His cardiac journey had begun in childhood with a rare and complex congenital heart defect — Tetralogy of Fallot (TOF) with absent pulmonary valve syndrome. At the age of 10, he underwent corrective surgery with implantation of a 17mm mechanical pulmonary valve.
But as the child grew into a 130-kg adult, the 17-mm valve became too small for his circulatory requirements, resulting in severe patient–prosthesis mismatch (PPM) and pulmonary valve obstruction and right ventricle failure. He also developed significant subpulmonary/RVOT narrowing, massively dilated branch pulmonary arteries and severe aortic regurgitation.
The cardiac surgical team at Manipal Hospitals Vijayawada took up the challenging redo operation.
During the complex surgery, the old 17-mm pulmonary mechanical valve was replaced with a 25-mm mechanical valve, along with reconstruction of the RVOT and pulmonary artery. On the left side, the challenge was equally important: the aortic root was enlarged to accommodate a 25-mm mechanical aortic valve, deliberately providing an adequate valve size and avoiding patient–prosthesis mismatch in this young patient. The original draft confirms the 25-mm valve replacements, aortic-root enlargement, pulmonary-artery reconstruction and widening of the narrowed right-sided outflow.
From being unable to perform his routine activities without severe breathlessness to walking toward recovery after one of the most complex redo cardiac procedures, the operation has given this young man not merely larger valves—but a larger chance at life.
The surgery required careful planning and precise execution, as the team had to correct several structural problems in a patient who had already undergone major heart surgery. Financial difficulties had also made accessing treatment challenging for the family. Support through the Chief Minister’s Relief Fund helped them proceed with the necessary surgery.
Following the procedure, the patient made steady progress and is now stable. He has been shifted from the intensive care unit to the general ward and is expected to return home shortly.
Commenting on the case, Dr. Dilip Ratti, Consultant – CTVS, Manipal Hospitals Vijayawada, said, “Redo heart surgery in a young patient with multiple complications requires detailed planning and a coordinated surgical approach. In this case, we had to address damage to two heart valves, abnormal blood flow and narrowing within the heart, while also considering the risks associated with previous surgery and obesity. The patient's steady recovery is encouraging, and we hope this treatment will help him lead a more active and healthier life.”
The successful surgery highlights Manipal Hospitals Vijayawada’s capabilities in managing complex heart conditions that require advanced surgical intervention. The coordinated efforts of the cardiac surgery, anaesthesia and critical care teams played an important role in the patient's recovery. For the young man and his family, the procedure marks an important step towards a better quality of life after years of living with a serious heart condition.
