Written by Dr Atul Mathur
I still remember my early training days in medicine in the mid-1980s when a middle-aged heart attack patient kept writhing in pain for hours due to limited diagnostic and therapeutic options. Today, like in other fields of medicine, cardiac care has evolved leaps and bounds to precise and minimally invasive therapeutic options. The latest technology is not just restricted to a few major centres in big cities but has percolated to tier B and C cities of our country as well.
We have moved from heart surgeries in a standstill heart supported by a heart lung machine to minimally invasive and robotic bypass on a beating heart and a pin-hole open heart surgery for valve replacement, using sleek and extremely durable artificial valves. These surgeries are precisely guided by intra-operative digital imaging by trans-esophageal echocardiography (TEE) to optimise outcomes while all patient vital parameters are closely monitored digitally to ensure safety.
STENTING MADE EASY
The non-surgical percutaneous interventions have evolved even faster, riding on the wave of rapid advance in digital technology, achieving precise and far improved outcomes. Use of a special pressure wire across the coronary blockages guides us today in precisely selecting only those blockages that would benefit from an intervention. Hence an unnecessary procedure is avoided in a multitude of patients where ambiguity drives the physician to over-treat rather than take a chance. Coronary stenting procedures for long were restricted to treating simple blockages only. Digital imaging techniques like intra-vascular ultrasound (IVUS) and optical coherence tomography (OCT) visualise the coronary artery which is being treated from inside. This allows extremely precise placement of stents in even very complex diseased portions of the artery with high calcium content or long blockages or blockages at branching points. All these tough lesions had suboptimal stenting outcomes with higher recurrence rates in early days when such imaging guidance was not available.
OPEN HEART SURGERY A THING OF THE PAST
Other than coronary arteries, there are many structural diseases of the heart involving the valves and holes in the heart, that are being treated with non-surgical percutaneous techniques. Most valve diseases earlier required a major open-heart surgery. These procedures are now being guided by advanced digital technology applied in echocardiography, which is now even happening from within the heart (intra-cardiac echocardiography or ICE). This allows a three-dimensional viewing of the heart (3-D Echo). The precise pre-procedural planning of most such cases is enabled by advanced computerised tomographic (CT) imaging. Disorders of heart rhythm often need accurate ablation of trigger points within the heart, which is now enabled by a three-dimensional mapping. The success of such procedures has significantly reduced morbidity and the need of prolonged medication with side effects.
CORRECTING CONGENITAL DEFECTS
It is devastating for young parents who bear children with a birth defect. Digital imaging has now allowed early and precise diagnosis of congenital heart disorders in the foetus to enable timely treatment and avoid lifelong deformity in many of them. The convergence of surgical as well as non-surgical procedures towards minimally invasive techniques will go a long way in alleviating human suffering.
HOW DIGITISED RECORDS ENSURE CONTINUITY OF CARE
One wouldn’t fail to remember the immense role of digital record- keeping that has tremendously facilitated current cardiac therapy by lowering errors and maintaining continuity of care. The future is already here in artificial intelligence getting rapidly incorporated in our machines employed in cardiac diagnostics and the role envisaged by 3-D printing techniques to assist in manufacture of prosthetic implants meant to replace diseased portions of the heart and blood vessels. Nearly everyone now carries a smartphone, and lakhs of people use wearable devices to track their health using an Apple Watch or similar gadgets. Instead of an annual visit, health tracking information for many patients is now available 24×7 for the entire year.
Here also smart software and artificial intelligence are being incorporated into the wearable applications to detect abnormality of heart rate and rhythm, oxygen saturation, lung congestion and body temperature, alerting patients to contact their doctors. It is indeed heartening to see the evolution of such technology in our country and the rapidly narrowing gap when compared with facilities available in the best of the developed world.
Lastly but not the least, the role of digital technology in spreading medical education across the country cannot be underestimated. A young cardiologist or cardiac surgeon while sitting at home or in the office can watch and learn the steps of a new technique which he can subsequently use for his patients. He can even be proctored using current audio-visual technology by an expert sitting in another part of the world while he is performing a new procedure on his patient. This concept is a game changer enabling rapid spread of uniform high-quality care of our patients in the remotest parts of the country.