Contributions in the development of Interventional Cardiology in India
Lal has been at the forefront of cardiac innovations in India, performing several landmark procedures such as the first slow rotational angioplasty, coronary atherectomy, and non-surgical closure of atrial septal defects. His contributions have paved the way of advanced, minimally invasive treatments, significantly improving outcomes for patients with complex cardiovascular conditions. • In November 1989, Lal performed the first case of slow rotational angioplasty in India at Apollo Hospital, Chennai. The procedure was conducted on a 33-year-old patient, who was a general surgeon, with a 100% blocked left anterior descending artery of the heart. The patient had previously been recommended for bypass surgery. As of 2018, the patient continued to do well. • In September 1990, Purshotam Lal performed India's first Coronary Atherectomy (shaving of fatty tissue) at Apollo Hospital, Chennai. The procedure was carried out on a patient from Haridwar who was employed at Bharat Heavy Electricals Limited (BHEL). Coronary Atherectomy is a technique used to remove fatty tissues from blocked arteries, particularly in challenging cases where balloon angioplasty is ineffective. • In June 1991, Purshotam Lal implanted, for the first time in the country, coronary stent, made of tantalum, manufactured by Strecker Company, in a patient at Apollo Hospital, Chennai. The patient, who suffered from unstable angina and acute occlusion of the right coronary artery, had undergone a balloon angioplasty of the RCA. The stent was successfully implanted as a bailout device. • In February 1992, Lal performed India's first athero-abrasion (Rotablator - Diamond Drilling) procedure at Apollo Hospital on a patient from Dhuri, Punjab, who had a critical ostial block of the circumflex artery. The device was used to treat calcified arteries as balloon angioplasty was not effective. • Lal was the first investigator for Inoue balloon mitral valvuloplasty called as PTMC. After working with A. Inoue, the inventor of the balloon at Japan, Lal persuaded both Inoue and the manufacturer, the Toray company to allow the procedure to be done in India, where the large number of patients suffering from Mitral Stenosis & Rheumatic Heart Disease till to this day, unlike the western countries. From 1990 onward, Lal introduced Inoue Balloon in the country & trained many cardiologists to do the procedure. The patient had previously suffered a brain stroke and was unable to afford the expenses associated with a Cath Lab. This was the first PTMC procedure in the country to be performed without a Cath Lab. • In September 1992, Purshotam Lal performed a non-surgical closure of an Atrial Septal Defect (ASD) on a 19-year-old patient. The procedure utilized a device, made of nylon mesh named - MonoDisk, being it the first case of the world using MonoDisk Device. • Lal also credited to perform the world's first transcatheter aortic valve replacement (TAVR) using the CoreValve system. This procedure, done in 12 July 2004, conducted for a patient with severe aortic stenosis who was unfit for open-heart surgery, marked a significant advancement in non-surgical valve replacement techniques. This was first-in-man experience, got published & presented for the first time, internationally. • In October 1990, Purshotam Lal performed India's first supported high-risk angioplasty utilizing cardiopulmonary bypass. This groundbreaking procedure involved managing a patient with severe left ventricular (LV) dysfunction by employing a Biomedica heart-lung machine for oxygenation. A catheter was inserted into the patient's right atrium, with another positioned in the aorta to facilitate the process. Lal presented the first scientific paper on this procedure at the Annual Conference of the Cardiological Society of India in 1991, and it was subsequently published as an abstract in the Indian Heart Journal. • In July 1991, Dr. Purshotam Lal performed India's first non-surgical Left Atriofemoral Bypass Support procedure designed by him. The case involved a 58-year-old patient in cardiogenic shock with a systolic blood pressure of less than 50 mmHg and an ejection fraction of 15%. The patient was deemed unfit for surgery due to the high risk. Lal successfully carried out an aortic valvuloplasty with the support of this innovative bypass technique, demonstrating its utility in high-risk interventions like valvuloplasty and angioplasty for patients in cardiogenic shock. Lal's technique involved withdrawing oxygenated blood from the left atrium using an 18-French catheter, which was then circulated to the aorta through a roller pump. Unlike conventional systems, this approach did not require an oxygenator, making it significantly more affordable for Indian patients. Initially utilizing a custom-made device and roller pump, the procedure laid the groundwork for more advanced and expensive systems like the TandemHeart. He presented the papers on this technique at Annual Conference of Cardiology Society of India, which later got published. • In July 1998, Purshotam Lal achieved a milestone in Indian medical history by performing the India's first non-surgical repair of an abdominal aortic aneurysm involving both iliac arteries. The procedure was conducted on 68-year-old PhD doctor, who also had multiple blocked arteries that were treated prior to addressing the aneurysm. At the time, surgical repair carried a 10% mortality rate, escalating to 50% in emergencies. The innovative two-hour procedure, performed in a cath lab under general anesthesia, involved deploying an endoprosthesis made of nitinol wire mesh folded within an 18 French catheter. Guided through the groin to the aneurysmal sac, the prosthesis expanded upon exposure to blood heat, mimicking the shape of the natural aorta and iliac arteries. This groundbreaking intervention not only eliminated the need for open surgery but also significantly reduced associated risks, marking a turning point in the treatment of abdominal aortic aneurysms in India. • On November 6, 2016, Dr. Purshotam Lal performed the first hybrid procedure combining the use of the Venibri aortic valve, a pre-crimped device from Venus Medtech, for Transcatheter Aortic Valve Replacement (TAVR) and stenting of the main artery (LAD) at Metro Heart Institute, Noida. This was only the second global use of the Venibri valve, following its debut in Argentina, however, use of Venibri Valve & stunting of left main artery in same sitting, happens to be the 1st in human history. The groundbreaking procedure, completed in under 45 minutes, integrated Venibri TAVR with Percutaneous Transluminal Coronary Angioplasty (PTCA) and stenting. This achievement highlighted a significant advancement in minimally invasive cardiac interventions, reinforcing Metro Heart Institute's position as a leader in innovative cardiovascular care. • In 1990, Dr. Purshotam Lal performed India’s first non-surgical closure of a patent ductus arteriosus (PDA) using the modified porstman's technique. The procedure, conducted on a 12-year-old boy from the Maldives at Apollo Hospital, Chennai, involved closing the congenital heart defect by introducing a specialized foam plug through a catheter. This minimally invasive approach provided a cost-effective alternative to surgery for PDA closure in children. • In 1992, Dr. Purshotam Lal performed India’s first non-surgical closure of a patent ductus arteriosus (PDA) using the Russian technique. Conducted on a 28-year-old patient from Andhra Pradesh, the procedure involved using a polyurethane bottle-shaped plug, which was placed at the defect site through a specialized catheter. This minimally invasive approach, completed in just 30 minutes, provided a cost-effective alternative to surgery and marked a significant advancement in interventional cardiology in India. • In 1998, Dr. Purshotam Lal performed India’s first implantation of a 24-carat gold stent at Metro Heart Institute, Noida, on a 45-year-old patient, Mr. Narendar Kumar from Barnala. Completed in under 30 minutes, the procedure successfully opened the blocked artery with excellent results. Gold, being an inert metal, was chosen to minimize foreign body reactions and reduce clot formation. Weighing less than a gram, the gold stent also helped lower the risk of restenosis, marking a significant advancement in interventional cardiology. • In February 1998, Dr. Purshotam Lal performed India's first ultrasound-assisted thrombolysis. The procedure was conducted on a 48-year-old patient who had suffered a heart attack due to a major blockage in the left anterior descending (LAD) artery caused by a blood clot. Utilizing an innovative approach, a probe attached to an ultrasound device was introduced through a guiding catheter to the site of the clot. Ultrasound energy was then delivered for five minutes, breaking the clot into fine particles that subsequently dissolved into the bloodstream. This technique was considered a breakthrough, particularly for patients with conditions like peptic ulcers or stroke, where conventional blood thinners pose a risk of severe bleeding. • In April 1998, Dr. Purshotam Lal performed India’s first Angiogenesis procedure at Metro Heart Institute, Noida. This pioneering technique promotes the formation of new blood vessels in areas of arterial blockage, offering a potential treatment for patients deemed unfit for both bypass surgery and angioplasty—often categorized as "No-option" patients. The procedure involved injecting vascular endothelial growth factor (VEGF), a growth hormone, to stimulate blood vessel growth. In some cases, stem cells extracted from the patient’s bone marrow were also injected to enhance the angiogenesis process. • In February 2001, Dr. Purshotam Lal performed India’s first non-surgical closure of a ventricular septal defect (VSD)resulting from a myocardial infarction (MI) at Metro Heart Institute, Noida (Delhi NCR). The patient, Mrs. Pushpa Devi Batra, a 62-year-old woman from Alwar, Rajasthan, had suffered a severe heart attack. Her condition was further complicated by hypertension-induced renal dysfunction. A coronary angiography revealed a 2 cm hole in her heart, a completely blocked right coronary artery (RCA), and additional blockages in other arteries. Given her critical condition, Dr. Lal opted for a percutaneous device closure, marking the first instance of this technique being used in India for post-MI VSD repair. ==Memberships==