Michael E. DeBakey VA Medical Center - Houston, Texas

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Houston VA Docs Refuse to Give Up on Veteran with High-Risk, Difficult Cardiac Case

January 21, 2010

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Army Veteran Charles Roulhac runs through tests during a follow-up appointment with his physicians at the Michael E. DeBakey VA Medical Center. From left, Peeyush Bhargava, M.D., Nuclear Medicine Section chief, Roulhac, Danny Chu, M.D., cardiothoracic surgeon, and Hani Jneid, M.D., Interventional Cardiology assistant director. PHOTO: Bobbi Gruner, Public Affairs Officer

 

HOUSTON – Health care providers from the Cardiology, Cardiothoracic Surgery, Radiology, and Anesthesiology departments at the Michael E. DeBakey VA Medical Center (MEDVAMC) used a multidisciplinary approach to successfully treat a 61-year-old Army Veteran from Florida suffering multiple symptoms of heart failure.

Veteran Charles Roulhac had an extensive history of coronary artery disease, a severely weakened heart muscle, and a left ventricular aneurysm, and had suffered an heart attack in the early 1990s.

Roulhac had already endured extensive cardiac evaluations at two premiere cardiovascular, non-VA institutes in the United States. One facility suggested a heart transplant. The other performed a cardiac catheterization that confirmed multiple blockages in his heart and a chemical stress test that revealed multiple scars on his heart muscle. Although offered open-heart surgery, he was advised it was high risk and offered marginal benefits.

“I couldn’t walk more than 10 steps without gasping and sharp chest pains,” said Roulhac. “The doctors there told me I only had a 10 percent chance of making it off the operating table alive.”

“Mr. Roulhac was referred to me for a second opinion in July 2009 after experiencing increased chest pain, which had markedly limited his daily life activities,” said Hani Jneid, M.D., Interventional Cardiology assistant director at the MEDVAMC and assistant professor at Baylor College of Medicine. “It was clear his medical problem needed to be identified, diagnosed, and treated expeditiously; otherwise, death was imminent.”

Roulhac’s heart function was assessed with a cardiac ultrasound performed in the Echocardiography Laboratory. After confirming the extremely poor condition of the Veteran’s heart, Jneid ordered a two-day thallium redistribution study, a highly specialized nuclear cardiology study, to determine if any portion of the heart muscle was still viable. 

“The nuclear study, which was quickly arranged, revealed large parts of the heart muscle were indeed viable, especially the anterior and lateral walls of the heart,” said Peeyush Bhargava, M.D., Nuclear Medicine Section chief. “Consulting with Dr. Jneid, we determined a large portion of the heart was dormant, but could potentially recover if blood flow could be restored to those segments.”

Jneid and Bhargava met with Danny Chu, M.D., cardiothoracic surgeon. After examining the patient’s previous angiography film, Roulhac underwent a cardiac catheterization procedure at the MEDVAMC to obtain updated information about the condition of his heart. With these results in hand, the physicians offered Roulhac the option of high-risk, quadruple coronary artery bypass surgery.

Coronary artery disease is where blocked arteries stop the blood and oxygen from getting to the heart. With coronary bypass surgery, surgeons use healthy blood vessels taken from the patient’s arm, leg, chest, or abdomen and connect it to other arteries in the heart so blood can go around the diseased or blocked area.

“I am glad I chose the VA in Houston. I trusted my doctors and nurses; it made the decision to go ahead with the operation easier,” said Roulhac, three months after the surgery. “Today, my chest pain is gone and I’m walking two miles a day. I’m waiting for the go-ahead to start lifting weights again.”

“It is the multifaceted approach to cardiovascular care at the Michael E. DeBakey VA Medical Center that allowed us to provide the best possible health care to this Veteran,” said Chu.

“It is really the integration of clinical data with advanced cardiac procedures such as echocardiography, nuclear viability testing, cardiac catheterization that we execute routinely at the DeBakey VA Division of Cardiology, and our ability to work with some of the most skilled radiologists and cardiac surgeons in the country,” said Jneid. “This unique environment enables us to provide world-class cardiovascular care.”

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