The new way to ease agonising heart pain ...BLOCKING a vein

IT SOUNDS utterly bizarre, but surgeons have discovered a new way to relieve the pain of previously untreatable angina – by blocking a major vein in the heart. The condition, which affects about two million Britons, occurs when the circulation that supplies the heart muscle with blood is reduced by narrowed diseased arteries.

First-line treatment includes medication and surgery to insert stents – tiny expandable wire mesh tubes – into arteries around the heart to prop them open.

The procedure, angioplasty, restores the circulation and relieves the symptoms of angina, which includes sometimes debilitating chest pain usually triggered by exertion.

Others are offered heart-bypass surgery, which involves taking a vein from elsewhere in the body and implanting it around the heart, restoring blood flow.

However, five to ten per cent of patients do not respond to these approaches or are ineligible due to other health complications, and they are said to have refractory angina.

Now, in a move described by one leading surgeon as ‘counterintuitive’, a new kind of stainlesssteel stent that is shaped like an hour-glass is being used to narrow the coronary sinus, the vein that transports blood from the heart to the lungs.

The narrowing causes smaller surrounding arteries to dilate, increasing blood flow elsewhere in heart and alleviating angina pain.

The Coronary Sinus Reducer system is now being offered to patients in NHS hospitals and trials have demonstrated that the life-changing procedure can improve blood flow to the heart muscle, relieving symptoms in about 70 per cent of refractory angina patients.

The implant is inserted via a tiny incision in the jugular vein in the neck, when a patient is sedated.

A fine plastic tube – a cannula – is threaded through the blood vessels until it reaches the coronary sinus vein at the back of the heart.

A guide wire, with the collapsed mesh implant on the end and a deflated balloon inside it, is then pushed through.

Once it is in the correct position, the balloon is used to inflate the ends, leaving a narrow middle section. The entire procedure takes about 20 minutes and patients go home the same day.

The stent remains in place and the blood vessel walls grow into and around the implant, leading to a narrowing of the vein. Cardiologist Dr Steven Lindsay, who is fitting the device into patients at Bradford Royal Infirmary, said: ‘Life for patients with refractory angina is pretty miserable.

‘We have patients who find they are in pain just walking from room to room at home. Others live in constant fear that they are having a heart attack, as the chest pain is severe – although this isn’t the case. This is such a problem that we actually offer them psychotherapy to help them cope.’

The condition is not fatal, but often feels like a heaviness in the chest which may spread to the arms, neck, jaw, back or stomach.

Some sufferers describe a feeling of severe tightness, while others say it is more of a dull ache. Some people also experience shortness of breath. Angina symptoms are often brought on by physical activity, an emotional upset, cold weather or after a meal. The episodes usually subside after a few minutes.

Dr Lindsay added: ‘When we first heard about this new procedure it seemed counter-intuitive that narrowing a vein could help blood flow, but studies have proven it to be effective and safe.

‘We warn patients that they won’t feel any different immediately afterwards, as the stent itself doesn’t cause the narrowing.

‘It’s only once the vein walls start to grow around the hour-glassshaped tube after a month or so that the symptoms start to disappear.’ ONE patient to benefit is Robert Swift, 65, a retired plumbing business owner from Huddersfield, who first started suffering from angina at the age of 28. He was fitted with the new device two years ago. At the time he was regularly racked with chest pain and could not climb the stairs to bed without suffering an attack.

He said: ‘It hasn’t cured my angina, but I don’t get an attack just getting up from my chair, which was the case previously.’

The father-of-two mistook his angina symptoms for heartburn – which can feel similar – until, at the age of 42, he suffered the first of six life-threatening heart attacks, with the last three years ago.

The former smoker has also had four coronary stents fitted and has had a quadruple bypass.

Mr Swift added: ‘I’m a pretty extreme example. They had tried just about everything on me and there was nothing else that could be done before this device came along.

‘I’ve got a bit of my life back after suffering so much for so many years.’