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San Miguel Hospital Performs City’s First Ever Open-Heart Surgery

Suergeons performing Susan´s surgery

Doctores trabajando

Doctors performing the surgery

By Jesús Aguado

A multidisciplinary cardiac surgery team of 21 MAC Hospital medical personnel got into San Miguel de Allende’s history books on May 18 when they performed the city’s first ever open-heart surgery.

“Patients are [routinely] sent to León, Guadalajara, México City, or Monterrey,” MAC’s cardiovascular surgeon Francisco Meléndez Alhambra, who led the surgical team, said. “The idea [with this surgery] is to make these procedures commonplace in a small city like San Miguel.”

Open-heart surgery is considered routine in big cities with tertiary-care hospitals, but until now, Sanmiguelenses needing open-heart surgery faced traveling to bigger nearby cities like Querétaro or México City, as well as the costs associated with such travel.

Tertiary-care hospitals are hospitals that can provide more complex medical interventions and follow-up care. Examples of tertiary care include open-heart surgery, cancer management, plastic surgery, and severe burn treatment.

The historic patient

The patient who underwent the historic surgery, San Miguel expat artist Susan Kirby, originally of Salt Lake City, is 66 years old. Her artwork now decorates the MAC Hospital lobby. When Atención spoke to her prior to surgery, she said her only wish once she recovers is to return to her daily life—caring for her cats and her house, painting every day, and exercising.

“San Miguel is my home,” she said. “I have medical care in the United States, but it would take a long time to get that surgery, and I don’t have the strength or the time to go. The care of the doctors is good here, and I have many friends nearby.” As she spoke, she embraced a rag doll that she had designed.

Kirby first came to San Miguel because, “I was told it’s an artist paradise and that I would love it.” Her planned visit lasted three years. She then returned to Utah to care for her dying mother, sold her house, and returned to San Miguel, where she bought a house in colonia Los Frailes and now has a studio and gallery.

Kirby is also a devotee of tango. “I’m a tanguera,” she said. It was after a tango event that she first realized something definitely was wrong with her heart.

“The first time I felt that I couldn’t get enough air was 10 years ago,” she said. “I was skiing, and I suddenly felt I could not breathe. They had to bring me down on a toboggan; it was serious.” However, she did not pay much attention to the incident afterward.

A decade later, about a month ago, she had finished a tango competition and found she was tired. The following morning, she woke with strong pain but let it go for three or four more days, not sure what to attribute it to. When the pain did not disappear, she drove to MAC Hospital, where she met with Dr Grace Joanne Lim Baga.

The diagnosis

Lim Baga, who was born in Toronto and grew up in San Miguel, studied medicine at the Universidad Autónoma de Guadalajara, did her internship and rotation in internal medicine at the Royal Victoria Hospital in Montreal, then worked in ICU care in México City. A specialist in critical-care medicine, she is also Kirby’s primary care physician. When Lim Baga saw her in the emergency room, she told Kirby that Meléndez Alhambra would need to repair her damaged mitral valvd that they were going to begin preoperative care immediately.

“We have to see that there are no infections anywhere. We do studies,” said Lim Baga. “We give antibiotics, do cultures, catheterize. We even check to see that the patient has no cavities.” Nutrition is also a factor.

Meléndez Alhambra explained Kirby’s diagnosis to her, which he made soon after emergency room personnel alerted him that Kirby was experiencing thoracic pain and dyspnea due to lack of air.

“We suspected a heart murmur. The diagnosis was corroborated, and a mitral insufficiency was found,” he told Atención before the surgery. “The heart has four valves. Her mitral valve is the one affected. When the left ventricle contracts, instead of expelling the blood into the aorta for the entire body, a portion goes back through the mitral valve, which is not working properly. She’s already had clinical symptoms—pain, shortness of breath. Due to the mitral insufficiency diagnosis, surgery is recommended.”

When we asked if Kirby was taking risks by undergoing this surgery at her age, Meléndez Alhambra commented that it was a routine procedure. He spoke calmly and with clear confidence in the success of the operation.

“Heart surgery at any age is risky. Not all hearts function the same way, and the patient is an individual [case]. It is risky, but it’s routine. Everything has a risk,” he added philosophically, “even crossing the street.”

He found the prospect of performing this surgery in San Miguel interesting, he said, because even though the procedure is not exactly newsworthy these days, it has never before been performed here.

MAC, part of a hospital group that started in Celaya, has six hospitals throughout México, all equipped with the physician-specialists, instruments, and medical support teams to perform these surgeries. The staff at the San Miguel hospital collaborated to obtain the necessary materials to perform cardiac surgery here.

“It was arduous labor by all involved in the hospital—the administration, the cooperative… As it becomes more common, it will be easier and more frequent,” Meléndez Alhambra said.

In the operating room

On the day of the operation, at 8:30am, Meléndez Alhambra and a first- and second-assistant surgeon, a risk-prevention officer, various surgical and circulating nurses, an echocardiogram technician, and an anesthesiologist and his assistant began preparations for anesthesia and the placement of catheters, respiratory tubes, and a lung probe. Eventually, Kirby’s sternum was opened, and her mitral valve was replaced.

Prior to the surgery, Lim Baga explained that after the surgery, Kirby spend the next 24 hours in the ICU, where she would be under Lim Baga’s direct care, as is standard practice. Medical personnel watched Kirby closely to make sure her condition remained stable and that no other organs were affected by the surgery.

“Arrhythmias are common. They [the patients] come out cold from the operating room,” said Lim Baga. “We need to warm the patient until she reaches normal temperature, do everything to stabilize her.”

If all went well, Lim Baga told us, Kirby would be woken up, according to her tolerance level, and would be eventually deemed well enough to breathe on her own without a tube. Before we left the hospital, Lim Baga predicted that Kirby would likely be able to go home in seven days. Then three to six months of recovery would follow before Kirby could resume those daily activities to which she so looked forward.

Read our next edition for our postoperative conversation with Kirby.

 

BOX

MAC Hospital, which has five affiliates in Celaya, Puebla, Guadalajara, Irapuato, and Aguascalientes, is located in San Miguel de Allende at Camino a Alcocer 12. The hospital’s emergency phone number is 150-3900.

 

 

 

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