MEDICARE
Heart, a mystery still
GOUTAM GHOSH
Dr. Solomon Victor ... health education should begin early.
Dr. Solomon Victor, director, The Heart Institute, Vijaya Health Centre, Vijaya Hospital, Chennai was the other surgeon from India who was invited to share his experience at the Advanced Cardiac Techniques in Surgery (ACTS 2004) in New York, a continuing education meet for physicians in the West.
Dr. Victor, whose line of degrees is at least thrice as long as his name, is a researcher whose distinctions and career excellence have hardly had an impact on his humility. GOUTAM GHOSH found it easy to meet him for a chat.
HOW is it you were invited to the ACTS 2004?
I was invited probably because of what my colleague, Dr. Vijaya Nayak, and I published about the rhythm of the heart as well as the mitral and tricuspid valves. We still don't know all the secrets of the heart. Nobody knows yet how the heart as an organ is so perfectly timed, with an undisturbed rhythm even though it beats more than 200 crore times in an individual who lives to be 65.
What is new about this rhythm?
The classical concept of the source of cardiac rhythm is that it originates from the sino-atrial node, the heart's natural pacemaker located on top of the right atrium. Our research comparing the hearts of animals — from lobsters to human beings — has shown that the superior and inferior vena cavae along with the coronary sinus (the chamber through which the carbon dioxide-laden blood from the body tissues including the heart drains into the heart's right atrium) as well as the four pulmonary veins (bringing oxygen-rich blood from the lungs to the left atrium) all throb and pulsate with perfect coordination before the atria contract.
These vessels show a squeezing action no different from the chambers of the heart, though milder. It is as if these vessels squeeze blood out into the atria before the atria contract. There is a systemic waltz, represented by sequential contractions of the three veins carrying impure blood to the heart, the venous sinus (collecting chambers) and the right atrium proper. There is a pulmonary waltz, linking the four pulmonary veins, pulmonary venous sinus and the left atrium proper, all of which deal with oxygenated blood. A single sino-atrial node cannot generate these waltzes and duet performed by seven blood vessels draining into the atria before every beat of the main heart chambers. We have postulated that the brain and the nervous system trigger these waltzes and duet, just as electronic circuits trigger traffic lights.
You insist that the sino-atrial node is not the supreme commander, then what about the higher centres of the brain?
A professor of cardiology at the University of California, Los Angeles, asked the same question, which takes you to the realms of faith. Our brain is probably a server under cosmic command. Take the mind for example. Everyone knows it exists but science cannot locate, describe or define it. We know it generates thoughts and actions. Negative emotions can lead to heart disease. Positive emotions can promote harmony, happiness and health. Yogis in India can voluntarily control their breathing and heartbeats. True merger of faith and science would make humans humane and concerned about each other. We should focus more on meditation and less on making money, swallowing mood-elevating medications, alcohol, or filling our lungs with tobacco smoke.
(Daniel Hofstadter et al in their book Mind's Eye pose an interesting problem: What would be your response if you stated to yourself, "I am a brain" and "I have a brain"? It is more likely that you will agree with the second proposition. If so, what is that "I"?)
What are the practical implications of the new theory?
The mystery surrounding heart and life is no less deep today than a few centuries ago. Today we seem to understand that abnormal rhythms are related to diseases of the mind, brain and nerves. We have devised surgical techniques to minimise disturbance to the complex cardiac rhythm. Today we are stopping the heart for surgery, using potassium. Tomorrow neural stimulus may be used to arrest the heart.
What do you think needs focus in the field of medicine today?
We have set up the Golden Heart Foundation for a not-for-profit campus to focus on research and heart care to provide the poor. India needs to support basic and fundamental research. Our nation is blessed with profound intellectual resources. I strongly feel that man should use resources to wipe out poverty and promote happiness and welfare, not squander it on weapons or warfare. What we need today is funds to set up an electrophysiological laboratory in India for keen physicians to do basic research. I agree that it is difficult because the Government will argue that instead of spending Rs.80,00,000 on a lab, the money could be used for primary medical care. But if you slash the defence budget, you will have enough money for social priorities. There will be enough and more for poverty alleviation, for instance.
How do you justify your focus on mitral and tricuspid valves?
Both valves, which are as unique to each of us as our fingerprints, have a common design, with a straight and curved leaflet guarding a D-shaped orifice. The design has evolved over 800 million years. Nearly 2500 years ago, the term tricuspid valve was coined in Greece. This name was given because the curved leaflet of the tricuspid valve has front and back segments, apparently forming three leaflets along with the straight leaflet. But the curved leaflet of either valve has six sections to adapt to the contracting heart. So the term tricuspid valve is erroneous. The strings or chords, which restrain the leaflets can be grouped like a Japanese fan on either half of these valves. This concept helps to repair these valves when they are blocked or leaking. We have used a patient's leg vein, pulled it inside out to repair ruptured cords or narrow the dilated leaking valve, thereby avoiding artificial, expensive devices.
Why is the study the mitral and tricuspid valves relevant to India?
Rheumatic heart disease (RHD) is common in India. Nearly 30 per cent of heart operations in India is to correct RHD against hardly one per cent in developed countries. The disease begins as a throat infection in school children aged five to 15, caused by streptococcus, a bacteria. Later the disease damages the mitral, aortic and tricuspid valves. Once the valves are damaged, the disease cannot be cured. Therefore, all schools must provide primary and preventive health care to children; and health education should be a part of the school curriculum. Don't you think India should focus on hygiene and eradication of poverty so that the inimitable valves in the heart will not be damaged?
(Concluded)
The first part of this article appeared in The Hindu Sunday Magazine dated July 4, 2004.
E-mail the writer at goutam@thehindu.co.in
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