Monday, August 06, 2012


                                    A view of West Lake ( Hangzhou ) from Leifang Pagoda.

As I wrote last week, I left for Beijing on the afternoon of 31st July, and landed in Beijing Capital International Airport at past 12 MN on 1st Aug 2012. My local host met us ( I was accompanied by a local company representative ), at airport and took us to the Langham Hotel, at the airport. The first cultural shock ( and I go to China every year,  sometimes twice or thrice a year ) was that I have to walk down a 100 room corridor to get to my room ( pass 100 rooms ). They woke me up at about 6 am for breakfast at 7am, to leave for Tianjin.
We arrived at Tianjin No 1 Hospital at about 10am ( it was raining all the way ). We were welcomed by Dr Lu ( the head of Interventional Cardiology ) warmly. I then discovered by the banner that I was part of a cardiology roadshow. I gave a lecture on Bifurcation PCI for about 30 mins and took questions. After the lecture, I was ushered to the cath. lab to do cases. The first case was a CTO ( Chronic Total Occlusion ), in the RCA with a tight L Cx lesion, in a symptomatic male. I manage to cross the CTO ante-gradely and stented it. I also stented the tight L Cx. I also had time to do another tight L Cx with a subclinical stenosis that was borderline, even on IVUS, but Dr Lu felt the it should be done, as the plaque appeared ulcerated. I used a provisional stent technique and for the LAD and also stented the L Cx. The last case was a tight LAD ostia with a L Cx ostia and Ramus I ostia and also a tight mid Cx lesion. Dr Lu decided to randomise this case to the on-going DK II Crush study that they was collaborating with the Nanjing Hospital group led by Dr Chen ( Nanjing Hospital ). I stented the L Cx ( mid ) and did a minicrush on the LMS, ignoring the Ramus I. I showed them how I did my DKII Crush. So now, I have also contributed a case for the DK II Crush study. After the long day, they took us to a nice restaurant for dinner with the team. There was so much food and Dr Lu ordered some Chinese Rice Wine, that was so strong. They kept toasting, and I was so afraid of getting drunk, as I have to work the next day. Anyway, they did not force me, so I just sip at each toast. Obviously, the locals were seasoned drinkers. I survived. There was so much food wasted.
On 2nd Aug., I worked in Tianjin 3 hospital ( obviously a less popular hospital ). No lectures. They took me to the cath lab, and showed me the angio of a lady who had two previous PCI on the RCA, which had a re-stenosis. However, what they did not tackle was a very tight ( subtotal mid-LAD ), at a severe angle and slightly calcific. That was the culprit and my task.  There was also a 50% ostia LMS lesion. The patient refused CABG, so I am told. Besides these severe angiographic disease, this lab also had severe limitation, in terms of facilities. No IVUS. No rotablator, only one type of Guide-wire and no OTW balloon ( that is the problem of working in a new lab ).  They only had a micro-catheter. I tried to wire the angulated mid LAD with the tight lesion at the ostia of mid LAD. When I started to engage my guiding to the LMS, she developed severe chest pains and hypotension. Of course, I disengage, and waited. The chest pains was so severe and she began to cry and moan. And that was the story for the morning. Every time I wanted to work, she was moaning and crying, and they could not calm her down. I managed to wire the first 1 cm of the mid-LAD, but the micro-catheter could not follow pass the angulated tight mid LAD, so I failed to wire the LAD fully. After about 1 hour, I told the head of the Lab that I thing that we should accept failure and stop while the patient was still stable. She agreed and I withdrew my Guide-wire, and she explained to the patient's relatives. I think that she should go for CABG. I did a second case of a discrete mid-RCA. That went well.
Besides, we also had a plane to catch. I was due to leave Tianjin to fly to Hangzhou for the 6th QICC meeting, where I had to do a case for Live Demo at QICC and also give a lecture. I left Tianjin No 3 hospital at about 3.30PM.
So I left Tianjin at about 5 PM for Hangzhou, arriving at about 7.30pm. We had dinner then checked in to the conference hotel.
On 3rd August, I had a free day as my live demo and lecture were for 4th Aug. So I spend the 3rd Aug ( overcast sky with a light drizzle ), walking in West Lake, to see the Leifang Pagoda. Listen to stories about the "White Lady Snake - Bao Zushen", and her failed relationship. It is a nice, scenic lake, very tourisy.
I learned that West lake is a lake of contrast. "The broken bridge is not broken. The long bridge is not long. The lonely mountain is not lonely". Try and understand that. Anyway, it is a very vibrant city. 3rd Aug dinner was a faculty dinner, with plenty of food, wine, shows and tenor singing. It gave me an occasion to thank the organisers for inviting me, and do all the PR work.We went walking for a while after dinner to see the night scenes.
On 4th Aug., my case was in Zhejiang Provincial Peoples hospital. They gave me a case with a subclinical RCA long lesion and a critical L Cx mid, and prox lesion. I did the L Cx lesions first and implanted a long Endeavor Resolute stent. I wanted to IVUS or FFR the 50% RCA long lesion and was told that the patient had no funds for this. So I had to tell the panel sitting in Conference hall that I was not happy to stent the artery without IVUS or FFR evaluation. They agreed and so I stopped. In China, the social insurance will pay 40% of the overall cost and the patient had to pay the rest of 60%. I gave my talk in the conference and also acted as a moderator for the session in the afternoon of 4th Aug.
I left Hangzhou for Shanghai on 5th morning, to return to KLIA on 5th afternoon. I miss the LCW / LD badminton match as I was somewhere over the South China Sea.
All in all, it was a bit tiring but very educational for me. Obviously, Tianjin No 1 hospital, and Zhejiang Provincial Peoples Hospital were busy and well equipped, doing alot and good work. Some hospitals are weaker, and had limitations. They are running very fast to get there, but it is a big country and needs time. However, their system allows more centralised care and better organisation, whereas, ours seemed to be fragmented, and each one starts a center as they wish. The Tianjin No 1 hospital and the Zhejiang Provincial Hospital are doing 2-3,000 cases a year. China is doing 300,000 cases a year. How not to be good. Here, we have some centers doing less than 20 cases a month. How to maintain standard for staff and doctor.

                     At conference hotel, Hangzhou, with my host before going to Shanghai airport.

It is truly a learning experience for me. I enjoyed it.

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