A One-Man History of Cardiac Advances
TUESDAY Oct. 14, 2008 -- An 84-year-old New Jersey man is a living illustration of the progress that's been made in the diagnosis and treatment of heart disease in the past 40 years, a cardiologist reports.
"This single patient has embodied practically every major advance in cardiology over the past two generations," said Dr. Harvey S. Hecht, director of cardiovascular computed tomographic angiography at Lenox Hill Hospital in New York City, whose account is published in the Oct. 21 issue of the Journal of the American College of Cardiology.
The story begins in 1969, when the man, Murry Opatosky, was sent to the Cleveland Clinic because of angina-related, acute chest pains. There, he had the then-new X-ray diagnostic procedure called coronary angiography done by Dr. Mason Sones, the Cleveland Clinic cardiologist who invented it.
The test showed blockage of three heart arteries. Bypass surgery had not yet been developed, so his treatment was to have two arteries diverted into the heart muscle to supply it with blood, called the Vineberg procedure after its developer, D. Arthur Vineberg. Opatosky was one of the first patients to undergo the procedure.
But Opatosky's cardiac problems persisted through the years, with angina and a heart murmur. In 2006, he underwent a carotid ultrasound test and transthoracic echocardiography, which showed, among other troubles, a malfunction of the mitral valve.
When another test, the 64-detector computed tomographic angiography was performed, Opatosky became the first patient in which that procedure produced an image of a Vineberg operation.
He also had stress testing to evaluate the blood flow to his heart, Hecht said.
"So, over the course of the decades, he had every noninvasive diagnostic cardiac procedure done," Hecht said.
The artery-opening procedure called angioplasty, implants of drug-eluting stents and a defibrillator round out Opatosky's treatment picture.
"Dr. Roubin did a good job on me," Opatosky said. "First, he put three stents into my right carotid artery, and then, after angiography, he put another stent into the other carotid artery." He was referring to Dr. Gary Roubin, chairman of the department of interventional cardiology at Lenox Hill Hospital. The carotid arteries carry blood to the brain.
Opatosky, who lives in Wall Township, near Asbury Park, said he's feeling good these days. But he regrets that he doesn't see enough of his six grandchildren. "They're all over the country," he said. "It's a different world today."
Said Hecht, "You can see how far we have come by looking at this one person who encapsulates progress in cardiology over the last 40 years."
Dr. Samir Kapadia, an interventional cardiologist at the Cleveland Clinic, agreed. "It's remarkable that we can see the whole history of cardiac revascularization in a single patient," he said.
"It is remarkable to see how one patient can go through each of these innovative things and benefit from them at each point in time," Kapadia added. "Advancement is now so fast that we can see great differences in a lifetime."
You can get detailed descriptions of cardiac tests and procedures from the American Heart Association.
Posted: October 2008