Inside the heart: ultrasound breaks the plaque that hardened the arteries – 21/06/2022

When a plaque is there to obstruct the path of the blood, people often say that it is made of fat, almost to make life easier.

But among us, the signal is that many things are done. Fat, yes, without a doubt. But also, for example, fiber and calcium. Oh, yes, this mineral that has accumulated there over the years can contain a lot, slowly, without haste.

“As a result of this delay and the fact that more people are living, we are finding calcified coronary heart disease more and more often,” said cardiologist Pedro Lemos, referring to the network of arteries that supply the heart. And how is it from them!

“The heart is a muscle, if you take a small piece of it and look at it under a microscope, you will see that it is very similar to the thigh,” compared the doctor who is the coordinator of the Hospital’s Cardiovascular Intervention Center. Israelite Albert Einstein, São Paulo, Paulo, and the owner of the rare ability to talk about Medicine, as if he were telling a good story.

Where the resemblance ends: The heart muscle beats about 80 times a minute. “If I asked anyone to lift their thigh 80 times in the same minute, it wouldn’t take long,” he says.

Of course, to be an athlete stored in our chest, the heart needs a lot of energy constantly, it requires a beautiful supply of oxygen at all times. This supply service is provided by coronaries. That’s why it doesn’t take them more than a second to feel resentment if they are hindered by these signs.

“If you attach a clot to one of them, that obstacle is sudden. We have a heart attack,” says the cardiologist. “Now, if it happens slowly, because of the plaque that has grown, making the bloodstream narrower and narrower, the person feels the pain of angina.”

One way or another, something needs to be done in these moments, or the heart will not take the choke. Just then, with the balloons and stents, Pedro Lemos and his colleagues enter the scene navigating from the ships to the problem area, performing the famous angioplasty. But no one thinks twice about the problems that calcification can cause on that day.

“Well, fat is soft, grassy,” the cardiologist describes. “But calcium is the ingredient we find in bones and teeth.”

It’s easy to conclude where this story goes: when ore accumulates on the walls of vessels, they become increasingly hardened. “And it’s okay if they’re rigid, that is, if there’s a lot of blood in it,” Pedro Lemos said. “The problem stops when that happens.”

Until last week, for the doctor, such cases were synonymous with problems. “To release the coronary, I have to dilate, that’s for sure,” he says, giving the basic principle. “But how can I increase a hard container? stent Don’t do that. It’s just a support that keeps the coronary artery that I just dilated open. So, I repeat, what would I do if this artery was not dilated? “

Yes, there are alternatives. But the perfect answer to this question came last week, from Pedro Lemos and his colleagues at Einstein (in the picture), in an unprecedented procedure in the country, they used ultrasound and, at the same time, they just broke all that calcium in the coronary artery, which was as hard as a stone.

how it was before

In addition to not being able to spread the obstructed area properly, restoring blood flow, taking a balloon with the help of a catheter to inflate well at that moment, the doctors had the challenge: to reach the same area, if by chance. they found several other calcified stretches along the way.

“It was like skating on a cobbled street,” recalls Pedro Lemos. In fact, a blood vessel without so many plaques could look like a paved road that allowed the cardiologist to navigate the catheter as smoothly as possible. However, calcifications cause indentations, which often hinder the progress of the device.

“You may not even be able to reach the injury,” says the doctor. Therefore, he had to settle for poorly navigable and poorly dilatable arteries. By the way, to complete: no matter how many tests are required before the procedure, cardiologists feel it only when they touch the stiffness of the patient’s coronary arteries at this time.

“If they are very rigid, it is not always possible to stop what they are doing in the middle. But if they continue, the result of the unlock is never so good,” the doctor warned.

There were no perfect alternatives

There are high-pressure balloons that, say, widen the calcified coronary artery. “To give you an idea, normal blood pressure, which is 120 x 80 mmHg or millimeters of mercury, would be equivalent to 1/6 or 1/5 of the atmosphere, which is another unit for measuring pressure,” Peter teaches us. read. “And we have balloons that reach 24, 25 atmospheres. There’s no pressure on the bottom of the sea either.” Can concrete walls from calcified coronary arteries withstand so much? Not always. There is a risk.

Cardiologist interventions can also use microscopic slides to make even smaller incisions in calcium-filled plates. You can see the effect of this: “It’s like a watermelon, where I have to spear with a knife and it opens.”

Finally, another strategy is ablation, which works like sanding by interventional cardiologists, so to speak, hardened plaque. “It’s very safe and has been used for many years,” says the doctor. “But the equipment must touch the plaques, and in itself can only do so on the inner surface of the coronary artery. Some calcifications, perhaps most of them, are deep because they infiltrate the artery wall.”

The result: the person also improves, but we cannot say that the coronary arteries are completely obstructed. He still has some sort of problem that took him to the hospital. “But it was the armory we had until then,” says Pedro Lemos.

Ultrasound inside the chest

Einstein’s new technology, which landed in Japan in the same week as it was launched four years ago in Europe and a year ago in the United States, addresses many of these limitations.

Doctors call it lithotripsy, a name that says a lot because it means something like “breaking a stone.” Urologists have long pronounced it. They don’t use this very high-energy sound wave, which has a frequency above what we hear, to vibrate until the kidney stones explode. “It’s like a very loud sound when a glass breaks,” says Pedro Lemos.

In this case, however, the kidney stones turn to sand and serve the purpose of elimination through urine. “Coronary calcium doesn’t go anywhere,” the cardiologist said. “Alone, this large plate breaks into a thousand pieces, making a mosaic, and the wall of the vase becomes flexible.” Then, calmly, the angioplasty balloon can do its job.

Advantages of novelty

As soon as he arrived, the ultrasound was already in the routine of the São Paulo hospital. This is because, according to various clinical trials, it presents a rare combination in newly marketed devices.

“It is common for a new procedure in medicine to be more effective than before, but at a cost: more invasive or less safe,” said Dr. Pedro Lemos.

The opposite can also happen: a new treatment will lead to greater safety, but not as good a result as before. “But in the case of coronary artery lithotripsy, it provides excellent cleansing conditions and, at the same time, is much safer for the patient,” the cardiologist assured.

According to him, an angioplasty takes about an hour and a half when such a plaque is not calcified. However, the duration of the procedure is unpredictable when calcifications are very present. “Sometimes, when navigating the vessels with the catheter, we need a long time to make a minimum distance of the route,” says the doctor.

To give you an idea, the procedure should take an hour to leave the plates in pieces — including on the way to the injury, when necessary. Quickly, the coronary arteries lose stiffness and angioplasty is performed as usual. A day later, the person is usually at home, with clean arteries. And, I venture, much more flexible, giving full support to those 80-minute beats that fill us with life.

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