August 22, 2017, 5:19 pm
Facebook iconTwitter iconYouTube iconGoogle+ icon
1 Philippine Peso = 0.07147 UAE Dirham
1 Philippine Peso = 2.19187 Albanian Lek
1 Philippine Peso = 0.03469 Neth Antilles Guilder
1 Philippine Peso = 0.33668 Argentine Peso
1 Philippine Peso = 0.02451 Australian Dollar
1 Philippine Peso = 0.03464 Aruba Florin
1 Philippine Peso = 0.03892 Barbados Dollar
1 Philippine Peso = 1.5756 Bangladesh Taka
1 Philippine Peso = 0.03242 Bulgarian Lev
1 Philippine Peso = 0.00733 Bahraini Dinar
1 Philippine Peso = 33.60051 Burundi Franc
1 Philippine Peso = 0.01946 Bermuda Dollar
1 Philippine Peso = 0.02651 Brunei Dollar
1 Philippine Peso = 0.13349 Bolivian Boliviano
1 Philippine Peso = 0.06121 Brazilian Real
1 Philippine Peso = 0.01946 Bahamian Dollar
1 Philippine Peso = 1.2483 Bhutan Ngultrum
1 Philippine Peso = 0.19907 Botswana Pula
1 Philippine Peso = 389.56996 Belarus Ruble
1 Philippine Peso = 0.03888 Belize Dollar
1 Philippine Peso = 0.02447 Canadian Dollar
1 Philippine Peso = 0.01877 Swiss Franc
1 Philippine Peso = 12.5721 Chilean Peso
1 Philippine Peso = 0.12979 Chinese Yuan
1 Philippine Peso = 58.11442 Colombian Peso
1 Philippine Peso = 11.13232 Costa Rica Colon
1 Philippine Peso = 0.01946 Cuban Peso
1 Philippine Peso = 1.82448 Cape Verde Escudo
1 Philippine Peso = 0.43076 Czech Koruna
1 Philippine Peso = 3.44814 Djibouti Franc
1 Philippine Peso = 0.1229 Danish Krone
1 Philippine Peso = 0.91224 Dominican Peso
1 Philippine Peso = 2.13275 Algerian Dinar
1 Philippine Peso = 0.25874 Estonian Kroon
1 Philippine Peso = 0.34501 Egyptian Pound
1 Philippine Peso = 0.45257 Ethiopian Birr
1 Philippine Peso = 0.01654 Euro
1 Philippine Peso = 0.03921 Fiji Dollar
1 Philippine Peso = 0.0151 Falkland Islands Pound
1 Philippine Peso = 0.01511 British Pound
1 Philippine Peso = 0.08543 Ghanaian Cedi
1 Philippine Peso = 0.87566 Gambian Dalasi
1 Philippine Peso = 172.07628 Guinea Franc
1 Philippine Peso = 0.14152 Guatemala Quetzal
1 Philippine Peso = 3.97957 Guyana Dollar
1 Philippine Peso = 0.15221 Hong Kong Dollar
1 Philippine Peso = 0.45349 Honduras Lempira
1 Philippine Peso = 0.12172 Croatian Kuna
1 Philippine Peso = 1.20354 Haiti Gourde
1 Philippine Peso = 5.01888 Hungarian Forint
1 Philippine Peso = 259.9533 Indonesian Rupiah
1 Philippine Peso = 0.07033 Israeli Shekel
1 Philippine Peso = 1.2483 Indian Rupee
1 Philippine Peso = 22.7087 Iraqi Dinar
1 Philippine Peso = 640.80562 Iran Rial
1 Philippine Peso = 2.08893 Iceland Krona
1 Philippine Peso = 2.47247 Jamaican Dollar
1 Philippine Peso = 0.01374 Jordanian Dinar
1 Philippine Peso = 2.12376 Japanese Yen
1 Philippine Peso = 2.00234 Kenyan Shilling
1 Philippine Peso = 1.33721 Kyrgyzstan Som
1 Philippine Peso = 79.92995 Cambodia Riel
1 Philippine Peso = 8.16852 Comoros Franc
1 Philippine Peso = 17.51314 North Korean Won
1 Philippine Peso = 22.14964 Korean Won
1 Philippine Peso = 0.00587 Kuwaiti Dinar
1 Philippine Peso = 0.01596 Cayman Islands Dollar
1 Philippine Peso = 6.48297 Kazakhstan Tenge
1 Philippine Peso = 161.09555 Lao Kip
1 Philippine Peso = 29.29364 Lebanese Pound
1 Philippine Peso = 2.98307 Sri Lanka Rupee
1 Philippine Peso = 2.22611 Liberian Dollar
1 Philippine Peso = 0.26095 Lesotho Loti
1 Philippine Peso = 0.05932 Lithuanian Lita
1 Philippine Peso = 0.01208 Latvian Lat
1 Philippine Peso = 0.02661 Libyan Dinar
1 Philippine Peso = 0.1842 Moroccan Dirham
1 Philippine Peso = 0.34588 Moldovan Leu
1 Philippine Peso = 1.01323 Macedonian Denar
1 Philippine Peso = 26.52267 Myanmar Kyat
1 Philippine Peso = 47.3633 Mongolian Tugrik
1 Philippine Peso = 0.15677 Macau Pataca
1 Philippine Peso = 7.02471 Mauritania Ougulya
1 Philippine Peso = 0.64623 Mauritius Rupee
1 Philippine Peso = 0.30142 Maldives Rufiyaa
1 Philippine Peso = 13.93073 Malawi Kwacha
1 Philippine Peso = 0.34414 Mexican Peso
1 Philippine Peso = 0.08344 Malaysian Ringgit
1 Philippine Peso = 0.25604 Namibian Dollar
1 Philippine Peso = 7.1006 Nigerian Naira
1 Philippine Peso = 0.58844 Nicaragua Cordoba
1 Philippine Peso = 0.1538 Norwegian Krone
1 Philippine Peso = 1.99066 Nepalese Rupee
1 Philippine Peso = 0.02661 New Zealand Dollar
1 Philippine Peso = 0.00749 Omani Rial
1 Philippine Peso = 0.01946 Panama Balboa
1 Philippine Peso = 0.06301 Peruvian Nuevo Sol
1 Philippine Peso = 0.06168 Papua New Guinea Kina
1 Philippine Peso = 1 Philippine Peso
1 Philippine Peso = 2.0504 Pakistani Rupee
1 Philippine Peso = 0.07069 Polish Zloty
1 Philippine Peso = 108.34793 Paraguayan Guarani
1 Philippine Peso = 0.07086 Qatar Rial
1 Philippine Peso = 0.07605 Romanian New Leu
1 Philippine Peso = 1.14343 Russian Rouble
1 Philippine Peso = 16.06149 Rwanda Franc
1 Philippine Peso = 0.07297 Saudi Arabian Riyal
1 Philippine Peso = 0.1508 Solomon Islands Dollar
1 Philippine Peso = 0.26075 Seychelles Rupee
1 Philippine Peso = 0.1296 Sudanese Pound
1 Philippine Peso = 0.15772 Swedish Krona
1 Philippine Peso = 0.02651 Singapore Dollar
1 Philippine Peso = 0.01511 St Helena Pound
1 Philippine Peso = 0.43211 Slovak Koruna
1 Philippine Peso = 145.94279 Sierra Leone Leone
1 Philippine Peso = 10.8776 Somali Shilling
1 Philippine Peso = 405.39601 Sao Tome Dobra
1 Philippine Peso = 0.17027 El Salvador Colon
1 Philippine Peso = 10.02102 Syrian Pound
1 Philippine Peso = 0.25583 Swaziland Lilageni
1 Philippine Peso = 0.64604 Thai Baht
1 Philippine Peso = 0.04749 Tunisian Dinar
1 Philippine Peso = 0.04262 Tongan paʻanga
1 Philippine Peso = 0.06846 Turkish Lira
1 Philippine Peso = 0.13124 Trinidad Tobago Dollar
1 Philippine Peso = 0.58973 Taiwan Dollar
1 Philippine Peso = 43.43258 Tanzanian Shilling
1 Philippine Peso = 0.49523 Ukraine Hryvnia
1 Philippine Peso = 69.99416 Ugandan Shilling
1 Philippine Peso = 0.01946 United States Dollar
1 Philippine Peso = 0.55517 Uruguayan New Peso
1 Philippine Peso = 80.17124 Uzbekistan Sum
1 Philippine Peso = 0.19409 Venezuelan Bolivar
1 Philippine Peso = 442.24558 Vietnam Dong
1 Philippine Peso = 2.01985 Vanuatu Vatu
1 Philippine Peso = 0.04832 Samoa Tala
1 Philippine Peso = 10.84141 CFA Franc (BEAC)
1 Philippine Peso = 0.05254 East Caribbean Dollar
1 Philippine Peso = 10.76455 CFA Franc (BCEAO)
1 Philippine Peso = 1.95213 Pacific Franc
1 Philippine Peso = 4.86379 Yemen Riyal
1 Philippine Peso = 0.25581 South African Rand
1 Philippine Peso = 100.98268 Zambian Kwacha
1 Philippine Peso = 7.04223 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

Requiem for life

By ABIGAIL VALTE | August 22,2017
‘But the outrage is palpable this time, perhaps because the brazenness and impunity was caught on tape for all the world to see.’

Opinion of the Day

America losing its soft power in Southeast Asia (1)

By NESTOR MATA | August 22, 2017
‘Geopolitical analysts predict the end of America’s power in Asia.’