At 77, Mr Chua Wan Chuan looked like the picture of health. He kept active with daily walks, was feeling good and showed no signs of heart trouble. So, when a routine health screening revealed severe blockages in his main arteries, it came as a shock.
Says Mr Chua: “When I first got the news, I was really worried. I didn’t know what to do or what choices I had. The doctor said I might need an open heart bypass surgery, and that made me very uneasy – it just sounded too risky for someone my age.”
“That was a terrifying moment for us,” recalls his daughter Ms Michelle Chua, 44, an accountant. “It is a major surgery, and even though my dad was healthy, I worried about complications and the long recovery ahead.”
Traditionally, an open heart bypass surgery involves a large incision across the chest to access the heart – an option Mr Chua was not comfortable with. Angioplasty with stenting was a possible alternative. However, due to the presence of heavily calcified blockages in all of Mr Chua’s three major arteries, his cardiologist, Dr Lim Tai Tian at Mount Elizabeth Hospitals, cautioned against it. The long-term risks of repeat procedures and higher mortality made an open heart bypass surgery the better choice.
Then came a glimmer of hope: minimally invasive cardiac surgery (MICS).
Cardiologist Dr Lim Tai Tian from Mount Elizabeth Hospitals introduced Mr Chua Wan Chuan to the minimally invasive cardiac surgery.PHOTO: MOUNT ELIZABETH HOSPITALS
What is minimally invasive cardiac surgery
MICS, also known as keyhole cardiac surgery, uses small incisions in the chest and endoscopic instruments (thin, flexible tubes with a camera and light) to gain access to the heart.
Mr Chua, who had originally been slated for an open heart bypass surgery, was identified as a suitable candidate for this surgery.
“When we got the green light, my dad was relieved,” says his daughter. “He was thrilled that he could have the bypass without the trauma of a major chest operation.”
Mr Chua, who had originally been slated for an open heart bypass surgery, was identified as a suitable candidate for the minimally invasive cardiac surgery.PHOTO: MOUNT ELIZABETH HOSPITALS
The surgery was carried out by Professor Theodoros Kofidis, a cardiothoracic surgeon at Mount Elizabeth Hospitals, Singapore, who has specialised in MICS for over 10 years.
“Mr Chua was a suitable candidate for MICS,” says Prof Kofidis. “He is not obese, had a healthy chest size for his heart, no major calcium build-up in his aorta, and his heart’s condition and function were within a good range.”
Not everyone qualifies for MICS. According to Prof Kofidis, patients with severe obesity, poor heart function, multiple valve issues, have had past radiotherapy to the left side of their chest, or very high lung blood pressure are not suitable.
“For MICS, about 50 to 60 per cent of patients qualify. In Asia, factors like smaller, flatter chest anatomy can be a limiting factor,” he explains.
Mr Chua’s surgery was carried out by Professor Theodoros Kofidis, a cardiothoracic surgeon with over a decade of experience in minimally invasive cardiac surgery.PHOTO: MOUNT ELIZABETH HOSPITALS
Mr Chua’s keyhole cardiac surgery went smoothly a few months ago. He recalls: “On the second day, I was able to walk; then on the fifth day, I climbed the stairs. I was discharged within a week.”
Adds Ms Chua: “Initially, my dad walked slower and he was concerned he wouldn’t be able to walk as fast as before, but he kept walking daily, slowly but steadily. Weeks later, he was back to his normal self, walking at the same speed as he did before the surgery.”
Why cardiac screening is important
Like Mr Chua, many patients may not be aware that they have heart issues until they go for a screening.
Says Dr Lim: “Having no symptoms doesn’t mean you don’t have any underlying cardiac disease. Women, in particular, often don’t have any symptoms. They don’t complain of chest pain or shortness of breath. And they just feel tired. Some of them don’t even feel tired. For men, most of them have chest pain or shortness of breath.”
He remembers spotting very abnormal heart readings during Mr Chua’s treadmill test. This led him to order more tests – a CT (computed tomography) scan to check for calcium build-up in the arteries, and an angiogram to see how badly the three main arteries were blocked.
As part of the screening procedure, it is also important to ask questions to identify cardiac risk factors, says Dr Lim. These include age, whether one smokes or has smoked; has diabetes, high blood pressure or high cholesterol; whether they exercise; and have a family history of heart disease or stroke.
For example, if a family member had a heart problem at a young age, such as in his or her 50s, then other family members in their 40s are already at risk, Dr Lim notes. Diabetes will also increase one’s risk of heart disease by four to eight times. “So if you wait for the symptoms, it might be too late,” he adds.
Beyond MICS, the experienced team of cardiologists at Mount Elizabeth Hospitals uses current technologies for complex angioplasty procedures. These include imaging tools to see inside the arteries more clearly as well as balloon devices that use shock waves to break up hardened deposits so stents can be placed more safely and effectively.
The heart-team approach between Dr Lim and Prof Kofidis as seen in Mr Chua’s case is a common practice at Mount Elizabeth Hospitals. Whether treating straightforward cases or tackling complex heart conditions, such collaboration supports coordinated and effective patient care.
To learn more about how you can manage challenging medical conditions, visit Mount Elizabeth’s hub of resources.
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