医 疗 专 才

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微创型心脏手术 缩短术后康复期

心脏病是全球头号杀手,但只要及 早诊断和治疗,将有助于预防并发症如 心脏衰竭、中风、肾病等的发生,减轻 病患的痛苦。这里就请经验丰富的Dr Julian Tan为大家介绍微创型心脏手术, 以及消除人们对心脏病的误解。 问:何谓介入性心脏手术? 答:介入性心脏手术是心脏病学 的其中一个附属专科,主要通过非 手术或微创技术治疗心脏病。例如 我们可以通过手腕或腿上的小动脉, 以导管植入气囊或支架来疏通阻塞的 冠状动脉,而无需进行开胸手术。这 样,也能缩短病人在术后的康复期。 问:您最常做的介入性心脏手术 是哪些? 答:由于冠状动脉疾病(coronary artery disease)患者的人数日渐增加 冠 状 动 脉 腔 内 成 形术 ( c o r o n a r y angioplasty)也成了最普遍的介入性 心 脏 手 术 。此 外,随 着 经 皮 冠 状 动脉介入治疗(percutaneous coronary intervention,简称PCI)的技术越来越 先进,预计会有更多心脏病人选择以 导管为基础的非手术性治疗模式。 问:可以介绍目前一些较具前 沿性的介入性心脏手术或技术吗? 答:现在有越来越多病人选择 进行经桡动脉(transradial)PCI,因为 这比经股动脉(transfemoral)PCI出血 较少,康复期也较短,病人几乎在术 后便可马上恢复正常生活。 在支架技术方面,则有会逐渐 “消 失 ”的“ 生 物 可 吸 收 支 架” (bioresrobable scaffolds,简 称 BRS)。这类新支架和传统支架的功能 一样,但其特别之处在于它会在数年 后慢慢降解至血 液中。然而,不是 所有动脉变窄的病人都适合用BRS, 最好还是征询医生的意见。 另外,慢性冠状动脉闭塞病变 (Chronic Total Occlusions)传统上大多 需要进行开胸绕道手术,但随着新研发 的铁丝和新技术的诞生,医生现在能以 混合开刀手术和PCI来治疗这些病患。 主动脉狭窄的病患也可以通过经 导管主动脉瓣膜置换术(Transcatheter Aortic Valve Replacement)这个非手术 途径,来更换瓣膜。过程类似PCI, 尤其适合健康状况无法进行传统瓣膜 换置手术的年长者。 问:人们对心脏病存在哪些误解? 答:最普遍的是病人认为植入 支架后,病就痊愈了,可以不再吃药, 继续过不健康的生活。 screen-shot-2016-10-27-at-am-11-32-56 结果,他们在 不久后又得再植入支架。 还有,很多人都认为只有左胸疼痛 才是心脏病爆发的症状,其实不然。 心脏病的症状因人而异,但最常见的 包括胸部中央有压迫感、冒冷汗、下颚 疼痛、颈项疼痛、左手臂麻痹,有些 病患也会觉得上腹疼痛。 心脏病有年轻化的趋势,尤其是 有高胆固醇家族病史或风险因素的 年轻人。我最年轻的病人只有21岁, 他从14岁就开始抽烟! 总的来说,如果怀疑自己可能有 心脏问题,或有风险因素,还是建议 大家尽早就医。

CARDIOLOGY

Interventional Cardiology: A safer and less painful approach to treating heart disease

Heart disease treatment no longer involves the major open-heart surgeries like before, thanks to the advent of minimally invasive catheter-based techniques.

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Dr Julian Tan Physician & Interventional Cardiologist

The Heart Specialist Clinic 3 Mount Elizabeth #14-09/10 Mount Elizabeth Medical CentreSingapore 228510 Tel: 6690 4195 | Fax: 6235 8955 www.theheartspecialistclinic.com

How has interventional cardiology transformed heart disease treatment?

The field of interventional cardiology has allowed effective and safe treatment of heart diseases such as coronary artery disease without the need for openheart surgery, and with much shorter post-procedure downtimes. Heart patients should be made aware of the easy availability and cost-effectiveness of such less invasive treatment modalities

Could you give us some examples of interventional cardiology techniques?

An example of this would be the unblocking of clogged up coronary arteries (heart blood vessels) using balloons and stents inserted through catheters (tubes) that enter via small arteries in the leg or wrist.

What are the most common interventional procedures performed in Singapore?

The most common cardiac interventional procedure is that of coronary angioplasty or the use of balloons/stents to open up clogged up coronary arteries. This has become the bread-and-butter procedure of Interventional Cardiologists, because of the increasing prevalence of coronary artery disease in any population. Coupled with the ever advancing, new and innovative technology, increasingly more heart patients are expected to be treated using these catheterbased, non-surgical treatments.

Most people have heard of cutting-age procedures such as angioplasty; what else is new in the world of cardiology?

The benefits of coronary angioplasty using the transradial

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approach (artery at the wrist), as opposed to transfemoral approach (artery in the leg), result in less bleeding complications, shorter recovery time, and earlier mobility after angioplasty. The latest in coronary stent technology is the “disappearing” stent. These new stents, called Bioresorbable Scaffolds (BRS), work in the same way as current coronary stents on the market, but the difference is that after a couple of years, the BRS dissolves into the blood stream, leaving literally nothing behind in the newly opened artery. This concept of “leave nothing behind” is appealing to both doctors and patients, but not every type of narrowing in the arteries is suitable for treatment with the BRS.

Can you debunk some popular misconceptions about cardiac health?

MYTH: A patient is completely cured after successful coronary stenting, and can stop taking medication and resume an unhealthy lifestyle.

TRUTH: Repeated coronary stenting will be required over a short period of time, especially if the patient doesn’t take the medicine as prescribed, continues smoking or doesn’t control his blood pressure or cholesterol.

MYTH: A classic heart attack symptom occurs when pain is felt in the left side of the chest.

TRUTH: The symptoms are varied but the most commonly described symptoms are central chest “pressure”, excessive cold sweating, jaw ache, neck pain and left arm numbness. Occasionally, stomach pain can occur. When in doubt, seek immediate medical consultation.

MYTH: I am still young, so it is impossible to have a heart attack.

TRUTH: My youngest heart attack patient was only 21 years old. However, he was at high risk because he has a family history of high cholesterol, and has been smoking since the young age of 14!