By Michaela Gibson Morris
Tupelo's cardiologists and heart surgeons have seen the tools to diagnose and treat heart disease grow by leaps and bounds over the past 25 years.
On one end of the spectrum, cardiologists are looking at ways to catch heart disease well before it turns into a heart attack. At the other end of the spectrum, cardiologists and surgeons are exploring ways to keep hearts sick from congestive heart failure beating strongly.
"What's happening now was unheard of not too long ago," said Tupelo cardiologist Dr. David Irwin, who was an internist in Tupelo when the North Mississippi Medical Center opened its Heart Institute in 1981.
Clot-busting drugs were the first great advance, said Irwin, who went through extra training in cardiology and returned to Tupelo in 1986. The drugs gave physicians a weapon to actively fight a heart attack.
"They were a great, great advance," Irwin said. "The interventions with balloons and stents" to open clogged coronary arteries and keep them open "wouldn't work today if not for the pharmaceuticals."
With the advent of cardiac imaging with a CT scanner, Tupelo cardiologist Dr. Barry Bertolet said, more people will be checked for coronary artery disease. The 64-slice scanners are fast enough to catch a clear picture of the heart in four passes.
"There will be less undiscovered coronary artery disease," said Bertolet, who sees the scans becoming a routine screening tool in the near future. Currently, they are used in non-emergency cases with doctor's orders for specific medical reasons. "We're in the early stages of preventive cardiology."
NMMC heart surgeons are helping to pioneer the use of another medical imaging tool - the MRI - to help evaluate the health of the heart muscle, especially in patients about to go in for bypass surgery, said Dr. Vishal Sachdev, a cardiothoracic surgeon.
When a coronary artery is blocked, the portion of the heart muscle it feeds can be scarred, Sachdev said. The MRI helps the surgeons identify if the heart muscle has gone into hibernation or is dead.
"If the muscle is alive, we can do a bypass and it will be fine," Sachdev said. If the muscle is dead, "bypass alone won't take care of it."
The surgeons can use a technique called surgical ventricular restoration, which uses a special implant to help restore the shape of the heart and help it to beat more efficiently.
"You want to halt the progression into heart failure," Sachdev said.
The Tupelo cardiovascular surgeons are part of the research into the use the MRI for heart evaluation, and they've used it to help evaluate about 15 patients so far, Sachdev said.
"It will probably become the tool for the physiology of the heart," because it allows the physicians to see the size, blood flow and motion of the heart, Sachdev said.
Less of a pain in the leg
When patients need new vessels to bypass damaged coronary arteries, surgeons take veins from the leg. Now, instead of having to open the leg to remove the vein, they have a minimally invasive procedure to harvest the veins through a 2 cm incision.
"That's been a huge thing for our patients," Sachdev said. "We no longer have to cut the leg."
The surgeons have seen far fewer wound infections and faster recuperations.
Both cardiologists and the cardiothoracic surgeons have improved tools for treating atrial fibrillation - an irregular heartbeat where the two upper chambers of the heart quiver instead of contracting. The condition is caused by the heart's electrical system going awry.
The surgeons began using the MAZE procedure in 2002, which used a radio-frequency pen to zap the trouble-making heart cells.
In 2005, the Tupelo heart surgeons became one of nine groups around the country to use a new device that delivers ultrasound energy to create the electrical block to treat atrial fibrillation.
"We can do this through a small incision if we're not doing a bypass," Sachdev said. "The results are excellent so far."
Electrophysiologists - cardiologists who specialize in the heart's electrical system - have techniques to treat atrial fibrillation from the inside of the heart.
One technique mirrors what the surgeons do on the outside of the heart, using the MAZE technique. Another procedure involves mapping the heart's electrical system to identify the trouble spots where scar tissue pulls the heart's electrical system off track, said Dr. Jim Stone, an electrophysiologist.
"Atrial fibrillation is not one size fits all," and the same symptoms can result from different causes, Stone said.
Electrophysiologists are also involved in a study to see if early cardiac resynchronization therapy prevents worsening heart failure. The implantable device pairs a pacemaker and a defibrillator to keep the heart beating correctly.
"We know if they're sick from heart failure, they do benefit," Stone said. "This trial is designed to take people who are not very sick" yet from heart failure.
In the next few months, cardiologists will be able to close holes in the heart resulting from congenital defects in teens and adults, Bertolet said.
Down the road, the technology may allow physicians to do valve repairs without opening a patients chest.
In the next decade, cardiologists expect also to see a great growth in genetic therapy to treat heart failure.
"We'll be injecting genes into the heart to grow new muscle," Bertolet said.
In the operating room, robotic surgery will open the possibilities for more minimally invasive procedures, Sachdev said.
For heart failure patients, Sachdev believes coaxial pumps, which are currently used to buy dying patients more time for heart transplant, will come into use as an implantable therapy for severe heart failure.