TECHNIQUE OFFERS HELP TO HEART PATIENTS

Having a big heart is only a good thing in the context of generosity. Dr. William Logue sees people with big hearts in another light -- as patients for surgery.

Logue, director of cardiothracic surgery at St. Francis Medical Center, spoke Wednesday afternoon to members of the Cape Girardeau Lions Club. He explained a surgery option for patients with congestive heart failure.

Congestive heart failure is the term used when a patient's heart has grown swollen from disease or heart attacks. Normally, the heart weighs about 400 grams. When it swells, it can weigh as much as 800 grams.

Whether you are talking about the heart in a man, cow or whale, the amount of mass is exactly the right amount needed for the volume of blood the muscle has to pump, Logue said.

But when the heart starts growing and gets dilated, it can grow too large and cause problems. Why a heart gets swollen isn't always known. Sometimes it is caused by disease or a parasite or even a virus.

More than 2 million people in the United States have congestive heart failure and 500,000 are diagnosed with the disease each year.

What Logue and other doctors worldwide are trying to do is reduce those numbers by performing the partial ventriculectomy surgery.

The technique Logue uses for surgery isn't new, but it is innovative. He studied for a month in Brazil with doctors there who were already performing the surgery. He has been performing the surgery at hospitals in the U.S. since 1994.

In most U.S. hospitals, the surgery is still considered experimental.

Logue has performed more than 15 such surgeries at St. Francis since 1997. The exact technique Logue uses isn't used by doctors at Southeast Missouri Hospital.

The procedure from start to finish takes about 90 minutes. Logue used a videotaped surgery during his speech at the Lions Club meeting to show how the operation is performed.

A patient, who must have a "big, bad and sick heart," is prepared for surgery, he said. During the operation, Logue cuts away a portion of the heart, thus reducing the size of the swollen muscle. He then sews the heart back together.

"Even while I'm cutting it apart, it's still beating," he explained. And the portion that is separated from the body continued to beat in his hand. The blood is drained away from the heart and recirculated through the body and to the aorta during the surgery. No clamps are used on the heart.

By keeping the heart pumping, it reduces the amount of trauma to an already ailing muscle, he said. "Sometimes the part you cut away is the only functioning part left." Stopping the heart can cut down on its functioning rate.

About 75 percent of the patients -- most of them men -- who have the surgery recover quickly after the operations and are off medications within a year, Logue said. Some are even removed from transplant lists.

But if the heart isn't receptive to the surgery, and it fails, "it fails quickly, even within the day."

In some cases, "it's miraculous that they can even tolerate the surgery," Logue said.

The technique Logue uses varies by hospital and surgeon. In Italy, the heart's valves are replaced each time so that a greater portion of the swollen muscle can be cut away. In Cleveland, Ohio, surgeons stop the heart from beating when they perform the surgery. "There are all kinds of ideas that are developing," Logue said.