Fortunately for Yeltsin, when you’re the president, you can be sick in style. The government has released few specifics about Yeltsin’s heart trouble, but it looks like he’ll have his operation at the Cardiology Center, the top clinic in Russia. And heart specialists in the United States familiar with the clinic say its staff is well prepared to perform a coronary bypass, the operation Yeltsin seems likely to get.
A few details about Yeltsin’s health have made it to the outside. He suffers from angina, chest pain that occurs when the heart tries (and fails) to pump more blood in times of stress or exercise. Officially, Yeltsin has myocardial ischemia, wherein interrupted blood flow can cause pain or, at worst, the death of heart muscle.
Rumors of what really ails the president paint a bleaker picture Two treatments for ‘ischemia’ in July and last October may actually have been for heart attacks, and the president is reported to have large blockages in his three main coronary arteries, enlarging the left ventricle of his heart. Yeltsin is also reputed to have a drinking problem, which could mean damage to the liver and kidneys, and a further weakening of the heart muscle.
In some cases, doctors eliminate arterial blockage through a procedure called angioplasty, in which a long tube called a catheter is guided through blood vessels to the clog. A balloon on the end of the catheter inflates, widening the channel. But doctors tend not to perform angioplasty if multiple arteries are blocked. The president could be in for a triple coronary bypass.
That operation would be fairly straightforward. Doctors take a length of blood vessel-often a piece of vein from the thigh-and attach it to the aorta (diagram). Then they attach the other end to the blocked coronary artery, bridging the jam-up. In the United States, bypass operations have a 95 percent success rate; in Russia, it’s about 90 percent.
So how worried should Yeltsin be? Not very, if he goes to the Cardiology Center. ‘The hospital itself is very well equipped. It’s almost opulent,’ says Michael DeBakey, a cardiac surgeon at Baylor Medical Center. DeBakey helped train the center’s chief of surgery, Rinat Akchurin, who performed a bypass on Prime Minister Viktor Chernomyrdin in 1992 and will likely work on Yeltsin. Wayne Isom, head of cardiothoracic surgery at New York Hospital-Cornell Medical Center, visited the clinic back in Soviet days, and hunted wild boar and moose in the forests south of Moscow with Yevgeny Chazov, the head of the clinic. ‘I scrubbed with [Akchurin and another surgeon] just to see how they were doing things, and I was impressed,’ he says. Sidney Levitsky, chief of cardiothoracic surgery at New England Deaconness Hospital and another guest of the clinic’s, calls Chazov ’the father of Russian cardiology.’
And in the end, it took the father of Russian cardiology to persuade the president to go under the knife. Yeltsin apparently felt admitting illness was admitting weakness. Now he may face months of real weakness, recuperating from heart surgery.
Plaque may be gumming up Yeltsin’s coronary arteries, starving his heart of oxygen. Here’s how bypass surgery could help:
Surgeons commonly connect the mammary artery to a point past the blockage, returning nutrients to the weakened muscles
Before surgery, injected dye and X-rays locate blockages.
Vein Grafts from Yeltsin’s legs could also shunt blood past the clogs. Russian doctors report improvement in 90% of bypass cases.
