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Michael E. DeBakey VA Medical Center - Houston, Texas

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DeBakey VA Uses Skill and Technology to Tackle Rare, Life-Threatening Medical Condition

December 2, 2008

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Faisal Bakaeen, M.D., Cardiothoracic Surgery chief (left), and Biswajit Kar, M.D., Cardiac Catheterization Laboratory director, check up on Bobby Ray Kelly, a 73-year old, U.S. Navy veteran from Houston. Bakaeen and Kar are members of the cardiovascular team at the Michael E. DeBakey Veterans Affairs Medical Center who used their expertise, teamwork, and the latest cutting-edge technology to repair Kelly’s ascending aortic pseudo-aneurysm, a rare, life-threatening medical condition. PHOTO: Bobbi Gruner


HOUSTON – Recently, a cardiovascular team at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) used their expertise, teamwork, and the latest cutting-edge technology to repair an ascending aortic pseudo-aneurysm, a rare, life-threatening medical condition.

An aneurysm is a ballooning of an artery resulting from a weakening or stretching of the arterial wall. Aneurysms may occur in any blood vessel, but the most common place is in the abdominal aorta just below the kidney arteries. The aorta is the large arterial trunk that carries blood from the heart to be distributed by branch arteries through the body. A pseudo-aneurysm is where the aorta has slightly torn and the surrounding tissue has created a sack of blood.

The patient, Bobby Ray Kelly, a 73-year old, U.S. Navy veteran from Houston, has a complex cardiac history including previous open heart surgery with aortic valve replacement and coronary artery disease.

“Treating this extremely serious medical condition traditionally requires an extensive, re-operative, open heart surgery with the use of a heart-lung machine,” said Faisal Bakaeen, M.D., Cardiothoracic Surgery chief. “Mr. Kelly was very interested in an alternative where the possible benefits included reduced risk of infection, less blood loss, less post-operative pain and trauma, decreased length of stay in hospital, and swifter recovery time.”

“The patient decided this was the type of procedure he wanted and underwent a minimally invasive, catheter-based approach in our state-of-the-art hybrid surgical suite to treat the aneurysm,” said, Biswajit Kar M.D., Cardiac Catheterization Laboratory director. “The team placed an Amplatzer® device to close the patient’s large, ascending aortic pseudo-aneurysm.”

“This procedure is very unique and has only been performed a handful of times,” said, Pranav Loyalka M.D., a member of the cardiovascular team “Mr. Kelly is doing very well and went home just a few days after the procedure.”

The MEDVAMC’s hybrid surgical suite combines endovascular, cardiac catheterization, cardiac surgical, and radiological capabilities, allowing maximum flexibility and speed in the treatment of patients with even the most complicated cardiac and vascular conditions. Many veterans with complex aortic aneurysms, for instance, may undergo multiple procedures including open surgical and minimally invasive catheterization procedures utilizing the high-tech imaging technology.

“The hybrid surgical suite enables less invasive, more accurate, and very precise treatment of cardiac and vascular diseases and conditions,” said Peter Lin M.D., Vascular Surgery chief. “Using a digital angiography system to reconstruct arteries, physicians can manipulate images and obtain a better vision of complex anatomy or overlapping blood vessels.”

During this procedure to repair the ascending aortic pseudo-aneurysm, the doctor makes a small incision in the groin and threads the delivery system and implant through blood vessels to the site of the defect. When the doctor is certain the device is placed properly, the implant is released from the delivery system and opened so that the defect is sandwiched and closed by the mesh discs. The implant remains in the body and the delivery system is removed. Once the device is in place, tissue will eventually grow over it.

“I have been so impressed with each and every doctor and nurse at the Michael E. DeBakey VA Medical Center,” said Kelly. “Dr. Bakaeen and Dr. Kar are two of the best physicians I have ever met and I am very grateful for their absolute focus on my care and recovery.”

“The positive outcome of this very unique and difficult case is a perfect example of the multidisciplinary team approach that exists between the Cardiology and Surgical specialties at the Michael E. DeBakey Veterans Affairs Medical Center,” said Biykem Bozkurt, M.D., Cardiology Section chief.

In 2007, the MEDVAMC received praise from the VA Continuous Improvement in Cardiac Surgery Program for decreasing its already exceptionally low cardiac surgery mortality rate despite increased patient load caused by the 2005 hurricanes and from the VA Inpatient Evaluation Center for having a significantly low standardized mortality rate in its Surgical Intensive Care unit for fiscal years 2005 and 2006.

“We strive to offer our veterans the latest and the best in the field of surgery and medicine,” said David Berger, M.D., Operative Care Line executive. “Our surgery service handles a high volume of patients and has been recognized for its excellent patient outcomes.”

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