Dr Purshotam Lal is an Indian Interventional cardiologist who has to his credit the pioneering of over 20 interventional cardiology procedures for the first time in India, some of which were the first time in the World.[1][2] Trained in UK, US and Germany, and he has held various faculty positions including Professor, Advisor, etc.
Dr Lal receiving Dr B C Roy National Award by President of India in 2004
He has the unique distinction of pioneering the highest number of procedures in the field of interventional cardiology for the first time in the country, such as Slow Rotational Angioplasty, atherectomy, rot ablation, stenting, heart hole closure (ASD Closure),[3] etc. He has developed his own techniques for aortofemoral bypass support[4] (partial artificial heart) and the opening of tight heart valves using echocardiography without a cath lab. He performed world's first non-surgical aortic valve replacement using Core Valve. He has been invited by countries such as Italy, Germany and China to present the first care of Transcatheter Aortic Valve Implantation (TAVI) using the COREVALVE. Additionally, he introduced Inuoe Balloon Mitral Valvuloplasty in the country and was the first investigator.[5]
Dr Lal Receiving Padma Bhushan by the President of India in 2003Dr. Lal being honoured with the Degree of Doctor of Science (D.Sc.) by Rajasthan University of Health Sciences.Appreciation Letter by Prof. Dr. Adnan KastratiDistinguished Achievement Award of Highest Order for 2006-07
He presented and published scientific papers on all these new techniques for the first time in the country & these were published in Indian Heart Journal. He has been monikered as Father of Interventional Cardiology in India by Prof. Dr. Adnan Kastrati, Chief Physician & Deputy Director, Cardiovascular Disease Clinic, DHM, Germany for introducing all these techniques in the country. He is a highly decorated interventional cardiologist, having received the highest of Padma Awards - Padma Vibhushan,[6] along with Padma Bhushan and the Dr. B. C. Roy Award[7] by the President of India for his contributions in the development of Interventional Cardiology in India. Additionally, he has been honoured with the Distinguished Achievement Award of the Highest Order by the National Forum of Indian Medical Association for performing the largest number of angioplasties/stentings in the country as a single operator.[8]
He was also recognised by Prof Dr Hans (JJRM) Bonnier,[9] one of the first interventional cardiologists in the world, who congratulated him for his skills & achievements for doing the highest number of angioplasties in the country and was impressed with his endeavour to provide affordable healthcare to poor patients without compromising quality of healthcare delivery. He added that, his hospital model should be adopted by other hospitals as well.[10]
Early life and education
Dr Lal was born in 1954, in a small village of Firozpur District, Punjab, India. He got his early education in his village where there was no electricity. He completed his pre-medical education at DAV College, where he was inducted into the Hall of Fame as on of 80 distinguished alumni in the college's 100-years history. He pursued his medical degree from Medical College, Amritsar and was national merit scholarship holder. After finishing his MBBS from Amritsar, he went to United States in 1977 for further studies.
Dr. Lal aimed to share his expertise with his fellow countrymen and spent time at Apollo Hospital, Chennai, where he introduced several cardiology techniques for the first time in India. In 1996, he returned to India as the Coordinator of the Department of Cardiology at Apollo Hospital, Delhi. In 1997, with the mission of providing affordable healthcare to low- and middle-income patients, he established the Metro Heart Institute.
Philosophy
He developed multiple hospitals at the doorsteps of the lover-middle class people, after leading flourishing career at US, with the mission that "no patient should ever be returned for want of money". Dr Lal has been an advocate against the commercialisation of medical services in India, particularly when it negatively impacts access for lower-income individuals, particularly of rural areas. In recognition of his contributions, he was named the "Creator of Affordable Healthcare" by prestigious healthcare magazine Express Healthcare.
Further to achieve his goal of creating medical facilities in the rural areas, he joined Medical Council of India as Board of Governors for two years & developed three-point formula to make specialists to go to villages. Since he lost his father in his 40's due to non-availability of doctors in the village, this always been his goal to find out the ways where the specialists have to spend time in the village.
But so far he has not been successful in this particular mission, probably it requires some changes in government policies.
Professional associations
He is certified by the American Specialty Board, he has been a fellow of American College of Cardiology, Society for Cardiovascular Angiography and Interventions (USA), American College of Medicine, Royal College of Physicians (Canada), Indian College of Cardiology and British Cardiovascular Intervention Society (BCIS). He is also a member of German Centre for Cardiovascular Research. Dr Lal has been honoured with Degree of Doctor of Science (D. Sc.) by Rajasthan University of Health Sciences.
He got involved in the development of various new procedures in the field of interventional cardiology, as an alternative to open heart surgery. He has held the position of assistant clinical professor & attending physician at Michigan State University and Cornell Medical Centre USA, respectively in the Department of Interventional Cardiology. He was also the visiting consultant in UK & Germany where he was involved with advanced interventional cardiology techniques under the guidance of Professor Kaltenbach, including long-wire and slow rotational angioplasty techniques. He has also been appointed as a professor and advisor in the department of interventional cardiology at Rajasthan University of Health Sciences[11] and has served as an honorary professor and member of the National Advisory Board at Jaipur National University Institute for Medical Sciences and Research Centre.
Contributions in the development of Interventional Cardiology in India
Dr 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.[12] 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.[13]
In September 1990, Dr. 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).[14] Coronary Atherectomy is a technique used to remove fatty tissues from blocked arteries, particularly in challenging cases where balloon angioplasty is ineffective.[15]
In June 1991, Dr. 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.[16][17][18][19][20][21]
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.[22][23]
Dr Lal was the first investigator for Inoue balloon mitral valvuloplasty called as PTMC. After working with Dr A Inoue, the inventor of the balloon at Japan, Dr Lal persuaded both Dr Inoue & 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.[24] From 1990 onward, Dr 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.[25][26]
In September 1992, Dr. Purshotam Lal performed a non-surgical closure of an Atrial Septal Defect (ASD) on a 19-year-old patient.[27] The procedure utilized a device, made of nylon mesh named - MonoDisk, being it the first case of the world using MonoDisk Device.[28][29][30][31]
COREVALVE Certificate of FIRST USE
Dr. Lal also credited to perform the world’s first transcatheter aortic valve replacement (TAVR) using the CoreValve system.[32] 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.[33][34][35]
^Coronary Atherectomy – A New Approach for the Treatment of Obstructive Coronary Artery Disease, Indian Heart Journal 1991 (Volume 43, Issue 4, Page 140).
^ Lal et al., "Our Initial Experience with Tantalum Coronary Stent" (Abstract), Indian Heart Journal, 1991; Page 135.
^P. Lal, P. Jain, P.T. Upasani, "Intracoronary Stenting Using Long Stents" (Abstract), Indian Heart Journal, 48:538, 1996
^P. Lal, P.T. Upasani, S.M. Sachdeva, S. Kanwar, "Non-Randomized Comparison of Various Treatment Modalities for Restenosis Following Coronary Angioplasty" (Abstract), International Journal of Cardiovascular Interventions, 4 (Suppl 1): 34, 2001
^P. Lal, P.T. Upasani, A.K. Pandey, S. Kanwar, "Initial Experience with Lunar Starflex (Iridium Oxide-Coated) Coronary Stent for Prevention of Restenosis after Coronary Angioplasty" (Abstract), Indian Heart Journal, 54:598, 2002.
^ P. Lal, Upasani A.K. Pandey, S. Kanwar, "Use of Stenting for In-Stent Restenosis – Is it Justified" (Abstract), Indian Heart Journal, 54:597, 2002.
^ P. Lal, P.T. Upasani, A.K. Pandey, S.C. Manchanda, P. Arora, S. Kanwar, "Efficacy of Drug Eluting Stents in Patients with Diabetes Mellitus," Indian Heart Journal, 55:448, 2003.
^Lal et al., "Directional, Rotational and Extraction Coronary Atherectomy – Initial Experience," Indian Heart Journal, 1992, 44: 14(A)
^ P. Lal, P.T. Upasani, "Role of Rotational Atherectomy in Percutaneous Coronary Interventions," in Cardiology Update 2014, edited by Dr. H.K. Chopra, published by Jaypee Brothers Medical Publishers, 2015.
^Lal P. et al. Monodisk – A new Atrial Septal Defect Occlusion device, one year Followup. Indian Heart Journal; 1993 : 306: 387 (A).
^P Lal, PT Upasani, P Jain : First Clinical Experience with Transcatheter ASD Closure Using Monodisc Device : Immediate and Long -Term Results (abstract) Ind Heart J. 48:476, 1996
^P Lal, PT Upasani: First Clinical Experience with Transcatheter ASD Closure using Monodist Device : Immediate and Long -Term Results (abstract) J. Intern Cardiol, Volume 11, Issue Supplement S5 -S136, 1998.
^P Lal, PT Upasani : Percutaneous Therapy for Secundum ASD and Valvular Pulmonic Stenosis (abstract) J Inter Cardiol Volume 11, Issue Supplement S5 -S136, 1998
^First-In-Man Experience of Percutaneous Aortic Valve Replacement Using Self-Expanding Core Valve Prosthesis – P Lal, PT Upasani, S Kanwar, A Parihar, R Arora, E Grube, JC Laborde : Indian Heart J 63: 3, 241 -244, 2011.
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