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Coronary Artery Graft Bypass Operation Saves Lives

Prof. Habibuz Zaman
A male physictan. 50 was getting ready to go the Dhaka airport to catch his return flight for his duly station outside of Bangladesh when he was seized with heaviness and agonising precordial pain As a medical doctor. he realized
immediately that he was going tn for a real heart attack this time Previously he had suffered from chest pains on ex ertion (angina). which had disappeared with rest and nitro glycerine ("angestd") tablet, held under the tongue But this time tt was the real stuff, and gaining tn Intensity almost every minute. He had quickly de ctded to cancel his departure from Dhaka and had asked a near relative to try to reach a number of physicians over the phone.
Momentarily his thoughts liad drifted away to his wife — left all by herself at a forlorn duty station in a different country, several hundred miles away. Of course, she could not be told the truth The doctor s mind was still working. A cable had to be dispatched to his official supervisor. informing him of the situation and also requesting him to arrange for the travel of his (the afflicted doctor's) wife i.. Dhaka, under the pretext lh.it her husband would be held up tn Dhaka for several weeks on
an unexpected but important official work. Within minutes he had dictated a telex Io a relative and given instruction on how to dispatch It
The doctor could not help recall how his life had been so adversely affected by a sudden transfer to his present duty station. How the family life had been disrupted — the son had to be left behind at the doctor's previous duty station to enable the boy to proceed with his professional studies Two teen-aged daughters had to be sent away to a boarding school in England to pursue their studies. And here he has in Dhaka in the jaws of death but not all alone, as he would find out soon enough.
He had remained conscious when the first help had arrived — a good doctor friend had despatched his assistant with an E. C. G. machine, an ambu lance and a supply of medicines. The ECG readings had shown definite signs of a developing myocardial infarction. An Injection was given to relieve the pain and cause sedation. Within minutes the doctor patient was rushed to a local hospital — the doctor had chosen to go to a quiet and clean place with a reasonably dependent and caring medical and nursing staff. There were no facilities for continuous cardiac monitoring at the bed-
side In those days in Dluik.i Because of the almost Imme dlate attention he had re cetved. the doctor hud an un eventful recovery — no compli cations at all After six weeks of treatment and rest at Dhaka he was fit to travel to his duty station and to continue hi* works
Within two years, after he felt some heaviness In the precordium. he underwent a coronary angiography at London. This procedure determines ihc state of patency (openness of the passage) of the coronary arteries by inject Ing a radio opaque dye through a thin catheter. It was seen that three of the main trunks of the coronary arteries had some degrees of narrowing (65-90%). A coronary artery bypass graft operation was re quired. The patient was hospt talized for 16 days tn all and then asked to remain in l»ndon for two more weeks for a final check up after which he was allowed to travel home. On his return, he had monthly check-ups by his loca) cardiologist during the Initial period of six months. The doctor returned to full time work and retired from service in due course, seven years later
He is still active and tn rea sonably good health, more than 1 1 years after undergoing the coronary artery bypass graft
operation a procedure, tn which a piece of a superficial Ven from the patients leg or the internal mammary artery Is used as a graft to bypass the area of obstruction in one or more coronary arteries In well established medical centres, the operation has been very successful 1n the vast majority of cases, on whom it is undertaken The relief of symptoms Is dramatic and the quality of life Improves remarkably Once again the patient can live a full and vigorous Ute
If so Indicated It is prefer able to have a coronary bypass graft operation before suffer Ing an attack of myocardial in faretion When the cardiologist feels that there are enough changes tn the electro-cardio gram following exercise, to indicate a very severe degree of ischaemia (lack of blood supply) of the heart muscle he may refer the patient for corn nary angiography When the suspicions are confirmed, the patient may be advised to un dergo a coronary bypass graft operation — thereby saving the patient's heart muscle from Buffering infarction with con sequent weakening (of the heart muscle).
The coronary bypass opera tion requires facilities for open heart surgery A heart — lung machine is used to carry on
th« pumping action of the heart and to maintain the cir eolation throughout the bodv while the operative procedun is on. and the grafts are bring stitched to the coronary artcr les to bypass the areas of ob struction to the passage of blood.
Thia procedure to presently being carried out successfully in many centres tn several countries UirouglxHi' the World, including some countries in our neighbourhood Teams from friendly countries have also carried out this operation successfully at the Institute of Card to-Vascular Diseases. Dhaka Resources for this procedure are under-slaiKiabh being established al the Combined Military Hospital Dhaka Perhaps tn the not loo distant future, reliable facilities for this operation will be available routinely at Dhaka, so that patients In serious cardiac distress do not have to travel abroad at great personal tncon venfence and expense.
Obviously coronary bypass operation Is not the answer U> coronary heart disease; per haps It may be regarded as a last resort to save an Individ ual from Imminent danger and death. Does the answer lie in preventing coronary heart dis ease in the first place? Is that possible?