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New machines make heart procedures faster, safer

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Posted: Saturday, February 9, 2019 9:07 pm

HARLINGEN — Gary Bordelon lay sedated on the table, images of his pumping heart playing on a screen.

“ This is a sheath,” said cardiologist Dr. Charles Mild as he slipped the tubular instrument into an opening in Bordelon’s groin. Once in place, a catheter was slipped through the sheath into major arteries going to his heart.

This being American Heart Month, it seems only fitting that Bordelon was the first patient to receive a diagnostic angiogram on Valley Baptist Medical Center’s new Biplane Angiographic Suite.

The new machine takes pictures from two different directions instead of one. Two pictures instead of one provide more information for diagnosis and treatment.

This in turn requires fewer pictures to be taken, which reduces the time for the whole procedure. It uses less radiation and is therefore safer for both patients and medical personnel.

Furthermore, less contrast fluid is used, and that makes it easier on the kidneys. The new biplane makes an angiogram safer, simpler, and quicker.

The X-ray tubes of the new state-of-the-art machine whirred quietly Friday as they rotated around Bordelon’s chest, one from the side and another from the top. Image intensifiers magnified and processed the X-rays as the tubes shot 30 frames per second.

“ Now put in some contrast,” Mild said to Omar Davila, a cardiovascular technician who was decked out in scrubs and protective lead coat.

Davila injected a contrast liquid through the catheter to illuminate parts of the heart as the X-ray tubes took pictures. The catheter could easily be seen on the screen releasing contrast fluid into the heart.

Contrast fluid is a chemical used to make parts of the heart visible in an X-ray. It’s hard on the kidneys, so the less contrast, the better.

“ We’ve got some problems here,” Mild said, viewing the screen. “We can’t see from this view, that’s why we have to get another view.”

And that right there, another point of view, is why the new biplane is a key addition to Valley Baptist Medical Center - Harlingen. The hospital has three of the new biplanes. They can take pictures from two different directions, giving multiple points of view, resulting in a broader perspective.

Such a broader viewpoint of any situation is powerful. In this case, it reduces the time necessary for the same amount of pictures — and the danger.

“ If we didn’t have the biplane we’d have to take eight separate pictures with eight separate contrast injections,” Mild said. “With the biplane, we get two pictures with every contrast injection. So it limits the amount of contrast by 50 percent.”

CONTRASTING

Actually, the amount of contrast savings can be even more, making it even easier on the kidneys.

“ Sometimes when you get these double pictures you get so much more information you don’t have to take another picture,” he said.

Contrast, he said, is necessary to get pictures, but it’s also toxic for the kidneys. Less contrast, less toxicity, he said.

The machine used for the heart is smaller than those used for the brain and more maneuverable.

“ Since the heart moves, we have to move around it to see all the positions,” Mild said. “It reduces the dosage of the X-ray we need and all the X-ray goes directly to the heart, nowhere else.”

Biplanes used for procedures on the brain are a little bigger because they must go through more bone.

“ For the heart we don’t have to go through a lot of bone,” he said. “So why use all this extra X-ray that’s toxic to the body if you don’t need to? So we’ve got this new lab dedicated for hearts only.”

He added though that all three labs are multi-purpose.

The procedure on Bordelon went smoothly and quickly. The table on which Bordelon lay moved back and forth and Mild asked, “Ready?”

The cameras shifted and Mild explained, “This is the camera we use to take pictures of the heart’s movements.”

The procedure only took about 20 minutes, typical for a diagnostic procedure. Bordelon had suffered a heart attack, so Mild had expected more problems than he found.

“ He did have some blockage but not to the point we need to do surgery,” Mild said. “He doesn’t need angioplasty. A decision was made he was a candidate for strictly medical management. He’s a lucky man.”

Down the hall, the next patient waited for his own angiogram. Doctors planned to run the catheter through the arm of Vidal Castro, who’d experienced some shortness of breath recently. He appreciated the fact the procedure would be simpler and quicker, and he’d get results the same day.

“ It helps, people want to do it faster,” said Vidal, 42, of Raymondville.

His wife San Juanita Gallardo was also grateful.

“ He will know right away then what’s wrong,” she said. “The doctor will be there.”

CARDIAC TERMS

Contrast fluid - Contrast dye is a solution that is used to accentuate specific structures when looking at a body image. Radiocontrast agents are substances that are used in studies such as x-rays,

Biplane – This term is not to be confused with an airplane. In this sense, it’s used to describe a machine that takes angiograms with two X-ray tubes instead of one.

Angiogram — The Mayo Clinic describes a coronary angiogram as a procedure that uses X-ray imaging to see the heart's blood vessels. The test is generally done to see if there's a restriction in blood flow going to the heart.

Sheath — The insertion of a sheath into the artery preserves a constant source of access to that artery. Through the sheath, physicians can safely insert wires and catheters into the body while keeping bleeding to a minimum.

What is heart disease?

“ Heart disease is any process that causes some form of dysfunction of the heart.” Dr. Charles Mild.

Heart disease is divided into two main categories with broad variations in both.

Ischemic heart disease - Coronary artery disease develops when the major blood vessels that supply your heart with blood, oxygen and nutrients (coronary arteries) become damaged or diseased. Cholesterol-containing deposits (plaque) in your arteries and inflammation are usually to blame for coronary artery disease. www.mayoclinic.org

Cardiomyopathy - A disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body. Cardiomyopathy can lead to heart failure. www.mayoclinic.org

Cardiomyopathies are usually caused by high blood pressure. Some people are born with a form of cardiomyopathy. There are several ways the heart can fail. One is diastolic heart failure in which the heart muscle can’t stretch and therefore can’t fill with blood. If it can’t fill with blood it can’t pump blood.

Systolic heart failure is the heart simply can’t contract. Systolic heart failure can also result from a heart attack caused by ischemic heart disease. Dr. Charles Mild

Valley Baptist Medical Center – Harlingen has three new Biplane Angiographic Suites worth several million dollars. One is used for taking pictures of the heart, another is used for pictures of the brain, and a third is used to take pictures of both the brain and for electrophysiological studies of the legs.

The biplanes have two cameras. One is anterior for taking pictures from above, and the other is a lateral for taking pictures from the side. Each has an “image intensifier.”

Valley Baptist also has a monoplane for taking pictures of the legs. All four machines are multi-purpose.

A heart-healthy lifestyle involves diet and exercise, but what does that mean?

Dr. Charles Mild, cardiologist, said heart experts around the world are recommending the “Mediterranean Diet.”

Mediterranean Diet – Vegetables, fruits, fish, poultry, grains. No beef or packaged foods. Avoid bread. Use olive oil.

Mediterranean Diet Pyramid

1. Vegetables – Eat all the vegetables you want.

2. Fruits – Fruits are good, but they have more sugar than people need so they should be kept within limits.

3. Fish and poultry

4. Oatmeal – Oatmeal eats up cholesterol which is a primary cause of coronary heart disease.

Exercise is the other half of a heart-healthy lifestyle.

Minimum is 30 minutes of vigorous exercise at least every other day if not every day.

Weight bearing exercises are also important.

“ The group of people who that get the best benefit from lifting weights is older women. They fall and fracture their hips because they don’t have enough calcium in their bones. Exercising against weight puts calcium in our bones to protect our bones against things like falls. You need to do things to increase your strength, to build muscle, to build bones, and aerobic exercise keeps your heart pumping.” - Dr. Charles Mild

twhitehead@valleystar.com

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