Episode 37: Dr. Allan Stewart’s Childhood Appreciation of Mechanics Lead to “Unroofing” of Myocardial Bridges.

SPEAKER_00 0:00

Doctors who are not skilled or experienced with a particular type of surgery will err on the side of caution, meaning that they might not do the complete surgery. They might, you know, open up the artery, but if you don't open the muscle all the way down to the artery, you haven't fixed the problem because even one muscle fiber over the artery is still a bridge. It's maybe less tight, but it's still there and it's still going to constrict and you're still going to have symptoms. So unless it's completely unruven, it's not done.

SPEAKER_02 0:53

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. My guest this episode hails from a state where we've seen many requests for cardiothoracic surgeons. So if you're far south, like Florida, you now have an option. He's an accomplished cardiothoracic surgeon, and as you'll hear in the conversation, no stranger to myocardial bridges. His preference and specialty is minimally invasive cardiac surgery when appropriate. He worked at Columbia Presbyterian and Mount Sinai in New York prior to joining HCA Florida Kendall Hospital and HCA Florida Mercy Hospital, where he is medical director and chief of cardiovascular surgery. As a professor of cardiac surgery, physicians he has trained are all around our country, in Japan and Israel. And that's good news for us with myocardial bridges indeed. He's operated on six continents and in 21 countries, has received numerous awards of recognition, and has even been featured on many of the popular talk and morning shows. He has a personal passion for health and wellness, encouraging his patients to make healthy lifestyle choices, and he supports them to do so. He also practices what he expects his patients to do as well. I'm very pleased to introduce Dr. Alan Stewart to our coronary community. Dr. Stewart, welcome to Imperfect Heart. Thank you. It's an honor to be here. Hey, we are thrilled to have you here. Let me tell you. Let's start with what led you to become a leading cardiac surgeon in the country. You knew at quite an early age you wanted to head in this direction, like 11 years old.

SPEAKER_00 2:56

Yes.

SPEAKER_02 2:57

How does one manifest from 11 to today?

SPEAKER_00 3:00

Well, it's an interesting story. My my grandfather was a diesel mechanic. So when I was growing up, he he would always teach me how to do brakes and fix a carburetor and work on cars. And he would give me a present for Christmas, and the present was always a tool for my toolbox, and then a gift. And unbeknownst to me at the time, the gift was always broken, invariably, to the point where it almost became a running joke. What I didn't realize, and unfortunately it was much later after he passed away, that he broke the gift and he gave me the tool to fix it. One year it was a cuckoo clock, and he took the screws out to make the bird come out. And I called him up, I remember, and a month later, and I said, Papa, I fixed the, I fixed the clock and it works now. And I used I used that tool that you got me for Christmas to fix it. Oh, that's a great, what a you know, a bizarre coincidence. And I didn't realize that he broke the clock on purpose to teach me how to think critically. And then I watched a Nova episode when I was 11. It was the first pediatric heart transplant, and I was transfixed. I said, that's when I went to be when I grew up. And just never changed my mind.

SPEAKER_02 4:02

Boy, well, we're happy you were able to get through whatever the schooling was to get you here, because what you're doing is is something we're really, really interested in learning a little bit more about. You went from cardiac surgeon to also focusing on the less invasive strategies. Tell us a little bit about that.

SPEAKER_00 4:19

Yeah, so I think that what we first want to make sure is that we can do an operation and do it safely. And uh to the extent that can be accomplished, then we said, well, if it can be safe, can we do it in a way that is less traumatic to the body and or cosmetically more acceptable? Because sometimes we're doing these operations on people that are. I remember when I first got started, I was operating, I was doing an aortic word replacement on a cosmopoly. And she's like, Please don't cut my chest open. But I was saying, but she's got this big aneurysm. How am I going to do that? And then I thought about it for a while and I said, Well, I can make this incision underneath her breast implants and then flip them up and then open the chest from there and then put it back down. And we had a plastic surgeon involved, and we're able to do it. And I said, Well, geez, this is interesting. And then we start thinking about, well, are there other people that we can do these type of things in? And and sure enough, people appreciate it. But we never ever sacrifice a cosmetic result for safety.

SPEAKER_02 5:20

So not only cosmetic, but healing time on a on a less invasive procedure is is certainly a little more rapid, more often than not, less painful.

SPEAKER_00 5:32

Right. The key is that we what we want to make sure of when we're doing minimally invasive surgery, and and that's generally what we're trying to avoid cutting the chest open or cutting the chest fully open. Sometimes that means we're going to do a partial cut as an inverted T in the chest, or maybe go between the ribs in a small space and not break the ribs, but just separate them with special retractors that we have. And the key is that we're going to accomplish that doing the same operation as we would do as if we're opening the chest. Because what we don't want to do is sacrifice the quality of the operation for a cosmetically inferior operation. So assuming we can do the exact get the exact same results with full exposure that we can get to a partial one, we always do the partial.

SPEAKER_02 6:17

Not everybody's going to qualify for a thoricotomy or the minimally invasive. And I'm sure sometimes you begin that route, go down that path, and realize this isn't going to work. We need to actually go through a full strenotomy. How do you diagnose or assess initially that the person is likely a candidate for a thoricotomy?

SPEAKER_00 6:41

Well, for myocardial bridge specifically, it really depends upon how the heart's rotated. Because if the heart is moved, then most of the left side of the heart or the area that we're most interested in, which is the LED, that's the most common site for a bridge. That's running right smack in the side of the chest in this direction. And the heart's, when we look on a chest x-ray or a CAT scan and see that the heart's oriented properly, we know pretty well that we can get to the entire distribution of that artery through the side of the chest. If the heart's right up front behind the chest, behind the sternum, well, we're not going to see the whole LED from the rib base, and then that would be a bad idea because we'd only see the apex of it. And then that leads to the folks who become unhappy with the result because we're not necessarily seeing the whole artery. We might see the area that's seen on the angiogram, that that's the area where it looks like the bridges, but if we can't see the whole artery and unroof the whole artery, it leads to a potential of having an inferior result. So we want to make sure that the key is when we start the incision is that we can unroof that artery from the bottom of the heart all the way to the top.

SPEAKER_02 7:53

You're an expert in a variety of different heart procedures, aortic, specifically, if I'm not mistaken. What led you to addressing myocardial bridges?

SPEAKER_00 8:03

It it actually happened by chance because I did, I spent my my most of my career in Manhattan at Columbia University. And I was doing a lot of adult congenital surgery, meaning that kids who had birth defects, they had heart surgery when they were babies or infants, often would come back later in life either for a heart transplant, which I did, and or some revision of that first operation. Well, one of the things that is common as a congenital problem is what's called an aberrant coronary artery, meaning that one of the coronary arteries, either the left or the right, takes a unnatural course out of the aortic. And I was the head of aortic surgery. And so this unroofing procedure, as it's called, is unroofing it inside the aorta. Well, the patient booked an appointment for an unroofing procedure, but what they really came for was a myocardial bridge. And I said, Well, that's not a burnt artery. I said it's just when I was looking at the endocrine and it comes out of this like very abrupt U. And then as I heard the story of the of the patient, they were saying that, well, everybody thinks I'm crazy. I've got you know 10 catheterizations and five MRIs and a bag of, they come up with a bag of images. And I said, Well, you know, they're on my way with I said, Well, so geez, I'm I don't even know what you do for this. I quit. And so I I did some reading and found that one operation the person needs. And I said, Well, nobody will help me. And I said, Well, I'll help you. I just, you know, I didn't know that, just had a different opinion of why you were here. And and so I did that. And the person was so grateful. And then as happened down in in Florida, all of a sudden there's an office full of people who have bridges that that showed up. And because there weren't a lot of people there to help them. And this was kind of 15 years ago.

SPEAKER_02 9:48

15 years ago, boy, to think we really haven't made that much progress from 15 years ago to today. Although I think we're starting to get some attention now. And I'm glad to hear Columbia is producing the product that you are, because we just had somebody else who had their bridge unroofed at Columbia, as well as a double bypass while they were at it. So obvious other complications. Are you working on a beating heart or do you go on pump?

SPEAKER_00 10:15

It depends on the patient. And so the thing is about these operations is that there's really nothing in between the muscle and the way I describe a myocardial bridge is that it's almost like a python saw itself in a mirror and decides that it's it's prey. So it wraps itself around it and squeezes. The blood flow is cut off to its body, and then it can't squeeze anymore, so it lets loose. And that's some of the symptoms is that this little muscle that's circumferential around the artery will squeeze, but then ultimately there's no oxygen to that muscle that's around it, and it lets loose before the person has a heart attack. So they've got all the symptoms in the world of a heart attack, although they don't have one. And so that's what creates the anxiety and the frustration. But there's no separation between that muscle and the artery that's underneath it. So as long as we can get the heart perfectly stabilized, we'll do it off pump. But there are some folks that the uh the artery is almost in the right ventricle where you're cutting the muscle, and then all of a sudden you're inside the heart. Now, if you're on bypass, that's not a big deal. If you're not on bypass, it becomes rapidly a big deal. So doing it off pump through a mini incision without having the cannulas in can become you can be upside down very, very quickly. And so it's really a matter of looking at each patient individually. Again, we try and do everything with a minimally invasive approach, we try and do it with the least trauma, meaning stay off the heart lung machine. But again, we want to make sure that the the reason for coming to me is that you want this unroofed. And being on the heart lung machine for 15 minutes is not a big deal, which is really all it takes. And so to, and really it's just kind of seeing with my fingers to cut with a knife over the top of this artery, and the last muscle fiber that's keeping this in place is microscopic in size. And once that cuts, the artery pops up. The worst thing in the world to do is to cut the artery because now you're into a bypass surgery. Because if the artery is cut and it's say it's a millimeter and a half or two millimeters in its diameter, if it gets cut, we have to sew it. If we sew it, we're gonna make it narrow. And now you're creating a stenosis of the artery that didn't exist before. So generally, if you cut the artery in subtle dramatic fashion, you've got to bypass it, which may have happened at Columbia to that person. So most of the time, people with bridges don't have coronary disease, they just have a bridge. And so we don't want to allow that artery to be injured. So if I find it to be a very deep artery or it's a long segment that's in the muscle, then we'll just go and bypass for a few minutes, which is very, very well tolerated.

SPEAKER_02 13:04

As you prepare for diagnosis, what are your requirements to make the decision whether to perform the unroofing procedure for a patient? Do you require a full provocative testing? What is it that you're looking at to help you make that decision whether or not to offer the surgery?

SPEAKER_00 13:21

They're just not, they're not the greatest. There's really no pathonomic sign on any diagnostic test that's going to say this is the source of your problem. And that's that's what's frustrating, and that's what leads people to this despair, if you will, because they're told there's nothing wrong with you. Your arteries are completely fine. It just takes a little, it's just got a little kink. It's benign, benign. Don't worry about it. You don't have any coronary disease. There's nothing that can be offered. And they're given nitrates or they're given beta blockers, and and or they're told just don't overdo it with exercise. And and then that's frustrating to a lot of folks who, I mean, a good number of people that come see me, just by nature of being an endurance athlete, come to me because I am. So maybe I have your unique appreciation for their plight. So they say, well, you know, I've been told I can't exercise, or I can't do, can't ride my bicycle, or I can't, you know, run a marathon anymore because I've got this bridge. And that's very important to me. So my quality of life is gone. And as a surgeon, our goals are twofold. We want to preserve somebody's life and we want to make it better. And if we can only do one of them, we want to make it better because there's no sense being alive longer if you're miserable. So if your quality of life is being limited or impaired, well, then it's the right choice. Typically, the patient has had an angiogram. It shows that they've got no obstruction, but they've got this dramatic turn. We'll usually have either a CT angiogram or a cardiac MRI that clearly shows that there's a bridge, and then there's symptoms. If they're asymptomatic, we do nothing because there's nothing about this that would lead to sudden cardiac death. At least I've not seen that reported. So they've got a normal artery, it's got a bridge. The bridge from time to time will constrict, will cause the symptoms of a heart attack. So the patients are have usually had recurrent symptoms of one or two visits to an emergency room, has had anatomic testing. I don't really rely on provocative testing because I don't think it's it's you know formally embraced or reproducible.

SPEAKER_02 15:20

What is it that provides you the tool to say, okay, you've got a three, a four, or five centimeter bridge? What are you using as your best diagnostic to help you identify?

SPEAKER_00 15:32

Cardiac MRI, I think, is the best test. Although CT scans are getting better and better, the newer CT scans, as well as there's now a generative AI algorithm that's put in at least a 64-slice CT scan called heart flow, which can measure the fractional flow reserve in an artery without a CATH or without an MRI, has done it about 15 seconds. So more and more imaging centers and more and more hospitals are using heart flow as a good means of showing the virtual flow through an artery. So I have had two patients that were diagnosed on heart flow scans for the bridge. Now, the thing about that, it shows the difference in flow, but it does not show that doesn't give any anatomy of how deep the bridge is. It'll show the artery and it'll show the kink in the artery, but then you have to rely on the regular CT scan images. What heart flow is a three-dimensional rendering of just the coronary arteries. So you'll see the kink, but you won't see the muscle around it.

SPEAKER_02 16:32

Got it. And it's wonderful to hear. I I knew it was only a matter of time before AI would be stepping in to really benefit us with this situation because it can do so many things. If we've got X amount of points to identify, it's just going to fill in the blanks, which is just that much easier. I'm I'm thrilled to hear that. How many unroofing procedures have you done to date?

SPEAKER_00 16:56

Uh last I looked, it was 75, which is a good number. It's uh it's a very good number. For that, it's it's kind of a rare finding. So it's a bit more now, but that was the last uh plan writing up the experience.

SPEAKER_02 17:11

As more surgeons are doing the unroofing procedure, and we are really grateful that this is occurring, over the course of even just the last couple of years, we've seen so many more people willing to I I hate to use the word attempt, but in some cases it really is just an attempt. They're not getting the entire artery. You know, they're missing a segment, maybe they thought they had all of it, or there's other roofed arteries that are are significant and they're missing those. What we're learning now is there are procedures that each surgeon does and their own best practice. And we were talking just a little bit before we came on. If if you could share how you go about it, because I think that's a little different. This is the artery that's most often involved in a brew, so-called LED. For the benefit of those who are listening, Dr. Stewart is actually showing us a model heart. So the YouTube channel will have a video. Okay.

SPEAKER_00 18:07

So this artery here, come down. This supplies blood to the front part of the whole left side of the heart, as well as the area between the so-called septum. And so this is a major artery. This is does the line share. The yeomans uh share work in the heart to supply oxygen and nutrients to it. And you'll see up here where the spat is, there's no muscle up here. So if you get all the way up here on the artery, you know it can't possibly be involved with the bridge anymore. And this is really up high next to the pulmonary artery. So that's where the LED comes out. So the LED comes out. There's what's called the left main coronary artery. That's what comes out of the aorta, and that splits into the artery that goes to the side, the circumflex, making because it's circumferential around the heart. That's why it's named, and then the one that's long in the front. Long anterior, anterior means front, descending means it goes from top to bottom. So up here it's suspect. And then the muscle starts about here. So if you get up to here and then unroof it all the way down to the apex, you know there's no bridge because there's no bridge up here. And then if you come all the way down, and sometimes it involves moving this vein over here, or even ligating it because it's not that important. But at the end of the procedure, want to see that you want to see the artery from up here in this fat pad, and you want to see it all the way down to the apex with no area of obstruction. So if you open it in the front and just cauterize that muscle and move it to the side, and you can see the front of the artery from stem to stern, you know there's no bridge anymore. And because it's charred on either side, it's not growing back. And cardiac muscle doesn't grow back anyway. Yeah, that's why heart attacks are a lifelong problem. So once you you've cut it away and it moves to the side, it can't be circumferential anymore, so it can't cause constriction. Doing it for with a robotic case or a mini, sometimes you can't see the whole artery from the top to the bottom, depending upon how the heart's oriented in the chest. And while it's important to people to have a mini, I think it's more important to have a full unroofing.

SPEAKER_02 20:10

I applaud you because you are the first doctor in 12, 15 doctors I've spoken with who have given us show and tell. And we actually got to see the the heart as you diagnosed or demonstrated what that artery looks like from top to bottom. So thank you. Thank you so much for doing that. The other thing that's coming up now just recently is people are talking about scarring. And you mentioned, well, you the the heart tissue doesn't really grow back or scar, and then they're thinking that it could even scar over an unroofed artery. How would you address that?

SPEAKER_00 20:49

I would say it can't. It's not a it's not a possibility as long as the artery is exposed to the front. Now, what could happen is that on occasion the bridge is very deep or the muscle surrounding what's been cut bleeds. And what some surgeons will do is that in order to stop that bleeding, because as I mentioned before we get online, sometimes if the bridge is very deep, you can end up in the in the heart itself because there's not a lot of muscle tissue between that artery and the free wall of the heart. And sometimes even the artery can end up the way it's constructed, can end up actually in the heart itself, where in opening the bridge, you can end up in the the right side of the heart. That's often just sticks with a with a stitch, but you have to place it right so you don't constrict the artery. The other is there's bleeding. Sometimes surgeons will put a little glue over the top to stop the bleeding. The glue can actually cause constriction because the glue is now a shell over the top of the artery. So it's not a wise choice to put any glue or any topical agents that are going to stop the bleeding. You just have to sit there for a little while and let the bleeding stop. But as far Scar tissue forming over the top of the artery, that's not possible.

SPEAKER_02 22:03

Aaron Powell Okay, that's great to hear because I know a lot of people are talking about it. And it was certainly my understanding post-surgery that that wasn't the case either, because I asked about that. So I'm I'm glad to hear it. And I'm sure that will allay a lot of the concerns and fears that people have as a result of their surgery, thinking, okay, now I've got symptoms again.

SPEAKER_00 22:22

Aaron Powell I think with the artery being constricted as it is, there is a possibility of having that artery be a little bit more prone to constriction or some stimulants or things that would normally cause spasm of the coronary arteries, might be a little bit more, you might be a bit more susceptible to that if you had a bridge because that arterial tissue is used to being bent and maybe it's the integrity of the artery is a little bit off in that segment. That's something that may be best asked. You know, I'm someone who's saying more of a vascular specialist or a basic scientist, but I could see where that could occur. And then maybe that would be treated with some sort of calcium channel blocker to allow the prevent spasm. But as far as scar tissue is concerned, or as far as residual problems down the road, it it should not be related to an anatomic bridge. For me, I don't know if the if the camera on the laptop will be enough to pick this up, but if you look this.

SPEAKER_02 23:21

Oh yeah. If you hold that close, we can't, we can see it. Yes.

SPEAKER_00 23:24

This is a a successful bridge. And you can see the there's almost six centimeters of the LED in that area in the center. That is the artery, the LED, unroofed from the top to the bottom. And that's the result you want to have. That you see there's no there's nothing on that artery from all the way to the bottom to all the way to the top of it that has any covering at all on it. You can see it's completely exposed, and you can see that big divot of tissue all around it. That's a successful surgery. Yeah, and that's a nice plump artery there. Yeah, yeah, yeah. And and there were two areas in this patient, one up here and one up here, that were both constricted. So it's important that, you know, when someone says I have a bridge, to make sure that you're looking at the the images yourself as a surgeon and say, Well, no, you don't have a bridge, you have a couple. And you're not you're not limited to one.

SPEAKER_02 24:13

Lucky us, right? Right. So one of the things about the program is while it's intended for the benefit and giving hope to those who are suffering from a bridge and have no clue what's happening and what to do about it as they learn, get more educated. There's an equally important facet of what we're trying to accomplish, and that is to educate the cardiology community, the the cardiologists, the cardiac surgeons who still believe these things are benign. And patients present with symptoms, yet they say, that's not that. It can't be that. It's something else. Unfortunately, that's still the prevalence. It's more of that than recognition that this bridge is symptomatic. What would you say to those cardiologists, cardiac surgeons?

SPEAKER_00 24:56

Yeah, I think that that our traditional teaching is that flow through an artery is normal unless there's a fixed obstruction inside the artery, and that you can have an extrinsic obstruction. And one of the worst things I've seen are interventional cardiologists who will try and put a stent in meats. It doesn't work. The stent will just bend. And now you've got two problems because now you've got a stent that doesn't need to be there. And that in and of itself can be a nitis or a focal point to create scar inside of otherwise normal arteries. So stents are being put in a normal artery. Now, these stents have no real extrinsic radial force. The radial force is inside of them. So if there's a muscle that's constricting, it's still going to strict it and it's going to bend the stent. And then the person can have a real heart attack because now you're kinking a piece of metal that's inside the artery, and that can cause clot formation and sudden cardiac death. So you've got somebody who's got a disease that is a nuisance and it's it's making people miserable. And now your treatment has now increased their mortality by putting something, the stentilement that doesn't belong there. So my education to interventional cardiologists is this is not something that should ever be intervened on with percutaneous intervention. And that the population of these folks is enough to realize that the symptoms are reproducible. The symptoms do go away with being with having a definitive surgery. So no, the the people are not crazy. They're they do have an actual problem, and the problem requires a surgical solution. It can't be fixed endovascularly.

SPEAKER_02 26:33

Well, and thank you to your grandfather for helping you recognize these broken things have tools that remedy them. The other part of what we look at when we're determining on the surgeon that we might have an interest in performing our unroofing procedure is what are they like? And you guys have a tremendous amount of stress. You are a life and death situation. You hold the most important organ of somebody's body in your hands. How do you relax? What do you do to relieve stress? What's you know, what's Dr. Stewart do when he gets a few extra minutes?

SPEAKER_00 27:09

Well, I I feel like if you operate on the heart and you believe in, you know, we only have one, we're not our body, but we only get one of them, that we should take care of it. So uh I six days a week do a a workout called 54D. It's a muscle confusion, an hour-long exercise program that I've been doing for a few years. That's one. And then I train in karate with my 13-year-old and six-year-old boy. So we go and do that three times a week. I trained for 12 years as a kid, and my son, who's now 13, found it and dragged me back. And Sensei said, Well, are you gonna train with us? I said, No, no, I'm here with my son. And he he said, I heard he used to train. I said, Yeah, a long time ago. So sure enough, he I get roped into it, and I've been doing that for a few months now, in addition. So I still love to build things. I I built a house as a hobby, and I love to exercise. I do a lot of exercise with my former patients. So I had one guy who kind of wrote me into a marathon when I turned 40 and then a triathlon and and then recently an Iron Man, all with people who had surgery. That's been fun for me. Um I'm not competitive, so I finish, which is how I win. I win by getting a medal. I maybe just a few steps in front of the paraathletes, but I finish. But yeah, that's that's fun to me.

SPEAKER_02 28:30

That's amazing. And I I think many of the listeners know that I'm I'm a cyclist. Had you done my unroofing, we'd be going out for a ride somewhere at some point in time. We can do that anyway. You're still a patient. This is true. This is true. How would an interested party get hold of you? What's the best way to to get in touch with you at the hospital?

SPEAKER_00 28:48

Yes, what I what I normally give people, especially those who are calling from a distance, is I I just give them my cell phone. Because it's rather than trying to get through, it's becoming increasingly difficult to get in touch with a doctor through a normal means. So my and you can put it down on your show notes your site. It's 917-748-7836. It's my New York number. Kept it since I moved to Miami. And but I'm available to either leave a voice message or a text message, and I always answer with the end of the workday.

SPEAKER_02 29:22

Thank you for that. Very, very much appreciated. You know, I'm happy to say that now if you're living in the South, we have some really credible resources for our listeners to explore with Georgia, Texas, and now Florida surgeons to speak with. And that that's really exciting for us to know that there's a greater recognition and there's a greater competence that we can now rely on for the symptoms. Yeah. So, Dr. Stewart, thank you so much for for your time. I really appreciate you doing this for us. Your insight, knowledge, experience, it's more so for the training that you're providing into the the world with the the doctors that you've released through your program and taught, who we now know will accept us as we reach out to them and they won't think we're crazy. But your story really brings comfort to the people in need of getting to that next step. And you shared some things today that we've not heard from other surgeons as as everybody has a little bit different nuance, and I think extremely helpful, especially the demonstration of the heart model. That is a really big piece. And I'm going to encourage everybody to look at that on the YouTube.

SPEAKER_00 30:28

There's one thing I would say is that people are much more willing to travel to a restaurant than they are to travel to a church or a doctor. You generally go to your local church or you go to your local physician. But there are some operations that require you to get on an airplane. And this is one of them is that you don't want to have somebody who has not done this before taking a knife to a muscle fiber right above your artery. Because what happens then is you have this surgery, and doctors who are not skilled or experienced with a particular type of surgery work will err on the side of caution, meaning that they might not do the complete surgery. They might open up the artery. But if you if you don't open the muscle all the way down to the artery, you haven't fixed the problem because even one muscle fiber over the artery is still a bridge. It's it's maybe less tight, but it's still there and it's still going to constrict and you're still going to have symptoms. So unless it's completely unroofed, like the picture I showed you, it's not done. And it's important whether you come to South Florida or any of the other centers of excellence that do this, your hospital stay is about three days. And two days later, you can get on a plane and go back home. So it's not like you'd have to be planning on being in a particular place for weeks on end or incurring a massive expense. Most hospitals like ours have have rates with hotels right in the area. Although July and August are not ideal times to come to Miami the rest of the year is. And you know, there are worse places in the world to be than South Florida in the winter. But I think that for routine cardiac surgery, yeah, there's there are plenty of good places locally in in almost all states. But for nuance operations, it's important to find your surgeon, be comfortable with that person, and realize that it's not it's not the worst thing in the world to come in, have surgery, and go back home.

SPEAKER_02 32:23

And I think that's a great point. I'm glad you brought that up because it is about being comfortable with the surgeon. You may find somebody who says, Yeah, I can do this, and you say, Well, how many times have you done it? And they go, a couple. I'm I'm familiar. I'm not sure that's the person I really want to take.

SPEAKER_00 32:38

Because the worst thing in the world to end up is is that you have a normal artery and now you've got a bypass, or now you've got a stent, or now you've got some sort of or an incomplete fix. Because that that's actually a catastrophe. Because if you have the surgery and the unroofing wasn't complete, you're not going to be told that necessarily. Or the surgeon might think it was complete, but it wasn't. And now you've got all these symptoms. You've gone through an operation, and now to do that as a redo is a much bigger deal. Because now you have to just cut through scar tissue and then get to the artery, and all the visible planes aren't there. So to have a bad operation for this is probably worse than having no operation.

SPEAKER_02 33:16

Yeah. Well, thank you for that too, because we have seen that now a couple of times where they said didn't get the entire roofed portion of the artery or missed a part of it. And we've even had a situation where somebody went in and said, uh, nah, a little more complex than I want to do, and closed them back up. So Yeah, it's worse than doing another. Correct. Correct. Well, Dr. Stewart, thank you from the bottom of my imperfect heart for your participation on the program. And you know, best of luck to you as you continue doing what you do for us. Thank you. Thank you. Thank you for listening to Imperfect Heart. It's my hope that this information help 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.