MEDICINE

A forum for heart care

A Chennai-based doctor, along with some of his patients, launches a forum to gather information on the various aspects of heart diseases in order to help reverse and prevent heart ailments.

ASHA KRISHNAKUMAR

A LONG-TIME ambition of Dr. V.V. Bashi, cardiothoracic and vascular surgeon at the Malar Heart Foundation in Chennai, was to help reverse and prevent heart ailments. He realised it on April 8 when he and some of his patients launched the "Heart Care Foru m of India" at the Foundation, where dozens of surgical procedures are performed every day.

The Forum primarily aims at collecting and collating epidemiological data on heart diseases in India. The data are to be used to identify and monitor high-risk groups such as smokers, alcoholics, hypertensives and people with a history of heart disease i n their families; recognise hereditary diseases; monitor food habits; document lifestyle changes; and so on. The Forum will also educate people who have undergone bypass surgery on how to resume normal life.

Dr. Bashi says: "Although concrete data are not available, the incidence of the disease seems to have increased. In the United States (data are available in the case of the U.S.), the number of people who die of heart diseases is larger than the total nu mber of people who die because of cancer, AIDS (Acquired Immune Defi-ciency Syndrome) and accidents put together. Lifestyle changes, tension, workplace pressures and irregular eating habits are some of the reasons for this phenomenon. Awareness about the risks people are exposed to can go a long way in reversing and controlling heart diseases."

In order to spread awareness, the high-risk groups need to be identified. The survey, to be undertaken with the help of some Chennai-based colleges and the World University Services, will cover Chennai first and then other metropolitan cities. The Forum also plans to start a support group to arrange for the supply of blood and to assist patients and their families.

Needy patients will be provided financial assistance and help in procuring aid from the Prime Minister's and the Chief Minister's relief funds as well as from charitable institutions. The Forum has been assured of support from other sources as well. Dr. Bashi will donate 20 per cent of his earnings towards the Forum, and Malar Hospital chairman Dr. S. Ramamurthy Rs.500 per surgical procedure. One can become a life member of the Forum by donating Rs.1,000 or a patron by donating Rs.10,000. According to F orum president N.K. Koteswaran, tie-ups with insurance companies have been planned to get a better deal for patients.

THE Malar Heart Foundation specialises in valve repair, arterial grafts and treatment of aortic aneurysms. In the last three years, under the guidance of Dr. Bashi, the Foundation has carried out more than 1,000 complicated surgical procedures. The succ ess rate has been 99.5 per cent, which is comparable to that of some of the best hospitals in the world. (The success rate of bypass surgery in the U.S. last year was 95 per cent.)

Dr. Bashi, who is clinical director and chief surgeon of the foundation, has pioneered different kinds of cardiothoracic and vascular surgical procedures: clearing a clogged artery, repairing a defective heart valve or deflating a bulging aorta. He uses arteries for coronary bypass (total arterial revascularisation) surgery, which dramatically improves the results compared to the conventional procedure of using veins. While the chances of a vein graft getting blocked after 10 years is 60 per cent, in th e case of an arterial graft it is five per cent. This is because arteries can withstand pressure better. Not many surgeons prefer arterial graft because it is a difficult method. Dr. Bashi has done 400 arterial grafts with a hundred per cent success rate .

Similarly, where most surgeons replace impaired valves with mechanical ones, he tries to fix them, however arduous the procedure may be. He is one of the few surgeons in the country who corrects aortic aneurysm (balloon-like enlargement of blood vessels) . In this difficult procedure, the patient is put on a heart-lung machine before the blood circulation is stopped and the body is cooled to 150 Celsius. The heart and the aorta are drained of blood, and the aneurysm is deflated. The brain is kept alive for about an hour at a low temperature and with minimal blood circulation. In order to reduce the risk of brain damage, it is reperfused with cold blood from the heart-lung machine through the superior vena cava. As the functioning of the brain can be su stained in this manner for about an hour, aneurysm has to be deflated within that time.

T.A. HAFEEZ
Dr. V.V. Bashi, cardiothoracic and vascular surgeon.

Dr. Bashi performed total replacement of the thoracic aorta barely four months after the path-breaking procedure was performed in the U.S. Arising from the heart and arching over it to continue towards the chest and abdomen, the aorta is the largest arte ry. The part of it that lies in the chest is the thoracic aorta. If the walls of the aorta lose their muscular integrity and become lax, aneurysm develops: the artery balloons outwards, yielding to the pressure of the blood.

Dr. Bashi operated upon a patient who had aneurysm of the entire thoracic aorta, which had bloated to a huge pulsating mass, pressing the lungs. Its bursting could have proved fatal. The diseased aorta had to be replaced with a synthetic graft in two sta ges. The aneurysm had to be deflated, the valves replaced and coronary bypass surgery done. The patient, Sister Gladys, came from Kenya. The entire surgery cost her Rs.2.5 lakhs whereas it would have cost $70,000 (Rs.30 lakhs) in the U.S.

Dr. Bashi has pioneered a procedure for rare metabolic disorders: dissecting aneurysm. A 40-year-old patient's aorta had ruptured and the patient collapsed. On opening up her heart, it was found that the coronary arteries were separated, the aortic valve was leaking and there was no blood supply to the rest of the body. Any organ - liver, kidney or intestine - could have failed. This condition was corrected, and the patient now leads a normal life.

Dr. Bashi also did the country's first highly complicated "elephant trunk procedure" to correct the aortic arch aneurysm, and the first "autograph stenting", in which a stent is covered with a vein before being fixed.

He corrects the defects of the mitral valve while most doctors prefer the easier option of replacing it. Although a difficult operation, it is better to repair the valve because in that case there is no need for life-long medication and the risk of the formation of blood clots that might travel to the brain is the minimum. In the long-run, while a mechanical valve needs to be replaced, a repaired valve continues to work for a longer time and saves the trouble of continuous monitoring. Patients are also spared the trouble of taking for a long period of time medicines that thin the blood. While 65 per cent of patients survive 10 years after valve replacement, the success rate in the case of valve repairs is 95 per cent.

In 1997, Dr. Bashi repaired the valve of an 84-year-old patient, the oldest patient to undergo a successful valve repair. He has performed coronary bypass surgery for a congenital abnormality, the anomalous origin of the left coronary artery, on a six-ye ar-old child, the youngest patient to undergo this operation.

Dr. Bashi says that he never does a surgical procedure unless he is 100 per cent sure of the results, and more important, its implications. He says: "It is easy to decide to do a surgical procedure on a patient but not so to decide against it. That comes only from experience."

THE treatment for cardiac ailments has developed immensely in the last three decades. In the 1970s, when coronary bypass surgery was beginning to gain acceptance, everyone thought that a hundred per cent cure had been found. That was not so; bypass surge ry is only a palliative. In the 1980s, balloon angioplasty became popular; this also did not solve heart problems.

According to Dr. Bashi, great strides are being made the world over in the fields of medicine, genetics, diet management and use of traditional approaches such as yoga in the treatment of cardiac problems. India has the infrastructure and expertise to pe rform sophisticated procedures such as keyhole surgery, he says. "But," according to Dr. Bashi, "epidemiological research is what India should concentrate on." Dr. Bashi says that the incidence of heart ailments is likely to be close to one million in In dia. Only 35,000 bypass surgical procedures were performed last year. So there is a need to spread awareness about preventive measures.

Dr. Bashi, who has published over 50 technical articles in international medical journals, is now focussing his research on the effects of different types of cooking oil, varying lipid (cholesterol) profiles and dietary patterns on the heart. The data co llected by the Heart Care Forum will be used for these studies.