Natural bypass called 'enhanced external counter pulsation'

From: Dr. Jai Maharaj (usenet_at_mantra.com)
Date: 07/25/04 

Date: Sun, 25 Jul 2004 00:28:21 GMT

Natural bypass called 'enhanced external counter pulsation'

Dr. P. S. Bedi
The Tribune
Wednesday, March 26, 2003

Despite the increasing success of conventional medical
therapeutic approaches and continued development and
improvement of mechanical revascularisation approaches, a
significant number of angina and coronary heart disease
patients cannot be managed successfully. Also a
substantial proportion of these patients do not achieve
complete revascularisation even after successful
angioplasty/bypass surgery and continue to experience
exertional angina or ischemia despite medication. Apart
from these factors, the traditional procedures -- bypass
surgery (CABG) and angioplasty (PTCA) -- are expensive
and involve a certain degree of risk in the form of
iatrogenic morbidity and mortality.

Besides, unfortunately, treatment to clear blockages
often results in cell regrowth that can obstruct vessels
again. This condition, called re-stenosis, occurs after
about 20 to 30 per cent of PTCA procedures. Repeat
procedures are non uncommon and re-stenosis rates after
repeat PTCA are as high as 50 per cent. With bypass
surgery, repeat procedures are sometimes necessary. Six
to 10 per cent of CABG procedures are now re-operations.
However, re-operative mortality rates are two to three
times of those of initial procedure and range from 2 to 3
per cent for second operations and up to 15 per cent for
third and subsequent operations. Patients undergoing
repeat procedures generally have more advanced coronary
artery disease rendering the re-vascularisation process
less effective.

EECP or Enhanced External Counter Pulsation is a new form
of therapy that may relieve or eliminate angina by
increasing blood flow to the heart. This therapy has been
approved worldwide by the health authorities, including
the Food and Drug Administration, USA, the NHS, England,
and of course, China where it is widely practised.

The patient lies down on a padded treatment table. The
calves, thighs and hips are tied with cuffs which inflate
in a sequential manner from calves upwards, thus
"milking" and blood in the reverse direction precisely
timed in milliseconds with a sophisticated computer,
which increase the blood flow to the heart when it is
relaxing and when the blood flow to the coronary arteries
is at its peak. The increased blood flow pressure during
this phase of the cardiac cycle causes dilatation of the
coronary blood vessels, opens and expands the networks of
the dormant small blood vessels. These channels can
create natural bypasses around the clogged arteries
boosting blood supply to the oxygen deprived areas of the
heart. The permanent opening of these channels may
account for the long lasting benefits of EECP therapy.

Typically, EECP is done as a series of 35 sessions, each
lasting one hour. The patient is investigated through
standard tests such as treadmill test (TMT),
echocardiogram and stress thallium before and after the
completion of the sessions to verify the improvement in
the status of the patient. It is important to note here
that for this treatment, coronary angiogram is not
important as with it only the degree of blockage of the
main coronary arteries and their branches can be
assessed, and it is not suitable for visualising the
minute vessels, arterioles and capillaries or for
assessing the overall blood flow to a particular region
of the heart which is actually more important.

Clinical studies over the past few years have shown that
about 75 per cent of the patients treated with a single
course of EECP experience a reduction in angina frequency
and intensity, and are able to return to a more active
lifestyle. The need for anti-anginal medication is
reduced or eliminated. The ejection fraction (measure of
heart function) shows improvement and so do the TMT and
stress thallium scans.

Unlike procedures such as bypass surgery and balloon
angioplasty, EECP treatment is administered in outpatient
sessions, carries little or no risk and is relatively
comfortable and inexpensive.

At present, this treatment is being offered to those
patients who have chronic stable angina; who do not
receive adequate relief from angina by taking nitrates;
who do not qualify as candidates for invasive procedures;
who have exhausted invasive treatments without lasting
relief of symptoms; who are unwilling to undergo surgery
or angioplasty or who want to explore alternatives to
bypass surgery or angioplasty. Indeed, it is a viable
alternative for those coronary heart disease patients who
are not candidates for invasive or surgical interventions
by the physician's or their own choice.

The writer runs his own medical centre in Chandigarh.
 Phones: 0172-695018, 686974; 98140-14704.

More at:
http://www.tribuneindia.com

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