A specialist in coronary angiography and angioplasty, Dr Jamshed J Dalal is a rare triple Doctorate. He did his first coronary angiography in the United Kingdom in 1978. Since then, he has attended to more than 15,000 cardiology cases in the past three decades. He also began the angiography programme in India in 1984 (available in only four hospitals across Mumbai) along with a few fellow cardiologists. He has been involved in the coronary angioplasty programme since the invention of the angioplasty procedure. He has been teaching the procedure to doctors in India and China for the past 20 years. As the Chief Cardiologist at Holy Family Hospital in Bandra, Mumbai, he set up its ICCU unit. In 1987, as the Honorary Cardiologist at Hinduja Hospital, he set up the Cardiac Catheterisation Lab there and started the coronary angiography and angioplasty procedures. He headed the department for eight years and established it as a leading cardiac centre in India. In 1995, he joined the then under-construction Lilavati Hospital and contributed towards setting up the hospital, mainly the Department of Cardiology. Since its inception to his departure from the hospital in 2009, as the Coordinator of the Cardiovascular Division, he guided the specialty to international levels. In 1999, he, along with two colleagues, was instrumental in the establishment of Wockhardt Heart Hospital at Mulund, Mumbai. In 2008, he joined Kokilaben Dhirubhai Hospital as the Director of the Centre for Cardiac Sciences. The man behind the coronary and peripheral vascular and surgical programme, he is in the process of starting the paediatric cardiology and electrophysiology specialties. In an exclusive interview with Future Medicine, Dr Dalal talks about the Indian scenario in adult interventional cardiology
By Prashob K P
What is adult interventional cardiology and what are the treatments available in this field in India?
Adult intervention usually means coronary bypass surgery, or coronary angioplasty, for treatment of coronary artery disease. For electrical disturbances, it would include implantation of pacemakers, intracardiac defibrillators and ablation procedures. In patients with valave disorders, it would include balloon valvotomies and the recently-introduced percutaneous valve replacement.
Tell us about the imaging-based diagnostic techniques and minimally invasive modalities in treatment of cardiovascular diseases.
The imaging techniques would include 2D and 3D echocardiography, CT coronary angiography, cardiac MRI, and nuclear testing with technetium and PET scanning.
What are the challenges in adult interventional cardiology and how advanced is India in this field?
This field is very advanced in India. Bypass surgery and angioplasty, using latest devices and stents, is at par with the best anywhere. Electrophysiology is done less frequently than abroad and certain ablation techniques are not as evolved, though implantion of cardiac resynchronisation therapies and ICD is routine. And percutaneous aortic valve replacement is yet to start.
Isn’t high-priced treatment a disabling factor? How can the costs be brought down?
Yes, it is. However, there is a large population which is able to afford these life-saving treatments. On the other hand, the cost of stents and other devices is also steadily reducing.
Tell us about the techniques and medical procedures undertaken at Kokilaben Dhirubhai Ambani Hospital and the success rate in extending optimal patient care?
All procedures in adult interventional cardiology are done in this hospital, except percutaneous valve replacement. These are done at the hospital with the same risk as the West.
How sound is the research environment for adult interventional cardiology in India? Are we still dependent on foreign diagnostic and technological solutions?
Yes. We are nowhere close to the research done abroad. The research done here is mainly clinical and not true basic research. Somehow, our patients are not willing to participate, saying they do not wish to participate in “experiments”. We should be very thankful to the Westerners for active participation (in research).
Who requires the assistance of interventional cardiology and what’s the best you can offer in terms of longevity?
Patients with blockages in their arteries with angina and patients who develop heart attacks require the assistance of interventional cardiology. Patients with heart attacks, or unstable angina, benefit the most and improve their survival rate.
Is India’s cardiac patient population on the rise? What are the reasons for this and how can we contain the trend?
Yes, it is on the rise. We have bad genetics and this in association with the change in lifestyle, including stress, bad diet, and lack of exercise, and the increase in Diabetes and hypertension cases result in a marked increase in heart disease cases.
Can you suggest a few preventive measures for the common man?
People should bring about lifestyle changes, start exercises, maintain a good diet, reserve time for yoga and meditation, and avoid excess alcohol intake. Also, go for regular medical check-ups for early detection and treatment of Diabetes and hypertension.
How significant is post-operative care for cardiac patients? Is India lacking in this or any related area?
Post-op care has greatly improved in our country and is on par with the best. Good ICUs with intensivists trained in post-op care is vital. Good nursing with specialised nurses and modern monitoring systems have contributed to this improvement. Reducing infection rate is our biggest problem and is being actively targeted.
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