Meet Dr. Gagan Singh, new Heart to Heart medical volunteer

We recently had the great pleasure of speaking with Dr. Gagan Singh of UC Davis Medical Center, where he directs the Structural Heart Program and Clinical Cardiovascular Research Unit. Below are highlights of our conversation on innovations in interventional cardiology.

What appeals to you about Heart to Heart’s approach to expanding access to timely cardiac care around the world?

Let’s say I can take care of 100,000 patients in my career; going out and teaching exponentially increases the number of patients we can collectively impact in our lifetime.

What led you to accept Heart to Heart’s invitation to lead a mission that will focus on teaching and training our Costa Rican colleagues to treat mitral regurgitation in the cath lab?

I like the idea of going to a center where the local team wants to learn this particular procedure process, with all its nuances, including the imaging component, in order to obtain a successful outcome. And I appreciate the collaboration’s potential, developing this program in a country where it can expand to reach—realistically—hundreds of thousands more patients throughout the career of the local team.

Can you describe mitral regurgitation for us in laymen’s terms?

We say that the mitral valve is leaky when its two leaflets—think of them as tiny flaps—don’t come together the way they should to form a seal. The leaking is a problem, because it allows oxygenated blood back into the lungs—so the blood is regurgitated—rather than proceeding through the heart.

Traditionally, a cardiac surgeon treats these patients by opening the chest, putting the patient on a heart-lung machine, and performing a repair to recreate valve competence by establishing contact between anterior and posterior leaflets.

That was a terrific explanation. What recent developments in interventional cardiology are particularly exciting to you? 

The pace of innovation is exponential right now. Think of the heart like a house: it has plumbing and electrical systems, as well as doors and windows that open and close. The coronary anatomy provides the plumbing; the heart’s conduction is the electricity, and the doors and windows—which is to say the valves with their leaflets—promote one-way continuous flow throughout the heart and out of the heart.

For a long time, interventional cardiology was focused on the plumbing, to treat coronary artery disease. Now, we are increasingly able to make valve repairs via cath procedures. Interventionalists are inching closer and closer to being able to do what surgeons do, without opening the patient’s chest. 

Can you give us a layman’s explanation about the MitraClip procedure you will be teaching on the mission and how it works?

The MitraClip is a V-shaped clip. It looks sort of like a wine bottle opener with two arms that flip upside down. This tiny device was designed to grab the mitral valve leaflets and create an effective seal where there wasn’t one before. In the cath lab, an interventional cardiologist like myself can insert a catheter through the femoral vein in the groin and advance the clip above the mitral valve to just below the leaflets. Using x-ray and ultrasound, I can position the clip to grab the two leaflets. When it closes, it establishes contact between the leaflets. This procedure is called a mitral transcatheter edge-to-edge repair (M-TEER).

And what are the benefits for patients? 

Many people—including patients—don’t realize that, in the early stages, heart disease isn’t necessarily symptomatic. But with early diagnosis and intervention, we can prevent the disease from progressing. For later-stage patients whose symptoms limit their daily lives, a procedure like this has almost immediate—and dramatic—benefits.

Now, we can even relieve congestive heart failure with interventional devices, without patients needing to take pills forever to relieve their symptoms.

What does Heart to Heart’s tagline, Measurably expanding access since 1989, represent to you? 

"Measurably" is exactly the right word: more than 10,000 adults and 40,000 children have been treated by teams Heart to Heart trained—and those local teams are still working long after Heart to Heart departs.

I’d like to mention that the journey to access care is fascinating to me—as it’s different for patients in other parts of the world. Many patients with heart disease end up waiting years before they are treated. How patients adapt to that is remarkable. In contrast, in the U.S., patients are typically treated within months, if not weeks, of the discovery of their condition.