ME AND MY OPERATION: unblock arteries and come home faster with a new sonic blaster

THE PATIENT

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About 15 to 20 years ago I repeatedly had angina attacks – crushing pain in the middle of my chest – which, according to doctors, were caused by narrowed arteries that reduced blood flow to my heart.

I had always tried to live a healthy lifestyle, walk the dog and avoid greasy food, but the pain was worrying and I was increasingly out of breath.

I was prescribed bisoprolol medication to lower my blood pressure and make my heart work more efficiently, but I was still out of breath because my narrowed arteries made it harder for oxygen-rich blood to make my body flow.

Sometimes it was hard to breathe even when you watched TV. It came on stage that I could hardly do anything.

Under the knife: Farhad Mir-Shekari, 70, a retired software engineer from Kettering, started repeated angina attacks two decades ago - and then his problems started

Under the knife: Farhad Mir-Shekari, 70, a retired software engineer from Kettering, started repeated angina attacks two decades ago – and then his problems started

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Whenever I had a particularly severe attack from Angina, I called an ambulance and received emergency blue light in case it was a heart attack. This happened every few weeks.

On such an occasion, in April 2007, when I was 57, I had a heart attack on the A&E department. It was frightening, but I was lucky to be very careful. Tests showed that one of my two coronary arteries supplying the heart muscle was partially blocked by calcified plaques, and my heart muscle was damaged as a result.

I stayed in the hospital for five days before they brought me to Leicester Royal Infirmary, where they placed a stent (small tube) to dilate the artery and keep it open. That was great: suddenly, after so long, I could breathe well. Yet I had a new angina attack every few years. In July and August last year, they were again common – every few weeks.

My doctor referred me to the Kettering General Hospital, where I saw cardiologist Dr. Prashanth Raju. I had more tests, which showed that my other coronary artery was narrowed and this blockage was in a bend in the artery where it was harder to insert a stent.

Dr. Raju said they could use a specialized drill to break through the calcified deposits, but said that this entailed risks, including puncturing the artery. If it didn't work, it would mean open heart surgery, with a long recovery.

He then told me that he was using a new technique with a balloon and an electric charge that would & # 39; shake & # 39; to crack the calcium – they could then press it against the artery wall and insert a stent to hold the artery open. Instead of being a broken car windscreen, the calcium would burst and burst but stay in place, pressed back against the vessel walls.

I would only be his third patient to have it, but he was so confident about the approach that I felt happy too. I had the 30-minute procedure just before Christmas under local anesthesia and light anesthesia.

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Dr. Raju inserted a needle into an artery in my wrist and passed a catheter through it that contained the calcium-cracking balloon that went through my body to the blocked artery.

& # 39; Now I am much less out of breath and I have had no more angina attacks - it is great. I can walk more and help our older dog in the car, "he says

& # 39; Now I am much less out of breath and I have had no more angina attacks - it is great. I can walk more and help our older dog in the car, "he says

& # 39; Now I am much less out of breath and I have had no more angina attacks – it is great. I can walk more and help our older dog in the car, "he says

As he had warned, I felt out of breath and had a pain on my chest, like a mini-heart attack, during the procedure, but I knew it would pass. I didn't even feel the sonic pulses.

My son Rad (38) and wife Angel (62) took me home that evening.

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I took it easy for a few weeks and I still use medication to increase the efficiency of my heart.

But now I am much less out of breath and I have had no more angina attacks – it is great. I can walk more and help our older dog in the car.

THE SPECIALIST

Dr. Prashanth Raju is an interventional cardiology consultant at Kettering General Hospital.

Almost everyone over the age of 60 has a certain degree of coronary artery disease – covering the blood vessels that supply the heart with greasy plaques that calcify, making them inelastic and blocking them. This can lead to a heart attack.

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High blood pressure, smoking, age and uncontrolled diabetes increase the risk and the number increases as people live longer.

Angina is the pain that occurs as a result of having this plaque – it is not harmful in itself, but gives a person a higher risk of having a heart attack.

Decades ago, the most important intervention was bypassing the coronary artery, where blood is directed around the block through a healthy blood vessel taken from the leg, arm or chest. This major operation included sawing through the breastbone and recovered for up to six months.

But now we have many more options, including stents, which are actually a scaffold to keep an artery open and often covered with medication to prevent the lime from rebuilding.

We place them in place through the wrist, and extend a balloon into the narrowed artery to push back the calcification and keep the artery open with the stent.

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But in about 10 percent of the cases, the calcification is too severe, so there is only a small hole in the plaque – and when we try to turn the balloon off, it takes the form of a dog bone and will not expand. We can try to use a catheter with a knife at its tip, or rotation, which uses a small drill to work through the superstructure.

But this entails the risk that the artery will be damaged, or that small pieces of calcium will break down and cause a blockage.

Lithotripsy, involving shock waves, has been used for decades to break down hard kidney stones. However, its use in cardiology is very new and exciting – it has been around for several years, but 3,000 patients have already been treated in Europe.

Instead of a drill, we use a balloon that emits electrical pulses – these create sonic pressure waves, which pulsate and cause small cracks in the calcium, without affecting the surrounding tissues.

Once the hard calcium is in pieces, we can deploy a balloon to push the calcium back against the walls of the blood vessel and then hold the artery open using a traditional stent.

This is exciting because it has fewer potential complications than rotation and the patient does not have to spend the night.

The procedure takes about 30 minutes under local anesthesia and light sedation – and the cracking of calcium takes only a few minutes.

I insert a needle into the wrist artery and, guided by an X-ray, slide a catheter or tube to the heart artery. I slide the shock wave balloon through this tube to reach the constricted portion.

The balloon and catheter are connected to a machine that generates the sound waves and is controlled by a button that pulses ten times to crack the calcium – we can repeat this if necessary.

I then slide up a second balloon to press the cracked calcium against the artery wall and place a stent in place using a balloon to keep the artery permanently open. Most patients go home the same day.

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n The operation costs the NHS £ 4,000 – it is not available for private use.

WHAT ARE THE RISKS & # 39; S?

A low risk of heart attack and stroke – about one in 300, the same as for any angioplasty procedure (where a stent is inserted).

There is a theoretical risk that the sound waves cannot crush the calcium deposits, but patients are carefully selected and only suitable cases are treated.

"This procedure involves no more risk than a stent and less risk than the alternative, where a drill is used," says Dr. Joe Mills, a cardiologist consultant at Liverpool Heart and Chest Hospital. "It's simple and it's likely that this technique will become more important over time."

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