KATHMANDU: Many types of heart-related problems have started appearing recently. Although various types of treatments are available in Nepal, some people go outside for the same.

In this regard, Khabarhub’s Bina Neupane approached Dr. Anil Bhattarai, a senior cardiologist working at Manmohan Cardiotherapy Center to talk about heart-related problems, treatments available in Nepal, and precautions against heart-related hazards. Excerpts:

What is the status of heart-related problems in Nepal?

20 percent of people in Nepal have the types of heart hazards that need to take medicine for remedy. These include two types of diseases. Such diseases include congenital diseases, heart valve damage, problems with large arteries coming out of the heart, heart muscle, high blood pressure, etc.

How do heart valve problems occur?

There are 4 valves inside the heart. With every beat of the heart, the valves also open and close. The disease can occur in any of these 4 valves.

However, the most common one is the mitral valve and the pulmonary valve. There is one inherent in it. Sometimes the valve is not formed at birth. It might occur due to infection as well. It is called rheumatic heart disease.

It is more common in underdeveloped countries like ours. A germ called streptococcus causes tonsillitis. A valve might go leaky or can also be damaged. Now in Nepal, most of the operations are for valves.

What leads to the need to replace at a young age?

Sometimes a person is born with a valve problem. Some might suffer valve-related problems due to rheumatic heart disease. It can start even in 5 years. So, one should consult the doctor regularly.

What procedure should one go through when one goes to the hospital to replace the valve?

If there is already a diagnosis somewhere, we only go for screening. In it, you see a video X-ray of the heart. Unless we are assured of the tests, we look at all the valves.

We examine to see if the operation is possible. If surgery is possible, the heart should be protected from its valve as much as possible.

People under 40 years of age are ready for surgery after all the examinations. We see if there is a problem in the heart tube. It is so because in people over 40 years of age, this can lead to ischemic heart disease. And after that, all the doctors see the report and the operation is done.

When should one go for the heart valve repair and when to take to its replacement?

It is better if the valve is repaired. One need not even take medicine. It is normal. However, if one has to get the valve changed, that person has to take blood thinner medicines for the rest of his/her life.

One should get the blood tested every month. One has to be watchful to see whether there is a problem of bleeding.

In women of childbearing age, if their valves can be repaired, they can deliver babies easily. The valve can be changed after 10 years.

If a child between 10 and 12 years of age needs to have a valve replaced, it is recommended that they be fitted with a valve of a size that will work until they are older. Because the heart and blood vessels are also small.

Therefore, if a valve of a child of 15 to 20 kg is replaced, the valve will be smaller when the child is above 50 kg and the operation has to be done again. That’s why, if a small child’s valve can be repaired, it will work until it grows up and can be replaced later.

Are there chances of getting problems afterward after repairing valves at a young age?

Valve deterioration is caused by rheumatic heart disease, old age, genetics, etc. So there are many ways to repair it. Even in repair, rheumatic heart disease has a better outcome than hereditary congenital heart disease. Rheumatic heart disease may be followed by relapse.

Is the repair or replacement of the valve within the reach of all Nepalis financially?

Children below 15 years of age and above 75 years of age get this treatment free of charge. The government bears the cost for them. In some cases, if the materials have to be brought from outside the hospital, it costs money.

The government has a rheumatic heart disease program. Apart from that, in the case of a person who comes from outside the valley, they have to arrange the cost of their living and the donating blood.

However, it has been made cheaper in Nepal. The patients who have come to us so far have not been deprived of the treatment because of the lack of money.

What kind of risk can occur later if the person neglects the caring heart valve after replacement?

You should consult your doctor regularly. The patient who has undergone valve replacement has to take more care and caution than the person with valve repair.

People who are taking blood thinners should consult their doctor regularly. Negligence in such cases might result in getting the blood thickened and increasing the chances of death.

What should the person who is preparing for a heart valve replacement operation or has recently gone through such an operation pay attention to?

As you are preparing for the operation, you should first be prepared for what it is. There are also risks in heart surgery.

When we operate 100 people, 3 people may die. So you have to know that very well. If there is a wound in the body, the operation should not be done at that time.

Therefore, do not hide it and if you have taken any medicine, you should first tell the doctor openly. After the surgery, you should have a regular follow-up.

What should one pay attention to avoid any heart problems?

Firstly, one has to know about vulnerability. If the disease is hereditary, precautions can minimize the risks. Technology has made it possible to find out whether the child has a problem during pregnancy.

Even if the child has a lot of tonsils, the heart should be checked. By eating a balanced diet, you can take good care of yourself right from pregnancy. The government has also introduced many medicines now.

You have worked abroad for a long time, what difference did you find abroad and in Nepal?

Technologically, many things have developed in Nepal. All operations went well. We don’t have a heart transplant, it will happen in a few years.

Artificial hearts have not been started in Nepal. This means that people do not live forever with an artificial heart, so it has not come to Nepal.

The research here and the research outside are different. However, other things especially the treatment and the capacity of the doctors are the same here. Technological lapses sometimes might make the task difficult, yet the doctors are capable.