 Santosh. He was a big challenge in this period of Corona. He was a young gentleman who was a teacher by profession. But unfortunately the young gentleman had multiple comorbid problems apart with it. Not problem. He developed his diabetes very early. He developed his hypertension very early. He also developed chronic kidney disease because of a congenital kidney problem very early. On top of that he started developing a very badly leaking mitral valve which is happening. I mean going on for almost last 4-5 years since his symptoms were not that severe or he did not take it too seriously until he became very badly symptomatic last couple of months when he went into heart failure. Now when we looked at it they were sent to me through a friend of mine who knew what kind of work we have been doing for last 15-20 years in the mitral valve surgery. I taken the specific appointment of Dr. Devananda and I came on around July 15th. I came here. Before that I went to nearby hospitals. Finally I came. They said the surgery is must. I taken second opinion, third opinion. Finally I decided to come here. So when I had a look at this person his heart is quite significantly enlarged. We say the diastolic dimension is almost 8 cm which is very very dilated heart. Strength of contraction had come down to 30-35% which we consider as very severe dysfunction. When it comes to leakage of the mitral valves and his basic problem was mitral valve was leaking which probably was degenerative on the echo. Now the current treatment which is followed in our country often is valve replacements for it. Now when we go with biological valve so called tissue valves we do not require blood thinners but these tissue valves all have a limited lifespan. They probably may work for at the most 8-12 years after which it is 100% required that we have to redo the operation to change those valves. Also these valves again are not completely resistant to infection. The discussions happened and we advised certainly yes he certainly requires very high risk surgery. Repair probably 80-90% it is possible 5-10% chance that it probably has to be repaired and replaced. That is mainly because here we are dealing with a heart which is quite sick. Whatever we want to do to him should have very short operating period. We cannot have long operating period because that is going to affect his heart muscle. We also had doubt that once we make his valve competent either by repair or replacement. Will he come out bypass easily or will he require some other support to support the heart either temporarily or even for a longer time. Something like an interactive balloon or an ECMO all these things were discussed with him. And we had made an elaborate plan of how we have to go stepwise manner. He underwent surgery luckily he underwent a very good repair. He only required antibiotic balloon support for 3 days. He came around very good. His rejection faction when he is getting discharged on 5th or 6th day was around 30% with absolutely no leak of his own mitral valve which was repaired. Very thankful to Manipal Hospital for giving me back my health and life. Thanks to Dr. Devan sir. He has done very well. They are very happy for him. We also probably know that this strength of the heart probably would come back in next 3-6 months hopefully to normal levels. I am also sure that his creatinine which was raised part of the contribution would have come from the failing heart. Now with the heart recovering his creatinine the kidney function should also become better. And also hope that this repair problem would give him another 15-20 years at least of very comfortable good life.