heart Surgery

Many doctors have welcomed the plan to construct a Bi-Plane Catheterization (Cath) Lab at the San Fernando General Hospital (SFGH), noting that it would contribute to the economy by creating greater capacity within the public sector health system.

UDECOTT has currently put out a request for proposals for a Design Build Contractor to provide “Design, Construction and Equipping services for the establishment of a Cardiac Catheterization Lab and supporting services on the Third Floor above the Accident and Emergency Building at the at the San Fernando General Hospital.”

On the vacant floor area of approximately 14,800 square feet (sq. ft.) at the Level 3 of the SFGH – Hospital Extension, the proposed area identified to house the Cath Suite is located at the western end of the entire space with an area of approximately 6,000 sq. ft. and with a concrete floor base with a ceiling height of 12 ft.

The specification outline for the lab by UDECOTT include but is not limited to a procedure room, control Room, four doctors offices, Image Processing Room, Conference Room, Mechanical room, Patient Prep and Recovery Area (8 beds) and a Biomedical Service Room.

It added that a Lab Prep Room, Server Room and Hub Room would be determined based on the contractor’s consultation and opinion.

Describing a Bi-Plane as opposed to a Single-Plane Cath Lab, Dr Morton J Kern, professor of medicine, and chief of cardiology at the Long Beach Veterans Administration Medical Centre, said in an article: “”Two heads are better than one,” the adage goes, and it applies to imaging as well.”

Kern argued that simultaneous biplane cineangiography (motion-picture photography of a fluorescent screen recording passage of a contrasting medium through the blood vessels) of the heart provides accurate images from two different points of view.

Meanwhile, research from the British Journal of Radiology has indicated that with a Bi-Plane Cath Lab “examinations would become faster, use of fluoroscopy would be reduced, fewer cineangiography runs would be required and the average radiation dose to the patient would be comparatively lower than in the case of procedures performed with single-plane imaging.”

Former Medical Director of the SFGH, Anand Chatoorgoon said that the Cath lab at the hospital is “a great idea.” Chatoorgoon told the Sunday Business Guardian: “It’s been in the pipeline for quite some time. We’ve been talking about it for quite a few years, and yes, it will be excellent for San Fernando, because there’s a lot of heart disease and coronary artery disease in San Fernando.”

Chatoorgoon also remarked that the specifications outline in the proposal by UDECOTT is adequate. He added that this would benefit the population (600,000 citizens) served by the South-West Regional Health Authority (SWRHA) because the services of such a lab would be expensive, if done privately.

According to Chatoorgoon, it depends on the procedure that one is undergoing as it pertains to the price of cardiac services. He noted: “One is a simple x-ray procedure, where you are putting in dye to see if the vessels in the heart a blocked – that’s called an angiogram. That is simpler, that maybe about $10,000 or so.”

He added that if the cardiologist has to “clear the block so that the blood can flow freely to the heart”, the cost of that service can range between $30,000 and $40,000. Chatoorgoon continued: “Remember, especially in the South, a lot of poor people can’t afford that.”

The present system, Chatoorgoon said, involves a Cardiologist contacting the ministry of health in the situation where a patient cannot afford to pay for the services. He said that this is because there’s no cardiac cath lab in South.

One cardiologist familiar with the processes at the SFGH, noted that the additional Cath lab will create necessary capacity within the nation’s public health system.

The doctor, confirmed that the government currently funds cardiac procedures to people who cannot afford to pay at private labs.

According to this doctor, the way the government currently helps, is a time consuming process, where it takes a long time to get approvals. As it pertains to the payment of the private lobs, the doctor noted that there are a lot of accounting steps in the process.

The medical professional noted that the establishment of the Cath Lab at the SFGH would improve the timeliness by which those requiring cardiac medical attention can be served.

Also speaking to the SBG, Interventional Cardiologist Dr Ronald Henry said: “One of the problems that besets persons without means at this present time is accessing advanced cardiac services.”

He maintained that a Cath lab at the SFGH would allow persons who can’t afford to have the a particular procedure done through the private sector could have it done at the hospital.

Henry explained that the significance of a Cath lab is that it, “in simple terms, provides the road map of the arteries.” He said that is to determine whether they need medicines, surgery or angioplasty services.

The practice of modern cardiology, Henry said, is intrinsically tied to the ability to image these arteries and know what one needs to do – and that is where the cath lab comes in.

According to Henry, you need cath labs for two reasons: “One is to take these pictures (I am oversimplifying, of course) to see the road map, and that’s the diagnostic aspect.”

He continued: “And then if you need to fix these things with stents and angioplasty and balloons and wires, then this is also done in a cath lab.” He noted that stents are metal scaffolds, like springs in a boil point pen, which are meant to brace open the artery after you fix them with balloons.

Henry said that there has generally been a long waiting list for people to have angiograms done. Thus, he said it makes sense to increase the capacity in the public health service.

Emergency Angioplasty Services Required As Well

Although he noted that there is justification for building a Cath Lab in San Fernando to decrease the waiting time on angiograms, Henry alluded to a bigger issue when it comes to level of “fixing.”

Henry said: “We have a larger problem when people have heart attacks and these heart attacks we are treating now in the old fashioned way, which is to give drugs and then wait and try to fix them properly afterwards (properly means with angioplasty or surgery)”.

The interventional cardiologist said that is not best way to treat heart attacks. He distinguished this treatment from people who have blocked arteries but are stable and taking medicine.

The challenge, according to Henry, is that the nation needs emergency angioplasty services to serve the nation. He asked: “How do we migrate to that, so that when people get their heart attack, they can immediately get fixed the proper way?”

The President of Caribbean Cardiac Society, Pravinde Ramoutar also confirmed this challenge to the SBG.

Ramoutar added: “The benefits of doing angioplasty, is if you do it very early, within ninety minutes of getting a heart attack.”

He argued that if a system is set up like that where these services can be delivered within 90 minutes, a lot of lives can be saved and amount of damage done to the heart would be reduced.

According to Ramoutar, such a system would go a very long way in the country and would bring T&T close to “first world status”.

Meanwhile, Henry contented that the proper implementation of a such a s system would “decrease the duration of time spent in hospital, hence saving dollars, increase the survivorship and also increase the return of the productive members of society back to work, which has huge economic benefits.”

He said that the old way of doing things, where medicine is given and the outcome is awaited contributes to the loss of lives and ultimately the loss of productive members of the labour force.

As a result of this type of treatment, people not only stay away from work longer, but many of them never return to work, because even if they survive they have parts that are weakened permanently.

Henry revealed that building a Cath lab does not facilitate emergency angioplasty because emergency angioplasty depends on teams. He noted the limiting factor for this is not infrastructure, but the human resource element.

The aggregate human resource is already available, Henry said. He added that what is necessary to facilitate emergency angioplasty services is the creation of national network (combining private and public sector) that would be set up through a round the clock scheduling system where there is always a dedicated team and space available.

Henry said, there is no reason why this should not be implemented because over a year’s time “such a s system pays for itself”. He argued that he money that would be spent on hospitalization, care and medicine would be paid back by cost savings.

However, networking would not provide an incremental benefit to the country for the chronic stable cases of cardiac disease, he said. This is why Henry believes the establishment of the Cath lab in San Fernando would help with such cases and contribute to the society.