That heart stopping moment

With over a thousand open-heart operations last year alone, the dedicated team at the Heart Surgical Unit of the National Hospital continues to serve patients from all over the country.

By Kumudini Hettiarachchi

A man’s heart has stopped. With the rhythmic beating of the heart halting, the fluctuating line on the TV monitor that indicates life itself, becomes straight.

However, those around him do not panic. Just before the heart stops and even after, the quiet and measured instructions are clear and precise. There is no haste.“Start the machine. On the pump. Reduce the pressure.”

Senior Cardio-thoracic Surgeon Dr. Chandima Amarasena performing open heart surgery. Pix by M.A. Pushpa Kumara

And right before our eyes, a man’s heart has stopped, for he is undergoing open heart surgery at the Heart Surgical Unit of the National Hospital in Colombo. It is Friday, January 19, 2007.

This is also not the first. In 2006 alone, the unit carried out 1007 open heart surgeries in addition to 39 closed heart surgeries.

“We need to get the heart-lung machine to carry out the functions of the heart. Then we stop the beating of the heart, to enable us to perform the surgery,” explains Senior Consultant Cardio-thoracic Surgeon Dr. Chandima Amarasena, gowned, masked and capped in green, skilfully and intricately handling very fine surgical instruments.

Theatre J of the Heart Surgical Unit is abuzz with a medical team of about 10 headed by Dr. Amarasena and Consultant Cardio-thoracic Anaesthetist Dr. Hemantha Perera getting about their business – that of attending to the “heart troubles” of people.

Dr. Chandima Amarasena

Dispelling misconceptions that a majority of heart surgeries, both open and closed, are being done in the private sector, Dr. Amarasena gives out the good news about the service done by the state health service to the neediest of the needy in Sri Lanka. Of the open heart surgeries performed by the Heart Surgical Unit, 308 were coronary artery bypass grafting (CABG), considered difficult and complex, with the rest comprising valve replacement operations and operations for congenital heart defects such as atrial septal defects (ASDs), ventricular septal defects (VSD) and tetralogy of Fallots (TOF) etc.

How safe is heart surgery in Sri Lanka?

We lost only eight patients from among the 308 who underwent coronary artery bypass grafting last year, says Dr. Amarasena, explaining that it means the mortality rate is about 2.59%.

Dr. Hemantha Perera

The Sunday Times learns that Sri Lanka is well within the internationally-accepted 2 to 4% mortality rate for such major surgery.

There have been no deaths in connection with ASDs considered the simplest of open heart surgeries, according to Dr. Amarasena.

Such life-saving work is being done, The Sunday Times understands, amidst many constraints, including the lack of 40% of the cadres required of junior doctors, and also nursing and technical staff. Some of the equipment too needs replacing.

The state sector has only two units countrywide that carry out heart surgery -- National Hospital in Colombo and the Karapitiya Teaching Hospital in Galle. All those who are referred or who come directly to the Institute of Cardiology at the National Hospital are assessed by cardiologists and, if needing surgery, referred to the Heart Surgery or Cardio-thoracic Unit.

Patients recuperating at the Intensive Care Unit

The Sunday Times learns that this unit performs the largest number of heart operations in the country, far exceeding the number done in the private sector. The operations are free of charge, though outside they could cost from Rs. 300,000 to Rs. 1 million depending on the complexity of the surgery.

What of the dreaded “waiting list” for anxious patients and their loved ones? Do the patients have to wait years to get their hearts attended to?

“The maximum wait for a coronary artery bypass grafting is 5 to 6 months,” stresses Dr. Amarasena, adding that the patient is assessed and depending on the urgency placed on the waiting list. “This is like any other speciality, be it orthopaedics or something else,” he says, citing the case of the United Kingdom, a developed country, where patients have to be on the list for nine months for CABG under the National Health Service. At the National Hospital, the wait for ASDs is about 1 1/2 to 2 years and for valve replacement about 1 to 11/2 years.

The unit is working at maximum capacity from Monday to Saturday, even after hours and the staff is totally committed, says Dr. Amarasena adding that it is the reason why they have been able to accomplish so much.

Proof is hardly necessary. “Mata eeye kathakaranna puluwan wuna,” says O.N. Dayaratne, 51, overcome by powerful emotions, explaining that he is able to talk now. “I am well.”

Father of three, Dayaratne from Kalutara, who is into tourism felt a pain in the chest. Tests followed and he was told he needed an operation. Then came the telegram and he went under the scalpel on January 17.

When we met him on the 19th in the intensive care unit, holding a white baby pillow with a colourful butterfly sewn on it to his chest, he smiles when we ask him what he ate for breakfast. “String-hoppers,” he says, preparing to blow into some equipment with pink balls brought in by the physiotherapist to check out lung functions.

Dayaratne who is a smoker and is also suffering from diabetes has had open heart surgery for triple vessel disease.

Forty-three-year-old P.D. Jayaratne suffered a heart attack. With a triple-vessel block, his life was in jeopardy. His finances had also hit rock bottom. Two days after surgery, done free of charge, all tubes have been removed and he says he is feeling “very well”.

After surgery, heart patients are kept in the intensive care unit, then transferred to the step-down high dependency unit and finally to the ward before being discharged.

In Ward 25 of the National Hospital, where the heart patients are sent after surgery, P. Wimalawathie from Moratuwa is preparing to go home. Wracked by sudden bouts of coughing and breathlessness, she was diagnosed with a valve disorder, in the wake of rheumatic fever.

Now with a brand new mitral valve replacing the diseased one after surgery on January 12, this 47-year-old is packing her bag.
It will be just two more days, before Menaka Madhubashini, 18, will head home to Nuwara Eliya. “When I tried to do sports, I got chest pains,” she says, while Senior House Officer Dr. Chandana Gallage adds that she has undergone an ASD or the rectification of a hole in the heart.

“Now I can lead a normal life,” adds Menaka, all smiles. As The Sunday Times team talks to patients from all over the country who have either just had surgery or are awaiting surgery, the need of the country becomes clear.

More heart units, at least one in each province, would help the men, women and children with heart trouble, while the Heart Surgical Unit at the National Hospital can then move onto more complex operations and even venture into so far unexplored territory such as heart transplants.