First in Asia

Bandar Seri Begawan - Gleneagles JPMC performed a rare but successful opening up of blocked coronary vessels on four patients with CTO (Chronic Total Occlusions), with the help of Dr Tony Joe DeMartini, a consultant interventional cardiologist from the USA, and one of the limited number of specialists in the world who can perform the complicated procedure.

Brunei was the first country in Asia where Dr Tony Joe DeMartini performed the risky surgery.

Gleneagles JPMC said it was honoured and pleased to host Dr Tony Joe DeMartini, an internationally recognised expert in CTO cases and this was his first visit to Brunei. He left for Jakarta to perform similar procedure on eight patients.

Over two days on Feb 28 and 29, Dr DeMartini collaborated with Dr Patrick Ang, GJPMC's consultant cardiologist, in successfully opening up blocked coronary vessels on four patients with CTO.

Dr DeMartini also managed to conduct a review and audit of all interventional cases performed in GJPMC in 2011. GJPMC said this review is part and parcel of the hospital's quality assurance process to ensure that its pafient management and complication rates are in line with and equivalent to international standards.

CTO are a class of Coronary Artery Disease (CAD) whereby the coronary arteries (arteries taking blood to the heart) are completely occluded (blocked) over an extended period of time. Such occlusions tend to be much harder to treat than other kinds of CAD, due to several factors: a) calcification (calcium deposits) of the plaque (substance blocking the arteries) and b) inability of the interventional cardiologist to visualise the coronary arteries on X-ray while performing the procedure.

In the past, success rates for opening up such blocked coronary vessels were less than 50 per cent. Over time, a number of interventional cardiologists have mastered techniques for tackling such complex cases, raising the success rate. In cases of failed Percutaneous Coronary Intervention (PCI), the only recourse is for the patient to undergo Coronary Artery Bypass Graft surgery (CABG).

In an interview on the successful procedure, Dr Patrick Ang said all four patients were recovering very well. He said usually in a bypass surgery, patients will stay a week or so before they are able to go home. In this procedure, Dr Patrick said patients usually stay one or two days before being discharged. "There is no general anaesthesia, the patients are fully awake after the procedure, and they can (already) walk after six to eight hours and they can go home the next day or the day after," Dr Patrick said.

"So it is a very fruitful way of doing things without subjecting patients to bypass surgery," he further said.

Describing the procedure to the Bulletin, Dr DeMartini said these vessels are usually left alone if they don't get bypass, and very commonly the symptoms are fatigue, so people do not usually get chest pain like normal patients who have 90 per cent blockage.

"They usually have fatigue, shortness of breath and other symptoms, generally we can manage them medically because once we get them open we can take away that fatigue and shortness of breath and they can resume their normal lifestyle. That's the big advantage," Dr DeMartini said.

Dr Patrick Ang explained that usually the body has a way to compensate when the artery is 100 per cent blocked, there are other channels from the other vessels working to help out, but the symptoms are fatigue.