Dec. 15, 1999 (Washington) -- In what is being described as a first for the United States, a 53-year old man with severe angina has been treated for the crippling condition Wednesday with a tiny, spinning needle that poked 15 precisely arrayed holes in the left ventricle of his heart. Angina is chest pain caused by inadequate blood flow in the arteries that supply blood to the heart.
"I feel much better. I'm breathing better," said Norman Ridgeway, as the medical team was still hovering about him in the catheterization lab. Over the last 15 years, Ridgeway has suffered through bypass surgery and 13 angioplasties. Still, his condition has continued to decline to the point that he can barely walk. In no way is Ridgeway saying that he has been cured, but he does feel much improved.
The 30-minute procedure, performed under mild sedation by Fayaz Shawl, MD, director of interventional cardiology at Washington Adventist Hospital in Takoma Park, Md., was the first in a planned series involving 15 American patients to determine if the new approach can really work.
Ultimately, Shawl hopes it may benefit the estimated 1 million Americans who suffer from severe angina.
The technique, pioneered by Shawl, is called mechanical percutaneous myocardial revascularization (MPMR) and essentially involves running a tube with a miniature drilling device into the heart. It spins at up to 2,000 revolutions per minute.
In the last 10 years physicians have been treating some of their sickest angina patients by burning holes in their hearts with lasers -- an approach generally known as myocardial revascularization. While no one knows exactly why this works, it's thought that blood flow may be enhanced by the creation of these new channels.
In spite of its promise, the laser therapy has some drawbacks, says Shawl. If it's done by traditional surgery, the death rate is almost 10%. Also, the laser system and equipment cost $250,000, compared to $10,000 to $20,000 for the drill setup.
Before the procedure, Shawl reviews an image of the patient's heart to plot his line of attack. Once the catheter is inserted, he puts a transparent grid over a video monitor and marks it each time he drills a new hole in the heart wall. Each hole is 5 mm deep and 1 mm wide.
Shawl says Ridgeway's internal heart pressure has been reduced, and the pumping function of his heart has also improved.
Shawl has done nine of the procedures on patients in India since last August, and he says they are all doing well. One of the big advantages of the catheter, says Shawl, is that it allows the physician to withdraw tissue that can be used for a biopsy. That, he says, may help show what actually causes the improved functioning of the heart.
Alan Wasserman, MD, tells WebMD that even though these procedures do give patients short-term relief, more study is needed. "Anything that relieves pain, especially something like this that is relatively safe and relatively easy to perform, is a good start," says Wasserman, chairman of medicine at George Washington University Hospital in Washington, D.C.
The device is manufactured by AngioTrax Inc. of Sunnyvale, Calif., a company in which Shawl holds stock.
- For the past 10 years, physicians have been treating patients with severe angina by burning holes into the heart with a laser.
- In a new, similar procedure, physicians are using a tiny, spinning needle to drill holes into the heart.
- It is unknown why these techniques appear to work, but researchers hypothesize that the tiny holes enhance blood flow to the heart.