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Heart Valve Replacement Cost in India

What is Valve Replacement?

The heart is made up of tissues and muscles that pump blood. It is divided into a right and left side and has four chambers: 2 lower chambers called ventricles and 2 upper chambers called atria. Valves are present between each chamber of the heart to keep the blood from flowing back into the previous chamber and keep the blood flowing forward throughout the heart.

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    Pulmonary valve: It is located between the pulmonary artery and the right ventricle.

    Tricuspid valve: It is present between the right ventricle and atrium.

    Aortic valve: It is located between the aorta and the left ventricle.

    Mitral valve: It is located between the left ventricle and left atrium.

    When these valves are diseased or damaged and do not function normally, they may need repair or replacement. These conditions can be caused due to conditions like valve regurgitation (leaky valve) and valve stenosis (stiffness). When one or more valves become stiff or narrow, the blood has to be pumped with extra force by the heart. When one or more valves become leaky, the blood leaks back to the previous chamber leading to an inefficient amount of blood in the right direction.

    Earlier traditional open heart surgeries were performed to replace or repair the damaged valves. Now, minimally invasive procedures are done that use artificial valves (human valves donors or made from animal valves).

    Types of Heart Valve Replacement in India And Their Cost

    Depending on the disease and condition, the type of heart valve replacement surgery is chosen.

    Surgical valve repair: $3,061 – $6,123

    Commissurotomy: Repairing tight valves by slightly cutting open the valve leaflets or flaps to loosen them.

    Annuloplasty: Repairing leaky valves by sewing sutures around the valve’s base ring or attaching a ring-like device to support it.

    Valvotomy: Enlarging narrowed valves, sometimes done through a balloon.

    Non-surgical valve repair:

    Percutaneous or balloon valvuloplasty: $3,600 – $4400, used for narrowed or stiffened valves.

    Percutaneous mitral valve repair: $3,371 – $6,307, fixing the mitral valve in high-risk patients using a catheter and a clip.

    Heart valve replacement:

    Mechanical valve replacement: $4,950 – $6,050, durable but may lead to blood clot formation, requiring lifelong anticoagulants.

    Biological valve replacement: Enquire Now

    Transcatheter aortic valve implantation: $25,000 – $42,000, minimally invasive, placing a new aortic valve on top of the damaged one.

    Factors Affecting the Cost of Heart Valve Replacement in India

    Esteemed hospitals: Equipped with modern infrastructure, technology, and specialized intensive care units.

    Exceptional medical professionals: Highly skilled doctors and surgeons discussing procedures, risks, and aftercare with patients.

    Affordable cost: Medical packages covering treatment, medication, post-operative care, and other costs are affordable compared to other countries.

    Type of heart valve disease: Three types – Artesia, regurgitation, and stenosis, depending on the affected valve (mitral, tricuspid, aortic, pulmonary).

    Health and age of the patient: Overall age and health affect treatment costs, with younger, healthier patients tolerating higher doses of medications.

    Pre and post-operative costs: Physical examinations, blood tests, imaging tests, and post-operative 

    care contributes to overall costs.

    Who Should Undergo a Heart Valve Replacement Procedure?

    Congenital defects: Structural defects present at birth, identified before or after birth.

    Aging and age-related valve disease: Valves may harden or weaken with age, causing stiffness and a higher risk of heart murmur.

    Illnesses and conditions: Heart conditions like rheumatic fever, high blood pressure, infective endocarditis, heart failure, and heart attack can damage or scar heart valves.

    Benefits of  Valve Replacement Surgery in India?

    Increased energy: Improved heart valve function results in increased energy for many patients.

    Everyday activities: Patients regain the ability to perform daily tasks more easily.

    Breathing: Efficient pumping of blood improves oxygen delivery, reducing shortness of breath.

    Pain: Relief from heart palpitations, reducing pain and discomfort.

    Anxiety: Reduced stress and anxiety about the heart condition.

    Risks of Heart Valve Replacement Surgery in India

    • Bleeding, damage to blood vessels.
    • Blood clots leading to stroke, heart attack, or lung issues.
    • Infection at the incision area.
    • Pneumonia, breathing problems.
    • Endocarditis or infection at the new valve (common in valve replacement).
    • Arrhythmias or abnormal heart rhythms, requiring a pacemaker.
    • Adverse reactions to anesthesia.
    • Valve failure.

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      Symptoms of Heart Valve Disease

      Shortness of breath, especially with physical activity.

      Palpitations (rapid or slow heart rate).

      Dizziness or weakness.

      Chest discomfort, especially during activity.

      Edema (swelling in the abdomen, ankles, or feet).

      Fatigue.

      How is Heart Valve Replacement Performed?

      Before:

      An IV is inserted into the hand or forearm of the patient.

      Medicines and fluids are administered through the IV.

      Patients wear comfortable and loose clothing, avoiding contact lenses, jewelry, nail polish, eyeglasses, etc.

      If hair is present in the operation area, it may be shaved off.

      For most surgeries, patients receive medications inducing a sleep-like state or general anesthesia.

      Some may be connected to a heart-lung bypass machine to maintain blood flow during surgery.

      During:

      Aortic valve repair: Done through open-heart surgery or minimally invasive procedures, addressing tissue tears, adding support, separating fused cusps, or replacing the valve.

      Minimally invasive aortic valve repair: Uses balloon valvuloplasty for less invasive treatment through small incisions.

      Aortic valve replacement: Involves removing and replacing the aortic valve with mechanical, biological, or other types of valves.

      Recovery after Heart Valve Replacement Surgery in India:

      After:

      • Patients may spend up to a week in the hospital, with a day or more in the intensive care unit.
      • Medications, fluids, and nutrition are given through IV.
      • Tubes may drain urine, blood, and fluid from the chest and heart.
      • Oxygen may be provided.
      • Time in the ICU varies based on the procedure and condition.
      • Breastbone healing takes 6 to 8 weeks, with full recovery in 2-3 months.
      • Heavy lifting and driving should be avoided.

      Success Rate Heart Valve Replacement Surgery in India

      The 5-year success rate of heart valve replacement surgery is about 91% for mitral valve replacement, 94% for aortic valve replacement, 96% for pulmonary valve replacement, and 79% for tricuspid valve replacement. Success depends on factors such as age, overall health, symptom severity, the valve requiring replacement, and surgery risks.

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        fortis-escorts-hospital

        Fortis Escorts Hospital New Delhi

        Number of beds:  310
        ICU Beds:                 158
        Airport Distance: 19 KMs

        About Hospital:

        • It was established in 1988 and is JCI accredited.
        • Fortis Escorts Heart Institute is a premier multi-disciplinary hospital providing tertiary care and is recognized worldwide for its clinical excellence in cardiac care.
        • The 310-beded hospital is a globally renowned centre boasting admirable outcomes for interventions like Cardiac Bypass Surgery, Minimally Invasive Surgery, Interventional Cardiology, Non-invasive Cardiology, Paediatric Cardiology and Paediatric Cardiac Surgery.

        Dr. ZS Meharwal

        Dr. Z S Meharwal

        • Dr. Z. S. Meharwal is part of the founding team of doctors at Fortis Escorts Heart Institute.
        • He has more than 31+ years of experience in cardiac surgery with over 30,000 surgeries to his credit, including complex heart operations. Read More

        Dr Krishna S Iyer

        Dr. Krishna S Iyer

        • Dr. Krishna S Iyer is Executive Director in Paediatric Cardiac Surgery.
        • Krishna Iyer is one of India’s most experienced pediatric cardiac surgeons for 30 years in this field. Read More

        Dr Ashok Seth

        Dr. Ashok Seth

        • Dr Ashok Seth is presently the Chairman of Fortis Escorts Heart Institute and the Chairman of Cardiology Council, Fortis Group of Hospitals.
        • Dr Seth has led the field of Interventional Cardiology for the last 30-years and has contributed Read More
        Dr. ZS MeharwalDr. Z S Meharwal
        Specialist:Cardio Thoracic
        Experience:31+Years
        Hospital:Fortis Escorts
        Dr Krishna S IyerDr. Krishna S Iyer
        Specialist:Ped. Cardiologist
        Experience:30+ years
        Hospital:Fortis Escorts
        Dr Ashok SethDr. Ashok Seth
        Specialist:Cardiac Surgery
        Experience:35+ years
        Hospital:Fortis Escort

        FMRI

        Fortis Memorial Research Institute

        Number of beds:    1000
        ICU Beds:                  298
        Airport Distance:  17 KMs

        About Hospital:

        • Fortis Memorial Research Institute was established in 2001.
        • It is an outstanding multi-speciality quaternary care hospital,having the top-notch infrastructure, advanced equipment, highly qualified and experienced medical professionals and super sub-specialists.
        • Fortis Hosptial Gurgaon is an advanced centre of excellence in Robotic Surgery, Neurosciences, Oncology, Renal Sciences, BMT, Organ Transplants, Orthopaedics, Cardiac Sciences and Obstetrics & Gynaecology.

        Dr. Nikhil Kumar

        Dr. Nikhil Kumar

        • Currently associated as Director of Cardiology Fortis Memorial Research Institute, Gurgaon. 
        • Experience of over 41 years in Interventional, Non-invasive and Preventive and Clinical Cardiology. Read More

        Manjinder Singh Sandhu

        Dr. (Col.) Manjinder Singh Sandhu

        • Dr Majindar Sandhu with a practise of over 27+ years is one of the most experienced & respected cardiologist in India.
        • Dr Majindar Sandhu has had the honour of being the accompanying Cardiologist Read More

        Dr. Udgeath Dhir

        Dr. Udgeath Dhir

        • Udgeath has operated over 7500 cases in the tenure of eleven years.
        • He is formally trained by Dr. Taweesak for Rheumatic Mitral valve repair at Central Chest Institute, Bangkok and recently got trained for TAVI. Read More
        Dr. Nikhil KumarDr. Nikhil Kumar
        Specialist:Int. Cardiologist
        Experience:41 years
        Hospital:Fortis Gurgaon
        Manjinder Singh SandhuDr. Manjinder Sandhu
        Specialist:Int. Cardiologist
        Experience:27+ years
        Hospital:Fortis Gurgaon
        Dr. Udgeath DhirDr. Udgeath Dhir
        Specialist:Cardio-Thoracic
        Experience:15+ years
        Hospital:Fortis Gurgaon

        Max Hospital Saket3

        Max Hospital Saket

        Number of beds:   500
        ICU Beds:                 267
        Airport Distance: 13 KM

        About Hospital:

        • Max Super Speciality Hospital at Saket is one of the topmost healthcare service
        • Providers in India. The multi-super speciality hospital has a capacity of over 500 beds, 250 functional beds. It is equipped with state-of-the-art facilities, advanced technologies.
        • With the help of over 300 leading specialist Doctors, strong nursing staff, and state-of-the-art innovative medical tools.

        Dr. Viveka Kumar

        Dr. Viveka Kumar

        • Specializes in complex angioplasties, including multivessel, bifurcation, and left main angioplasties.
        • Completed more than 7500 angioplasties and 2500 balloon valvotomy with excellent outcomes. Read More

        Dr. Sameer Shrivastava

        Dr. Sameer Shrivastava

        • Dr. Sameer Shrivastava is a Cardiologist with an extensive 27+ experience.
        • Elected as one of the members on the Editorial Board of Indian Heart Journal and Journal of Indian Academy of Echocardiography. Read More

        Dr. Kulbhushan Singh Dagar

        Dr. Kulbhushan Singh Dagar

        • Principal Director, Chief Surgeon & Head – Neonatal & Congenital Heart Surgery.
        • Dr. Kulbhushan S. Dagar has been in the field of cardiac surgery for over 30 years, of which the last Read More
        Dr. Viveka KumarDr. Viveka Kumar
        Specialist:Cardiac Sciences
        Experience:29+years
        Hospital:Max Hospital
        Dr. Sameer ShrivastavaDr. Sameer Shrivastava
        Specialist:Int. Cardiologist
        Experience:27 years
        Hospital:Max Hospital
        Dr. Kulbhushan Singh DagarDr. Kulbhushan Dagar
        Specialist:Cardiac Surgeon
        Experience:30+ years
        Hospital:Max Hospital

        indraprastha apollo hospital

        Indraprastha Apollo Hospital

        No. of beds: 900
        ICU Beds:     262
        Airport:  20kms

        About Hospital:

        • Indraprastha Apollo Hospital is a flagship hospital of India’s foremost healthcare groups,the Apollo Group. It is a highly renowned multi-speciality facility that offers tertiary and quaternary care services to domestic and international patients.
        • The 900 bedded hospital is outfitted with the most modern technology for diagnostics as well as therapeutic purposes.
        • A team of highly trained medical professionals work under all the 52 specialities at the hospital.

        dr bhaba nanda das

        Dr. Bhaba Nanda Das

        • Bhaba Nanda Das is one of the best professionals for cardiothoracic and cardiovascular surgeries in the country, presently working as the Chief Cardiac Surgeon (CTVS).
        • He has about 38+ years of experience in this field of speciality. Prior to this, he was working as a Senior Consultant Read More

        Dr. N Sastri

        Dr. N Sastri

        • Dr. N Sastri is a cardiothoracic, vascular surgeon practicing successfully for over 36+years.
        • He offers treatment for Cardiothoracic and Vascular diseases. Read More

        Dr. Anoop K.Ganjoo

        Dr. Anoop K. Ganjoo

        • Dr Anoop K.Ganjoo is a renowned cardio thoracic surgeon in India.
        • He has completed his MBBS, MD & Mch degree from the prestigious All India Institute of Medical Sciences. Read More
        dr bhaba nanda dasDr. Bhaba N. Das
        Specialist:Cardio Thoracic
        Experience:38+  years
        Hospital:Apollo Delhi
        Dr. N SastriDr. N Sastri
        Specialist:Cardiac Surgeon
        Experience:36+ years
        Hospital:Apollo Delhi
        Dr. Anoop K.GanjooDr. Anoop K. Ganjoo
        Speciality:Cardiac Surgeon
        Experience:28 years
        Hospital:Apollo Delhi

        Medanta-Hospital-Gurgaon

        Medanta The Medicity Hospital

        Number of beds:  1250
        ICU Beds:                300
        Airport Distance: 18 KMs

        Brief About:

        • Medanta – The Medicity is amongst India’s largest and most renowned multi-super speciality healthcare centre with 1250 beds, 29 super speciality units and more than 800 accomplished doctors.
        • Supported by state-of-art infrastructure, all the departments in the hospital are fully equipped with cutting-edge technology, modular Operation Theatre and modernized monitoring systems in ICUs.
        • The panel of doctors from Medanta, headed by A.S.Soin performed the first successful intestinal transplant in India.

        Dr.-Naresh-Trehan

        Dr. Naresh Trehan

        • The Chairman and Managing Director of Medanta – The Medicity,
        • Dr. Naresh Trehan is a world-renowned cardiovascular and cardiothoracic surgeon. Read More

        dr. anil bhan

        Dr. Anil Bhan

        • Bhan is an outstanding Pediatric & cardiovascular surgeon at Medanta Hospital.
        • He possesses the largest experience of more than 37 years in Aortic surgery in India. Read More

        Dr. Praveen Chandra-Cardiologist

        Dr. Praveen Chandra

        • Currently associated as Chairman with Division of Interventional Cardiology at Medanta, The Medicity Gurgaon
        • Dr. Praveen Chandra is a leading Cardiologist and Chairman of Interventional Cardiology. Read More
        Dr.-Naresh-TrehanDr. Naresh Trehan
        Speciality:Cardiology
        Experience:41+Years
        Hospital:Medanta Hospital
        dr. anil bhanDr. Anil Bhan
        Speciality:Cardiovascular
        Experience:37+ years
        Hospital:Medanta Hospital
        Dr. Praveen Chandra-CardiologistDr. Praveen Chandra
        Specialist:Int. Cardiologist
        Experience:32 years
        Hospital:Medanta Hospital

        BLK_Super_Specialty_Hospital

        BLK-Max Hospital

        Number of beds: 700
        ICU Beds:               175
        Airport Distance: 13 Km

        About Hospital:

        • BLK Super Speciality Hospital was established by Dr. B.L. Kapur  in 1959. It was inaugurated by the then Prime Minister of India, Pandit Jawahar Lal Nehru.
        • BLK Super Speciality Hospital was established by Dr. B.L. Kapur  in 1959. It was inaugurated by the then Prime Minister of India, Pandit Jawahar Lal Nehru.
        • BLK has a unique combination of the best in class technology, put to use by the best names in the professional circles to ensure world-class health care to all patients.

        Dr. T. S. Kler

        Dr. T. S. Kler

        • Currently associated as the Executive Director, Cardiac Sciences and Head of Department of Cardiology, Fortis Memorial Research Institute, Gurgaon.
        • The first doctor to implant an Implantable Cardioverter Defibrillator (ICD) in April 1995 in India. Read More

        Dr. Subhash Chandra

        Dr. Subhash Chandra

        • Currently associated as the Chairman  & HOD at the Cardiology department of the BLK super speciality hospital, New Delhi.
        •  He has successfully performed over 25,000 complex cardiology procedures. Read More

        Dr. Ramji Mehrotra

        Dr. Ramji Mehrotra

        • Currently associated as a Principal Director & Chief in Cardiothoracic & Vascular Surgery with BLK-Max Super Speciality Hospital, New Delhi.
        • Specializes in Beating Heart CABG, Total Arterial CABG, Minimal Access Mitral and Aortic Valve Surgery Read More
        Dr. T. S. KlerDr. T. S. Kler
        Specialist:Int. Cardiologist
        Experience:47+ years
        Hospital:BLK-Max Hospital
        Dr. Subhash ChandraDr. Subhash Chandra
        Specialist:Int. Cardiologist
        Experience:15 years
        Hospital:BLK-Max Hospital
        Dr. Ramji MehrotraDr. Ramji Mehrotra
        Specialist:Cardiac Surgeon
        Experience:25 years
        Hospital:BLK-Max Hospital 

        Artemis Hospital

        Artemis Hospital Gurgaon

        Number of beds:  600
        ICU Beds:                185
        Airport Distance: 19 Km

        About Hospital:

        • Artemis Hospital, established in 2007, spread across 9 acres, is a 600plus bed; state-of-the-art multi-speciality hospital located in Gurgaon, India.
        • Artemis Hospital is the first JCI and NABH accredited hospital in Gurgaon.
        • Designed as one of the most advanced hospitals in India, Artemis provides a depth of expertise in the spectrum of advanced medical & surgical interventions, a comprehensive mix of inpatient and outpatient services.

        Dr. Amit Kumar Chaurasia

        Dr. Amit Kumar Chaurasia

        • Dr. Amit Kumar Chaurasia is a dedicated interventional cardiologist with more than 9+ years of experience.
        • Dr. Amit Kumar Chaurasia is one of the highly experienced doctors in India having performed the maximum TAVR (more than 250) and left atrial appendage closure (LAAC, more than 50)  Read More

        Dr. Kuldeep Arora

        Dr. Kuldeep Arora

        • Interventional Cardiologist with 15+ years of experience.
        • Interest lies in TransRadial Angiography and Angioplasty, TransRadial Peripheral Intervention & EPS and PPI, AICD, CRT and CRT+D implantation. Read More

        Dr. Sameer Mehrotra

        Dr. Sameer Mehrotra

        • Dr. Sameer Mehrotra is an interventional cardiologist with 17+ experience.
        • His expertise lies in treating Rheumatic Heart Disease, Coronary Angioplasty, Coronary Angiogram, Pacemaker Implantation, Electrocardiography (ECG), Angiography, and Chest Pain Treatment. Read More
        Dr. Amit Kumar ChaurasiaDr. Amit Chaurasia
        Specialist:Int. Cardiologist
        Experience:9+ years
        Hospital:Artemis Hospital 
        Dr. Kuldeep AroraDr. Kuldeep Arora
        Specialist:Int. Cardiologist
        Experience:20 years
        Hospital:Artemis Hospital
        Dr. Sameer MehrotraDr. Sameer Mehrotra
        Specialist:Int. Cardiologist
        Experience:17 years
        Hospital:Artemis Hospital

        manipal hospitals dwarka Delhi

        Manipal Hospital Dwarka New Delhi

        Number of beds:  480
        ICU Beds:                 118
        Airport Distance: 8 Km

        About Hospital:

        • Manipal Hospital Dwarka is a prominent multi-speciality and quaternary care providing hospital with first-rate healthcare services and integrated facilities.
        • The world-class medical centre is a part of Manipal Education and Medical Group (MEMG), one of India’s forerunner healthcare groups.
        • These Hospitals as an entity came into existence in 1991 with the launch of a hospital in Bangalore. Today, the group has 15 hospitals in India and an international presence with a hospital in Malaysia.

        Dr. Rajnish Sardana

        Dr. Rajnish Sardana

        • Cardiologist with 24+ years of experience
        • Expertise includes Cardiac Devices (Pacemakers, Defibrillators (ICD), Biventricular pacing {CRT-P} and combo devices {CRT-D}), Electrophysiology studies (EPS) and Radiofrequency Ablation (RFA) of various complex cardiac arrhythmias. Read More

        Dr. Samanjoy Mukherjee

        Dr. Samanjoy Mukherjee

        • Dr. Samanjoy Mukherjee is an interventional cardiologist, having an extensive experience of nearly 26 years.
        • His areas of expertise include BP Monitoring, Dobutamine Stress test, device closure procedures, FFR, Holter monitoring, pacemaker implantation, radiofrequency ablation, coronary angioplasty, and many more. Read More

        Dr. Sarita Gulati

        Dr. Sarita Gulati

        • Dr. Sarita Gulati is an interventional cardiologist, with an extensive experience of nearly 20 years.
        • Some of the key areas of her interest are BP Monitoring, Color Doppler, PAMI, Holter Monitoring, Device Closure, FFR and many more. Read More
        Dr. Rajnish SardanaDr. Rajnish Sardana
        Specialist:Int. Cardiologist
        Experience:24+ years
        Hospital:Manipal Hospital
        Dr. Samanjoy MukherjeeDr. Samanjoy Mukherjee
        Specialist:Int. Cardiologist
        Experience:26 years
        Hospital:Manipal Hospital
        Dr. Sarita GulatiDr. Sarita Gulati
        Specialist:Int. Cardiology
        Experience:20+ years
        Hospital:Manipal Hospital

        Jaypee Hospital, Noida

        Jaypee Hospital Noida Delhi NCR India

        Number of beds:   525
        ICU Beds :               150
        Airport Distance: 32 KMs

        About Hospital:

        • The Jaypee Hospital was conceptualized by a revered Founder Chairman, Shri Jai Prakash Gaur in 2014, with the vision of promoting world-class healthcare amongst the masses by providing quality and affordable medical care with commitment.
        • Jaypee Hospital, Noida is established in the year 2014. This hospital is a NABH accredited and a multi-specialty hospital.
        • Jaypee Hospital at Noida is the flagship hospital of the Jaypee Group, which heralds the group’s noble intention to enter the healthcare space.
        • This hospital has been planned and designed as a 1200 bedded tertiary care multi-speciality facility and has commissioned 525 beds in the first phase.

        Dr. B L Aggarwal

        Dr. B L Aggarwal

        • Dr. B L Aggarwal is a well-known Interventional Cardiologist with experience of more than 19 years.
        • He has proficiency over the treatment of Coronary Artery Disease, Complex PCI, and Trans-Radial Interventions. Read More

        Dr. Sunil Sofat

        Dr. Sunil Sofat

        • Dr. Sunil Sofat is a renowned cardiologist with experience of more than 28 years.
        • Professionally, he is best known for performing procedures such as Interventional Cardiology including Read More

        Dr. Biswajit Paul

        Dr. Biswajit Paul

        • Dr. Biswajit Paul is a renowned Pediatric Interventional Cardiologist and has experience of 22 years in cardiology.
        • The Indian Academy of Echocardiography awarded him for his work in his field. Read More
        Dr. B L AggarwalDr. B L Aggarwal
        Specialist:Int. Cardiologist
        Experience:19+ years
        Hospital:Jaypee Hospital
        Dr. Sunil SofatDr. Sunil Sofat
        Specialist:Int. Cardiologist
        Experience:28+ years
        Hospital:Jaypee Hospital
        Dr. Biswajit PaulDr. Biswajit Paul
        Specialist:Int. Cardiologist
        Experience:22+ years
        Hospital:Jaypee Hospital

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          We offers these Services

          • Providing a doctor’s opinion and proper quotation
          • Selecting the best hospital and doctor as per your case
          • Arranging a call with the doctor (if the case required)
          • Visa assistance, Providing Visa Invitation Letter (VIL)
          • Providing full guidance how to get Visa from your country
          • Providing total cost including treatment, air tickets, accommodation, and food
          • Assitance to book flight ticket from your country
          • Arranging airport pick up/ drop
          • Providing professional language interpreter
          • Booking accommodation and guest house as per your budget/ prefrence
          • Providing help in money exchanging
          • Providing local sim card
          • Arranging video consultation with specialist doctor if case requires

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