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Media Contact: Tom Grant
tgrant@adventisthealthcare.com
301-315-3356

Published on June 05, 2002

Press Release

At Washington Adventist Hospital, Doctors at The Cardiac Center Make Sure the Beat Goes On

by Meredith Hooker, Gazette Newspaper Staff Writer

It's cool, almost cold in Catheter Lab C. But Dr. Mark Turco doesn't notice. He barely registers that he is wearing a heavy lead smock hanging off his shoulders and hips to protect his vital organs from radiation, clinging to him like a 10-pound second skin.

He's completely focused on his patient, the monitors mounted on the walls that display the insides of the patient's arteries and the monotonous blip, blip, blip of the heart monitor. He's going to open a blocked artery of the man lying in front of him. It will be an invasive procedure but no knives are involved -- just a well-placed needle.

Turco gives his patient, who is consciously sedated, an IV drip with anesthetic and applies a local numbing anesthetic to the patient's groin area. "You'll feel a little pressure there, OK?" he tells the man on the table, as he begins to insert a catheter along a stainless steel guide wire into his patient's femoral artery, streaking his white gloved hands with blood. "Can you feel any pain?" "Nope. No pain at all," the man replies with a small shake of his head.

Turco, 40, is the director of the Center for Cardiac and Vascular Research at Takoma Park's Washington Adventist Hospital, a facility nationally recognized for its cardiovascular work.

Turco spends three-and-a-half days a week in the hospital's cath lab, where he performs between five and seven procedures daily. On average, he said, he spends 10 to 12 hours a day in the lab. Yearly, he said, he'll perform about 250 procedures. "This is just a tremendously exciting field," he said.

It's a field that has made leaps of advancement over the years as older procedures have become refined and new procedures have been developed, particularly during the past 25 years.

Yet despite the numerous technological advances made in the cardiovascular field, heart disease is still one of the leading causes of death in the United States, according to data collected by the American Heart Association. Preventing those deaths is the reason for cardiac centers like Washington Adventist's.

Catheter Lab C is now dimly lit and Turco has inserted a catheter filled with radioactive dye into his patient's femoral artery, causing some blood to spurt onto a sterile blue cloth covering the man. A fluoroscopic x-ray machine projects an image of the artery on several monitors throughout the room, gently pulsing in time with the beating heart of the man on the table.

Turco stares at the screen, examining the artery and its damage. His patient, who was referred to him because of an abnormal stress test, is overweight and a heavy smoker. He has some blockage in the artery. Turco has to decide what to do. Does he put the man on medications and monitor his blood pressure, or should he perform an angioplasty? Then, a co-worker sticks his head through the lab's door and asks who wants chicken sandwiches for lunch. "Buying lunch?" Turco jokes, staring thoughtfully at the artery pulsing in black and white on the screen in front of him and resting a comforting hand on his patient's leg. "That's really nice of you."

When plaque forms and creates blockages in arteries, it creates heart disease. But the plaque is caused by a number of different factors. Increasing age and genetics, which cannot be controlled, can be factors. But, heart disease can occur in people of all ages, even children, warned Dawn Schaddinger, director of research in cardiology at Washington Adventist Hospital.

"It's not just a disease of older people," she said. Some contributing elements to heart disease can be controlled. Smoking cigarettes and being physically inactive can lead to heart disease. Additionally, high cholesterol, high blood pressure, obesity and diabetes can often lead to heart problems. A greater number of risk factors increases a person's chances of contracting heart disease and needing either open heart surgery, an angioplasty or stent procedure. Turco makes his decision. Angioplasty, which uses a balloon to compress plaque to artery walls, is necessary.

"We're going to need to do an angioplasty, OK, sir?" Turco tells the man on the table. "OK," the man replies, seemingly unconcerned. "Can someone scratch my chin? It itches." "Sure," Turco replies. "Let me find my chin-scratcher." An assistant gives the man's bearded chin a good scratch while Turco inserts a balloon catheter over a stainless steel guide wire to the diseased area of the artery. He inflates it and watches the plaque hug the artery walls on the monitors in front of him. He withdraws the balloon catheter and discards it, keeping the guide wire in place inside the man.

Now Turco must decide whether or not to use a stent, a tiny mesh tube resembling chicken wire, to help keep plaque compressed to the artery walls. He and his assistants take a closer look at an ultrasound and after a moment decide, yes, a stent is necessary. It doesn't appear the plaque will stay on its own. Turco measures the size of the man's artery and the size of the plaque in the artery to determine what size stent is needed, then calls to Schaddinger, his assistant, who is out in the hall. "Enroll him," he says.

Washington Adventist Hospital performs more than 5,500 angioplasty procedures a year. In many cases, a stent is needed to help keep the artery propped open. The hospital is also participating in a clinical trial that tests drug-coated stents' ability to prevent re-blockage in arteries. More than a dozen procedures have already taken place.

While stents have proven effective, Turco said, in some cases tissue will grow again and clog both the artery and the stent. Re-growth, known as restenosis, can require an additional angioplasty procedure or open-heart surgery. So medical experts are hopeful the drug-coated stents will be effective.

The clinical trial currently under way is randomized, Schaddinger said. Patients have a 50 percent chance of receiving a drug-coated stent. Neither doctor nor patient knows what kind of stent is being inserted, she said. She said the patient will come back in nine months and be re-examined to determine whether re-blockage has occurred. At that point it will be determined what sort of stent was inserted. If re-blockage does occur, she said, it will happen three to six months after the stent's implantation. Schaddinger steps into a nearby office, picks up a phone and dials the number of the company supplying the stents. She enrolls Turco's patient into the trial and receives a confirmation number. Schaddinger pulls a box with an identical number off a nearby cart and takes it to Turco. The box contains a stent, and only its manufacturer knows if it is drug-coated or not. Turco inserts a delivery catheter carrying the stent aboard a deflated balloon into the man's artery and follows the guide wire back to the treatment site. He inflates the balloon and expands the stent, watching it press against the vessel walls. He and his colleagues observe the artery from different angles to ensure the stent is fully deployed and the artery is completely inflated. If not, re-blockage could occur.
The artery looks all right, Turco decides.

"Almost done," he tells the man lying on the table. Drug-coated stents were first tested in Europe before they underwent clinical trials in the United States, Turco said. "They have a track record before they're ever implemented in humans," he said. "It's not like we're experimenting in any way with the patients." And, he said, patients are usually willing to participate in clinical trials once they are explained the procedure's risks and benefits.

"I truly feel patients benefit from participating because they get a closer follow-up," Turco said. Turco said in the early 1980s, stents were introduced to the cardiovascular field and now are considered commonplace. "Technology has gotten so good," he said. "We're able to treat the majority of blockages." Turco said scar tissue forms around ordinary stents 18 to 20 percent of the time. With drug-coated stents, he said, patients may have little to no re-blockage. And, he said, stent procedures have a 98 percent success rate. "There are few patients that need to go from here to the operating room due to complications," he said.

Turco carefully removes the catheter and guide wire from his patient, but the stent remains in his artery. It will act as a permanent scaffold to keep the artery open. He removes his bloodstained gloves and tosses them into a nearby metal trashcan lined with a red plastic "hazmat" bag. His blue sterile gown, booties and head covering follow suit. The monotonous blip, blip, blip from the heart monitor ceases as it is unhooked from the man on the table and the IV is pulled free from his body.

Turco steps out from Catheter Lab C and into the hallway as his colleagues wheel the man out of the room on a gurney. He peels his lead smock off his body and hangs it on a hook, next to several others. It's red and monogrammed at the neck with his initials, MAT, so he knows he will be able to find it when he puts it on again in an hour. He's been wearing his smock for nearly an hour and a half, and it has gotten heavy.

In a few hours, Turco will sit down with the man being wheeled away down the hall. They'll go over the pictures that were taken of his artery during his angioplasty and talk about what was done. Then the patient will spend the night at the hospital and if he remains stable, he will go home the next day. The patient will return in two to four weeks to have another stress test, and if it is normal Turco probably won't see him again for nine months, until he comes back for his required follow-up visit.

It was a standard angioplasty and stent procedure, and Turco says this one went well. "The gratification you get from being able to help someone is unmatched," he says.

copyright 2002 Gazette, reprinted with permission

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