problems. Can he still have TAVI?

Often, yes. Mild memory problems are common at this age and do not rule out TAVI. The team checks memory before the procedure because confusion after hospital stays is more likely. Moderate or advanced dementia changes the balance of benefit, so it needs an honest family discussion.

The post TAVI at 80, 85 and Beyond: Why Frailty Matters More Than the Number on the Birth Certificate appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Sep 18, 2026 · View LinkedIn profile

Valve-in-valve TAVI can treat a failing surgical tissue aortic valve by placing a new valve inside it, usually through an artery in the groin. It can avoid another open-heart operation in suitable patients. Whether it is right for you depends on why the old valve is failing, its internal size and the surrounding anatomy.

The old operation does not automatically rule you in or out. The first task is to identify exactly which valve you have.

What does it mean when a tissue valve wears out?

A tissue valve, also called a bioprosthetic valve, uses biological leaflets to control blood flow. Over time, those leaflets can become stiff with calcium or develop tears. A stiff valve may not open properly. A torn one may allow blood to leak backwards.

This deterioration is different from a blood clot on the valve or an infection called endocarditis. Leakage around the outside of a valve is another separate problem. The treatment may therefore be different even when two echo reports both say “prosthetic valve dysfunction.”

Prandi and colleagues’ review of valve-in-valve planning stresses identifying the cause before choosing a procedure. A new valve should not be the automatic response to every abnormal scan.

If the terminology is unfamiliar, our explanation of what TAVI involves covers the basic catheter procedure. Here, the extra challenge is fitting it safely inside an existing valve.

Which symptoms need a review?

You may notice breathlessness on a walk that used to be easy, or find that everyday activity leaves you unusually tired. Ankle swelling, chest discomfort or fainting can also need assessment. These symptoms have several possible causes, so they do not prove that the valve has failed.

Bring a change in symptoms to your cardiologist even if your routine echo appointment is months away. Comparing the current scan with earlier scans helps show what has changed.

Severe breathlessness at rest, ongoing chest pain or a collapse needs emergency medical assessment. Fever or chills in someone with a replacement heart valve also deserves prompt medical attention. Do not wait for a routine consultation when you are acutely unwell.

Who may be suitable for valve-in-valve TAVI?

The strongest reason to consider it is a significantly failing tissue aortic valve in someone for whom repeat surgery carries substantial risk. Previous chest surgery can make another operation more complex. Other illnesses and frailty also affect the balance.

But a difficult operation does not automatically make a catheter procedure safe. The new valve still needs room to open, and blood must continue to reach the coronary arteries that supply the heart muscle.

The Heart Team should compare both approaches. This includes an interventional cardiologist and a cardiac surgeon, with imaging specialists contributing to the plan. Our TAVI eligibility guide explains the general assessment; a previous tissue valve adds another layer of anatomical checks.

Surgery may be better if the original valve is too small, coronary obstruction cannot be prevented safely, or another heart problem also needs an operation. Active infection is a particular reason to consider a different treatment pathway. Younger patients need a longer view of future valve procedures as well.

What must the scans and old operation records show?

The label on your valve card is useful, but it is not enough by itself. Three questions deserve clear answers before consent.

How much room is actually inside the old valve?

The team needs the original valve’s model and size, then assesses its usable internal opening. The labelled size is not necessarily the space available for the new valve.

Putting a valve inside a small opening can leave a high pressure gradient, meaning the heart still has to push hard to move blood through it. If the effective opening is too small for your body’s needs, doctors call this prosthesis-patient mismatch. The old valve can be technically treated while the result remains less helpful than hoped.

Could the old leaflets block a coronary artery?

As the new valve expands, it pushes the old leaflets outwards. In some anatomies, these leaflets can obstruct a coronary opening. CT planning examines the coronary positions and the space around the old valve, including where a proposed new valve would sit.

Prandi and colleagues describe why this planning matters. A specialised protective technique may be possible in selected cases, but it does not remove every risk. Some patients are better served by surgery.

Will the result preserve future treatment options?

The team also considers access to the coronary arteries after implantation and what another valve procedure might involve later. This matters especially when life expectancy is long. “We can keep adding valves” is not a sound lifetime plan.

Kidney function and the arteries used to deliver the valve also need assessment. Tell the team about previous contrast reactions and bring existing scan images, not just written reports.

How does it compare with another open operation?

Valve-in-valve TAVI usually avoids reopening the chest and a new breastbone wound. Repeat surgery removes the old prosthesis and may allow the surgeon to address a small opening or other problems at the same operation. Each approach solves a different set of constraints.

A 2022 meta-analysis by Raschpichler and colleagues combined 15 nonrandomised studies involving 8,881 patients. Valve-in-valve was associated with lower short-term mortality and less acute kidney failure. However, severe prosthesis-patient mismatch was more frequent and the remaining pressure gradients were higher. Midterm mortality did not differ significantly.

These were not randomised comparisons. Differences between the patients selected for each treatment could affect the findings. They do not establish that TAVI is safer for every individual.

For broader recovery differences, see our comparison of TAVI and open-heart surgery. Your own decision needs the specific risks of a repeat operation and the CT findings together.

What happens during the procedure and recovery?

The replacement valve is carried on a catheter, most often through a groin artery. Imaging guides it into the old tissue valve, where it is expanded. The old surgical valve remains in place. The team then checks blood flow and looks for leakage or coronary problems.

Avoiding a chest incision does not make this a minor procedure. Risks include bleeding or artery damage, stroke, kidney injury and valve leakage. Some patients need a pacemaker. Coronary obstruction and death are also possible and belong in the consent discussion.

Afterwards, monitoring checks heart rhythm and the groin access site. An echo assesses the new valve. Discharge depends on recovery and any complications, rather than a promised number of nights. Our day-by-day TAVI admission guide explains the hospital routine, although a repeat-valve case may need a different stay.

Leave with a written medicine plan and follow-up dates. Blood-thinning treatment depends on your other conditions as well as the procedure. Do not start, stop or change it yourself. Ongoing valve surveillance and attention to dental health remain part of care.

What should you bring to a Jaipur consultation?

Bring the old operation note and valve card if available. Add your latest echo with images, earlier echo reports for comparison, and a current medicine list. Include records of any bypass operation or coronary stents.

Dr. Degawat’s second-opinion assessment includes an independent review of prior findings. For a failed tissue valve, the discussion should explain the cause of failure, the predicted result with each treatment and the reason for the recommendation.

Valve-in-valve TAVI offers another route for some families facing repeat surgery. The useful next step is an assessment of the existing valve, not a promise based on age or a single report. Arrange a TAVI consultation with Dr. Prem Ratan Degawat in Jaipur to review those options.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is Associate Director of the TAVR & Structural Heart Disease Program and Director of the Mitral & Tricuspid Valve Program at Eternal Hospital, Jaipur. His work includes valve-in-valve and TAVR-in-TAVR procedures.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas, Italy.

• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Hospital for procedures: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Contact: +91-8960594076

Book a valve consultation

FAQs

Can valve-in-valve TAVI treat a mechanical heart valve?

No. Standard aortic valve-in-valve TAVI is intended for a failing tissue valve, not a mechanical valve with rigid moving components. If you are unsure which type you have, check your valve card or operation record. A mechanical valve problem needs its own assessment and treatment plan.

Can it treat a leaking valve as well as a narrowed one?

It can treat selected surgical tissue valves that have narrowed, developed leakage through damaged leaflets, or both. Leakage around the outside of the prosthesis is a different problem. Echo and other imaging must identify the source of the leak before the team can recommend the appropriate treatment.

How long will the new valve last?

There is no guaranteed lifespan for an individual valve-in-valve implant. The original valve’s size and the final blood-flow result matter. Published results for first-time TAVI cannot simply be applied to every repeat procedure. Our valve durability guide gives background, while your team should explain the evidence relevant to your situation.

Can I have another TAVI after a previous TAVI?

Sometimes. This is often called redo TAVI or TAVR-in-TAVR. The existing transcatheter frame and the position of its leaflets make coronary access and obstruction separate planning concerns. Suitability must be checked with imaging; a previous successful TAVI does not guarantee that a second or third one will be feasible.

Is repeat surgery ruled out because I am older?

No. Age is one part of the decision, alongside frailty and other illnesses. A small old valve or unsafe coronary anatomy can make surgery the better choice even in an older person. Ask the Heart Team to explain both options using your scans and your goals for recovery.

The post Valve-in-Valve TAVI: When a Previous Tissue Valve Wears Out appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Sep 10, 2026 · View LinkedIn profile

अगर आपकी echo report में “severe aortic stenosis” लिखा है, तो इसका मतलब है कि heart का aortic valve इतना सिकुड़ चुका है कि उसे बदलने पर विचार शुरू कर देना चाहिए। Report में तीन आंकड़े यह तय करते हैं: mean gradient, aortic valve area और peak velocity। नीचे हर आंकड़े का मतलब, guideline में तय सीमा के साथ दिया गया है।

एक बात साफ़ रहनी चाहिए। Report सिर्फ़ बीमारी की गंभीरता बताती है, इलाज नहीं। इलाज का फ़ैसला आंकड़ों और मरीज़ के लक्षणों, दोनों को देखकर होता है।

ये सीमाएं 2020 ACC/AHA valvular heart disease guideline से ली गई हैं। European guideline में mild की सीमा थोड़ी अलग है, इसलिए अलग-अलग labs की report में किनारे पर हल्का अंतर दिख सकता है। बीच की दोनों श्रेणियों पर दोनों guidelines एकमत हैं।

Echo Report में क्या देखा जाता है

Echo ध्वनि तरंगों पर आधारित जांच है। इसमें न विकिरण होता है और न कोई चीरा लगता है।

यह जांच valve से गुजरने वाले खून की रफ़्तार नापती है। Valve जितना सिकुड़ता है, खून को उतने ही तंग रास्ते से निकलना पड़ता है और रफ़्तार बढ़ जाती है। इसी रफ़्तार के आधार पर report के बाकी आंकड़े निकाले जाते हैं।

इसलिए report में लिखा हर आंकड़ा आखिर में दो ही बातें बताता है। valve कितना कम खुल रहा है, और heart को उसमें से खून भेजने के लिए कितना ज़्यादा ज़ोर लगाना पड़ रहा है।

Report की चार लाइनें जो सबसे अहम हैं

Peak velocity (Vmax). खून की सबसे तेज़ रफ़्तार, m/s में। Valve जितना सिकुड़ेगा, यह उतना बढ़ेगा। 4.0 m/s इसकी severe सीमा है।

Mean gradient. Valve के दोनों तरफ़ दबाव का औसत अंतर, mmHg में। मेरे अनुभव में यह सबसे भरोसेमंद आंकड़ा है, क्योंकि यह पूरी धड़कन का औसत लेता है, सिर्फ़ एक ऊंचे पल का नहीं। 40 mmHg या उससे ऊपर severe माना जाता है।

Aortic valve area यानी valve के खुलने की जगह, cm² में। सामान्य valve 3 से 4 cm² तक खुलता है। 1.0 cm² पर इसे severe माना जाता है, यानी सामान्य का करीब एक-चौथाई।

LVEF यानी ejection fraction बताता है कि heart का पंप करने वाला हिस्सा हर धड़कन में कितना खून बाहर भेज रहा है। 50 से 70 प्रतिशत सामान्य माना जाता है।

जब आंकड़े आपस में मेल न खाएं

यही वह स्थिति है जिसमें सबसे ज़्यादा उलझन होती है, और इसका कोई एक सीधा जवाब नहीं है।

कई बार valve area तो severe सीमा में होता है, लेकिन mean gradient 40 mmHg से नीचे रहता है। दोनों एक साथ कैसे हो सकते हैं?

इसकी वजह यह है कि gradient तभी ऊंचा बनता है जब heart में इतनी ताकत बची हो कि वह खून को पूरे ज़ोर से आगे भेज सके। अगर पंप करने की ताकत कमज़ोर है, या heart का हिस्सा छोटा और सख़्त हो चुका है, तो हर धड़कन में कम खून निकलता है और दबाव का अंतर भी कम बनता है। Valve उतना ही सिकुड़ा रहता है, लेकिन gradient उस गंभीरता को दिखा नहीं पाता।

इसे low-flow low-gradient severe aortic stenosis कहते हैं। इसमें एक और आंकड़ा देखा जाता है, stroke volume index, और 35 mL/m² से कम होने पर बहाव कम माना जाता है। कमज़ोर पंपिंग वाले मामलों में अक्सर dobutamine stress echo करनी पड़ती है, ताकि असली गंभीरता सामने आ सके।

इलाज के लिहाज़ से यह स्थिति अहम है। अगर यहां गंभीरता कम आंकी जाए तो इलाज देर से शुरू होता है। मेरे पास ऐसे मरीज़ आए हैं जिन्हें सालों तक moderate मानकर दोबारा जांच पर टाला जाता रहा।

Report क्या नहीं बताती

Report यह नहीं बताती कि valve बदलवाना चाहिए या नहीं।

Guideline के मुताबिक यह फ़ैसला गंभीरता और लक्षण, दोनों को मिलाकर लिया जाता है। Severe stenosis के साथ अगर चलने पर सांस फूलती है, सीने में भारीपन रहता है, चक्कर आते हैं या बेहोशी हुई है, तो इलाज पर तुरंत विचार होना चाहिए। Severe होने पर भी अगर कोई लक्षण नहीं है, तो कई मरीज़ों को नियमित जांच पर रखा जाता है।

OPD में मैं एक सवाल ज़रूर पूछता हूं। कई बुज़ुर्ग मरीज़ कहते हैं कि उन्हें कोई तकलीफ़ नहीं है, जबकि असल में उन्होंने चलना-फिरना धीरे-धीरे कम कर दिया होता है। सीढ़ी चढ़ना छोड़ देना भी एक लक्षण है, भले ही वह report में कहीं दर्ज न हो। यह सवाल मैं अक्सर मरीज़ से नहीं, उनके परिजनों से पूछता हूं, क्योंकि जवाब ज़्यादा सही मिलता है।

Moderate aortic stenosis वाले मरीज़ों के लिए एक बात ध्यान देने लायक है। ACC/AHA guideline के मुताबिक moderate aortic stenosis आमतौर पर हर साल करीब 0.3 m/s रफ़्तार, 7 mmHg gradient और 0.1 cm² valve area की दर से बढ़ती है। यानी moderate कोई ठहरी हुई स्थिति नहीं, बल्कि आगे बढ़ने वाली बीमारी है। इसीलिए दोबारा जांच की तय तारीख टालनी नहीं चाहिए।

Cardiologist को कब दिखाएं

अगर report में severe लिखा है, तो valve का काम करने वाले cardiologist से एक बार सलाह ज़रूर ले लेनी चाहिए, चाहे लक्षण हों या न हों।

Moderate के साथ अगर लक्षण मौजूद हैं, तब भी दिखा लेना बेहतर है, क्योंकि तब यह तय करना होता है कि तकलीफ़ valve की वजह से है या किसी और कारण से।

और अगर आंकड़े आपस में मेल नहीं खा रहे, जैसा ऊपर बताया गया, तो यह अपने आप में दिखाने की पर्याप्त वजह है। ऐसे मामलों में गंभीरता तय करना ही सबसे बड़ा काम होता है।

Aortic stenosis के लक्षण और इलाज के विकल्प aortic stenosis के इस page पर विस्तार से दिए गए हैं। अगर valve बदलने पर बात चल रही है, तो TAVI क्या होता है पहले पढ़ लें, और TAVI के लिए सही उम्मीदवार कौन है वाला page भी देख लें।

Jaipur में echo कहां कराएं

Echo ज़्यादातर बड़े cardiology सेंटरों में हो जाती है। Valve की बीमारी में फ़र्क़ मशीन से कम और नाप करने वाले के अनुभव से ज़्यादा पड़ता है, खासकर low-flow वाले मामलों में, जहां नापने का तरीका ही नतीजा बदल देता है।

कौन सी जांच कब और क्यों की जाती है, यह valve के इलाज से पहले होने वाली जांचों वाले page पर दिया गया है। वह page बताता है कि जांचें कैसे होती हैं, और यह page बताता है कि उनके आंकड़ों का मतलब क्या है।

Valve की जांच और इलाज Eternal Hospital, Jaipur में हमारे TAVI और structural heart programme के तहत किया जाता है। बाहर से आने वाले मरीज़ अपनी report पहले भेज दें, ताकि पहली मुलाकात ज़्यादा काम की रहे।

दिखाने आते समय पूरी report साथ लाएं, सिर्फ़ आखिरी summary लाइन नहीं। पुरानी echo भी रखें। दो reports के बीच का अंतर अक्सर किसी एक आंकड़े से ज़्यादा बताता है।

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur
• Contact: +91-8960594076

Book an appointment today

अक्सर पूछे जाने वाले सवाल

Mean gradient 45 mmHg का मतलब क्या है?

2020 ACC/AHA guideline के मुताबिक 40 mmHg या उससे ऊपर severe aortic stenosis माना जाता है, इसलिए 45 severe सीमा में आता है। इसका मतलब है कि valve बदलने पर विचार शुरू होना चाहिए। आगे का फ़ैसला आपके लक्षणों और बाकी आंकड़ों पर निर्भर करेगा।

Valve area 0.8 cm² है, क्या यह चिंता की बात है?

1.0 cm² या उससे कम severe माना जाता है, इसलिए 0.8 severe सीमा में है। यह ऐसी स्थिति नहीं कि उसी दिन भागना पड़े, लेकिन इसे टालना ठीक नहीं। valve का काम करने वाले cardiologist से एक बार सलाह ले लें।

क्या severe होने पर तुरंत ऑपरेशन ज़रूरी है?

हमेशा नहीं। अगर गंभीरता के साथ लक्षण भी हैं, तो इलाज जल्दी होना चाहिए। बिना लक्षण वाले कई मरीज़ों को नियमित जांच पर रखा जाता है। यह फ़ैसला cardiologist ही करेंगे।

LVEF कम है, क्या इसका मतलब valve ठीक नहीं होगा?

नहीं। पंप करने की ताकत का कमज़ोर होना अक्सर valve पर पड़े बोझ का ही नतीजा होता है, और valve बदलने के बाद कई मरीज़ों में LVEF सुधर जाती है। कम LVEF इलाज रोकने की वजह नहीं है।

Echo दोबारा कितने समय बाद करानी चाहिए?

यह गंभीरता पर निर्भर करता है। Severe में आमतौर पर छह महीने से एक साल के बीच, moderate में करीब हर साल, और mild में उससे कम बार। सही समय आपके cardiologist तय करेंगे।

Report में “sclerosis” लिखा है, क्या यह stenosis ही है?

नहीं। Aortic sclerosis का मतलब है कि valve मोटा हो चुका है, लेकिन खून के बहाव में रुकावट अभी नहीं आई। यह stenosis से पहले की स्थिति है। इस पर इलाज नहीं, नज़र रखी जाती है।

Sclerosis कितनी बार stenosis में बदलता है और इस दौरान क्या करना चाहिए, यह हमारे लेख Aortic Valve Sclerosis vs Aortic Stenosis (अंग्रेज़ी में) में विस्तार से बताया गया है।

The post Echo Report कैसे पढ़ें: Aortic Stenosis की Grading, Gradient और Valve Area का मतलब appeared first on Dr Prem Ratan Degawat.

Medically reviewed by Dr. Prem Ratan Degawat, MD, DM (Cardiology)

Senior Interventional Cardiologist · Director, Mitral & Tricuspid Valve Therapy · Associate Director, TAVR & Structural Heart Disease Program, Eternal Hospital, Jaipur

Last updated on Sep 5, 2026 · View LinkedIn profile

If you have been told your aortic valve is bicuspid and that this complicates a TAVI, the short answer is that it complicates the planning, not the possibility. Most bicuspid patients who need their valve replaced can have it done through the leg, without opening the chest. The anatomy changes how carefully the valve has to be sized and chosen, and in some patients it still tips the decision toward surgery.

Here is the honest summary before the detail.

What a bicuspid aortic valve actually is

Your aortic valve is the door between the heart and the body. It normally has three leaflets that open and shut with every beat. About one person in every fifty to two hundred is born with only two, which is what bicuspid means. It is the most common condition anyone is born with in the heart, and most people who have it never find out until a scan or a murmur brings it up.

Two leaflets do the same job. They just do it under more strain.

Why a bicuspid valve narrows earlier

A two-leaflet valve opens in a slightly oval shape rather than a clean triangle. The leaflets flex against each other in a way three leaflets do not. Over decades that extra mechanical stress speeds up calcium deposits on the valve.

The practical effect is age. Aortic stenosis in a person with three leaflets usually becomes a problem in the late seventies or eighties. In a bicuspid valve it often arrives ten to twenty years sooner. That is why I see bicuspid patients in their fifties and sixties with severe stenosis, sitting in the clinic looking otherwise fit and healthy, and completely thrown by the diagnosis.

Many of them also have some widening of the aorta just above the valve. That is part of the same condition and it has to be measured, because it sometimes changes the whole plan.

Why bicuspid anatomy used to rule out TAVI

Early TAVI valves were designed around a round opening with three leaflets. Bicuspid anatomy is not round. It is more elliptical, the calcium sits in heavier and more uneven ridges, and there is often a raphe, which is a fused seam where two leaflets joined during development.

That combination caused three problems in the early years. Valves did not always expand evenly. Leaks around the edge of the new valve were more common. And a stiff, heavily calcified ring carried a risk of tearing when the valve was expanded into it.

Those were real concerns, and bicuspid patients were excluded from the trials that first proved TAVI works. Being excluded from a trial is not the same as being harmed by a treatment, but it left a gap in the evidence that took years to fill.

Three things changed. Imaging got better, so the anatomy can now be measured precisely before anyone touches the patient. Newer valve designs seal better against an irregular ring. And operators built up enough bicuspid volume to learn how these cases behave.

What the evidence actually shows now

This is where I want to be careful, because the honest answer has two halves and most pages only give you the first one.

The reassuring half comes from the STS/ACC TVT Registry analysis published by Makkar and colleagues in JAMA in 2021. It matched 3,168 pairs of low surgical risk patients, bicuspid against three-leaflet, all treated with the same balloon-expandable valve. Death at 30 days was 0.9% in the bicuspid group and 0.8% in the other. There was no significant difference in death or stroke at 30 days or at one year, and no difference in how well the valves worked afterwards.

The cautionary half comes from NOTION-2, which randomly assigned 370 younger low-risk patients to TAVI or surgery and followed them for three years. Across the whole trial the results were close. In the patients with three leaflets they were almost identical, 14.5% against 14.4% for the combined outcome of death, stroke or hospitalisation. But in the bicuspid patients the numbers separated: 20.4% after TAVI against 7.8% after surgery. The confidence interval was wide and the difference did not reach statistical significance, so this is a signal rather than a verdict. It is still a signal I take seriously in a 62-year-old.

So the fair summary is that bicuspid anatomy is not a barrier in older patients with suitable anatomy, and remains a genuine open question in younger ones.

How I plan a bicuspid case

A bicuspid TAVI is won or lost on the CT scan, not in the cath lab. Before I commit, I want four things settled.

I measure the annulus and the level just above it separately. In a three-leaflet valve, sizing off the annulus alone is usually enough. In bicuspid anatomy the narrowest point is often higher, at the level of the fused raphe, and a valve sized only to the annulus can sit too large for the space it actually has to open into.

I map where the calcium sits. Heavy calcium on the raphe, especially in a continuous bar, is the pattern most associated with uneven expansion and leaks. When I see it, I size down rather than up.

I measure the aorta above the valve. If it is dilated beyond the point where it needs treating in its own right, then the valve is no longer the whole problem, and an operation that deals with both may serve the patient better than a procedure that deals with one.

I check the height of the coronary arteries. Bicuspid leaflets are often long, and a displaced leaflet can sit across a coronary opening.

Only when those four line up do I talk to the patient about a date. If they do not, I say so, and I explain why. You can read how this fits the wider assessment on our page on who qualifies for TAVI.

When I still recommend open surgery

There are bicuspid patients I do not offer TAVI to, and I would rather say that plainly than pretend the procedure suits everyone.

If you are in your fifties or early sixties and fit for an operation, I will usually put surgery on the table as the first option, and the NOTION-2 bicuspid numbers are the reason. If the aorta above the valve is significantly enlarged, surgery treats both problems in one sitting. If the anatomy is heavily and asymmetrically calcified in a way that suggests the valve will not seat evenly, the catheter route stops being the gentler route. And if the coronary heights are unfavourable, the risk is not worth it.

None of that is a failure of TAVI. It is the reason a heart team exists.

Recovery and what happens afterwards

For a bicuspid patient who is suitable, recovery looks like any other TAVI. Most people are up the next day and home within two to four days, with no chest wound and no sternum to heal.

The durability question matters more here, because bicuspid patients are younger and will live with the valve longer. In NOTION-2 at three years, moderate or worse deterioration of the valve was 4.5% after TAVI and 5.2% after surgery, so the early durability data are reassuring. Three years is still short for a 60-year-old, and I say that openly. We cover this in more detail on how long a TAVI valve lasts.

Which valve gets used is part of the same conversation, and the trade-offs are set out on our page comparing balloon-expandable and self-expanding valves.

Where to start if this is you

Bring your echo report and, if you have one, your CT angiogram. If you do not have a CT yet, that is the scan that will answer most of the questions above. If you are new to the procedure itself, start with what TAVI involves.

Assessment and treatment for bicuspid aortic stenosis are done at Eternal Hospital, Jaipur, as part of our TAVI and structural heart programme. If you are travelling from outside Rajasthan, send your reports ahead so the first visit is useful.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur
• Contact: +91-8960594076

Book an appointment today

FAQs:

Is TAVI safe if I have a bicuspid aortic valve?

In low surgical risk patients, the 2021 JAMA registry analysis by Makkar and colleagues found 30-day death of 0.9% in bicuspid patients against 0.8% in three-leaflet patients, with no significant difference at one year. Safety depends far more on your specific anatomy than on the number of leaflets.

Am I too young for TAVI if my bicuspid valve is failing at 55?

You are not too young for the procedure, but age changes the balance. In the NOTION-2 trial, younger bicuspid patients did better with surgery over three years. For a fit patient in their fifties, I usually recommend discussing surgery first.

Why was my bicuspid valve only found now?

Most bicuspid valves cause no symptoms for decades. They are commonly found when a murmur is heard, or when an echocardiogram is done for something else. Finding it later is normal and does not mean anything was missed.

Does a bicuspid valve mean my children should be checked?

It runs in families more often than a three-leaflet valve does, so first-degree relatives are usually offered a screening echocardiogram. It is a simple, painless scan.

Will I need my aorta treated as well?

Sometimes. Widening of the aorta above the valve is part of the same condition. If it is large enough to need treatment in its own right, that changes the plan and often favours surgery, because both can be dealt with together.

Can a bicuspid valve be repaired instead of replaced?

Repair is possible in selected younger patients, mostly when the valve is leaking rather than narrowed. Once a valve is heavily calcified and narrowed, replacement is the realistic option.

The post TAVI for a Bicuspid Aortic Valve: What It Means, and Why It Is Not a Reason to Panic appeared first on Dr Prem Ratan Degawat.

Many congenital heart defects can now be closed with a small implant passed through a vein in the leg, with no chest incision and no heart-lung machine. The procedure is called device closure. Most patients walk the next morning and go home within a day or two.

That is the short answer. The longer answer is that not every defect qualifies, and deciding who qualifies is most of the work.

What device closure actually involves

You lie on the cath lab table awake, with sedation and local anaesthesia at the groin. There is no general anaesthesia in most adult cases.

A thin tube goes into the femoral vein at the top of the leg. Under X-ray and echocardiography guidance, that tube is advanced to the heart and across the defect. The device, which is a small mesh implant shaped like two discs joined at the waist, is pushed through the tube and opened on both sides of the opening. The discs sit against the walls and sandwich the defect shut.

Nothing is stitched. Over the following months your own tissue grows over the mesh and it becomes part of the wall.

The whole thing usually takes under an hour. You are awake for it, and you will hear the team talking.

Which defects can be closed with a device and which cannot

This is the part patients most want a straight answer on, so here it is.

ASD. Only the secundum type is suitable. That is the most common variety, sitting in the middle of the wall between the atria. It works because the defect has a border of tissue all around it, called a rim, that the device can grip. Primum and sinus venosus defects sit at the edge of the septum with no usable rim on one side. Those still need surgical repair, and I say so plainly when the echo shows it.

PDA. Most are closable with a duct occluder or a coil. The vessel is a tube, and a plug sits in it well.

VSD. The most selective of the three. Muscular defects in the middle of the septum are the friendliest. Perimembranous defects sit close to the heart’s electrical conduction system, and pressure from a device there can cause heart block that needs a permanent pacemaker. That risk is the reason VSD device closure is offered to fewer patients than ASD closure, and it is the risk I spend the most time explaining.

The 2020 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease recommends closing a secundum ASD when there is right heart enlargement and evidence of a significant shunt, even in patients who feel well. That last part matters, because plenty of adults with a sizeable ASD say they feel fine.

How the decision actually gets made

A defect on a report is not by itself a reason to close anything. Before I commit to a device I want four things answered.

First, is the right side of the heart enlarged. A defect that has been shunting blood for years stretches the right atrium and right ventricle. That enlargement, more than the size of the hole, is what tells me the heart is carrying a load it should not.

Second, what do the rims look like. This needs a transoesophageal echo, where the probe goes down the food pipe and sits directly behind the heart. Surface echo is not enough to size an ASD properly. I have sent patients for a TOE after a normal-looking surface study and found the rim was too thin to hold a device.

Third, what are the lung pressures. If pulmonary pressure has already climbed too high, closing the defect can make a patient worse rather than better. This is the single most important reason not to rush.

Fourth, is there anything else going on. Adults sometimes arrive with an ASD and atrial fibrillation together, or with valve disease alongside. The plan has to account for all of it.

If you want to understand the tests themselves, we have written them up in plain language in our guide to heart tests in Jaipur.

The day of the procedure

You come in the day before or the same morning, depending on the case. Blood work is reviewed. You stop eating from midnight.

In the lab, the groin is numbed. Access is taken, the defect is crossed, and the size is measured. Then the device is opened and, before anything is released, we check the position from several angles and confirm there is no leak around the edges and nothing is pressing on a nearby valve. Only then does the device come off its cable.

You lie flat for a few hours afterwards so the groin site seals. Most patients eat dinner the same evening.

Afterwards

You will be on a blood thinner for a period, usually aspirin, while the surface of the device heals over. The exact duration depends on the device and the defect, and I set it case by case.

You will need an echo before discharge, and again at intervals over the first year. Antibiotic cover before dental work matters for the first six months after implantation.

Most people return to desk work within a week. Heavy lifting waits longer.

What surprises adults most is how much better they feel. Someone who has spent years assuming they were simply unfit often notices within weeks that stairs stopped being an event.

When I do not close a defect

Being honest about this is more useful than a list of successes.

I do not close a small defect that is causing no chamber enlargement and no symptoms. It does not earn the implant.

I do not close when pulmonary pressures are too high, because the defect may be acting as a relief valve at that stage.

I do not close a defect with an inadequate rim just because the family would prefer to avoid surgery. A device that embolises is a far worse day than a planned operation.

And I do not close a perimembranous VSD without a long conversation about the pacemaker risk first.

Device closure sits in the same family of work as the other structural procedures we do in Jaipur, including left atrial appendage closure and paravalvular leak closure, and the same principle applies across all of them. The catheter route is a better route only when the anatomy suits it.

If you are weighing an operation you have already been offered, a second opinion before heart surgery is a reasonable thing to ask for, and no cardiologist should mind you asking.

Where this is done in Jaipur

These procedures are performed at Eternal Hospital, Jaipur, in the same cath lab used for our TAVI and structural heart work. Bring your echo report and any previous records to the first visit. If you are travelling from outside Rajasthan, send the reports ahead so the visit is useful rather than exploratory.

You can read more about the practice on our page for interventional cardiology in Jaipur.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur
• Contact: +91-8960594076

Book an appointment today

FAQs:

Is device closure safer than open heart surgery?

For the right anatomy, it avoids a chest incision, the heart-lung machine and a long recovery. That is a real advantage. But safety depends on suitability, not on the route itself. A defect that is wrong for a device is safer treated surgically.

How long does the device stay in the heart?

Permanently. Within a few months your own tissue grows over the mesh and covers it. It is not removed and does not need replacing.

Will I need a pacemaker afterwards?

For ASD and PDA closure this is uncommon. The concern is mainly with perimembranous VSD closure, where the device sits near the conduction system. I discuss that risk in detail before offering it.

Can an adult have an ASD closed, or is it only for children?

Adults are closed regularly, and many are diagnosed only in adulthood. The 2020 AHA/ACC congenital heart disease guideline supports closing a secundum ASD in adults with right heart enlargement and a significant shunt.

What tests do I need before the procedure?

An ECG and a surface echocardiogram to start. A transoesophageal echo is usually needed to size the defect and assess the rims properly. Some patients also need an assessment of lung pressures.

How soon can I go back to work?

Most people doing desk work return within about a week. Heavy physical work and gym training wait longer, and I set that individually.

Does a small hole always need closing?

No. A small defect causing no chamber enlargement and no symptoms is often watched rather than closed. Treatment should follow the load on the heart, not the presence of a finding on a report.

The post ASD, VSD and PDA Device Closure in Jaipur: Treatment Without Open Heart Surgery appeared first on Dr Prem Ratan Degawat.

If you are reading this from Rohtak or Ludhiana or south Delhi, you have probably already been told your parent needs an aortic valve replaced, and someone has suggested Jaipur. The practical questions come next. How long will we be away from home. What do we send before we travel. Where does the attendant sleep. What does the whole thing cost once travel is counted. And the question nobody asks out loud: is this trip even a good idea.

This page answers those in order. It is written for families coming to Eternal Hospital in Jagatpura, Jaipur, Rajasthan, from outside the state, and it includes an honest section on when you should stay home and have the procedure done locally instead.

Why families travel to Jaipur for a heart valve at all

Three reasons come up again and again in our outpatient department.

The first is volume. Structural heart work is a procedure where practice shows in the results, and the 2020 ACC/AHA valve guideline explicitly recommends that these interventions happen at centres that do enough of them and report their outcomes. Dr. Degawat has done over 600 TAVI procedures, including bicuspid valves, valve-in-valve cases and TAVR inside a previous TAVR. Those are the cases that get turned away elsewhere.

The second is the Heart Team. The same guideline asks for a joint decision between an interventional cardiologist, a cardiac surgeon and an imaging specialist rather than one doctor deciding alone. That structure exists at Eternal and it is why some patients who arrive expecting TAVI leave with a recommendation for surgery, or for waiting.

The third is cost. A TAVI in Jaipur generally lands below what the same valve and the same procedure cost in a Delhi or Mumbai corporate hospital. For a family paying out of pocket, the difference is usually larger than the entire travel budget.

Send the reports before you send the patient

This is the single most useful thing in this article, so it goes early.

Do not put an eighty-year-old in a car for six hours to find out whether the procedure is even possible. Send the reports first and get an opinion on them. Almost every case we accept from outside Rajasthan starts that way.

What to send, as clear photographs or PDFs:

• The echocardiogram report, with the images on a CD or drive if you have them
• The CT angiogram if one has been done, images included, not just the printed summary
• Any coronary angiography report
• Recent blood work, including kidney function
• The ECG
• A list of current medicines, photographed as the actual strips
• A one-page summary of what other doctors have already advised, and what they said no to

The images matter more than the reports. A radiologist’s summary tells us the valve is severely narrowed. The actual CT images tell us the annulus measurement, the calcium pattern and whether the femoral arteries will take the delivery system, which is what decides whether the trip is worth making. Our page on getting a second opinion on heart surgery covers what a good second opinion should give you back.

You should get one of three answers: come for assessment, this needs surgery rather than TAVI, or this can be managed where you are.

What the first visit covers

Assume the first trip is an outpatient visit, not an admission. OPD runs Monday to Saturday, 10:00 AM to 4:00 PM.

The consultation reviews everything you sent, examines the patient, and usually repeats the echocardiogram on our own machine, because measurement technique varies between labs and the numbers drive the valve choice. If the CT angiogram has not been done, or was done without the protocol we need, it gets done here. That is normally the same visit or the next morning.

You leave that visit knowing whether TAVI is being offered, which valve, roughly what it will cost, and when a slot is available.

How long to plan for

For most outstation families the honest answer is seven to ten days in Jaipur, and it splits like this.

One to two days for the consultation and any repeat imaging. A gap of a few days while the Heart Team reviews and the slot is confirmed, though this can be compressed if you have travelled far. Then three to four days for the admission itself, which is the standard TAVI stay. The PARTNER 3 trial reported a median hospital stay of three days after TAVI, and our numbers sit in the same band. Then a day or two before travelling home, because we like to see the patient once after discharge before a long road journey.

Some families split it into two trips instead: come for the assessment, go home, come back for the procedure. That works well if you are within a day’s drive, from Delhi or Haryana say. It works badly from Surat, where the travel itself is the tiring part and doing it twice costs more than the extra hotel nights.

We have set out exactly what those admission days involve in our day by day guide to a TAVI admission in Jaipur.

Where attendants stay near Jagatpura

The hospital is in Jagatpura, on the Jagatpura Road near Jawahar Circle, which is the south-eastern side of Jaipur and about 20 to 25 minutes from the airport.

One attendant stays in the patient’s room overnight. Everyone else needs a bed outside. There is a range of guest houses, service apartments and hotels within a short auto ride of the hospital, across a wide price range, and the hospital’s front desk keeps a list. Book for a longer stay than you think you need and extend rather than shorten, because moving hotels mid-admission with an exhausted family is miserable.

Practical points families tell us afterwards they wish they had known: keep one person free of hospital duty to handle billing and paperwork, carry cash for small things even though the hospital takes cards, and expect Jaipur to be considerably hotter than Punjab from April to September.

What to budget beyond the procedure

TAVI itself runs in the ₹15 to ₹30 lakh band at private centres in India, and the valve is most of that figure. On top of it, an outstation family should budget for travel for two to four people, seven to ten nights of accommodation for the attendants, local transport, food, and the pre-procedure imaging if it is repeated here.

That travel and stay total is real money, but it is normally a small fraction of the valve cost, and it is often less than the price difference between Jaipur and a metro corporate hospital. Work out both totals before deciding on geography alone.

If you are covered by a scheme or a private policy, start the paperwork before you travel, not after you arrive. Pre-authorisation takes time and it is far easier to chase from home.

When you should not travel

No competitor page in this space has this section, and it is the most important one here.

Do not travel if the patient is in decompensated heart failure right now, breathless at rest or unable to lie flat. That patient needs stabilising at the nearest hospital first. A six-hour car journey in that state is dangerous and we will not accept the case until it is controlled.

Do not travel on the strength of an echo alone if the patient is frail enough that the journey itself is a risk. Send the reports, and let us tell you whether it is worth it.

Do not travel if a competent centre near you already offers the same procedure and the same valve, and the Heart Team there has agreed the plan. Distance adds nothing on its own. There is no benefit to a Jaipur postcode if the case is straightforward and the local team does enough of them.

And do not travel if the real problem is that you did not like the answer you were given. If three cardiologists have advised surgery rather than TAVI, a fourth opinion is unlikely to change the anatomy. Get the reasoning explained properly instead.

Where travel does make sense is the opposite situation: a patient turned down as too high-risk for open surgery, a complex valve, a previous valve that has failed, or a case where nobody nearby offers the procedure. Several of those stories are collected in our TAVI patient stories from north India.

Coming from your state

If you want the detail specific to where you are travelling from, we keep separate pages for TAVI and TAVR patients from Delhi, from Haryana, from Punjab and from Surat and Gujarat. The practice details and consultation options are on our TAVI and TAVR page for Jaipur and Rajasthan.

To start with a report review rather than a journey, send the documents on +91-8960594076 and ask for an opinion before you book anything.

About Dr. Prem Ratan Degawat

Dr. Prem Ratan Degawat is a senior interventional cardiologist in Jaipur who specialises in structural heart disease. He is Associate Director of the TAVR and Structural Heart Disease Program at Eternal Hospital and has performed more than 600 TAVI procedures, including bicuspid, valve-in-valve, and TAVR-in-TAVR cases.

He completed his DM in Cardiology at King George’s Medical University, Lucknow, and trained in advanced structural heart intervention at IRCCS Humanitas in Italy. He is among a small number of cardiologists in India certified in TAVI, MitraClip, TRI-Clip, and TMVR procedures.

Dr. Degawat is known for explaining conditions and options in plain language, so patients and families can decide with confidence.

Consultation details:

• Hospital: Eternal Hospital, 3A Jagatpura Road, Near Jawahar Circle, Jaipur 302017
• OPD: Monday to Saturday, 10:00 AM to 4:00 PM
• Clinic: 6/384, In front of Railway Headquarter, Sector 6, Malviya Nagar, Jaipur, Rajasthan 302017
• Contact: +91-8960594076

Book an appointment today

FAQs:

Can I get an opinion before travelling to Jaipur?

Yes, and you should. Send the echocardiogram, CT angiogram images, angiography report, recent bloods, ECG and a medicine list on WhatsApp to +91-8960594076. You will be told whether to come for assessment, whether surgery suits better, or whether this can be managed near you.

How many days should an outstation family plan for in Jaipur?

Seven to ten days covers most cases. That is one to two days for consultation and imaging, a short wait for the Heart Team review and slot, three to four days for the admission itself, and a day or two after discharge before a long journey home.

Where do attendants stay during a TAVI admission?

One attendant stays in the patient’s room overnight. Others use guest houses, service apartments or hotels near Jagatpura, a short auto ride from the hospital, across a wide price range. The front desk keeps a list. Book longer than you expect and extend rather than move hotels mid-admission.

Is TAVI cheaper in Jaipur than in Delhi or Mumbai?

Usually yes. TAVI runs about ₹15 to ₹30 lakh at private centres in India, and Jaipur generally sits below metro corporate hospital pricing for the same valve. For most outstation families the saving is larger than the entire travel and accommodation budget, though you should compare both totals.

When should we not travel for TAVI?

Do not travel if the patient is breathless at rest or in decompensated heart failure, as that needs stabilising locally first. Do not travel if a nearby centre already offers the same procedure with an agreed Heart Team plan. Distance adds nothing on its own.

Do we need to repeat tests done in our home city?

Often the echocardiogram is repeated here, because measurement technique varies between labs and the numbers decide the valve size. A CT angiogram is repeated only if it was not done to the protocol needed for annulus measurement. Bring images, not just printed reports.

Can the whole thing be done in one trip?

Yes, and most outstation families prefer that. Splitting into an assessment trip and a procedure trip works well within a day’s drive, from Delhi or Haryana. From Gujarat, the second journey usually costs more in money and fatigue than the extra nights in Jaipur.

What should we arrange before leaving home?

Start insurance or scheme pre-authorisation before travelling, since it is easier to chase from home. Collect all reports and imaging discs in one folder. Photograph the actual medicine strips. Decide who handles billing, and keep that person off overnight hospital duty.

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