Open-heart surgery and heart transplants are routine procedures at Saudi Arabia's cardiology centers and hospitals.

In the mid-1970s in a small hospital in Jeddah, a surgeon performed the first open-heart surgery in the Kingdom. In 1986 at a Riyadh military hospital cardiac clinic, a Saudi surgeon performed the first heart transplant in the nation. Today, teams of Saudi and expatriate specialists in world-class cardiology centers in the Kingdom's top hospitals perform open heart surgery routinely and successfully complete scores of transplants annually. While Saudi Arabia has achieved dramatic progress in a wide range of fields, the advancement of cardiology constitutes one of the most impressive.

More than 7,000 open heart surgeries have been performed since the techniques were introduced in the Kingdom two decades ago. These days many medical centers located throughout the Kingdom offer specialized cardiac care, and the nation's cardiac units are experiencing a 70 percent success rate, according to a recent Ministry of Health report. The momentum is expected to continue with the opening of a new multimillion dollar medical center in Riyadh that will be devoted to the treatment and research of heart and liver diseases.

The King Faisal Specialist Hospital and Research Centre in Riyadh houses one of the many state-of-the-art cardiology centers in the Kingdom

"Cardiac services are expanding and improving tremendously in Saudi Arabia," says Dr. Fakhry Al-Deeb, director of the cardiac catheterization laboratory at King Fahd National Guard Hospital in Riyadh. "Every year there's something new. Today the facilities in the Kingdom are operating at a high level comparable to any Western hospital," he said.

It all began in 1977 when King Faisal Specialist Hospital and Research Center in Riyadh established a cardiac unit. A cardiac team from Baylor College of Medicine in Houston, Texas, ran the program, initiating techniques and procedures while treating patients with heart ailments. The following year, Saudi Arabia's Ministry of Defense and Aviation opened its Riyadh hospital, which included a ten-bed cardiac unit. A promising young Saudi surgeon named Dr. Muhammad Al-Faqeeh and surgeons from California's Loma Linda University performed about 100 surgeries in the center's operating room that first year.

In just under two decades, both centers and a third cardiac department in the King Fahd National Guard Hospital have evolved into bustling, sophisticated cardiology centers keeping pace with modern technology. In addition to the three major centers, King Saud University Hospital in Riyadh operates another famous cardiac center. Private hospitals, such as Dallah Hospital and the Consulting Clinics, recently opened cardiac clinics in Riyadh. Elsewhere in the Kingdom, the Al-Noor Specialist Hospital Heart Center in Makkah and the cardiac clinic at Jeddah's King Khalid Military Hospital are pioneers in this field.

Riyadh's top three centers offer a view of the advances being made in cardiology in Saudi Arabia:

Prince Sultan Heart Diseases Center

Today Dr. Al-Faqeeh directs the Ministry of Defense and Aviation's Prince Sultan Heart Diseases Center, which has evolved from a small cardiac unit into the Kingdom's premier hospital treating heart diseases. The center ranks among the top medical facilities in the world, Dr. Al-Faqeeh says. Noted for specialized treatment of pediatric heart diseases, its surgeons have performed about 1,200 heart surgeries, 400 of them on children.

In 1986, Dr. Al-Faqeeh performed the first heart transplant in the Kingdom, successfully placing the heart of a nine-month-old baby into a two-year-old boy. Since then, he has performed 27 heart transplants, three of them last year. Dr. Al-Faqeeh, who introduced neonatal surgery into the Kingdom in 1982, said there is a need for considerably more transplants, and plans are underway to ensure that the need is adequately met.

Housed in a new building opened last September, the Prince Sultan Center has 160 beds, four operating rooms, five cardiac catheterization labs and a research center. All of the hospital's senior staff are Saudis, and the center emphasizes training as a major component. "We train more than 100 technicians a year," Dr. Al-Faqeeh said. Research is also stressed. Staff surgeons publish 15 to 20 professional papers each year, and the center hosts one or two symposia annually.

Children and young adults receive specialized treatment at a network of modern health care facilities, including the Saudi Medical Center for Children.

Dr. Al-Faqeeh, who has pioneered cardiology in the Kingdom, said the center - which treats all Saudis, not just military personnel and their dependents - uses advanced medical equipment and the most sophisticated techniques, including icing procedures for some pediatric cases.

King Faisal Hospital's Cardiac Unit

Likewise, King Faisal Hospital's cardiac center has made impressive strides since it opened nearly 20 years ago. The Baylor College of Medicine team, which ran the program until 1985, performed the first open heart surgery at King Faisal in 1978. When the hospital took charge of the program that year, the number of open heart surgeries totaled 50. The next year it swelled to 305, and the number has continued to rise every year since.

Physicians and technicians at cardiac catheterization laboratories use modern equipment to determine cardiac ailments.

Today the 58-bed Department of Cardiovascular Diseases is one of the hospital's busiest sections. Its staff of 48 - which includes four surgeons, 14 assistant doctors and ten fellows - cares for about 40 percent of the patients handled by the entire hospital every year. In 1996, King Faisal Hospital's surgeons performed more than 1,000 open heart surgeries, 771 cardiac procedures and 28 heart transplants. The hospital's outpatient clinic, which was established in 1978, treated 20,661 people in 1996, a 13 percent increase over the previous year.

Supported with the latest medical equipment, King Faisal's cardiology staff also uses innovative treatment techniques. In line with international trends, hospital cardiologists frequently use less invasive methods, especially endoscopic surgery. This past year, endoscopic surgery was used for two aortic valve replacements. Both patients are recovering well.

King Fahd Hospital's Cardiology Department

Riyadh's third top cardiology unit opened in 1995 at King Fahd National Guard Hospital. In the two years since its establishment, its 16 surgeons have performed more than 1,500 cardiac procedures. The cardiac facility has two operating theaters, a ten-bed critical care unit, a four-bed intermediate care unit and a 24-bed ward. An out-patient clinic is expected to open this year.

Dr. Al-Deeb heads the cardiac catheterization division at King Fahd Hospital's cardiology department. "We're using all the most advanced techniques and equipment," he said, pointing out technologically improved "stents," tiny mesh-like metal tubes that are implanted into collapsed coronary arteries. In the past two years the world's leading surgeons have adopted the metal stents, which they believe are superior to the previously typical technique of balloon angioplasty, because they dissolve into the artery wall and strengthen it. Dr. Al-Deeb also noted the use of other state-of-the-art tools, such as small drill-like devices called rotablators, which are used to remove hard lesions from arteries. High-tech computer imaging equipment has been installed, along with other cutting-edge technology, he said.

Saudi cardiology hospitals now boast highly trained surgeons, physicians and nurses, such as the staff at King Faisal Hospital Cardiac Center.

To provide for a growing population requiring specialized heart treatment, the Kingdom plans further expansion of its cardiac facilities. An ultra-modern, 100-bed center specializing in heart and liver diseases is expected to open in 1999. Now under construction adjacent to King Fahd Hospital, the new King Abdul Aziz Medical Center promises to be a world-class facility.

Top-notch technological equipment is being ordered for the center's cardiology unit, which will occupy one floor. It will have three operating rooms for open heart surgery and transplants and four for bypass surgery. The design includes a critical care unit, an 11-bed intermediate unit and another 12-bed coronary care unit. The center will emphasize training a national cadre of heart and liver specialists and devote significant space and resources to research, specifically concerning liver and heart transplants.

Saudi hospitals and surgeons are receiving growing recognition in the region and the world. As an example, the number of patient referrals from neighboring countries has increased steadily over the past decade, growing 14 percent in 1996 alone.

These referrals are not only due to the modern facilities available at Saudi hospitals, but also to the expertise of Saudi surgeons and physicians. Among the many Saudi cardiac specialists who have attained international recognition is Dr. Zuhair Al-Halees of King Faisal Hospital. In August 1995, he was invited to the University Hospital in Edmonton, Canada, to perform 16 complicated heart operations. The hospital arranged for the world-renowned child heart specialist to perform the delicate pediatric surgeries, as well as to participate in an assessment of the hospital's Pediatric Heart Surgery Department. Dr. Al-Halees has since visited Canada to perform additional surgeries on children.

Dr. Howaida Obaid Al-Qethamy is another famous Saudi surgeon who has distinguished herself in pediatric and neonatal heart surgery. A staff surgeon at the Armed Forces Hospital in Riyadh, she was trained as a cardiac surgeon at King Abdul Aziz University and in Canada. "I elected to pursue work as a cardiac surgeon for children and neonates despite the intricacy and difficulty of such a specialty," she explains. After working as a general cardiac surgeon for eight years, during which time she performed more than 3,000 procedures, she switched to her new specialty. Dr. Al-Qethamy now conducts an average of six to eight surgeries a week in Saudi Arabia and visits hospitals in other countries to perform challenging operations on newborns. She is renowned for her skill in the correction of congenital defects, replacement of valves and open heart surgery. She also conducts procedures to open blocked coronary arteries -valvotomy - and banding of the pulmonary arteries to control excess blood flow to the lungs. Dr. Al-Qethamy is also pursuing research to conduct surgical procedures to treat life-threatening congenital heart defects on fetuses before they are born. Such procedures can save the lives of some fetuses that would be stillborn due to severe heart ailments.

In addition to providing world-class cardiology centers to treat Saudis suffering from heart diseases, the country's top centers are also embarking on preventive care. Doctors blame changes in diet and lifestyle as factors causing increased heart disease in most countries, including Saudi Arabia. Dr. Al-Deeb, who serves on the executive board of the Saudi Heart Association, said the medical community seeks to increase public awareness about a heart-healthy lifestyle.

Like many cultures that have experienced rapid development in recent years, Saudis are consuming high-cholesterol, fatty foods available in scores of fast food restaurants and supermarkets. The Kingdom's continued improvement and expansion of cardiac centers and the pro-active stance of the medical community, it is hoped, will provide the necessary care for those currently suffering from heart disease and, ultimately, reduce the incidence of heart disease in the future.

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