Heart to heart: Two masters of cardiac catheterization at Bangkok Heart Hospital talk about their careers
Of all the organs in the human body, the heart is the most vital to life. It beats continuously, pumping blood to nourish other organs so they too can perform their live-giving tasks. This physiological “teamwork” is nurtured by the professional teamwork of two cardiac specialists at Bangkok Heart Hospital, both respected experts in cardiac catheterization.
Clinical Professor Dr. Damras Tresukosol, an expert in cardiac catheterization through the wrist, is also faculty chief of the Centre of Excellence Cardiovascular Institute. The pioneer of the inclusion of treatment of heart disease under the 30-baht universal healthcare system scheme from which many heart disease patients in Thailand have benefited, his focus today is on developing Bangkok Heart Hospital into a Centre of Excellence on par with other world-class heart hospitals across the globe.
The scion of a family of businessmen, young Damras first became attracted to a career in medicine while studying at Bodin Decha Secondary School. In 1975, he applied to Mahidol University’s Faculty of Medicine, Siriraj, Thailand’s best-known and most respected school of medicine, and was awarded a scholarship.
“When I applied to study at Siriraj, I had no idea where Siriraj was or even the subjects I would be studying. During the first two years of the pre-clinic course, we studied human anatomy and were required to apologise to the human bodies we used for study before proceeding with dissection. The dissection was divided into chapters, starting with arms, then the legs and chest and so on. The smell of the formalin was so strong that it killed any appetite for food. Yet we survived,” he recalled.
A keen student of the complexity of the human body, Damras also became interested in playing a part in what was then a major challenge facing health professionals – teaching Thais to look after their own health.
First steps in the white gown
After graduating, the newly minted Dr. Damras was assigned to Pong Nam Ron Hospital in Chanthaburi Province for two years. During his time at the 30-bed hospital near the Thai-Cambodian border, he cared for local in-patients and out-patients and was a member of a mobile clinic that provided health services in a nearby camp for Cambodian displaced persons.
That experience taught him a great deal about examination and treatment.
“We had to give patients a clear explanation, for example, about heart disease. We needed to explain how many chambers a heart has, what each chamber is called, and what a vessel consists of. I used to compare our coronary vessels to Mitraphap Road or Phaholyothin Road and the small lanes that run off them. I found this helped patients visualise and better understand their own health. It was fun for us then.”
A pioneer in cardiac catheterization
After completing his compulsory service upcountry to repay his scholarship, Dr. Damras returned to Bangkok to continue his studies in internal medicine and also pursue a nascent interest in surgery. He combined the two branches, first studying internal medicine in cardiology and later extending his field of interest to include coronary artery treatment through catheterization. With limited facilities in Thailand for this type of training, he applied for and won a scholarship to study catheterization at Leiden University Medical Centre (LUMC) in the Netherlands, becoming one of the first three Thai physicians to receive this training.
Despite being urged to stay on Leiden to work towards a doctoral degree, Dr. Damras chose to return home. Armed with new knowledge of treating heart disease treatment through catheterization, he took part in research studies, taught other physicians how to use stents, founded a centre for heart disease and developed a full-service treatment system.
“Twenty years ago, heart disease treatment cost a great deal. I joined a team working on the healthcare policy, the 30-baht healthcare scheme as it was known, led by (then Public Health Minister) Khunying Sudarat Keyurawan, Dr Surapong Suebwonglee and Dr Aroon Phaosawad, the former Dean of the Faculty of Medicine at Siriraj, and pushed hard for heart disease treatment to be covered by this scheme, which many people decried as being for minor ailments such as common cold.”
Dr Damras was a member of the team that set the criteria for treatment zoning in Thailand which saw the country divided into 13 zones, each responsible for taking care of 5 million people.
He also spearheaded the establishment of several heart disease centres in Thailand between 2002-2005.
Elevating Bangkok Heart Hospital to a world-class centre
After retiring in 2018, the doctor joined Bangkok Heart Hospital and has played an important role in developing the Centre of Excellence Cardiovascular Institute’s roles in academic circles and in holistic treatments.
“Generally, heart centres of private hospitals offer only treatment, but those under Bangkok Hospital’s network provide educational and research services as well as examination and treatment. My job is to give patients confidence in private hospitals and provide them with holistic care throughout the treatment. This helps patients live long lives without needing repetitive treatment. I usually visit each heart centre in our network to keep them informed what excellence must look like along with overseeing, monitoring and examining their quality so that we will become a world-class hospital,” Dr. Damras explained.
In 2016, he was recognised with the Chien Foundation Award for Outstanding Lectureship and Lifetime Achievement in Percutaneous Coronary Intervention at Asia-PCR Conference in Singapore and received the Lumen Global Achievement Award from Her Royal Highness Princess Chulabhorn at the Lumen Global Conference in Bangkok in 2014.
The other key figure in Bangkok Heart Hospital is Dr. Wichai Jiraroj-Ungkun, a medical cardiologist and an expert in the placement of heart stents. The director of the Progressive Care Unit in Cardiovascular Medicine, he advises a team of more than 30 professionals and also performs surgery himself.
He earned his first medical degree on scholarship from the Faculty of Medicine, Chulalongkorn University and was eventually assigned to Lanta Island Hospital, a community hospital in Krabi Province. His main job was visiting the community to educate the island’s residents on basic healthcare.
Three years away from the mainland made the young doctor aware that he needed more knowledge so he headed back to Bangkok to study internal medicine at his alma mater for another 3 years.
“The first question I was asked by a professor was the area in which I wanted to specialize. I chose cardiology because heart disease treatment is challenging, Dr. Wichai said.
After receiving his certification in 2000, he took care of heart patients for 6 years, then in 2006, went for further training at the Central Chest Institute of Thailand and made study trips to Belgium and Japan.
Recognition as an expert in cardiac catheterization
He joined the team of Bangkok Heart Hospital in 2004 and over the past two decades has seen the number of patients with coronary heart disease continuously increase. He has also observed the age of the patients seeking treatment decrease significantly due to their lifestyle.
Most patients come to see a doctor because of tightness in the chest and a general feeling of weakness. They are taken through various diagnostic tests, starting with an exercise stress test by walking on a treadmill, echocardiogram/ultrasonography, MRI/cardiac computed tomography (cardiac CT) and coronary angiogram.
Bangkok Heart Hospital is well-known for cardiac catheterization. This method is designed to dilate narrowed blood vessels with a balloon and a stent. In the old days a catheter was put into a blood vessel in a patient’s groin or upper thigh, but today it can be put into a wrist, which enables patients to recover speedily, take care of their wound easily and go back to leading a normal life faster.
This method can treat all types of coronary vessel defects including severe coronary vessel stenosis, coronary artery blockage, and coronary artery calcification. Expertise and experience in treatment along with good equipment and tools help increase the chances of success.
“When we watch a TV series like ‘The Good Doctor’ or ‘ER’, we feel that our work is similar to the series except for the happy endings. At the end of the series, we don’t know what will happen later. But in real life, we need to follow our patients long after treatment. Taking care of a patient is a long-term activity to prevent the recurrence of their illness and that involves talking with patients and their families.”
Elderly can survive coronary artery disease.
Of all his cases, Dr. Wichai most clearly remembers the 93-year-old grandfather who had defects in three coronary arteries, with the result that his heart was only functioning at 30-per-cent capacity. “Despite his degenerative heart valves and the severe stage of his disease, this patient did not want surgery. Thus, we solved the problem by using the balloon and stent method in each of those arteries. The treatment was successful and he recently celebrated his 100th birthday.
“Another case was an 80-year-old grandmother whose coronary vessels were at crisis stage. After going hospital shopping and getting similar advice – that is surgery –from different doctors, she turned to us. Because of her age, we decided to use balloon and stent catheterization to solve the problem in each of her defective vessels. After several years of treatment, we continue to follow up and the outcome has been good.”
Dr. Wichai is aware that he is responsible for people’s lives and tries to do his job to the best of his ability each day. That means spending sufficient time with patient.
