29 Feb 2012

The Day, Part 2–Description of Angioplasty procedure

Following the recent angioplasty at hospital, I am now back home, and can write about the actual procedure itself. The delay is due to a sore wrist. The entry to the heart was done via my right wrist, right on the joint.

The procedure for an angioplasty is similar to that of an angiogram, with some minor differences which I will explain in my post as I go along. I was the last patient, so despite being prepped by 11 AM (I was at the hospital by 9:30 AM), I went to theatre at 2 PM. The wait is nerve wracking, something I am sure patients not familiar with either angiogram or angioplasty will find discomforting. However, both procedures are very safe and thousands are done daily without problems.

I was spoken to by the Registrar (while the consultant was in theatre setting up) at 10 AM, pre-surgery. The entire procedure, benefits as well as risks, was explained very thoroughly and I was given ample opportunity to ask as many questions as I needed to. No rush, and no hoggish attitude a là Third World ‘tin Gods’. I was even provided with hot tea, and a sandwich and biscuits!

Anyway, at 2 PM I was wheeled into the theatre by a nurse. Again, First World precautions started… before I entered the theatre, I was checked thoroughly as to my identity - hospital bracelet (barcoded too) checked, and I had to answer several questions regarding personal information in my file only I would know. Identity confirmed, I entered and lay on the table.

I was covered with a sheet, my right arm extended off the table but supported by a large plastic ‘board’ which extended off the table on the right side. My arm was raised and a sterile sheet covered me, with only a hole about 4 inches in diameter (yes, it was round) which opened directly over the wrist.

The screens (3) were on my left, across the table from the doctor. One screen on the left showed my name alone, the middle one the X-ray videos/photos of my heart and the right my vital signs (via an ECG machine and blood pressure monitoring equipment etc.). Two IVs were set up, one with the contrast dye and the other with water to flush when needed. A third with a vasodilator was later added, but attached to a cannula inserted in my left forearm. Over me was a highly manoeuvrable  X-ray machine manipulated by a technician standing at my feet, while the table itself was controlled in height, angle (forward or back) by the surgeon via control pedals at his feet.

The surgeons were the consultant, the registrar and a visiting professor of cardiology from Italy. Three very experienced doctors, plus a very experienced team of nurses, technicians, anaesthetist etc.

Stent Before 1

The photo on the left is one of the ‘souvenir’ pictures given to me (at my request) showing the clogged artery (circumflex) at the back of the heart.

You can see that the clog was sufficient that the contrast dye almost does not show up, indicating reduced flow of blood in that area.

First, my wrist was injected with an anaesthetic which was given about 2 minutes to work, at my request. (^_^)

Next, an incision was made in the wrist at the same point at my last angiogram. What happened next was an unbelievable amount of pain that left me writhing on the table as the surgeons tried to put the catheter in. Apparently what happened was that the old scar tissue from the initial angiogram had gotten hardened on the artery and the catheter was difficult to insert. The surgeons took a scalpel, made a nick and voilà, in it went.

The catheter was inserted and went all the way into my heart through the artery passing through my right shoulder. You can see the catheter appearing as that big ‘fish hook’ shadow in the upper left of the picture. The contrast dye lights up the blood vessels brilliantly, as you can see.

Stent After 1Out of two blocked arteries, one showed minimal restrictions in blood flow and was left without treatment (though later on some work may be needed). At the moment though, the risks are not worth the trouble since I gain no actual benefit.

The second, the circumflex in the picture, had a stent put in. You can see on the left the blood flow immediately as the stent was opened. To do this, the vasodilator was injected into my veins and I immediately felt sick… my heart (and my intestines) began feeling as if I had run a marathon non-stop and wanted to faint and vomit at the same time but couldn't decide which. (^_^)

After the catheter was deflated and removed, a clamp was placed on my wrist to restrict blood flow from the cut. This clamp was actually unusual in that it was a Velcro locked plastic strap filled with air pockets underneath, next to the skin. Once the strap was in place, a syringe was used to inject 10 CC’s of air into these pockets which tightened the clamp immediately. It was removed about 4 hours after by drawing the air out in stages and then unstrapping.

Then, back to the ward for overnight observation and home in the evening.

Today, two days after, I have minimal pain, and feel vastly different prior to surgery. A childhood friend who is also a highly skilled cardiothoracic surgeon (THE Man) did mention I will feel a lot better. He was right.