CARDIAC CASE STUDY - Rotablation (high speed drilling through calcium) assisted leftmainstem/LAD/Lcx PTCA (coronary stenting)- 1st of its kind in Sri Lanka and a UNIQUE CASE in SOUTH ASIA.
Mrs Vishaka Nancy Cook (patient) and Mr Roshan Cook (her son) were getting ready to leave hospital when we visited her room barely 48hrs after this unique procedure.
Mrs Cook, at the age of 84 is a person who had travelled frequently overseas as her sons live around the world. She was an ex-journalist for the Daily News paper which she mentioned proudly to us. She looked a strong nice little lady. Next to her was her strong
and tall son who was beaming in happiness to see his
mother up on her feet and happy.On the night of 23rd of September 2014, Mrs Cook experienced tightness in the chest and palpitations and was investigated urgently by referral to Dr Pandula Athaudaarachchi, Resident Consultant interventional Cardiologist at #Durdans
It was identified that she had a cardiac rhythm problem brought on by lack of blood supply to the heart. A coronary angiogram undertaken
had shown heavily calcified (hardened) and severely narrowed left main and main branch narrowings upto 90%. She had Diabetes and Hypertension with other complications.
Under normal circumstances, a bypass operation may have been the only suitable option available, but joint heart team review was conducted due to the complexity of the case; Dr Kesava Dev presented the pros and cons of open heart surgery and Dr Pandula
Athaudaarachchi had given the perspective of novel interventional cardiology procedure of rotablation assited percutaneous coronary intervention (PTCA) in the left main artery. Both had spoken to Mrs Cook and the family. With her medical conditions and age,
the interventional approach, despite the technical challenges, had a lower risk and a quicker return to normalcy and was accepted.
Dr Pandula Athaudaarachchi had performed many such complex procedures in many years of his overseas training in UK both as an interventional fellow and a consultant. He is formally recognised in UK as a trained consultant operator in this complex procedure.
He detailed out the plans A, B, C to the family and safety nets should a difficulty arise, which made the family very confident to proceed with the new technique.
Rotablation assisted leftmainstem / LAD / Lcx PTCA (stenting) was conducted under the support of a intra-aortic balloon pump and impressively the patient was awake throughout the procedure and comfortable with local anaesthetia.
Dr Dushyanthi Perera, Consultant Anaesthetist was on standby if a need arises for ventilatory support, but the procedure was carried out seamlessly and precisely, within 2 hours without any complication- the left main,and its two big branches had all been drilled, expanded
and 3 stents deployed with precision to achieve a perfect result within these 2 hours.
The patient could eat and drink immediately afterwards and the balloon pump could be removed after 6 hours. The patient could walk within 24 hours and was ready for discharge next day. This procedure was a huge success given the technical complexity and was an impressive quick recovery for the 84 year old lady.
‘Really fantastic staff! They were all very helpful. Both doctors explained the procedure and its risk factors very well. Mainly, because of Dr Pandula’s excellent planning and methodical ways of handling this complex procedure, we were assured and confident in going
ahead with the right decision’ were the concluding words from Mr Roshan Cook.
Dr Pandula Athaudaarachchi Commented “The skill and
technolgy for such complex procedures is here and I am glad that I can offer our patients state-of-the-art coronary treatment on par with the world’s developed countries, so that they do not have to travel overseas
to get such treatment at a huge cost and risking their lives. I wish more such patients will be sent in by their physicians for treatment-many people did not have such options for a long time”.
Before I left her room, Mrs Cook stood for a photograph
with Dr Pandula and her son, with a lot of joy in her