May 28, 2018, 1:26 am
Facebook iconTwitter iconYouTube iconGoogle+ icon
1 Philippine Peso = 0.06987 UAE Dirham
1 Philippine Peso = 2.04394 Albanian Lek
1 Philippine Peso = 0.03405 Neth Antilles Guilder
1 Philippine Peso = 0.46707 Argentine Peso
1 Philippine Peso = 0.02507 Australian Dollar
1 Philippine Peso = 0.03386 Aruba Florin
1 Philippine Peso = 0.03804 Barbados Dollar
1 Philippine Peso = 1.58684 Bangladesh Taka
1 Philippine Peso = 0.03178 Bulgarian Lev
1 Philippine Peso = 0.00718 Bahraini Dinar
1 Philippine Peso = 33.30759 Burundi Franc
1 Philippine Peso = 0.01902 Bermuda Dollar
1 Philippine Peso = 0.02521 Brunei Dollar
1 Philippine Peso = 0.13049 Bolivian Boliviano
1 Philippine Peso = 0.06941 Brazilian Real
1 Philippine Peso = 0.01902 Bahamian Dollar
1 Philippine Peso = 1.2997 Bhutan Ngultrum
1 Philippine Peso = 0.18862 Botswana Pula
1 Philippine Peso = 380.82557 Belarus Ruble
1 Philippine Peso = 0.038 Belize Dollar
1 Philippine Peso = 0.02456 Canadian Dollar
1 Philippine Peso = 0.01888 Swiss Franc
1 Philippine Peso = 11.92087 Chilean Peso
1 Philippine Peso = 0.1215 Chinese Yuan
1 Philippine Peso = 54.23245 Colombian Peso
1 Philippine Peso = 10.69241 Costa Rica Colon
1 Philippine Peso = 0.01902 Cuban Peso
1 Philippine Peso = 1.79018 Cape Verde Escudo
1 Philippine Peso = 0.41871 Czech Koruna
1 Philippine Peso = 3.37645 Djibouti Franc
1 Philippine Peso = 0.12092 Danish Krone
1 Philippine Peso = 0.9416 Dominican Peso
1 Philippine Peso = 2.20987 Algerian Dinar
1 Philippine Peso = 0.25394 Estonian Kroon
1 Philippine Peso = 0.33993 Egyptian Pound
1 Philippine Peso = 0.51779 Ethiopian Birr
1 Philippine Peso = 0.01623 Euro
1 Philippine Peso = 0.03907 Fiji Dollar
1 Philippine Peso = 0.01422 Falkland Islands Pound
1 Philippine Peso = 0.01425 British Pound
1 Philippine Peso = 0.08823 Ghanaian Cedi
1 Philippine Peso = 0.89024 Gambian Dalasi
1 Philippine Peso = 171.23835 Guinea Franc
1 Philippine Peso = 0.13955 Guatemala Quetzal
1 Philippine Peso = 3.93875 Guyana Dollar
1 Philippine Peso = 0.14924 Hong Kong Dollar
1 Philippine Peso = 0.45305 Honduras Lempira
1 Philippine Peso = 0.11993 Croatian Kuna
1 Philippine Peso = 1.23264 Haiti Gourde
1 Philippine Peso = 5.18261 Hungarian Forint
1 Philippine Peso = 268.49914 Indonesian Rupiah
1 Philippine Peso = 0.06761 Israeli Shekel
1 Philippine Peso = 1.28921 Indian Rupee
1 Philippine Peso = 22.52235 Iraqi Dinar
1 Philippine Peso = 800.64676 Iran Rial
1 Philippine Peso = 2.00476 Iceland Krona
1 Philippine Peso = 2.38368 Jamaican Dollar
1 Philippine Peso = 0.01348 Jordanian Dinar
1 Philippine Peso = 2.08195 Japanese Yen
1 Philippine Peso = 1.91839 Kenyan Shilling
1 Philippine Peso = 1.2975 Kyrgyzstan Som
1 Philippine Peso = 77.23036 Cambodia Riel
1 Philippine Peso = 7.96595 Comoros Franc
1 Philippine Peso = 17.12003 North Korean Won
1 Philippine Peso = 20.46376 Korean Won
1 Philippine Peso = 0.00575 Kuwaiti Dinar
1 Philippine Peso = 0.0156 Cayman Islands Dollar
1 Philippine Peso = 6.24805 Kazakhstan Tenge
1 Philippine Peso = 158.41735 Lao Kip
1 Philippine Peso = 28.6285 Lebanese Pound
1 Philippine Peso = 3.00552 Sri Lanka Rupee
1 Philippine Peso = 2.59102 Liberian Dollar
1 Philippine Peso = 0.23569 Lesotho Loti
1 Philippine Peso = 0.05799 Lithuanian Lita
1 Philippine Peso = 0.0118 Latvian Lat
1 Philippine Peso = 0.02586 Libyan Dinar
1 Philippine Peso = 0.18008 Moroccan Dirham
1 Philippine Peso = 0.31929 Moldovan Leu
1 Philippine Peso = 0.99391 Macedonian Denar
1 Philippine Peso = 25.77516 Myanmar Kyat
1 Philippine Peso = 45.76412 Mongolian Tugrik
1 Philippine Peso = 0.15373 Macau Pataca
1 Philippine Peso = 6.73388 Mauritania Ougulya
1 Philippine Peso = 0.65627 Mauritius Rupee
1 Philippine Peso = 0.29618 Maldives Rufiyaa
1 Philippine Peso = 13.63553 Malawi Kwacha
1 Philippine Peso = 0.37196 Mexican Peso
1 Philippine Peso = 0.07566 Malaysian Ringgit
1 Philippine Peso = 0.23683 Namibian Dollar
1 Philippine Peso = 6.82899 Nigerian Naira
1 Philippine Peso = 0.59717 Nicaragua Cordoba
1 Philippine Peso = 0.15404 Norwegian Krone
1 Philippine Peso = 2.06962 Nepalese Rupee
1 Philippine Peso = 0.02745 New Zealand Dollar
1 Philippine Peso = 0.00732 Omani Rial
1 Philippine Peso = 0.01902 Panama Balboa
1 Philippine Peso = 0.0621 Peruvian Nuevo Sol
1 Philippine Peso = 0.06201 Papua New Guinea Kina
1 Philippine Peso = 1 Philippine Peso
1 Philippine Peso = 2.19897 Pakistani Rupee
1 Philippine Peso = 0.06975 Polish Zloty
1 Philippine Peso = 108.10348 Paraguayan Guarani
1 Philippine Peso = 0.06924 Qatar Rial
1 Philippine Peso = 0.0751 Romanian New Leu
1 Philippine Peso = 1.17631 Russian Rouble
1 Philippine Peso = 16.13468 Rwanda Franc
1 Philippine Peso = 0.07134 Saudi Arabian Riyal
1 Philippine Peso = 0.15092 Solomon Islands Dollar
1 Philippine Peso = 0.25547 Seychelles Rupee
1 Philippine Peso = 0.34155 Sudanese Pound
1 Philippine Peso = 0.16566 Swedish Krona
1 Philippine Peso = 0.02546 Singapore Dollar
1 Philippine Peso = 0.01422 St Helena Pound
1 Philippine Peso = 0.42241 Slovak Koruna
1 Philippine Peso = 149.32471 Sierra Leone Leone
1 Philippine Peso = 10.69051 Somali Shilling
1 Philippine Peso = 397.78391 Sao Tome Dobra
1 Philippine Peso = 0.16644 El Salvador Colon
1 Philippine Peso = 9.79608 Syrian Pound
1 Philippine Peso = 0.23678 Swaziland Lilageni
1 Philippine Peso = 0.60662 Thai Baht
1 Philippine Peso = 0.0483 Tunisian Dinar
1 Philippine Peso = 0.04363 Tongan paʻanga
1 Philippine Peso = 0.08961 Turkish Lira
1 Philippine Peso = 0.1286 Trinidad Tobago Dollar
1 Philippine Peso = 0.56886 Taiwan Dollar
1 Philippine Peso = 43.27563 Tanzanian Shilling
1 Philippine Peso = 0.49705 Ukraine Hryvnia
1 Philippine Peso = 71.0291 Ugandan Shilling
1 Philippine Peso = 0.01902 United States Dollar
1 Philippine Peso = 0.5933 Uruguayan New Peso
1 Philippine Peso = 151.83565 Uzbekistan Sum
1 Philippine Peso = 1494.25528 Venezuelan Bolivar
1 Philippine Peso = 433.30797 Vietnam Dong
1 Philippine Peso = 2.03595 Vanuatu Vatu
1 Philippine Peso = 0.04914 Samoa Tala
1 Philippine Peso = 10.63667 CFA Franc (BEAC)
1 Philippine Peso = 0.05136 East Caribbean Dollar
1 Philippine Peso = 10.63667 CFA Franc (BCEAO)
1 Philippine Peso = 1.926 Pacific Franc
1 Philippine Peso = 4.75366 Yemen Riyal
1 Philippine Peso = 0.23681 South African Rand
1 Philippine Peso = 98.716 Zambian Kwacha
1 Philippine Peso = 6.88415 Zimbabwe dollar

Beating heart surgery

OFF Pump Coronary Artery Bypass surgery is the most popular minimally invasive heart bypass operation today, one that is done on a beating heart. Conventionally, coronary bypass is done on an arrested heart (chemically-induced cardiac arrest to allow for a quiet field) with the patient connected to a heart-lung machine (pump) that temporarily takes over the oxygenation (lung function) and circulation (heart function) of the patient while the surgery is going on.

Is OPCAB better?

If at all possible, OPCAB, or beating heart surgery, is preferred. Doing the coronary bypass on a beating (non-arrested) heart precludes the use of the heart lung machine. This pump has the potential of destroying some blood cells, of wasting some essential clotting factors in the blood, and of forming blood clots or air bubbles that could cause stroke, albeit very rare. So, not using the heart-lung machine is a definite advantage, much less invasive and stressful for the patient. As a result, OPCAB patients recover a lot faster, go home much sooner, usually after 3-4 days after surgery. However, OPCAB is not for everyone.

How is the heart stilled?

With the patient connected to the pump, the heart is arrested by lowering the body temperature (thru blood cooling using a special cooler machine connected to the pump) down to about 28-30 degrees centigrade, and by giving the patient a high dose of potassium chloride which stops the heart beat in a relaxed (flabby) muscular state. This allows the cardiac surgeon to make tiny (2 mm-4 mm) anastomoses (suturing together two arteries or a vein and an artery of the heart, like sewing a sleeve to the shirt, an end-to-side or T-connection) using a magnifying surgical loop (special eyeglasses for an enlarged view), on a non-beating heart.

What are the sizes of the arteries?

The coronary arteries (which feed the muscles of the heart) and the internal mammary arteries (which are harvested as grafts from the undersurface of the breast bone, one from the left and one from the right side) are usually about 2 to 3 millimeters in diameter, about the size of a round toothpick or the lead in pencils. The vein grafts that are harvested from the leg are on the average about 4 to 5 mm in diameter.

To connect vessels this small, we arrest the heart and use a magnifying loop as mentioned above for precise suturing. This is a delicate and a most essential part of the bypass surgery, and requires extreme attention to details, in order for the “pipe connection” to allow maximum blood flow, with the least resistance or impedance. Any buckling, purse-stringing, or twisting of the anastomosis will cause blood clots in the area of the T-joint which eventually blocks off, leading to failure of the surgery. This could spell a disaster, a heart attack. This particular “plumbing job” must be “perfect.”

What suture materials are used?

The sutures we use for the anastomoses have a diameter smaller than human hair. They are technically known as 6-0, 7-0, or, 8-0, which is the smallest of the three. They are prophylene (plastic-like, but with greater tensile strength) sutures, commercially called Prolene, which are non-absorbable, unlike silk, which disintegrate with time. Prolene sutures stay intact forever.

How are blockages diagnosed?

The stenoses (narrowing) or occlusion (total blockage) of the coronary arteries are diagnosed with the aid of coronary angiogram (also referred to as cardiac catherterization), where a spaghetti-sized catheter is inserted into the femoral (groin) artery under local anesthesia and its tip directed to the opening of the left and right main coronary arteries. Dye is injected into the coronary arteries and the whole procedure is recorded in a video movie. This will show the dye in motion, the diameter and integrity of the lumen (inner channel) of the arteries and whether there are blockages or none.

Why not do this test on everyone?

While cardiac catheterization is a safe procedure done daily in various heart centers around the world, it has potential complications like transient irregular heart rhythm, blood clots, arterial leak, disruption in the wall of the artery, bleeding at the puncture site in the groin. While these are rare, there is a golden rule in medicine that says tests, in general, must only be done if there is an clinical indication (justification). If a person has no symptoms or strong family history of heart disease, cardiac catheterization is not recommended. Just about the only exceptions could be an employer required executive check-up, or airline mandated test for commercial pilots. Besides, this is an expensive procedure and insurance companies do not consider this to be a reimbursable prophylactic test.

How is OPCAB done?

With the patient under general anesthesia, the chest is split in the middle, from the base of the neck down to about the tail of the sternum (breastbone), same as in the conventional technique. With OPCAB, the patient is not connected to a heart lung machine. There is a special instrument (cardiac stabilizer) that minimizes the heart action in the area of the artery to be bypassed. The rest of the heart continues to beat. This stabilizer restricts the contraction of the heart in the target area, allowing the cardiac surgeon to do his suturing, aided by a surgical loop for magnified (3-4 times) view. With beating heart surgery, the patient does not feel so zapped, rundown and tired compared to the standard procedure where heart lung machine and cardiac arrest are used.

Does every heart surgeon do OPCAB?

No. Only those who had additional training on this particular technique perform beating heart surgery. It is a more tedious procedure and more difficult for the surgeon but much easier on the patient. Putting sutures on tiny arteries while the heart is beating is just like “shooting a tiny moving target.” A surgeon has to “retrain” his mind and hands, and gets used to this cutting edge-technology to be able to do OPCAB. 

This writer had to undergo such hands-on OPCAB surgical training at the Boston University Hospital in Massachussetts, under Dr. R. Cohn, the inventor of the Genzyme Cardiac Stabilizer. My team and I did our first OPCAB on a 68-year-old American from California, a retiree in Cebu, on June 8, 1999, the first quadruple OPCAB bypass performed in the Philippines, at the Cebu Doctors University Hospital. Even in the United States, only a little more than 60% of the surgeons perform OPCAB procedures.

Is the conventional bypass obsolete?

Most definitely not. There are still a large number of patients who could be better served with the conventional on-pump heart bypass. As I stated earlier, OPCAB is not for everyone. But the trend shows more and more coronary bypass procedures are being done on beating hearts today. It stands to reason that OPCAB is here to stay.

***

Visit philipSchua.com Email: scalpelpen@gmail.com
Rating: 
Average: 4 (1 vote)

Column of the Day

Frat hazing time again...

Dahli Aspillera's picture
By DAHLI ASPILLERA | May 25,2018
‘Schools will be opening in a few weeks. Drunken sprees at hazing sites!’

Opinion of the Day

Wasted first two years

Ellen Tordesillas's picture
By ELLEN TORDESILLAS | May 25, 2018
‘Malacañang spins these firings of officials to show that Duterte is a no-nonsense, decisive chief executive. Sorry, but that’s not how we see it.’