Cardiovascular care: Year in review

The Peter Munk Cardiac Centre is the leading cardiovascular centre in the province, with clinicians and physicians brace to care for people with the most challenging and complex health issues.

The team meets compelling people daily, and performs cutting-edge surgeries and procedures to help keep patients healthy.

Read on to discover two very different stories from 2018 that illustrates PMCC’s exceptional drive and talent – and incredible people.

Beating the odds

It was a normal Friday for Amir Bacchus. Until the heartburn started. Or, at least that’s what it felt like to the 28-year-old car salesperson. “I just felt weird,” he recalls.

By Sunday, Amir’s symptoms had worsened to include back pain and a fever. After some coaxing from his wife, Sue, Amir went to a walk-in clinic, where the nurse took his blood pressure and heart rate.

A normal heart thumps anywhere between 60 and 100 times per minute. Amir’s was 186.

He was rushed to a hospital where three shocks to his heart accomplished nothing. He was then transferred to the Peter Munk Cardiac Centre (PMCC) at around 4 a.m. acutely ill.

It was Monday, two full days since Amir had originally experienced symptoms. Now, he needed life-sustaining therapy – ECMO – to help support his rapidly failing heart.

He was urgently assessed in the coronary care unit with the assistance of many, including Dr. Patrick Lawler, Dr. Vivek Rao, Dr. Juglans Alvarez, Dr. Carolina Alba and Dr. Phyllis Billia.

It was clear the team needed to make a decision, and fast. Making judgements on the turn of a dime that can fundamentally impact the course of a patient’s life is something the team at PMCC is used to doing. But this case was unique. Amir was young and was inching closer to death as the clock continued to tick. Time was on no one’s side, and many from different areas needed to drop their work, come together and brainstorm a series of solutions that would ultimately save Amir’s life.

“Our big, overarching question we asked ourselves was ‘how do we get him out of this?’” recalls Dr. Billia, who co-ordinated Amir’s initial care.

The team transferred Amir to the medical surgical intensive care unit, where he was cared for with the help of physicians, nursing, perfusionists, surgeons and respiratory therapists, to name a few.

However, within 24 hours, Amir’s heart had become distended – a consequence of his left ventricle not pumping strongly enough to empty the chamber.

Again, the team needed to act quickly. They transported Amir to the cath lab, where they would map the arrhythmia and attempt to get rid of it by burning it with a tool. And they needed to put a hole in Amir’s heart to place a tube in order to shrink the left side.

With the incredible teamwork of Drs. Nanthakumar, Chauhan and Krishnan from the electrophysiology team, catheters were placed in Amir’s groin and then blindly through the diaphragm, under the heart. Eventually, the team was able to map and mark the arrhythmia.

But, they couldn’t get rid of it.

Meanwhile, Drs Horlick and Osten were waiting in the cath lab, ready to act. Their job was to place a separate tube to help reduce some of the pressure in Amir’s left ventricle by making a hole in the upper chambers of Amir’s heart.

Except the team was forced to abandon this plan when blood started pouring out of Amir’s diaphragm. The team struggled to find the source.

With no time to spare once again, the team worked quickly to take Amir to the OR where his chest was opened. Here, Dr. Yau was able to confirm a small hole had been made in the heart. He did this by placing the catheters through the diaphragm.

The hole needed a stich to stop the bleeding. As surgery continued, Dr. Yau lifted up Amir’s heart, found the markings made previously and applied a cryoablation tool that freezes the area of the heart where the arrhythmias originate.

Sure enough, the first application of the tool settled Amir’s abnormal rhythm.

Everyone in the operating room was astounded.

“We had tried everything else, this was really our last resort,” says Dr. Billia.

This is the first time staff and clinicians at PMCC had performed an ablation in a critical ill patient supported with an ECMO machine.

“This story is an example of the “pit crew” approach to patient care: clinicians across disciplines and programs pulling together to help this young patient,” says Dr. John Granton, who was involved in Amir’s care. “It was extraordinary.”

In a few days following his life-saving procedure, the catheters that were previously inserted to help rest and support Amir’s heart were removed.

His recovery took weeks.  Throughout all of this, his wife, Sue, has been Amir’s rock, his advocate, his partner and his lifeline. “Every day, I woke up wondering ‘what is this nightmare?’” she says.

For now, his family remains focused on his recovery at home. And, since he’s likely had an arrhythmia since he was quite young, Amir and Sue are intent on having their one-year-old screened for heart disease in order to prevent him from enduring Amir’s challenging journey.

“Dr. Billia is a godsend, our angel,” says Sue. “She made him a priority, and we are so grateful Meliodas [our son] can see his Daddy – it’s a gift.”


Disarming the “bomb” in his chest

Thomas York points at the tiny scar on his left shoulder. The cut of less than one centimetre made way for a sophisticated procedure that restored his peace of mind.

“I was walking around with a bomb in my chest that could blow up at any time,” he says.

At age 71, Thomas lived the past five years with an aortic aneurysm. Repairing it is one of the most complex and delicate procedures in vascular care. And, in Thomas’ case, it was also a remarkable achievement of minimally invasive technique in Canada.

A silent and often fatal disease, an aortic aneurysm is an enlargement of the major artery that carries blood from the heart to the rest of the body. An aneurysm usually causes no symptoms, but it weakens the wall of the aorta, which can lead to a sudden rupture and massive internal bleeding.

Thomas’ “bomb” was disarmed by a surgery called endovascular thoraco-abdominal aneurysm repair.

Surgeons from the Peter Munk Cardiac Centre (PMCC) inserted a custom made graft that has branches for his bowel and kidney arteries in his aorta. This graft is a flexible synthetic tube that basically works as a new aorta in the area that is enlarged. The branches are then attached to the four bowel and kidney arteries with short bridging grafts inserted from above an artery under the collar bone.

His surgery is believed to be the first totally percutaneous aneurysm repair in Canada for this specific type of aneurysm. Thomas had a thoraco-abdominal aneurysm, which stretches from the chest all the way down to the lower abdomen.

“I woke up with this tiny cut and it’s just like magic,” says Thomas. “I could hardly believe the surgery was done. It really blew my mind that they could do something with this level of precision like this.”

Dr. Thomas Lindsay, the vascular surgeon at the PMCC who led Thomas York’s case, says the recent advances don’t impress only the patients.

After witnessing the evolution of vascular repair from open surgery to a state-of-the art minimally invasive procedure like this over the last two decades, Dr. Lindsay says he can barely believe how far medicine has come.

“My generation, we were trained to do repairs for this type of aneurysm in open surgery,” says Dr. Lindsay. “Something like this was a pipe dream when I was training.”