Episode 33: Dr. Danny Ramzy’s Vision for the Future of Robotic Cardiac Surgery and Unroofing Myocardial Bridges.

SPEAKER_01 0:00

Right now, when I see patients, I still can't say your bridge isn't very classic. I'm not sure 100% that you're gonna have 100% pain relief because it's not the classic. I keep saying that, but maybe one day I'm gonna stop saying that because every single one of those non-classic myocardial bridges have symptom relief, and their vessel is either the bridge course is small or it's not very deep, or it's only partially encased. There's a couple of patients I've done where the muscle does not completely cover the LED, it just almost covers it, where you unroof them from the side, and they also have symptom relief.

SPEAKER_00 1:08

We'll talk with healthcare professionals, those in related fields that support our condition, and others just like us with stories of their myocardial bridge experiences. It's my intention for this content to inform, educate, entertain, and even motivate or inspire you in your personal journey on dealing with a myocardial bridge. Most importantly is to have you leave each episode with hope, knowing you're not alone and that what you're experiencing is real. I have to share that there are days when I marvel at the willingness and support from the cardiologists, cardiac surgeons, and medical professionals who so generously give of their time to talk with me on this podcast. We've already had two cardiac surgeons performing the unroofing process robotically on the program, and each with their own unique processes and practice. Well, I'm excited to introduce another cardiac surgeon doing the procedure robotically. Slightly different than Dr. Balkey or Dr. Guy, we're going to hear his take on a familiar surgery, the unroofing surgery, as each of the surgeons does things the way they choose to do them, and with their own creative interpretation of the best way to accomplish the objective. Today we go to Houston, virtually, of course, to speak with Dr. Danny Ramsey, a globally recognized leader in the implementation of all forms of minimally invasive and robotic cardiac surgical interventions available today. His expertise includes various robotic procedures, including unroofing for myocardial bridges. His leadership in the development of new devices has led him to become an innovator in education. His innovations in minimally invasive robotic and transplantation methodologies have led to over 100 peer-reviewed publications and over 200 abstracts. Widely regarded for his editorial activity, Dr. Ramsey was named Reviewer of the Year in 2020 by the Analyst of Thoracic Surgery in the field of adult cardiac surgery. Dr. Ramsey seeks to join with his distinguished colleagues in assuming the mantle of cardiac surgical leadership that originated in Houston and to become a leading voice in the next generation of cardiac surgical interventions to his advocacy of minimally invasive robotic mechanical support devices and transplantation. As a leader in the Houston community, Dr. Ramsey's goal is to make McGovern Medical School at UT Health Houston a center in the proliferation and normalization of minimally invasive and robotic surgeries. He's devoted his clinical and academic career to teach the advantages of minimally invasive and robotic procedures and raising the standard of care for future generations of patients and physicians. Dr. Ramsey is currently Chief of Cardiac Surgery at McGovern Medical School at UT Health Houston and the medical director and surgical director for the Heart and Vascular Institute and Memorial Herman Memorial City Medical Center. It's my privilege and my pleasure to welcome Dr. Danny Ramsey to Imperfect Heart.

SPEAKER_01 4:04

Well, thank you for having me on. It's a pleasure to be here and to talk to about a topic that's important to me in terms of heart surgery and how to benefit patients.

SPEAKER_00 4:13

Let's start with what led you to become one of the leading minimally invasive heart surgeons in the country.

SPEAKER_01 4:26

So my journey, but you know, it's like a lot of people sometimes, you know, they they find their passions by by something that affects their family. And my family had members of my family that required and had heart disease and required surgery. And I saw the toll it took on them. And I got interested in heart disease and and surgery, and and that's how I got my pathway going into medicine and ending up as a heart surgeon. And then of course you get trained, classically training, doing all these operations and through the front, and also known through a sternotomy. And slowly, slowly you you see other people doing doing different things through, you know, either through conferences or your mentors. And when you see the difference in terms of recovery, that's sort of what led me to say, well, there's some merit to this. And then and I was fortunate to go to a training and stu training hospital that a training program where I got to be exposed to memory invasive and a little bit even of some robotic. And that's how my interest and grew and and and decided to to pursue that avenue, memory invasive and robotic surgery. Because at the end, it's all what we do is all about the patients, and and they do so much better, their recovery is quicker, and the return to work is quicker. So at the end of the day, patients want the least invasive procedure, they want the least disruption to their lives, and they want to be able to get back to work and back to their activities sooner with the least amount of disruption.

SPEAKER_00 5:50

Well, and it certainly seems the opportunity is now because there's the prolification of technology with robotics, and they've improved so significantly over the course of time, and they will just continue, especially as we even get into AI, and they can perform some of the basic functions that you don't have to take the time to do. So you can now focus on the most critical part of the of the surgery. When did robotics come into the equation for you?

SPEAKER_01 6:16

My first exposure was during my training and fellowship to learn to become a heart surgeon. And I was exposed to one of our surgeons there, one of my mentors, was doing robotic mid-caps, minimum invasive direct corneal artery bypass surgery. So they would use a robot to harvest the an artery, and then they would make a small incision and do the bypass, which was drastically different than doing a standard approach for a bypass. And when I saw this, it it sort of caught my attention. Wow, you know, one of the technology, I'm fascinated by technology and robotics, and to combine that with heart surgery was where my eyes was were were open towards there's still more to do and there's more innovation to do in heart surgery, and that's how my I got exposed to it in training in my fellowship. And it was just since then it was always something that I tried to pursue to innovate and try to make our procedures less and less invasive. And the robotic platform seemed like a perfect fit for that.

SPEAKER_00 7:14

You were doing more traditional surgeries with the robot coronary bypasses and sunset. What brought you to myocardial bridges to say, hey, I think this might work here as well?

SPEAKER_01 7:26

It was happenstance. So you do all these, you know, regular cases, and then eventually you you get a patient who needs a mid-cap or you know robotic bypass, but they have an intramyocardial LAD. So a vessel, a heart vessel that goes into the myocardium. It wasn't it was not diagnosed as a bridge, was not does not have symptoms of classic history of bridge, but they had cornearter disease, and you happen, you do look at the cath, you look at the CT scan, and when you go inside to operate with the robot, they have it. And so that's how I realized you could actually use the robot to unroof a vessel because I needed to do it for a standard bypass case, uh, where the only spot I could find the artery was behind the muscle. So it became evident that wait a minute, we could do these less invasive procedures for this problem. And it wasn't for quite a while until a patient came to me specifically because they they were diagnosed with a myocardial bridge that were and they were symptomatic. Then said, well, maybe that's an opportunity. Now we could just do the same procedure without doing the bypass. Just use a robot and unroof the patient.

SPEAKER_00 8:34

Oh, but the great news there was you're already familiar with it because you had been doing it for those people with the coronary artery disease.

SPEAKER_01 8:41

That is correct. So we I've seen I've done it two or three times before. Intramyocardial vessels are actually quite common. 10 to 20% of patients have intramyocardial vessels. But depends on depending on the depth and how the muscles cross the artery, some patients end up having symptoms. So those patients who are who we classically call have myocardial bridging, where the artery gets squeezed by the muscle and then have a pathological problem because of it.

SPEAKER_00 9:06

Aaron Powell On that pathological point, let me back up just a second. Do you believe that it's possible the people with that coronary artery disease that you were working on with for the bypass could actually have been caused by the bridge?

SPEAKER_01 9:18

Aaron Powell It's always possible to have two problems at the same time. That patient had chlastic cornear disease with tight vessels, calcium, plaque. So most likely their issues were from cornear disease. And a large proportion of the population have, even though the percentage is small, like I said, 10, pretend that most 20% have intramyocardial portions of their vessels. But who actually has pathology and who just happens to have vessels going into the through it through the muscle or very close or to the muscle, it's hard to predict, but mostly it's one theory is the directions of the muscle fiber which causes symptoms. And also when you scan them, you could see which patients have issues and which don't.

SPEAKER_00 10:00

Boy, that's gonna be amazing if we can get to the point where we know a relatively large percentage of the population does have this condition, but it's unusual that only this small percentage is symptomatic. And that would be a wonderful blessing for a lot of people to know that we can identify that that one is gonna possibly become symptomatic where the other one has different striations of the way the muscle lays on it, that it won't be a problem. I had no idea.

SPEAKER_01 10:28

Yes. It's all it's this this disease is a challenge because there's a group that believe they're when you see this, it's all just intermyocardial AD that's not causing the problem. And it's very difficult just to look at it to be conclusive to say, well, this is a problem or not a problem. That's why, and uh, and I'm sure we'll talk about this a little bit later. We have provocative testing, we have imaging, and then we have basically also a history in physical. You talk with the patient and see their history and their symptoms, and then that would all the all these components together will lead to know if these what we see on imaging is actually the problem.

SPEAKER_00 11:05

When you're doing your surgery on a myocardial bridge, maybe even on a coronary artery, are you doing this on a beating heart or on the machine?

SPEAKER_01 11:16

So most of my coronary artery bypass surgeries were done off pump. So without the on a beating heart, whether for bypass or for myocardial bridge, sometimes we have to do we have to do it on a on a on-pump, which is on the heart-lung machine case, either beating or arrested, where we actually stop the heart. We stop flow to the heart and and give it an agent called cardioplegia, where we stop the heart, keep it cold, and protect it to we so we could be able to do the case. But my most common form that I in strategy I use now is to do it on a beating heart without the heart-lung machine.

SPEAKER_00 11:49

And I would imagine since you're doing this robotically, this is our opportunity to just touch and plea too intuitive, the Da Vinci people, to say the stabilizer is important for the way that you're you're working on these beating hearts, correct?

SPEAKER_01 12:03

Correct. The stabilizer would make the operation a lot more efficient, safer, and easier to perform. The stabilizer, the moving target is no longer a moving target. It's much it's stabilized, it moves a small amount versus moving a larger amount. There's ways to do the operation without the stabilizer. There's techniques and other types of stabilizers we could use that are not attached to the robot, but nothing nothing comes close to having the stabilizer that's already on the robot that you can move as you're working. That is a that would be a tremendous benefit to have something like that back again in the hands of the surgeons.

SPEAKER_00 12:40

Thank you for that, because we do want to plead to the intuitive the makers of the DaVinci robot to say, look, this is an important piece, it's an important tool. It expedites things, it saves money on the insurance expense, it's time and it's safer. And the more doctors we can get to just support that situation, maybe we can get them to listen.

SPEAKER_01 13:01

Fully agree with that.

SPEAKER_00 13:03

On the process, we've already stepped into the surgical part of it, but let's take a step back, if we could, for a second. Do you have the requirement of a full provocative before you make a decision on what to do? And by provocative, I mean the full testing with acetylcholine and debutamine to really identify what's happening in the heart?

SPEAKER_01 13:24

No, if I see a classic image on usually they get an angiogram because they're comparing out this chest pain and it's completely classed as a long segment and the artery gets completely obliterated, then I if they haven't, if they didn't do the provocative testing, I usually don't send them back for provocative testing. I would get a CT scan that will further confirm the diagnosis and also give me information in terms of how deep it is, where it's located, and if it enters the heart or not. So it's one thing being in the muscle, but if it goes into the ventricular cavity, the actual heart, then that requires a different operation, a different kind of setup for. So once I have that put together, then no. If if it's everything's classic, it all makes sense, and it's fairly obvious, I don't require it. So in the cases where it's not classic bridging, or there's some doubts that that might be the problem, then I would add the provocative testing to get the diagnosis. And the other aspect is to test the other vessels as well. You know, the classic bridging is the LED and we unroof those. Unroofing of the right cornea artery and circumflex or other arteries are not routinely done and or and in some circles not routinely thought that that it causes a problem. So that's what where I do provocative testing specifically on all three main major vessels to determine if other bridging that are present is actually significant or just or just an intramyocardial vessel.

SPEAKER_00 14:51

That answers a really, really poignant question at this point in time. And if I could even dig a little bit deeper, there's a lot of talk about the extra arteries that could be potentially roofed and the significance of those arteries to the sensation, the symptoms, angina, shortness of breath, et cetera. In terms of the testing, what is it you look for and how far can you go? At what point do we believe enough is enough to say that we've unroofed the LED, but maybe the circumflex or a few other arteries that we can see to make the decision that this could be symptomatic or causing some of the symptoms that the patient's experiencing beyond the LAD?

SPEAKER_01 15:36

No, the the LAD in terms of the LED, I unroof from normal vessel to normal vessel. So I start where the vessel is normal, I see it epicardially with no muscle, and I unroof it completely until I hit until I hit the LED that is completely normal to make sure that it's fully unroofed. I also unroof from the side. So there's one thing muscle crossing over, but if it's encased in muscle, and it's so the muscles, the muscles also coming off to the side, and I make sure that the vessel is freed onto the side, so it doesn't get squeezed from the side, even though you unroofed it from the top. So the vessel is freed. And then the other vessels, if there's evidence of intramyocardial or muscle bridging on the other vessels, if it's positive and provocative testing, I I unroof them. So so some patients will will have vessels that are intramyocardial. And if they're if the provocative test is negative and it's just and and I when I go in and it looks as a completely normal, benign process, then I'll leave that alone. But the other aspect is to make sure that provocative testing is negative. If it's positive, I unroof those as well.

SPEAKER_00 16:40

Is there a point where you you just can't get to a particular artery that you can see is possibly roofed?

SPEAKER_01 16:49

So is it are there's situations where we can't unroof? Yes. Once the artery gets very small, it gets risky to unroof because if there's any injury, then the artery gets closed. So we there's no fixing it. So we unroof, we unloof the larger vessels until they get to a point where we we are confident that we've gone a full unroofing. But yeah, some vessels, small branches still go deep in the muscle, but they're usually not causing any problems. And if they do, they're small and distal, so further away. I don't believe that there's any issues by leaving those small branches alone.

SPEAKER_00 17:23

And just logically, it would make sense they're not feeding that much from the size of that particular vessel, not to mention you might make more trouble by going in and trying to correct it. Correct. One of the questions we get often is surgery, you know, traditional strenotomy, and the the patient has their diagnosis and they're heading down that path, and of course, the majority of us will go online and we'll find out, oh, there's a robotic option, which is less invasive, seems to be technically competitive at this point to where it's it's not as risky. And certainly all the points you made earlier, quicker healing, less pain, et cetera, et cetera. If somebody's looking for one or the other, let's say it's a more traditional case, what would you say to that patient who is a candidate for either option?

SPEAKER_01 18:18

So the patient who's a candidate for either a robotic and a and a minor invasive approach or an open approach, a classic sternotomy approach, the me as if me as a patient would choose a robotic approach because it's less invasive. The more important thing is you have to make sure it's someone who's experienced in the robotic approach. If the patient doesn't have access to or be able to get access to to a team that does it robotically, then there's the mini-invasive approaches. It could be done through the side, through a small incision, a mini thorachotomy approach versus a sternotomy approach. And at the end of the day, the operation is the same on the inside. The vessel gets unroofed, and you have to make sure that it's unroofed comp totally and completely. And the team has to have experience on roofing. Now, the experience is small because none of us see many of them. So it's not that the the experience you're gonna see someone who's done a hundred of them, but someone who's already experienced with the approach that they're gonna use, especially if you're going towards it for a mini-invasive or a robotic surgeon that they've done that use the platform or use the techniques before, and at least have some exposure and knowledge on myocardial bridge on roofing.

SPEAKER_00 19:30

How many robotic unroofing procedures have you done to date?

SPEAKER_01 19:34

About a dozen in my and the over the last few months I've been seeing more as a as we talked before offline that I just had a patient being referred to me from a cardiologist with a question mark. Do you do these and does it actually benefit patients? So they're there, and we we'll see a little bit, we'll see more of them as the minimum invasive option is there, and the education about this pathology is is more readily known, but the numbers are still going to be small. So I would suspect a busy surgeon would be doing around that number in a year.

SPEAKER_00 20:10

Right. One of the things that comes up in conversation, and I enjoy speaking with the doctors who are doing this robotically, is when you are physically doing it with your hands, there's a haptic feel. You sense the tissue and you can feel the you know the heart muscle. How do you acquire that sense of feel with the robot?

SPEAKER_01 20:33

It's time and experience because there is no haptic feedback. That is correct. So when we operate, we we have to gain experience of how much we could actually pull, push, operate with the robot. And a strange phenomenon happens with experiences. My brain thinks feels sometimes. So when I pull on something, I feel like I'm pulling. And obviously there is no feel, but it's my eyes and my brain saying, Oh, this is you're pulling to you're you're having this pull. But the there's truly no feedback, and there's no platform really right now that has haptic feedback. Now the first one just came out, the new Da Vinci system has some feedback, haptic feedback. So that was that's a good development, especially for cases like this where you don't want to push too far or and cause any injury to the actual vessel you're on roofing. But it's it's experienced right now. Until we have a greater distribution of the newer systems with haptic feedback, right now none of the systems really have, unless, like I said, except for the new system that came out.

SPEAKER_00 21:36

It's amazing. And I would imagine as technology and AI get more and more involved, they're gonna find a way to give you some sense of feel and pressure and tension as you're working with that with that robotic arm, which is amazing. In terms of the people who are pending surgical repair or trying to find a surgeon who will even do the Bridge on roofing, we have a lot of people in the community, the cardiology community, the surgical community, who still dismissed the condition. And I think we were talking earlier, that patient that's coming to you new, he had a question mark. Does this work? What would you say to the community out there who's still on the other side of the fence in not accepting it as a true condition that's symptomatic and sees them just as benign?

SPEAKER_01 22:27

I would say that the vast majority of intomyocardial vessels are benign, but if you have a vessel that is now pathological, you have a myocardial bridge, and that is not benign. When you have a myocardial bridge with the symptoms, and which is also confirmed with provocative testing, that that is not a benign process, and that these patients do suffer chest pains and adginal pain, and it affects their work, their home life, and their psyche in some patients, in terms of you know being told that it's there's nothing, but they feel something, and you're saying, Well, no, no, there's nothing. So I think that that it exists and that that we need to do the testing. We need to do the angiogram, the provocative testing, and the CT scan that will help us understand which patients have just intramocardial LEDs and which patients have a myocardial bridge. But also, I think what is important is I don't think we have the full knowledge on this disease because I've had seen patients where, you know, classically, as we operate, if it's the provocative testing, it's this deep, uh, two and a half centimeters long. I found that not to be very reliable anymore. I think I've unroofed patients who had much smaller bridge and their symptoms gone. And I was surprised. There's a lot of even right now when I see patients, I still console like your bridge isn't very classic. I'm not sure 100% that you're gonna have 100% pain relief because it's not the classic. I keep saying that, but maybe one day I'm gonna stop saying that because every single one of those non-classic myocardial bridges have symptom relief, and their vessel is either the bridge course is small or it's not very deep, or it's only partially encased. So this other group of pay, there's a couple of patients I've done where the muscle does not completely cover the LED, it just almost covers it, where you unroof them in terms of mostly from the side, and they also have symptom relief. So there are patients out there that would benefit from from unroofing, and we need to find them. They usually are the ones that come in complaining of a lot of chest pain, and you can't find anything else.

SPEAKER_00 24:31

I'm so glad to hear you say that because a lot of people get to that point of they've got symptoms, but they get diagnosed with a minimal bridge. And to hear that even in every case that you've done something, it's improved their quality of life. And maybe it's not 100%, and we certainly understand that's a condition that we enter into the operation with, but to just hear that you could go from what would be 20% quality to 80% quality or even 30 to 70, that's a big improvement. And in many cases, I would suggest probably worth it, but that's my opinion in terms of why I would do it.

SPEAKER_01 25:12

Well, it's very important to have that conversation with the patients. Those who I see a long classic bridge, I tell them we're gonna unroof this, I am very confident your chest pain is gonna go away. There are patients who have short bridge, small bridge, and I and I say, We're going to unroof the vessel, but you will be on medication probably for your lesser life because I think you have a vessel spasm as well. And but they do better once unroofed. And because I see it where I unroof a patient and then their vessel goes into spasm acid in one case, and and that's the patient I said, and the recovery, I said, listen, you're going to need to be on medication because your vessel spasms. So I think that is really another group of patients who I think not because you unroofed them, you should stop all your medications. You could take very small doses, and that's that's what we're we're doing in our program now, is patients who are not classic, who have small shorter bridges or less deep, or who have diagnosis of uh coronary spasm, we still continue their medications on a lower dose.

SPEAKER_00 26:11

And perfectly understood, especially to the point that you know endothelial dysfunction could have even been caused by the beating the arteries taken over the course of a lifetime, depending on when they started to become symptomatic to the point of correction. You know, in my case, it was 65 years. So I understand that poor little artery took a beating and had a rough time. You are doing something at the hospital that I think is worth mentioning. And if I'm not mistaken, you're looking to have the McGovern Medical School at the University of Texas Health in Houston become one of the transformative hospitals for minimally invasive and robotic surgery. Is is that correct?

SPEAKER_01 26:55

Aaron Powell Yes, especially on the robotic side. There's a lot of programs that are teaching minimally invasive. There's very few that are training the future robotic surgeons. We're training, we're training colleagues, we're training surgeons who have finished their training and are in practice and then want to learn robotics as well. But there are very few that are training residents and training fellows and making it part of cardiac surgery training as a standard approach to make sure that that is part of the tr standard training, as it's seen with other specialties, all the other surgical specialties now. The robotic training is part of the residency program. And that's sort of what we're trying to accomplish here is try to start a robotic fellowship and a robotic training in our residency program so that it's just part of the training. So and and hopefully more important programs will do this in heart surgery. It's being done in all other specialties, but heart surgery has been lagging behind, and more programs are starting to see it this way as well.

SPEAKER_00 27:56

Well, in that case, I think Intuitive should be sitting in your lobby right now saying, what do we need to do to get that stabilizer back?

SPEAKER_01 28:05

Yes, the stabilizer is one thing, but I think I was just in a meeting in Orlando where we just witnessed 10 other robotic platforms for 10 other different companies. It's a space that's rapidly growing and with newer tools, newer systems, and as you mentioned earlier, AI, there's a lot growing in this field, and and I'm glad to see that that is happening. It's no longer one platform, it's no longer one area, it's all over the world, companies from all over the world in this space. And the other specialties have really grown fast, and cardiac surgery is starting to catch up.

SPEAKER_00 28:40

Yeah, just as an aside, there's a handful of you, and I mean you doctors who are performing robotic surgery on the heart to any great degree, not here and there, but as a as part of your practice. Globally, are there any other countries that are becoming more adept at robotic surgery, or is the United States a leader?

SPEAKER_01 29:04

United States is one of the leaders, and but a lot of countries are starting to develop and increase their robotic platform. Now, robotic surgery is is that is being done everywhere around the world. It's robotic cardiac surgery is is where it's lagging, where it's slower to the to grow and move, but it's growing in in in it's growing in countries more and more. You know, there's a new platform in India that's robotic platform and it's growing in cardiac surgery there and other specialties as well. There's great interest in bringing this these these robots, these robotic platforms in cardiac surgery across the world. Europe, they were doing a lot of robotic cardiac surgery. It slowed down a little bit because of approvals in terms of what procedures you can and can't do with the robot. For example, even here in the US, the newer robotic platform can't be used right now for it's not approved for cardiac surgery. You can use it, but it's not approved yet. So cardiac surgery is always a little bit behind. And I'm I'm I can't wait for the day where it's in front. Not just joining the group, but leading the group.

SPEAKER_00 30:06

Well, I'm sure not only can you not wait, the people who need the surgery robotically are as anxious, if not more so, to get it, to get it here. I'm gonna shift gears a little bit on you now, if we could. You as a cardiac surgeon have an incredible amount of stress. You know, what you do really is life and death, and it's so significant in the moment that when you're there, I'm sure there is absolutely no other distraction. But when you get some downtime, as many of the patients like to know their doctors a little bit to know what they do when they're not in their surgical uniforms. You what what's what does Dr. Ramsey do for fun?

SPEAKER_01 30:48

Well, there's a there's a few things I like to do for fun. You know, I'm I'm a big foodie, so I like to try out new places, new cuisines, new restaurants, or cook a new meal. And for activity-wise, I love to hike. So, you know, you know, one of some of my favorite places is like Yosemite and Death Valley. So these are activities I like to do and to to try to stay away from from the reality and and the day-to-day business is really step outside and also be active. You know, I like to run and so so I combine being active and and seeing something new and seeing the country. And so traveling to national parks has been a big hobby of mine and sampling cuisines from around the country and around the world.

SPEAKER_00 31:26

Well, I will personally welcome you to Northern California. We have wonderful cuisine here. We are the leader of the Farm to Fort Capital. Everything's from the field to the plate. And you mentioned Yosemite, that's one part of California, and Death Valley is on the other part. So if you ever do make your way out here, we would love to host you to dinner. How does an interested party get hold of you? What's the best way to approach you if they have an interest in exploring robotic surgery?

SPEAKER_01 31:54

Well, I think the best way would be to call my team, my office at 713-486-6690, and they will they'll be in contact, they'll be in connection with one of my team members that could that would help them set up actually an in-person consultation or a telemedicine or a phone visit.

SPEAKER_00 32:14

What does a consultation look like with you?

SPEAKER_01 32:16

So if it's in-person, they they would come to the office, they would be seen by by nurse, my nurse practitioner, get all the information, all the imaging. I will review everything, and then I'll go in and talk with them in terms of what we see, what we think the diagnoses are, what we recommend, what and what we believe the courses are if we do nothing, if we do the surgery, and what we think are the risks and benefits of the procedure. And then we we we answer all their questions. They tend to have a lot of questions. And the patients with myocardial bridge tend to have a lot of questions, and also they've already seen one or two other doctors or surgeons as well. So we have to go through all that and and then come up with a plan.

SPEAKER_00 32:55

I'm really pleased to hear that because you're not the first surgeon that has said the myocardial bridge patients come in and they have done a lot of homework. They have a pretty good understanding of what their situation is. And I think we're really fortunate in the fact that we have a very active Facebook group out there that's a little over 24, 2,500 people now of either pre-unroof, people diagnosed as having the bridge, searching for information, and then the support group has already gone through their surgery. And then those who are maybe two, three, four years out, I think the person that I spoke with the most tenure was was 10 years, almost 12 years since her surgery. So that's a that's a really robust group of people to help in terms of this, you know, this process of identifying and uh next steps because as you know, it's it's frightening, it's scary, it's uncertainty, and you just don't know. And in many cases, we know there's a cadre of people, and I I think it's above 50 percent still of the surgeons that and cardiologists that uh just don't diagnose it as symptomatic. So they're trying to treat everything that prolongs the the grief and the pain for the patient. You have been wonderful in this conversation, and I I I really appreciate you taking the time out of your busy day. We we know that what you do is is truly, truly significant for so many people. And I just want to say thank you for giving me the opportunity to help you share the story to the people who listen to the to the podcast because it does mean a lot and there's so many questions. You were wonderful in your explanation. So I just want to thank you from the bottom of my imperfect heart for your participation, Dr. Ramsey.

SPEAKER_01 34:39

Well, thank you very much. Thank you for having me. And it was a pleasure talking to you and and answering your questions and and also hopefully providing some information, some knowledge to patients suffering from this disease. And it's a learning process. I had to learn as much as the patients had to learn about myocardial bridge, because it's I think we're we're learning more every day and that there's patients out there suffering that that we may be able to help.

SPEAKER_00 35:04

Well, thank you. It's that positivity and the intent to learn more that makes all the difference in the world, and it clearly shows with what you're doing. Thank you. Thank you for listening to Imperfect Heart. It's my hope that this information helped in some way to improve your situation or will help you better understand this condition. More importantly, that it gives you hope through stories that there is help and you most certainly are not alone. If you've been diagnosed with a myocardial bridge, please be sure to join the private Facebook group, Myocardial Bridge Support Group. For more information about our program or to reach me directly, visit the website myimperfectheart.com. If you like what you heard today, please give a positive review, thumbs up, high five, whatever your app likes. And be sure to share with everyone important to you so they understand what it is you're dealing with. Please subscribe as well. Welcome each day with gratitude and positivity. The views and opinions expressed in this program are solely those of the host and the guest, and are not intended to provide, nor are they a suitable substitute for professional care by a doctor, therapist, mental health professional, or other qualified medical professional. Imperfect Heart is a production of Hear Me Now Studio.