Angioplasty OR Bypass Surgery

A person suffering from Angina or any coronary artery diseases may need either Angioplasty or Bypass surgery

• Angioplasty to widen the narrowed artery
• Coronary artery bypass surgery to create a separate blood vessel which will supply the heart

What is Angioplasty?

Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). The balloon crushes the fatty deposits, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn.

Advantages of Angioplasty:

• Non-surgical procedure
• Recovery time is quick – usually just about a day
• Can be performed under local anesthesia (Patient is under sedation but awake)
• Chest does not have to be opened
• No use for a heart-lung machine which reduces the chances of stroke

Sounds good? So then what’s the problem with Angioplasty?

Some patients who have undergone Angioplasty may have to undergo the procedure once again or may even have to undergo a bypass surgery (recommended because a repeat angioplasty could be fatal or ineffective in some cases). This is due to a problem called restenosis. What is Restenosis?

‘Restenosis literally means the reoccurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow. Restenosis usually pertains to an artery or other large blood vessel that has become narrowed, received treatment to clear the blockage and subsequently become renarrowed’. 

Today due to advancements in medical technology, stents are used in Angioplasty which to an extent reduces the occurrence of restenosis as the artery is kept open. However Stents come with its own risks. A patient who has an implanted stent may have to take medications up to a year as there is a risk of formation of clots around the stent in the long run.

Situation:

My doctor recommends an Angioplasty. He also adds I may have to undergo the procedure at a later stage. Cant I just have a bypass if I have to undergo Angioplasty several times?

Doctors recommend Angioplasty depending on the medical reports. Since the entire procedure itself is less stressful for the patients, doctors try it at least once. Even if a repetition of the procedure is required for long lasting results, we recommend this because it is a less stressful procedure for YOUR BODY.

Under what circumstances is Angioplasty NOT recommended?

• Severe plaque buildup in a particular location of the artery. It is usually risky to perform Angioplasty in this area, often fatal
• Some people have narrowed arteries in several places – widening every block with angioplasty is just plain impractical
• Severe narrowing of the left main coronary artery
• Severe narrowing of any three arteries in a person who ALSO has a less EF (Ejection fraction) or simply put a heart that beats slow/weak
• Severe narrowing of the left anterior descending artery and at least one other coronary artery, plus either diabetes or a weakly pumping heart

In all above circumstances, a bypass surgery is recommended

There is a little math that goes in to all of this:

There is one important factor we consider in deciding between Angioplasty or Cardiac Bypass Surgery. That is to measure whether your heart is pumping weakly or strongly

Using one of the several imaging methods, we measure:

• How much blood flows from the upper chamber of the heart to the lower chamber
• Ejection fraction: Fraction of blood that is squeezed out with every beat.

A heart that has an ejection fraction of 50% or more can withstand an Angioplasty. If the numbers are poor, we go for a bypass surgery.

Before change of heart, a pump does the job

CHENNAI: A week after surgery, 46-year-old Mohana Thirupurasundari was spending time reading Bhagavad Gita in the intensive care ward of Frontier Lifeline on Wednesday. A mechanical pump that surgeons connected to her ailing heart pushes blood continuously and gives her weakened heart muscles some time to rest.

Dr K. M. Cherian talks to the patient, Mohanatirpurasundari, at the hospital

The woman, who suffered heart failure, could not be treated with medications or stem cell therapy. The doctors thought she would urgently require a pump as she had no time to wait for a heart transplant. But her health condition has improved after the surgery, the doctors said.

The pump, called the left ventricular assist device, comes in different models. Thirupurasundari got the one which is fitted outside the heart. The tubes were connected in and out of the left-ventricle and the aorta which were in turn connected to a pump outside the body.

The device leaves recipients without pulse as the pump keeps pushing blood without mimicking the heart’s own pulse beat. Thirupurasundari felt nothing unusual without the pulse. “I feel better now. I am able to breathe easy, my chest is lighter,” she said. Her vital parameters are beginning to look normal.

The surgery by a team of doctors at Frontier Lifeline eight days ago made the difference. Unlike conventional devices, the pumps do not contain seals or bearings and hence there is no wear and tear or risk of blood clotting. These pumps work on a magnetic levitation principle, where the blood is sucked and pushed.

Heart surgeon Dr KM Cherian of the Frontier Lifeline says these are not cures or substitutes for an ailing heart. The pump is meant to act as a bridge to transplant. The hospital has flagged an emergency for Thirupurasundari who is on the waiting list for heart transplant. “Until then she will be in the intensive care unit. We will be able to wait for up to 90 days with the equipment. By then we must be able to get the right donor,” he said.

Doctors believe that the best time to refer patients for such therapy is before kidney, liver and lung damage develops. Quality of pumps are also increasingly getting better. “Some pumps are fixed inside the heart. Such people can be sent home,” Dr Cherian said. Though the team prefers to wait for a few days to allow Thirupurasundari to adjust to the new pump and recover from the surgery, they say she is fit enough to undergo a heart transplant.

The cost of the implanting the assist device, its daily maintenance and investigations would cost Rs 10 lakh to Rs 15 lakh for 30 days. Patients will have to spend another Rs 10 lakh for a heart transplant. “We are willing to spend that money to save my mother,” said her daughter Karunya M, who has just graduated in medicine from China.

(This article is a reproduced as it is from a news item in ‘The Times of India’)

http://articles.timesofindia.indiatimes.com/2011-09-01/chennai/29953233_1_heart-device-intensive-care

Indian heart throbs at Egyptian Chest

A 51-year-old male from an impoverished background, met an untimely end in a road accident, and was declared brain-dead on June 30, 2010 at Stanley Hospital, Chennai. But his life had not ended in vain as his family which includes 3 daughters, were determined to donate his organs to offer fresh leases of life to those awaiting that rare second chance.
Dr. J. Amalorpavanathan, Convenor – Cadaver Transplant Program, Tamil Nadu issued word on the availability of donor organs. A nationwide search was made to determine compatibility among existing recipients, especially for the heart.

Meanwhile, an Egyptian male lawyer aged 43 years, who had previously undergone CABG for Coronary Artery disease in 2007 in Egypt, was undergoing treatment in a reputable hospital in Chennai for his failing heart. His condition was deteriorating as his Ejection Fraction was gradually decreasing (EF – 25%). He was informed that a heart transplant was the only option available as advised by his referring doctor in Egypt.

Subsequently he was admitted in Frontier Lifeline and was being managed medically. He was also enrolled under the Transplant Registry at Frontier Lifeline. With the help of the interpreter, he was prepared mentally by our transplant coordinator regarding the benefits, prognosis and usage of long term immuno-suppressive therapy.
Upon intimation of an available donor heart, the Egyptian patient’s case was put forward as a possible recipient and after having determined the unavailability of a suitable Indian recipient, the Convener made a timely decision to let the heart be used for the waiting Egyptian patient. The heart was harvested at Stanley and brought to Frontier Lifeline in a record 19 minutes in peak hour traffic at 7:20pm with the timely cooperation of V Balakrishnan – a driver from Puliathrope, Sreedhar, Traffic Inspector – Pulianthrope and S Gunasheakran, Traffic Inspector – Thirumangalam on that very day (June 30, 2010).

Dr.  Prashanth Vaijyanath and the Cardic Transplant Team consisting of Dr. Krishna Manohar, Dr. Kulasekaran, Dr. Saravana Ganesh, Dr. Ganapathy and Dr. Silesh at Frontier Lifeline successfully undertook the critical operation and the patient is doing well.

Saving lives knows no boundaries and Frontier Lifeline is glad to be able to cross frontiers of nationality,   race, culture, religion and language.

The gift of life

My name is Reena Raju and I’m from Bangalore. I recently underwent a successful Heart Transplant at Dr K.M Cherian Heart Foundation Frontier Lifeline. Now I’m fit & healthy like anyone else, however life for me has been on a different path than it is for everyone. I was diagnosed with Dialated Cardiomyopathy at the age of 25. In this condition the heart enlarges & does not pump blood properly – severe LV dysfunction. For a normal person the heart functions at 50-70% but for me it was 15% & gradually increased to 30 & finally dropped to 25%!

I was an outgoing person & represented my school, college & university at the national level for hockey. After my illness I was unable to do most of my normal activities. I could not climb more than 2 steps & had to stop n relax. My diet was restricted & even my liquid intake was restricted to750ml-1ltr a day which included water, juice, curd, soup etc. I was in constant pain & unable to do much. I believe life is about choices. I could either crib & cry or enjoy the experience, chose to live and relish every moment. I did it all! Though I could not play hockey, I played the guitar and sang my heart out. A vocalist since childhood, I performed with my Fiancée Raj, did voice over and much more. I also used to write and will publish a book this year.

I met Raj after I fell ill. I wanted to do something constructive so I bought a keyboard and was looking for a good tutor. That’s when I met Raj & we just knew we were meant to be together. He held my hand then despite knowing my condition, he never let go of me. He nursed me back to health, never made me feel like a patient & would sacrifice his TV interviews, press conferences ands shows just to be with me in the hospital. Raj is a music director in the Kannada film industry & has made Shankar Mahedavan, Chitra sing to his compositions. A live performer, he plays 6 instruments and opened for Boney M, Rednex to name a few. Raj has also acted in a movie too!

During 2009 my condition got worse and the only option left was a Heart Transplant. Time was running out. My sister, Raj and close friends did a research on good Heart Transplant Hospitals. That’s how we got to know about DR KM Cherian’s Heart Foundation. I registered in Chennai, received a call in a month that they had found a perfect match but I refused as I was scared of what will happen. Later I felt guilty cause I missed an opportunity that God gave me. I had surrendered to the will of God cause none of us are wise in deciding in the matters of life & death.

I got a call again from Frontier Lifeline that they had found another perfect match. This time I went for it. By then I was in a critical state with my heart functioning only 20%, so weak and fragile. All my close friends pitched in & helped right from, booking flight tickets to raising funds to being there with me on the night of the transplant. I was anxious but believed that God will do what’s best for me. I somehow made it to Frontier Lifeline at midnight, whispered a small prayer & hugged everyone, my sister Roopa, my best friends & pillars of strength, Raj, Vinitha & Dennis. The hospital staffs took me in quickly & prepared me for the transplant. I was just 28 years, I was biting my own nails and remember being given anesthia.

The next thing I remember was waking up with tubes, feeling like a log and saw a nurse walking around dressed like an astronaut! I thought Jesus this should not be heaven. I was made to walk two days post transplant. I was shifted to another ward after three days. I started eating well and played pranks and joked with the doctors and nurses at the ward. I remember my first meal vividly, the sponge bath after, kind people around who took care of me like a baby. Priya Jabekaran the transplant coordinator gave me constant emotional support and strength to my loved ones when I was battling between life & death. She takes care of every patient with a lot of attention even post transplants.  We’ve become best buddies now!

I was in Chennai, a place I’ve never been before but felt loved and cared for, felt good despite of pain. The diet food was yum, grill chicken custard meals. My birthday is on December 4th & I was at the hospital then. My sister & I usually celebrate our birthday together as we are twins but she was in Bangalore preparing for my return. But I was in for a surprise; the staff filled me with cards and also ordered a special diet birthday cake for me! All the people I had ever met before were there, celebrating with me! It was an awesome birthday, one which I’ll cherish and never forget. 15 days and I was back in Bangalore with an angels heart.

There is a God and He’s given us Dr. K M Cherian, and through him Frontier Lifeline and because of FLL, many patients have gotten a new lease of life, including me! Dr. Cherian is a visionary, a mon of few words and a pioneer in his field but very down to earth. A wonderful human being, precise and cheerful, we often call him Cherry boy lovingly and look up to him. Any man at his age would want to retire and travel the world, but not the doctor! He is already working on Frontier Mediville, a mega project 10 km away from Chennai that will benefit not only patients but also provide an ideal stage for students

3 months post my transplant I was back in Chennai performing for the Frontier Lifeline  annual function with my sister & fiancée Raj. I sang 3 songs and played the guitar for another. I had also recorded a special song for Dr K M Cherian just 1 month after the transplant that had made a big difference in my life. The quality of my life has definitely improved. I hate it when some people pity me cause I’ve never lived like a patient & all of us are here with an expiry date. It doesn’t matter how long we live but what we do with our life. I’ve resolved to make the best of this beautiful life. Life is so beautiful that it’s senseless to hold on to any pain.

The rest my article says it all. I never knew I was the first & youngest heart transplant woman in the state of Karnataka. I took part in the Sunfeast World 10k Marathon on 23rd May this year promoting organ donation. I’m alive against all odds for a reason. Now I sing, play the guitar, jog, cycle and hang out with friends…the quality of life has definitely improved post transplant. My heart functions now at 60%.There’s meaning to my life now and I’m young and even more confident to promote organ donation. Doing my bit here, I want to reach out to the nation and let them know what a difference it has made in my life just because an ANGEL donated a heart for me. When it’s time for me to leave this world I would definitely want to help another live by donating my organs. Every state should take the initiative to propagate organ donation. I am all set to publish my book this year. I’ve been writing for 3 yrs now about my experience and how I conquered fear through faith and joy despite the pain. I also plan on becoming a motivational speaker. For 4 years I’ve been on the receiving end now I’m happy to also share a bit of my life to motivate others. It’s wonderful to give than receive.

Seeing is believing and I’m all set to give my bit to society. I remember everything, my childhood playing hockey and all the singing – some people have this misconception that when the heart changes a person changes but I’m still the same, in fact even better! I can still play hockey dribble & scoop; as kids my sister used to be the victim of all my pranks as we looked the same & she’d get punished for all my mischief – not that she was any less! I’m a living example for all to see now & know that no one changes with a transplant and I’m relishing every moment in life. Thanks to God for Dr. K M Cherian and all the wonderful people at FLL who through the grace of God add color to the lives of less fortunate people. My scar will be my style statement, it reminds me of how I got my life back & I’ve stared at death in its face so many times over the past 4 years. I’ve conquered the fear of death. It’s a wonderful experience. Vinitha my childhood & best friend says that it’s my faith in god & sheer will power, that healed me.

The author can be contacted at reenanraj2010@gmail.com

Two Successful Heart Transplants in One Night

Chennai, March 23, 2010: In 2009, history was made as reported in the Daily Telegraph Reporter, published 13 Mar 2009, 6:06pm GMT, UK – “Surgeons performed 2 heart transplants in one day in what is thought to be a British-first operation to save 2 babies’ lives”.

We are pleased and humbled by the opportunity to achieve a similar first, not only in India but in the whole of Australasia, through the successful dual heart transplants which were conducted simultaneously on the same night.

22yr old male, a Food Technology Engineer, had Dilated Cardiomyopathy. He had been put on the organ recipient waiting list for the past 3 months since registration, and was admitted twice on receiving calls from donors, but was found unsuitable for the available heart.

32yr old male, a Sound Engineer, had Coronary Artery Disease, and underwent Coronary Artery Bypass Surgery (CABG). His recovery was not up to the mark, which was further complicated by severe left ventricular failure. He was the organ recipient waiting list for the past 3 months since registration, and had been admitted twice on receiving donor calls. However, he was found unsuitable for the available heart.

Both recipients were suffering from end-stage heart disease with an Ejection-Fraction of less than 15% as opposed to the normal range (50 – 70%). They were breathless with the slightest exertion.

Given the critical need of both the recipients, it was decided by the Convener of Cadaver Transplant that both the available hearts should be offered to the recipients at Dr. K. M. Cherian’s Frontier Lifeline Hospital (FLL).

The call was received at 8.20pm on Thursday, March 18, 2010 at night; and in an extraordinary feat of coordination and precise synchronization, both recipients were mobilized to the hospital for preparation, while the 2 hearts in separate locations were simultaneously harvested by two separate teams and brought to FLL in record time. The team behind the safe and speedy transportation were coordinated by Mr Ravi, Additional Commissioner of Police – GH to FLL: Mr Sreedhar C., Inspector of Police for Traffic, Pulianthorpe, driven by Mr Yuvaraj G. Apollo to FLL: Mr Tharani V, Inspector of Police for Traffic, Nungambakkam, driven  by Mr Murugan.

The smooth flow was expertly guided by Dr KM Cherian and executed by Ms Priya Jebakaran, Transplant Coordinator, FLL (Hotline: 98400 44424), with the dedicated efforts of the transplant teams at FLL, who successfully carried out this achievement at the same time that night, in 2 operation theatres next to each other. Both the transplants started at 3.00am and completed at 7.30am. The incomparable teamwork and coordination of the organ donation program in our nation is highly laudable.

This is the first time in the world that such an accomplishment has taken place; a similar precedence can be found in 2001 at New York, when dual heart transplants were carried out on twins, 6 days from one another and again in 2009 as stated above, when 2 heart transplants were carried out on the same day at Newcastle, UK.

Links to news items:

http://www.thehindu.com/2010/03/24/stories/2010032454070400.htm

http://timesofindia.indiatimes.com/city/chennai/After-three-month-wait-2-patients-get-new-hearts-on-same-day/articleshow/5717421.cms

http://www.deccanchronicle.com/chennai/take-heart-youth-saved-jiffy-577