By Tedler D. Depaynos, MD
It was incidental that a Cardio-Vascular surgeon who was visiting the local College of Medicine and hospital where he graduated met one of his retired professors, who appears to be limping. He is now practicing in Metro Manila and he just came home to visit his parents. For old time’s sake, he invited his elderly teacher for a plate of “pansit” and a can of Coke in the hospital canteen and they had a fruitful conversation regarding his practice.
Sensing the lack of knowledge of his once brilliant professor, he lectured him on Heart By-Pass which is one of the routine procedures they practically do.
Heart By-Pass is actually creating a passageway to by-pass a heart or coronary artery supplying the heart that is obstructed. There are several coronary arteries supplying O2 to the heart muscles so that triple or quadruple by-pass procedures are usually done. Most of the time the superficial greater saphenous vein which is located posterior to the leg is used. A segment of the vein is attached before the obstruction and the other end after the obstruction. If feasible an artery posterior to the chest wall called internal mammary artery is attached beyond a coronary artery that is obstructed so that it becomes an efficient blood supply route to the heart muscles.
In this delicate surgical procedure which to them appears routine, the specialist MDs work as different teams. There is a team of surgeons that remove the veins to be transplanted and another team that opens the chest wall exposing the heart where the by-pass procedures would be done. During the surgery, the patient is attached to a Heart Lung Machine managed again by another team of specialists which functions as an artificial heart so the heart would be bloodless during surgery. Actually to control its pumping movement, they even freeze the heart muscles.
After the surgical procedure, they stimulate the heart to return to its normal function. Healing would take some time and the patient is monitored closely. Many of the patients return to their normal activities after 2 to 3 months.
The Cardio-Vascular Surgeon however, emphasized that the procedure is just a mechanical one and not a permanent cure. From their statistics a number of the patients undergo the same procedure after 10 years.
Obstruction of the coronary arteries is usually due to “atherosclerosis” where plaques of cholesterol, lipids, calcium and other chemicals are deposited into the arterial walls. This would take many years but, eventually, the blood vessels fail to dilate and their lumen become smaller. Blood supply which carries O2 decreases resulting to “ischemia” manifested by worsening chest pains or “angina”. Physical exertion like running, climbing or even walking which requires more O2 to the heart may cause “angina”. Surgery may remedy the obstruction but a change to a healthy lifestyle is a must. Smoking obviously is taboo and control of lipids and cholesterol by diet, gradual exercises and medicines is a must. Other diseases must be controlled like Hypertension, Diabetis Mellitus, etc.
Noticing that his old professor appeared to be very attentive and interested, the Cardio-Vascular Surgeon suddenly asked if he is a by-pass candidate as they finished their “merienda”. The old professor smiled that he is alright except for his osteoarthritis. He later murmured that a lawyer friend of his is a candidate but refused to undergo the procedure because anyway he is already old. Laka lakay kanon! **
