Doctor First in Victoria Certified for Heart Surgery

By Pamela Bond

Victoria Advocate

Dec. 17, 2007

Before Oscar Villanueva, 60, of Edna had a defibrillator implanted in his heart, he had three heart attacks and two heart operations.

“I’m bionic,” he joked. “Call me the bionic man.”

If the computer chip in the defibrillator detects an abnormal heart rhythm, it will shock the muscle back into its normal pace, giving Villanueva a 90 percent chance of making it to the hospital and continuing to live through a heart attack.

Villanueva had his surgery on April 20. At that time, no one in Victoria was able to oversee the surgery, so a doctor from another city, such as
Houston or El Paso, was flown in. Today that’s changed, because Dr. Harish Chandna, a Victoria cardiologist, is the first in the city to become a certified heart rhythm specialist.

In the past, patients requiring the surgery either had to go to another city, or a doctor who was certified had to come to Victoria. For the certification, Chandna was required to do 35 pacemaker operations in one year (he averages 60 to 70), participate in 10 proctored defibrillator surgeries and take a rigorous exam, which he completed Sept. 7. He found out in November, when he received the results of the test, that he was certified.

“I was very excited,” Chandna said. “It was a tough exam.”

Chandna has participated in 36 defibrillator surgeries in the past eight months, 35 at DeTar Hospital and one at Citizens Medical Center. He hopes to continue with 30 to 40 of these operations each year. The defibrillator is a small, battery-operated computer chip with small leads, or wires, connected to the heart’s chambers. It records the heart’s pace any time the pulse accelerates to a pre-programmed number, usually about 130 beats per minute. It will send an electric shock of about 25 Jules, compared to the 200 in an external defibrillator, whenever that pulse goes up to second pre-programmed level, usually 190 beats per minute, in case of a heart attack.

To be eligible for Implantable Cardioverter Defibrillator (ICD) surgery, a patient must have a heart function of 35 percent or less, usually caused by a heart attack or even a long history of untreated high blood pressure. The patient also must show abnormal results on a T-Wave Alternans test.

Currently, Chandna’s practice, located at 2104 Patterson Drive, is the only one in Victoria that owns the machine to conduct the test. The surgery lasts about an hour and a half to two hours. During the procedure, the defibrillator, which is about twice the size of a pacemaker, is implanted into the heart and the leads are connected.

Then, the defibrillator must be tested. Doctors induce a heart attack on the patient and use the implanted defibrillator to shock it. Sometimes, the defibrillator is tested more than once to make sure that the amount of electric shock it is programmed to administer is enough for the heart to respond.

Villanueva said he did not have a hard time recovering from the surgery.

“This one wasn’t bad,” Villanueva said. “In two to three weeks I started doing things. My second heart attack, that was bad.”

The surgery does carry risks. Because a heart attack is induced, there is a very small chance that it won’t respond again. To implant the device, doctors must puncture a vein going into the heart and there is a small chance a lung could be punctured as well.

After the device is implanted, patients might experience a shock unnecessarily when their heart rate increases, such as during exercise. Chandna said cases like that are not common. Only one person in Victoria reported unnecessary shocks during the past year.

“It doesn’t hurt, but it’s not a good feeling,” Chandna said. “It’s frustrating. If it saves their life, they don’t mind.”

Despite the risk, Chandna said he sees a need for the surgery. One million people have heart attacks each year, and one third of them do not make it to the hospital in time.

“There’s strict criteria for the surgery,” Chandna said. “It’s expensive, but it’s life-changing.”

After the surgery, patients go in for routine checkups, where the device is checked and it reports any abnormal rhythms. Patients also need to be checked anytime the defibrillator shocks them. A procedure to replace the device and its battery should occur every two to four years, said Bryan Moore, a trained technician and sales representative for ELA medical group. Moore conducted a six-month checkup on Villanueva on Wednesday.

“That’s a much simpler procedure,” Moore said. “A lot of times, patients will ask if they can re-charge, but it doesn’t work like that.”

Villanueva said that he had noticed a difference because of the surgery and doesn’t get tired like he did before getting the device.

“It’s like life insurance, isn’t it?” Moore added.

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