By SOLA OGUNDIPE

SIXTY five-year-old Bond Chukwu Onwurah is a happy man. The source of joy of the Anambra State-born retiree and self-employed artisan is no other than Cynthia, his wife of over three decades. Fifty six-year-old Cynthia has just undergone a successful open heart surgery to correct a protracted case of chronic heart pain.

The surgical procedure which gone down in the record books as the first of such to be carried out in any Nigerian hospital, is described in medical parlance as Off-pump Coronary Artery Bypass Grafting OCABG- a modification of the regular Coronary Artery Bypass Graft (CABG)surgery. It is an invasive heart surgery performed on the beating heart to provide coronary artery bypass grafting. The technique is often referred to as off-pump CABG.

Part of the joy was that Cynthia did not have to travel abroad to find a permanent solution to her problem, she found it right here in a Nigerian hospital run by Nigerian medical specialists.  The other part was that the celebrated procedure, carried out by a medical team at the Critical Care Unit of the Lagos State University Teaching Hospital, LASUTH, was a resounding success.

Narrating the development to Sunday Health Report shortly after Cynthia, a science teacher of 26 years had, over the last five years, battled with an acute case of angina, or heart pain, occasioned by blockage of arteries in her heart, Bond described it as a miracle. He related how, prior to the land mark LASUTH surgery, the mother of six had been the first patient of alternative cardiology at Reddington Specialist Hospital, Lagos where she was first to receive a “stent” three years ago.  A second stent followed months later, but the pain gradually aggravated over time, compelling the patient to seek further help until she was referred to LASUTH.

“Indeed, the last four years have been very gruesome,” he noted. “My wife had blockages in the heart and suffered terrible heart pain (angina) everyday and every moment in the heart. She got it over again and could not walk more than three metres without needing to take a rest. It is a feat we want the world to know. Before the surgery, she was affected in every way.

According to Bond, Cynthia had been looking for help in the last five years. “She came down with this angina one day where we went to buy drugs and could not go home. It was there we were recommended us to a hospital in India for the coronary by-pass surgery.’

Surgery in LASUTH

But the N4 million bill that went with that option was the greatest inhibition. “I did not have the money to take her to India and even when we were referred to LASUTH, I had no money and was told we might have to defer the surgery, but I could not even consider that option because I had been warned that the ultimate consequence of not having the procedure was death.”

According too Bond, Cynthia was later given the procedure. “I’m happy with the surgery. I was told it would be a two-hour surgery but by the time it became a four-hour surgery I was concerned. But we believed God, prayed and waited. My apprehension was not for bad, I was not suspicious of anything.

The entire surgery cost N1.2 million. I’m yet to pay up and owing close to N1.0 million to balance. I’m happy with the staff and the professional touch at the hospital, but I’m appealing for help from Nigerians to enable me pay up the debt so my wife can return home,” he remarked.

Consultant Cardiothoracic Surgeon and Head of the LASUTH cardiac team, Dr. Bode Falase, explained that coronary artery disease develops because of hardening of the arteries (arteriosclerosis) that supply blood to the heart muscle. He said the CABG surgery was necessary to reestablish sufficient blood flow to deliver oxygen and nutrients to the heart muscle.

Explaining further, Falase said a heart attack is simply a blockage in the arteries of the heart. “As we get older, if there isn’t enough exercise, and there is high blood pressure, poor diet, other lifestyle issues, those are bad habits that are leading to damage to the arteries, which are getting blocked. And when the arteries get blocked, the heart muscles are strained and these manifests as chest pain.”

About Cynthia, he stated: “Over the last three years, as a teacher, it affected her lifestyle. She couldn’t walk without pain (angina), the arteries were blocked, but can be unblocked. We work closely with cardiologists and she was referred from Reddington Hospital, Lagos.

“In this type of problem, there are two options. One either unblocks the artery, by using a stent, and allows blood flow, or do a by-pass.

The patient was one of the first to receive a stent at Reddington, about three ago, and she has had two to date. However, the disorder is progressive. “Once started, without exercise, or proper diet, it gets worse. Despite the stents the patient was still having angina and she was referred to LASUTH.

Describing the off-pump coronary artery by-pass CABG, he said it is a dual process. “You attach the artery, so the artery that normally diverts blood to the chest now supplies blood to the damaged artery of the heart. What makes this particular procedure a bit more interesting is that it did not involve use of the heart-lung machine that would have required stoppage of the heart and for the machine to take over.

Because the coronary vessels are on the surface, so we can use the by-pass.

“The advantage of doing that is that we do not have to stop the whole heart, cause that on its own has a disadvantage. It is less invasive and has fewer disadvantages. The cost of operation is also drastically reduced.”

He said many patients who go to India for this same operation pay more for the same procedure. “We achieved two things. Prior to this, there had not been this procedure done in Nigeria. This is the first time there would be this procedure in any Nigerian hospital. To us it is a big deal, it is the first time, but the sad thing is that it should be available to more people who need it. Our facilities are under-utilised due to funding challenge. We need to overcome this challenge.

“We have done this procedure now but we hope to do more. Bond wanted his wife to have the surgery and came here and we said yes, we can do it, and we did it. But we hope to build this confidence over time.

Awareness even among our colleagues is necessary. Even among us we need to get the word out that this is available. We need to get the word out.

“We know Nigerians suffer heart attacks and our colleagues abroad have been handling the corrective surgeries. But we decided to pick the ideal. Technology is advancing, and whatever is done is in the best interest of the patient. We look at balance.”

Proposing early detection and increased awareness is the way to go, he said. “It is commonplace to still find people with heart-related problems do not go to the hospital until it is too late. There is a real need for awareness among medical persons and members of the public as a whole about these diseases. Things such as seeking help early, lifestyle modifications, watching for known risk factors and others are essential.

Also speaking, Dr. Michael Sanusi, another Cardiothoracic surgeon at the LASUTH noted: “There are preventable and non-preventable heart problems. Pregnant women should take only medicines prescribed by their doctors and avoid taking local herbs. Mothers need to know that if a child has hole in heart, should not have guilty feelings.

“Mothers should look for pointers such as ‘blue’ babies with dark lips, too tired to eat, and no energy to run about and play like other children. Poor growth rates, persistent cold, fever and other the heart cannot cope, as result of hole in heart, all pointers to heart problem.

“Prevention could begin from the womb, and there is actually an aspect of medicine called perinatology where disorders are picked up even before the baby is born babies with heart disorders can struggle for years but generally have a short life span. Many holes in the heart cases are genetic, but it is best to pick up the problem and deal with it early, this is why women should attend antenatal services during pregnancy. When a baby is born there should be a thorough check and even then there could be something such as a heart murmur that may not be picked up.”

Although the procedure isn’t at all new as it was first performed in the 1950s, the technology behind it has gradually become more sophisticated. The technique employed by the anesthesiologist and perfusionist (person monitoring blood flow) have improved tremendously to preserve cardiac function during the procedure to help the surgeon achieve the desired outcome.

According to trends in coronary artery disease and associated risk factors in sub-Saharan Africans as reported in the Journal of Human hypertension, suggest that the prevalence of coronary artery disease is steadily increasing although still comparatively low compared to what obtains in the economically developed countries. But there are concerns the trend is rapidly changing due to trends in urbanization, changes in lifestyle, acquisition of technology and the increasing numbers of tertiary care institutions.

Indeed, the prevalence of coronary heart disease risk factors in Nigerians with systemic hypertension is considered significant.

Findings show that LASUTH has incredible potential for cardiac surgery. Indeed, the institution’s cardiac unit has come a long way since the first cardiac mission in 2004.

It all began with an annual cardiac mission that is intended to evolve into a monthly routine cardiac surgery plan. Since then, a lot of progress has been made in infrastructure, equipment and personnel but observers say in order to achieve the goal of regular monthly surgery, the obvious limitations must be addressed.

In response to a submission from the Cardiac Unit and as response towards enabling the goal of conducting regular operations every month, a committee was set up to brainstorm and come up with a plan that would ensure that the goal of being able to operate regularly is achieved.