First-Of-Its-Kind Catheter Therapy In North India Shows Promise For PAH Care

In a first-of-its-kind intervention in North India, doctors at Yatharth Super Speciality Hospital, Greater Noida, have successfully performed an advanced catheter-based procedure to treat a young woman suffering from long-standing Pulmonary Arterial Hypertension (PAH), offering renewed hope for the patients battling the debilitating condition.

The procedure, known as Pulmonary Artery Nerve Denervation (PAND), is a modern catheter-based technique aimed at reducing elevated pressure in the pulmonary arteries and has so far been more commonly performed in centres in South India owing to its technical complexity, said Dr. Viresh Mahajan, Chairman, Cardiac Sciences.

The PAH condition is a serious and progressive disorder commonly seen in patients with congenital heart defects (CHD), autoimmune diseases and chronic lung conditions.

“Pulmonary arterial hypertension (PAH) is more common in women than men. If left untreated, it can lead to severe exercise intolerance, right heart failure and even sudden death,” Dr. Mahajan said. “Currently, treatment options are largely limited to medications. This intervention marks a significant step forward.”

Talking about the case, the doctor said the patient, a 24-year-old woman, first presented with persistent symptoms despite years of treatment. Describing the condition, Dr. Mahajan, her struggle began early. “In 2008, during childhood, she underwent heart surgery for an underlying cardiac defect. However, a delay in intervention meant that elevated pressures in the lungs persisted, eventually progressing to PAH.”

For nearly 17 years, she remained on continuous medical treatment and follow-up. While medications helped stabilise her condition, she was never able to regain a sense of normalcy. Simple activities such as brisk walking would leave her breathless, while even minor exertion resulted in fatigue.

Doctors said the chronic nature of the illness also cast a long shadow on her personal life. Uncertainty about the future — particularly concerning marriage and motherhood — remained a constant concern for her family.

“Simple activities like brisk walking would leave her breathless, and even minor exertion caused fatigue,” Dr. Ved Prakash, Director and HoD of CTVS said.

As improvement plateaued despite prolonged medication, the medical team opted for an advanced interventional approach. On February 12, a specialised procedure was performed by a team led by Dr. Mahajan, under the guidance of Dr. S. Guruprasad, an expert in PADN from Chennai. The team also included Dr. Binay Pandey, Dr. Amit Kumar, Dr. Nupoor Goel and Dr. Dinkar.

The three-hour procedure was carried out in the cardiac catheterisation laboratory and did not require open-heart surgery, significantly reducing procedural risks and recovery time.

In PAND, which is a minimally invasive approach, a thin catheter is guided through blood vessels to the pulmonary arteries. Using 3D mapping and radiofrequency energy, doctors selectively target overactive nerves surrounding the arteries, which play a role in maintaining high blood pressure in the lungs.

“As it is not an open surgery, the risk of complications is less than 1%,” Dr. Prakash added. “The goal is to improve the effectiveness of medications and enhance the patient’s functional capacity and quality of life.”

Doctors said the success of the procedure could pave the way for similar treatments in patients with advanced PAH who show limited response to conventional therapy.

CHD include holes in the heart such as atrial septal defect (ASD) and ventricular septal defect (VSD), abnormalities in heart valves, or defects in the large arteries that carry blood to and from the heart. In many cases, these conditions allow oxygen-rich and oxygen-poor blood to mix, placing extra strain on the heart and lungs.

While some CHD are detected soon after birth through screening or early symptoms such as poor weight gain, fatigue or bluish discoloration of the lips and skin, others may remain silent for years. In such cases, patients may not become aware of the condition until adolescence or adulthood when symptoms such as breathlessness, fatigue, palpitations or fainting episodes appear, said Dr. Mahajan.

Light to moderate physical activity, tailored to individual capacity, along with strict adherence to medical therapy, remains crucial in improving long-term outcomes in patients with PAH.