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THE HEARTBEAT OF NATIONAL UNIVERSITY HEART CENTRE, SINGAPORE
ISSUE 37
JULY 2021
WWW.NUHCS.COM.SG
COVER STORY
At The
Helm Leadership changes hands at NUHCS
IN THIS PG 10 PG 18 PG 31
ISSUE The New The Next Frontier of Every Second
Cath Labs Thoracic Surgery Counts
MCI (P)081/12/2020. All information is correct at time of print.
PULSE | ISSUE 37 | TABLE OF CONTENTS
04
TABLE OF Message from
CONTENTS
Prof Tan Huay Cheem
Outgoing Director of NUHCS
05
Message from
THE TEAM A/Prof Yip Wei Luen James
Incoming Director of NUHCS with
Editorial Directors effect from 1 July 2021
Prof Tan Huay Cheem
A/Prof Poh Kian Keong COVER STORY
Editors
Mr Don Chan
Ms Juliette Lim
Publications & Abstracts
Ms Fion Tay
Ms Lin Xiao Yun
Ms Tan Sze Hwee
COVER STORY |
Publishing Agency At The Helm
The Orange Press Pte. Ltd
Pulse is a biannual publication 06 CLINICAL
by the National University At The Helm
Heart Centre, Singapore Leadership changes hands at
(NUHCS) NUHCS
1E Kent Ridge Road, NUHS EVENT
Tower Block, Level 9,
Singapore 119228
16
Detecting A Lesser Known
nuhcs@nuhs.edu.sg Disease
Cardiac scintigraphy for the
www.nuhcs.com.sg diagnosis of transthyretin
www.youtube.com/NUHCS
10 amyloid cardiomyopathy
The New Cath Labs
www.facebook.com/NUHCS NUHCS builds modern cardiac 17
invasive catherisation laboratories First Of Many
with new upgrades First Uniportal Non-Intubated
Video Assisted Thoracic Surgery
Copyright © is held by the
publishers. All rights reserved.
12 (UNIVATS) performed in
Singapore
Reproduction in whole or in Ladies First
parts without permission is Throwing a spotlight on women’s
prohibited. heart health
2
PULSE | ISSUE 37 | TABLE OF CONTENTS
FACES OF NUHCS NEWSBYTES
24
In Pursuit Of Answers To The
Heart
Researchers at the Cardiovascular
Research Institute look at broad
18 spectrum of issues to improve
disease burden in Singapore
The Next Frontier Of Thoracic
Surgery
33
Adoption of advanced robotic What's On TV?
surgical system pushes thoracic Guest medical experts on
surgery possibilities with better MediaCorp’s Channel 8 Body SOS
patient outcomes
19
Expansion Of Thoracic
Surgery At Ng Teng Fong 26
General Hospital The Accidental Career
NUHCS works with NTFGH as Perfusion Week highlights critical
OneNUHS role of perfusionists
33
Planting A Tree For Future
Generations
NUS Yong Loo Lin School of
Medicine’s 115th Anniversary Plant-A-
Tree programme
34
20 28 Awards & Promotions
Safer, Quicker Discharge Never Walk Alone Congratulations to all our award-
After Heart Surgery The role of patient support winners and newly-promoted
Evidence-based protocols to groups doctors!
optimise patient care
RESEARCH
36
EDUCATION Publications & Abstracts
21
Finding Home With NUHCS
Dr Kent Anthony Tan shares his
fellowship experience at NUHCS
23
Covid-19, The Vaccine, 31
And Our Heart Every Second Counts
Getting the facts straight The impact of the Covid-19
pandemic on the Western STEMI
Network
3
PULSE | ISSUE 37
OUTGOING
DIRECTOR'S
MESSAGE
Parting words from Prof Tan Huay Cheem after
serving as the Director of National University Heart
Centre, Singapore (NUHCS) for the past 13 years.
Dear readers and colleagues, NUHCS family. It has always NUHCS into what it is today, a
been my belief that our team heart centre which all of us and
To many, NUHCS is not just can only be as strong as we Singapore can be proud of. This
a medical heart centre. It is are, because of the support has been my legacy.
known for its soul where a we receive from our families.
strong cohesiveness and a colle- Besides, the enthusiastic perfor- It has been my privilege and
gial working culture perme- mances have been always been honour to have the opportu-
ates, where strong bonds and a crowd wow factor! nity to lead the Centre as its
friendships are forged amongst director. I found my calling here,
the people working in and with The time has now come for me and every day has truly been a
NUHCS. to step aside for another to take joy for me, to work alongside
the helm. But certainly, this is some of the most talented and
Many of the staff, including not a farewell. I will always be passionate people you can find
doctors, nurses and medical a strong supporter of NUHCS as in healthcare.
technologists have committed I take on other roles outside of
the best parts of their lives to the Centre. To James, I wish you good
working here, devoting their health and luck. May you
time and energy to care for I have worked with James on retain your sense of humour
patients. I am eternally grate- numerous occasions, and there and contagious laughter as you
ful for the support and contri- is no doubt in my mind that he take on the Directorship.
bution of each staff, and wish I is one of the best cardiologists
could embrace each individual that we are blessed with. With
with thanks. his gifts in digital science and Tan Huay Cheem
technology, I cannot wait to
Prof Tan Huay Cheem
One of the key highlights of see the digital transformation
Senior Consultant, Department of
my year has always been our of NUHCS in the years ahead.
Cardiology, NUHCS
annual Family Day celebrations
when I get to meet colleagues While no leadership is perfect, I
and gather with their fami- can say with all honesty that I
lies for fun and food, bonding have done my best to contrib-
together as part of the larger ute towards the building of
4
PULSE | ISSUE 37
INCOMING
DIRECTOR'S
MESSAGE
A/Prof Yip Wei Luen James takes on the role of
Director, National University Heart Centre, Singapore
(NUHCS) with effect from 1 July 2021.
Dear colleagues, Having benefited from their tute-
lage, I aspire to pay it forward; to
It is my privilege to address you, for continue their good work and pave
the first time, as Director of NUHCS. the way for those who will come
Prof Tan Huay Cheem has left me after me.
with big shoes to fill, to say the least.
During my term, I will continue my
I remember feeling this way back in lifelong focus on People, Process and
2003 when I was newly promoted to Technology, in this order of priority. I
be a consultant in cardiology. I was believe that as an organisation, we
feeling a little overwhelmed and must put our people first if we are
perhaps it showed. Prof Tan, who to expect our people to put patients
was just taking over the mantle of first. We will give you the support
chief then, looked at me reassur- and skills you need to ensure that
ingly and said, “The only difference the right workflow, organisational
between the two of us is just a little structure and technology are in
experience.” place, so that, together, we can fulfil
National University Health System’s
Those words assured me that with tripartite mission of patient care,
the passage of time, we would education and research.
become better prepared for all of
life’s challenges. I have had the priv- I look forward to working with each
ilege of standing on the shoulders and every one of you in the days to
of the ones who have come before come.
me — Prof Tan included — and what
a view it has been!
James Yip
A/Prof Yip Wei Luen James
Director and Senior Consultant,
NUHCS
5
PULSE | ISSUE 37 | COVER STORY
A
fter serving five years as At The
Helm
the Chief of the Cardiac
Department, and the
next 13 years as Director of
National University Heart
Centre, Singapore (NUHCS),
Prof Tan Huay Cheem is pass-
ing on the leadership role to
senior consultant cardiologist,
A/Prof Yip Wei Luen James. Leadership changes hands at NUHCS
Stepping into the new direc-
tor role, A/Prof Yip says of the
transition, “With the passage
of time, we would become
better prepared of all of life’s It is not only about
challenges. I have had the priv-
ilege of standing on the shoul-
adding years to life
ders on the one who has come but life to years –
before me and what a view it that would be our
has been!” Centre’s mission
A/Prof Yip Wei Luen, James,
Two defining moments in Director and Senior Consultant, NUHCS
Prof Tan’s tenure was when
the Severe Acute Respiratory
Syndrome (SARS) epidemic hit
Singapore in 2003, and more
recently, the ongoing corona-
virus pandemic that broke out
in 2020, requiring NUHCS to
pivot and respond quickly in
efforts to contain the outbreak.
Few other leaders can claim the
same of steering a heart centre
through two global health
crises.
Not only has NUHCS survived
the stress tests of these infec-
tious disease outbreaks, the
Centre has evolved and
emerged stronger, transform-
ing itself into the world-class
academic heart centre, as it is
known today.
Prof Tan’s leadership at NUHCS
was one that has led the path
6
PULSE | ISSUE 37 | COVER STORY
of the Centre on an upwards Today, NUHCS provides a
trajectory. From fewer than wide spectrum of tertiary and
eight cardiology consultants, quaternary services organ-
and just two surgeons in the ised uniquely into six different
department, NUHCS has grown core clinical programmes with
into a team of over 60 cardi- a focus on patient-centric care
ologists and 20 surgeons over in a multidisciplinary and inte-
three hospital sites, managing grated set-up. The Centre has
almost three times its patient not only transform its facilities
load in a span of 17 years. with modern technology incor-
porating the latest treatment
“It is however not the number techniques in the field of cardi-
that matters, but rather ovascular medicine, but has
the talents these individu- also expanded its capabilities
als possess, the public service offering specialised care such
ethos and values they uphold as geriatric cardiology, complex
that distinguishes the Centre,” cardiac pregnancy manage-
affirms Prof Tan. ment, pulmonary hypertension
and vascular medicine with
Leaning on the support and specialists trained cardiologists
expertise from two interna- and cardiothoracic surgeons.
tional advisory panels, Prof Tan
worked with his small team Furthermore, NUHCS has estab-
to conceive a heart centre lished a research arm, the Cardi-
designed to meet the grow- ovascular Research Institute
ing cardiovascular disease (CVRI), which delves deeper
burden, and provide higher into the issues of heart failure
quality care and treatment with wide ranging research
outcomes for patients in areas including immunoassays,
Singapore. mass spectroscopy, molecular
biology, epigenetic infrastruc-
ture, animal models and clini-
cal cohort studies across several
clinical sites.
The greatest In just over a decade, CVRI
has already received nota-
fulfilment is the
ble commendations from
ability to effect other established institutions
change and make acknowledging the quality
things happen research it has put out, having
published more than 50 papers
Prof Tan Huay Cheem, Senior
Consultant, Department of
in the top 10 percent of high
Cardiology, NUHCS impact medical and scientific
journals in the last three years.
7
PULSE | ISSUE 37 | COVER STORY
“There are strategic transfor- towards computer science and
mational plans that have been information technology has
mapped out to take NUHCS to kept NUHCS ahead in digital
even greater heights, enabled science and applications, which
by a solid organisation struc- will be instrumental in taking
ture, a capable leadership team, NUHCS to its next digital trans-
and supported by rapid techno- formation, turning it into a
logical adoption and a strong future-ready medical centre.
corporate culture,” opined Prof
Tan. As the current Group Chief
Medical Informatics Officer
On A/Prof Yip as his succes- within National University
sor, Prof Tan is in full support Health System (NUHS), it is no
of his appointment. “There is secret that A/Prof Yip is a firm
no doubt in my mind he is one advocate of technology and
of the best cardiologists that healthcare analytics as a means
NUHCS is blessed with. Besides to improve healthcare stand-
his clinical competence, James ards for the people.
is a genuine person with so
much compassion for everyone “It is always first about the
around him.” patients and the people whom
we need to look after; followed
In particular, Prof Tan high- by developing the process
lighted A/Prof Yip’s inclination and infrastructure to help our
organisation function effec-
tively,” expounded A/Prof Yip
8
PULSE | ISSUE 37 | COVER STORY
on his top priorities as NUHCS’ Singapore. Every new advance- ity is to help our patients fulfil
Director. “Finally, technology ment in technology that poten- their life goals and to prepare
will be the answer to help us tially increases human longev- for the end.”
provide cost effective solutions ity, brings on the added cost
for the public and to achieve of caring for older, frailer As the baton of leadership
the first two priorities.” and medically more complex passes onward, the evolution
patients. of NUHCS will continue on its
The most concerning for A/Prof trajectory -- improving commu-
Yip is reaching the increasing Hence, it is A/Prof Yip’s aspira- nity health with better and
number of people who are at tion that NUHCS will be able to more cost-effective care that
risk of cardiovascular diseases predict the value of interven- will empower people to take
in what he terms as the “hidden tions for healthy longevity and ownership of their own health;
epidemic”. “These are patients manage the cost effectiveness nurture the next generation
who do not know they are in of therapies for the payors of of cardiovascular profession-
trouble, or who think they are healthcare, such as the govern- als and further expand on its
doing well until something ment and insurance companies. world-class research facilities.
happens.”
Enthusiastic about future possi-
On this front, NUHCS has bilities in the field, A/Prof Yip ARTICLE BY
already initiated the use of quipped, “Cardiologists always NUHCS Pulse Editorial
remote cardiac monitoring seem to have one more trick up
technology for some heart our sleeves to prevent death
patients. However, epidemio- or disease progression that we
logical trends show that cardi- often forget our responsibil-
ovascular disease remains the
biggest disease burden in
9
PULSE | ISSUE 37 | EVENT
THE New
CATH LABS
NUHCS builds modern cardiac invasive catherisation
laboratories with new upgrades
National University Heart Centre, and improved clinical outcomes Diagnostic physiologic modalities
Singapore (NUHCS) first set-up compared to traditional sternot- such as fractional flow reserve,
its cardiac invasive catherisation omy procedures, the demand for thermodilution for coronary flow
laboratories (also known as “cath modern cath lab facilities has since reserve (CFR), and the index for
labs”) facility in 1992, sharing the been on the rise. microvascular resistance (IMR) al-
same space with the radiology low cardiologists to assess coro-
department. This meant that the In fact, many changes have been nary artery function more precisely.
time allowed for procedures in the made to the standard require-
facility has to be divided between ments of a modern cath lab in In addition, the cath labs are
the two departments. the past decade alone. This pre- equipped with the latest calcium
cipitated an expert panel from the modifying therapies such as orbit-
Cath labs are specialised proce- Society for Cardiovascular Angiog- al atherectomy and intravascular
dure rooms where doctors per- raphy and Interventions to release lithotripsy. These are used to tackle
form minimally invasive tests and a consensus statement this year, issues with heavily calcified coro-
procedures to diagnose and treat with specific recommendations on nary lesions which pose technical
cardiovascular diseases. At that setting up, operating, maintaining difficulty during angioplasty and
time, the shared facility was suffi- the highest standards of quality can translate to adverse outcome
cient to support the relatively low and establishing current best prac- of stent restenosis and thrombosis.
volume of about 300 coronary an- tices of modern cath labs.
gioplasty cases each year. Implanting mechanical circulatory
Over the years, NUHCS has been support systems such as non-sur-
With the growing geriatric popu- progressively updating its cardiac gical heart pumps in patients with
lation and rising incidence of car- invasive cath labs (ICL) to meet more complex and high-risk coro-
diovascular diseases, advanced current and future healthcare chal- nary artery diseases can be carried
diagnostic cardiac catherisation lenges. Today, they are equipped out in these cath labs.
and angiography procedures have with many advanced coronary in-
since been introduced to support tervention technologies, such as In addition, the electrophysiologist
the burden of coronary disease lo- intravascular ultrasound and op- (EP) team which utilises the same
cally. tical coherence imaging for intra- facility performs tertiary complex
vascular imaging which is used to arrhythmia ablations and device
Coupled with the advent of min- assess the severity of coronary ar- implantation using advanced pro-
imally invasive cardiac surgery tery disease by providing a tomo- cedures such as cryoablation and
and innovative catheter-based graphical image of the coronary His bundle pacing (HBP)1 for con-
approaches which have generally arteries. duction system pacing in the labs.
resulted in shorter recovery times
10PULSE | ISSUE 37 | EVENT
In January this year, NUHCS up-
graded all three cath labs with
Cath Lab in 1990 modern biplane imaging systems.
These advanced medical imag-
ing technologies use two rotating
cameras to take simultaneous im-
ages, forming a 3D portrait of the
body area with highly detailed im-
ages of blood vessels, soft tissue
and blood flow in real-time.
Furthermore, the cath labs are
connected to a hybrid operating
theatre equipped with an angio-
graphic imaging capability, ena-
bling the entire facility to support a
wide range of endovascular, cath-
eter-based interventional therapies
in the field of coronary, peripheral,
congenital and structural inter-
ventions, as well as electrophys-
iological studies, radiofrequency
ablation, and pacemaker device
implantation.
These new upgrades mark yet an-
other milestone in the expansion
of the cath lab facility and services
at NUHCS, ensuring the allocated
space remains highly efficient to
serve the current annual load of
about 1,700 cases of percutane-
ous coronary intervention and 660
cases of EP ablation and device im-
plantation procedures.
New Cath Lab in 2021
1
His bundle pacing (HBP) – A therapy with
the intent of overcoming sites of atrioven-
tricular (AV) conduction disease and delay.
affecting a large area of the heart.
ARTICLE BY
Prof Tan Huay Cheem
Senior Consultant,
Department of Cardiology,
NUHCS
Prof Tan is a Professor of
Medicine, Yong Loo Lin School
of Medicine, NUS and has a master of Medicine in
Internal Medicine. He is an active clinical researcher,
visiting professor at several hospitals in China and
invited speaker at many international cardiology
meetings.
11Ladies
PULSE | ISSUE 37 | EVENT
First h rowing a s
T potligh
t on women’s heart health
Commemorating International Women’s Day
in March 2021, the National University Heart
Centre, Singapore’s (NUHCS) Women’s Heart
Health Programme launched a public education
campaign focusing on women’s heart health
issues.
The message was clear – women need to put
themselves first and prioritise their heart health
as well.
In a commentary published in The Straits Times
and Lianhe Zaobao, Dr Wang Yi Ting Laureen,
Associate Consultant, Department of Cardiology,
"Celebrating Strong Women"
NUHCS wrote about the cardiovascular risks at
every life stage of a woman, and the preventa- Scan the code
tive steps that can be taken. In her article, she to watch the
inspirational
emphasised the need to keep the heart in tip-top
video:
condition as crucial to the process of aging
gracefully.
NUHCS also released an inspirational video across
its online platforms, honouring the “Wonder
Women” in the healthcare industry. These
women took on the role of caring for others in
their profession, continuously delivering high
standards of patient care, whilst caring for others
in their personal lives.
12PULSE | ISSUE 37 | EVENT
Wearing multiple hats and managing expec-
tations in both their personal and profes-
sional lives, these nurses, cardiac techni-
cians and doctors from NUHCS share their
greatest pride at work in caring for patients
with cardiac conditions. At the same time,
they made the call for all women to protect
their hearts.
In collaboration with Something Private
podcast, Asst Prof Low Ting Ting, Consult-
ant, Department of Cardiology, NUHCS
c u r e a b r o k en h e art" joined Dr Wang and the producer to discuss
"The doctors who c an women’s heart health in a 40-minute
podcast show, “Ladies, let’s have a Heart-
Watch the to-Heart about your Heart”. The show
podcast here: was broadcast on Spotify, YouTube, Insta-
gram, and Facebook. Asst Prof Low and
Dr Wang described the warning signs of
heart diseases, discussed the consequences
of self-neglect, and called for the need to
raise awareness of heart disease in women.
Working with digital publisher, Our Grand-
father Story, a comic strip was conceptu-
alised to depict the symptoms of a heart
attack in women. These are often subtle
and ignored, further increasing the risk for
women. Published and shared across multi-
ple media platforms, the comic communi-
cated the need for women to prioritise the
health of their hearts.
ARTICLE BY
Asst Prof Low Ting Ting
To the busy everyday Consultant, Department of
Cardiology, NUHCS
women – self-care is
not a luxury, it is a
Asst Prof Low Ting Ting is currently
the clinical director of the Women’s Heart Health
Programme, which provides gender-tailored cardiac care
necessity. Be heart and subspecialty management in pregnancy and heart
disease, female phenotype coronary syndromes and
smart and treat your heart failure conditions with a predilection for women.
She is active in leading clinical trials and multi-centre
heart right. registry work as well as research in advancing therapies
for rarer conditions. She is also passionate about mentor-
Asst Prof Low Ting Ting, Consultant, ing and leads the undergraduate cardiology programme
Department of Cardiology, NUHCS in the National University of Singapore (NUS).
13PULSE | ISSUE 37 | EVENT
Read our
What
Women's Heart
Health brochure:
How To Recognise
a Heart Attack In
Symptoms in Men & Women Symptoms
both men & in women:
women:
Shortness of Breath Dizziness
Jaw, Neck, Extreme Fatigue
or Back Pain
Lower Chest or
Chest Pain Upper Abdomen Pain
(not always for women)
Indigestion
Cold Sweat
Oestrogen may play a strong role
in protecting women from heart
disease which could explain why
women are at higher risk of a
heart attack after menopause.
Women are MORE likely to ignore
the symptoms of a heart attack or
Nausea or delay seeking treatment. As a
Vomiting result, they are LESS likely than
men to receive timely treatment.
14PULSE | ISSUE 37 | EVENT
Need to
Know 10 Vital
Statistic
about W
Heart H
s
omen's
ealth
1 in 3 women die of Only 6 out of 10 women know that
shortness of breath is the more
cardiovascular disease every year
common warning sign of a heart attack
Women are 2
times at risk of death
7 out of 10 women correctly
identified chest pain as a heart
within 30 days after a heart attack
attack symptom
3 out of 10 women know that Only 8 % of women surveyed talked
heart attack symptoms in women about cardiovascular- related topics with
are different than in men their doctor in the past 12 months
445 lives were claimed by breast Women are 3. 9 times at risk of a
cancer while cardiovascular disease
heart attack from stress
claimed 2,689 women lives in 2019
Women are 5
5% less likely than men 10 years after a heart attack,
to participate in cardiac rehabilitation, women are 2.1 times more likely to
even after a heart attack die compared to men
E C HARGE
TAK E
ND REDUC
A
RISKS
YOUR
ART
Healthy Diet Avoid Lose Weight Check Blood
OF HE E Alcohol Sugar
S
DISEA
Here are some things you can
do to aid in the prevention of
heart disease!
Sleep Well Stop Exercise Check Blood
Source: National University Heart Centre, Singapore Smoking Pressure
(NUHCS), a survey conducted by Singapore Heart
Foundation in 2020 and American Heart Foundation 15PULSE | ISSUE 37 | CLINICAL
DETECTING A
LESSER KNOWN
DISEASE
Cardiac scintigraphy1 for the diagnosis of transthyretin
amyloid cardiomyopathy2
Amyloidosis is a protein for the purpose of removing
mis-folding disorder, occurring small samples of heart muscle
when native blood proteins tissue for microscopic examina-
aggregate abnormally into tion.
insoluble fibrils (amyloid)
and deposit into various end- In collaboration with the
organs. The heart can be Department of Diagnos-
affected in some forms of tic Imaging, National Univer-
amyloidosis, one of them being sity Hospital, National Univer-
transthyretin (TTR) amyloidosis. sity Heart Centre, Singapore
(NUHCS) recently started the
TTR is a transporter protein technetium pyrophosphate
produced by the liver. In the scintigraphy3 service for the
presence of genetic mutation diagnosis of ATTR-CM.
or with age, TTR can mis-fold
into insoluble amyloid fibrils This nuclear scan modality has
and deposit in the heart. been shown to be as reliable
as an endomyocardial biopsy
Transthyretin amyloid cardio- for the diagnosis of ATTR-CM We envision that the
myopathy (ATTR-CM) patients in the right clinical context, availability of this
typically present with heart and allows patients to be diag- service will allow early
failure and low blood pressure. nosed without going through diagnosis and prompt
An echocardiogram will reveal an invasive procedure. treatment of ATTR-CM
marked left ventricular wall patients in the future.
thickening. About 20 patients have under-
Asst Prof Lin Weiqin, Clinical Director, Heart
gone the scan since its introduc- Failure Programme and Consultant, Department
ATTR-CM was previously tion in November 2020, helping of Cardiology, NUHCS
thought to be a rare cause of doctors to diagnose and treat
heart failure amongst elderly them accordingly for ATTR-CM. ARTICLE BY
men. However, recent studies Asst Prof Lin Weiqin
scintigraphy – Procedure where a small amount
have shown that ATTR-CM is
1
Clinical Director, Heart
of radioactive chemical is injected into the vein Failure Programme and
likely underdiagnosed due to to produce scans of the body’s internal structures Consultant, Department of
used to diagnose, stage and monitor disease such
a lack of awareness about the as cancer
Cardiology, NUHCS
disease. 2
cardiomyopathy – A condition caused by Asst Prof Lin is trained in the management of acute
abnormalities in the heart muscles, resulting in heart failure with temporary mechanical circulatory
dysfunctional heart pumping support, as well as caring for advanced heart failure
In the past, the only way to diag- patients with implanted durable left ventricular
3
technetium pyrophosphate scintigraphy –
nose ATTR-CM was through A radiotracer scan used to differentiate transthy-
assist devices (LVADs) or heart transplantation.
Besides heart failure, his other subspecialty interests
endomyocardial biopsy, which retin from light-chain amyloidosis, in patients with
cardiac amyloidosis
include cardiomyopathies and echocardiography.
is an invasive procedure done
16PULSE | ISSUE 37 | CLINICAL
FIRST OF MANY
First Uniportal Non-Intubated Video Assisted Thoracic Surgery
(UNIVATS) performed in Singapore
The thoracic surgery and
anaesthesia teams at the
National University Hospital
(NUH) successfully introduced
UNIVATS for the treatment
of a patient with a rare nerve
tumour called Schwannoma
on 21 January 2021. This marks
the first UNIVATS procedure
performed here in Singapore.
UNIVATS is a new procedure
combining Uniportal Video
Assisted Thoracic Surgery
(UVATS) with Non-Intubated
Video Assisted Thoracic Surgery
(NIVATS). UVATS is performed
through a single port thora-
coscopic1 surgery via a small
1-inch incision on the patient’s
chest. NIVATS is a more natural
way of administering anaesthe-
sia during surgery, as there is no
need for an endotracheal2 tube
to go deep into the airway, and compared to the usual 2 to 3 ARTICLE BY
milder forms of anaesthetic days. After the operation, the A/Prof John Tam Kit Chung
Head and Senior Consultant,
medications are being used. patient’s chest discomfort from Division of Thoracic Surgery,
the nerve tumor is relieved, Department of Cardiac
Thoracic and Vascular Surgery
By combining both UVATS and the patient expressed high (CTVS), NUHCS
and NIVATS, UNIVATS can be levels of satisfaction with the
A/Prof John Tam is the founding Head
performed with even smaller surgery, the anaesthetic tech- of Thoracic Surgery at the NUHCS. He is a thoracic
incisions, allowing patients to nique, as well as the overall surgeon specialising in performing minimally inva-
sive single-port keyhole surgery using advanced
benefit from less physiological experience. techniques in Uniportal Video-Assisted Thoraco-
scopic Surgery (UVATS). His research has been
stress, airway trauma, thereby published across many high-impact medical and
reducing the risk of respiratory UNIVATS is currently the most scientific journals. He also serves as a member on
the Singapore Residency Advisory Committee for
infection, resulting in faster advanced minimally invasive Cardio-Thoracic Surgery. He has won many awards
recovery from anesthesia, over- thoracic surgery procedure in in recognition for his service to patients and his
contribution to the field of academic surgery.
all recovery time, and a shorter the field, which combines the
hospital stay. expertise from the surgical and
anaesthetic teams to achieve
In particular, the first patient, the best outcomes for thoracic Dr Deborah Khoo Xian Li
Consultant, Department of
who had a successful UNIVATS surgery patients. Anaesthesia, NUH
procedure to resect a rare nerve
tumour in the chest stayed Dr Deborah Khoo is a Consultant at
the Department of Anaesthesia, National
1
thoracoscopic – A minimally invasive procedure
in the hospital for 23 hours in the chest that is performed using an edoscopic University Hospital with research interests in the
camera field of difficult airway management and training,
in a day surgery ward, which medical education and methodology, as well as the
is a substantial improvement endotracheal – Inside the trachea
2
use of anti-fibrinolytics in spine operations.
17PULSE | ISSUE 37 | CLINICAL
THE NEXT
FRONTIER OF
THORACIC
SURGERY
Adoption of advanced robotic surgical system pushes thoracic
surgery possibilities with better patient outcomes
The division of thoracic surgery The division’s coherent move
in the National University Heart to adopt the advanced robotic
Centre, Singapore (NUHCS) has system has been proven to aug-
always been at the forefront ment thoracic surgical proce-
of minimally invasive thoracic dures and accelerate the capa-
surgery in Asia, adopting the bilities of thoracic surgery for
latest surgical technologies lung and mediastinal1 surgery.
to achieve better patient out-
comes in a safe and reliable way. The first robotic thoracic sur-
gery performed for a mediasti-
Employing video-assisted thor- nal tumor was carried out by Dr
acoscopic surgery, the divi- Mithiran, with the guidance of
sion led by A/Prof John Tam, a robotic proctor Dr Aneez D.B
together with Dr Harish Ahmed, Director and Senior
Mithiran Muthiah and Asst Prof Consultant at the International
Ooi Oon Cheong, have per- Centre for Thoracic Surgery, in
formed more than 3,000 tho- March 2021 at the National
racic surgeries to date. University Hospital (NUH). The
surgery was a success with the
Recently, the division invested patient discharged the follow-
resources in robotic-assisted ing day.
surgery where significant
advancements have been Equipped with this technology, ARTICLE BY
made. With the intuitive da NUHCS’ thoracic surgery divi- Dr Harish Mithiran Muthiah
Consultant, Division
Vinci Robotic system, surgeons sion is able to offer a compre- of Thoracic Surgery,
control the robotic arms from hensive suite of minimally inva- Department of Cardiac,
Thoracic and Vascular
a console situated within the sive thoracic surgery options for Surgery (CTVS), NUHCS
operating room. The robotic both lung and mediastinal dis-
arms are inserted through tiny eases with better precision and Dr Mithiran trained at NUH in
cardiothoracic surgery. He completed his advance
surgical incisions, acting as an better outcomes. surgical training in 2014 where he was awarded
extension of the surgeon’s arms, the Fellowship of the Royal College of Surgeons of
Edinburgh. He has a special interest in minimally
mirroring every hand move- 1
mediastinal – Refers to conditions that affect the invasive thoracic surgery which include Video-As-
mediastinum, the space in the chest, surrounded sisted Thoracic Sugery(VATS) and Robotic Assisted
ment. This enables delicate by the breastbone, spine and the lungs. Thoracic Surgery(RATS) for lung and chest diseases.
and complex operations to be He also currently serves as the Asst Programme
Director for the Cardiothoracic Surgery Residency
carried out with high precision Programme.
and safety.
18PULSE | ISSUE 37 | CLINICAL
EXPANSION OF THORACIC
SURGERY AT NG TENG
FONG GENERAL HOSPITAL NUHCS works with NTFGH as OneNUHS
We share the common vision
of providing high quality
services to our patients, and to
realise the vision of OneNUHS
for thoracic surgery services
across our cluster.
A/Prof John Tam Kit Chung, Head and
Senior Consultant, Division of Thoracic Surgery,
Department of CTVS, NUHCS
Following its opening in 2015, sion. The deliberation included
Ng Teng Fong General Hospital a walking tour of NTFGH facili- ARTICLE BY
(NTFGH) has been receiving an ties to review the patient flow A/Prof John Tam
increasing number of patients process. Kit Chung
Head and Senior Consultant,
requiring thoracic surgery, Division of Thoracic Surgery,
Department of CTVS, NUHCS
leading to a subsequent need To avoid a long waiting time
to scale up the provision of for thoracic surgeries at NTFGH, A/Prof John Tam is the founding
thoracic surgery services. the thoracic surgical team from Head of Thoracic Surgery at the NUHCS. He is a
thoracic surgeon specialising in performing mini-
NUHCS will perform urgent and mally invasive single-port keyhole surgery using
advanced techniques in Uniportal Video-Assisted
For that reason, the surgery emergent thoracic surgeries Thoracoscopic Surgery (UVATS). His research has
and operations team led by A/ at NTFGH. The hospital's surgi- been published across many high-impact medical
and scientific journals. He also serves as a member
Prof Theodoros Kofidis and A/ cal team will provide in-house on the Singapore Residency Advisory Committee
Prof John Tam Kit Chung from support to facilitate intraop- for Cardio-Thoracic Surgery. He has won many
awards in recognition for his service to patients and
the Department of Cardiac erative assistance and post- his contribution to the field of academic surgery.
Thoracic and Vascular Surgery operative care management.
(CTVS) at the National Univer- Patients can now also receive Dr Harish Mithiran
sity Heart (NUHCS) collab- after surgery care through the Muthiah
Consultant, Division
orated with the team from outpatient thoracic surgery of Thoracic Surgery,
NTFGH headed by Adj A/Prof services in NTFGH. Department of CTVS, NUHCS
Noel Stanley Tay to detail the
Dr Mithiran trained at National
provision of urgent and outpa- By increasing the thoracic University Hospital (NUH) in cardiothoracic surgery.
tient thoracic services at NTFGH. surgery capacity at NTFGH, resi- He completed his advance surgical training in 2014
where he was awarded the Fellowship of the Royal
Weighing in these discussions, dents in the Western region of College of Surgeons of Edinburgh. He has a special
interest in minimally invasive thoracic surgery which
from NTFGH, were Prof Philip Singapore will be better served include Video-Assisted Thoracic Surgery (VATS) and
Lau, Head of Surgery, and Asst and can expect a more efficient Robotic Assisted Thoracic Surgery (RATS) for lung
and chest diseases. He also currently serves as the
Prof Soon Yuen, Head of Upper system under the OneNUHS Asst Programme Director for the Cardiothoracic
Surgery Residency Programme.
Gastrointestinal Surgery Divi- cluster.
19PULSE | ISSUE 37 | CLINICAL
SAFER, QUICKER
DISCHARGE AFTER
HEART SURGERY
Evidence-based protocols to optimise patient care
National University Heart tive team involving surgeons, ARTICLE BY
Centre, Singapore (NUHCS) anaesthesiologists, intensiv- Dr Chang Guohao
recently implemented the ists, haematologists, endo- Consultant, Department
of Cardiac Thoracic and
Enhanced Recovery After crinologists, nephrologists, Vascular Surgery (CTVS),
Surgery (ERAS®) protocol for nurses, physiotherapists, dieti- NUHCS
cardiac surgery – one of the tians, counsellors, perfusionists Dr Chang is an accredited specialist in cardiotho-
most resource-intensive and and case managers to develop racic surgery by Singapore’s Ministry of Health
and was awarded the College of Surgeons Gold
complex surgeries. a comprehensive periopera- Medal in Cardiothoracic Surgery. He is currently a
tive programme, guided by Consultant in the Department of CTVS at NUHCS
with interests in all aspects of adult cardiac surgery
In 2019, the ERAS® protocol for the protocols from the ERAS® including extracorporeal life support.
cardiac surgery was published Cardiac Society, as well as
by the ERAS Cardiac Soci- published studies with further
A/Prof Ti Lian Kah
ety following a multi-discipli- recommendations from hospi- Director of Cardiac
Anaesthesia & Senior
nary systematic review of the tals in the United States of Consultant, Department
current literature. This protocol America, Germany and China. of Anaesthesia, National
University Hospital (NUH)
has adopted many principles
from abdominal surgery proto- NUHCS will be closely rev- A/Prof Ti is a tenured associate professor with the
cols, and also incorporated iewing pre- and post-protocol Yong Loo Lin School of Medicine, National Univer-
sity of Singapore. He did his cardiac anaesthesia
recommendations that reflect implementation with a series fellowship at Duke University in the United States
the unique nature of cardiac of preoperative, intraopera- of America (USA), and is accredited for perioper-
ative transesophageal echocardiography by the
surgery. tive and postoperative inter- National Board of Echocardiography, USA. His
research interest is on outcomes after surgery and
ventions (involving medical has published over 80 papers, including on compli-
Implementation of the proto- subspecialties and allied health cations such as acute kidney injury, atrial fibrillation
and poor neurological outcomes.
col requires establishing a support) to optimise overall
multi-disciplinary collabora- patient outcomes.
20PULSE | ISSUE 37 | EDUCATION
DELVING DEEPER
ARTICLE BY
NUHCS Pulse Editorial
INTO CARDIOLOGY
Dr Kent Anthony Tan shares his experience of the interventional cardiology fellowship at NUHCS
In September 2018, Dr Kent the 2019 AICT-Asia PCR meet-
Anthony Tan from the Phil- ing,” shared Dr Tan. “Some of
ippines was accepted into my mentors from back home
the Interventional Cardiol- were in attendance, so it
ogy Fellowship Programme at was a proud moment for me
the National University Heart when they commended my
Centre, Singapore (NUHCS) progress.”
after completing seven years
of his residency programme at Reminiscing his night duty
the Philippines Heart Centre. calls, he recollected being
stretched and challenged to
He spent one year train- meet the standards expected
ing in various contempo- at NUHCS when dealing with
rary atherectomy modalities1 the acute heart failure cases
and the second year delving that came rushing through
deeper into cardiovascular the hospital’s emergency
structural intervention. doors. The team’s razor sharp NUHCS Fellowship /
focus and vigilance for possi- Clinical Attachment
“Good judgement comes from ble complexities was inspiring NUHCS offers a Fellowship / Clinical
experience, and experience for Dr Tan. Attachment Programme to foreign
comes from bad judgment,” doctors to gain firsthand experience
shared Prof Tan Huay Cheem, “The hardest part of the in the Singapore healthcare industry,
develop and strengthen the regional
Senior Consultant, Depart- programme was turning in my
referral network, whilst acquiring
ment of Cardiology, who was hospital pass,” said Dr Tan. “It specific clinical skills under the
then the Director of NUHCS. was an act of finality, marking mentorship of leading medical
Dr Tan has since made it his the end of my time at NUHCS professionals at NUHCS. To find out
own maxim in becoming a and having to say goodbye. As more about the eligibility criteria
better doctor. all good things must come to and application process, please
email the programme coordinator at
an end, I am eagerly looking fellowship_application@nuhs.edu.sg.
He was actively engaged on forward to the next step in my
various levels in procedural career, where I can apply my AICT-Asia PCR meeting
and clinical work — treat- learnings from NUHCS.” Formed in 2019, AICT-Asia PCR is
ing patients with pulmonary built by local practitioners with the
atherectomy modalities – Methods of treat-
hypertension (PH)2, adult
1
support of centres of excellence in
ment to remove plaque build-up in diseased
congenital heart diseases and arteries, limiting the flow of oxygen-rich blood the Asia Pacific region and Europe, to
valve disorders, whilst being
to organs and other parts of the body. focus on the diverse needs of patients
PH – A type of high blood pressure affecting
2 in the interventional landscape. As
trained in various approaches the lung arteries and the right side of the a global educational meeting in the
to heart diseases and valve heart.
Asia Pacific region, the platform
pathologies. orbital atherectomy – A new methodology
3
allows knowledge exchange between
for treating arterial disease within the major
and branch arteries of the leg. peers and the opportunity for
“One of the highlights for me healthcare professionals to showcase
their research and innovation, aimed
was being part of a live trans-
at contributing to the development
mission working on an orbital of treatment and care possibilities to
atherectomy3 case along- better serve the region’s patients.
side A/Prof Adrian Low at
21PULSE | ISSUE 37 | EDUCATION
COVID-19,
THE VACCINE,
AND OUR HEART
Getting the facts straight
ARTICLE BY
Prof Tan Huay Cheem
Senior Consultant,
Department of Cardiology,
National University Heart
While Covid-19 initially affects However, it is also important to Centre, Singapore (NUHCS)
the airways and lungs, mount- note that many patients with
Prof Tan is a Professor of
ing evidence has shown that the mild Covid-19 infection, includ- Medicine, Yong Loo Lin School of Medicine, NUS
and has a master of Medicine in Internal Medicine.
heart muscle and the cardiovas- ing those with heart condi- He is an active clinical researcher, visiting professor
cular system are also affected, tions, have managed to recover at several hospitals in China and invited speaker at
many international cardiology meetings.
and can be severely damaged fully. Nonetheless, research-
as a result of the viral infection. ers are still compiling data to
better understand the long-
Scientists found that the SARS- term impact of the coronavirus
CoV-2 coronavirus can cause on the heart and the overall
high levels of inflammation in health of those who recover.
the body including the heart
muscles (myocarditis) or cause As a consequence of the
damage to the blood vessels, higher risks of developing seri-
compromising the cardiovascu- ous life-threatening compli-
lar system. In severe cases, this cations, experts encourage
could lead to a heart attack those with heart conditions,
(acute myocardial infarction), including those who are on
heart failure, abnormal heart blood thinners such
rhythm (arrhythmias), shock, as antiplatelets (aspi-
and cardiac arrest. rin or clopidogrel),
to protect themselves
As heart patients tend to be from the Covid-19
older (over the age of 65 years) virus by taking the
and usually suffer from multi- vaccination as soon as
ple comorbidities such as diabe- possible. Those on anti-
tes mellitus, hypertension, high coagulants (e.g. warfa-
cholesterol and kidney diseases, rin or newer agents
further contracting the Covid- such as rivarox-
19 infection makes them more aban, apixaban,
likely to develop severe compli- or dabigatran) are
cations. further advised to
apply compression
This explains why Covid-19 over the site of injec-
patients with underlying heart tion for an additional five
conditions are six times more minutes.
likely to be hospitalised and
12 times more likely to die,
compared with those without
any heart condition.
22PULSE | ISSUE 37 | EDUCATION
WHY VACCINE:
VACCINATE? MYTHS & FACTS
Lowers your risk of severe MYTH
complications from Covid-19 The vaccines were developed too
fast to be trusted for their efficacy.
Prevents the virus from
spreading to another person
FACT
Protects you and your loved ones The science is very clear on the efficacy
of the vaccine. It was developed much
Creates a protective web if many people quicker than usual because there are
in a community are vaccinated many eligible patients for testing in a
pandemic, instead of having to wait
Allows business and other
for patients to enroll in the tests. Addi-
social activities to resume
tionally, the phases of vaccine testing
were carried out concomitantly during
this pandemic which shortens the time.
Finally, there has been a total commit-
ment by manufacturers for rapid
vaccine development and co-operation
by the governing bodies to speed up
review and accreditation processes.
MYTH
The new mRNA technology of vaccines
may potentially transform recipients
from humans into “hybrids” through
alteration of the cell’s DNA structure.
FACT
The mRNA vaccine is made up of a
gene, which codes for a viral protein,
wrapped up in a fat droplet, and
administered intramuscularly. The
mRNA gene makes the cell produce the
viral protein to stimulate our body’s
immune response to the virus but does
not alter the host cell's DNA structure.
This is the very basis of the science
behind cells and cellular function. A
genetic modification would involve the
deliberate insertion of foreign DNA
into the nucleus of a human cell which
is not how a vaccine works.
23PULSE | ISSUE 37 | FACES OF NUHCS
IN PURSUIT OF
ANSWERS TO
THE HEART
Researchers at the Cardiovascular Research
Institute look at broad spectrum of issues ARTICLE BY
to improve disease burden in Singapore NUHCS Pulse Editorial
“In the 1980s, 80 to 90 percent ment including wet lab facili-
of the people who had heart ties, research animal breeding
failure were likely to die in the colonies, high-definition digital
next few weeks. Now, about imaging equipment, and high
half of these people will be throughput platforms to run
able to live for another five to and perform a wide array of
six years,” reflected Prof Arthur proteomic, metabolomic and
Mark Richards, Deputy Direc- nucleic acid assays and analysis.
tor, National University Heart
Centre, Singapore (NUHCS) on At any one time, CVRI tackles
the changes he has seen over around 50 different projects
the years in his career. relating to cardiovascular issues,
from looking at a particular
Even so, he added, such odds molecule in a cell in a lab to
leave plenty of room for running clinical trials of novel
improvement and many chal- approaches to the treatment of
lenges for clinicians and scien- heart failure.
tists to answer.
“One thing that stood out to
Describing the field as a me was the great deal of heart
specialty with many unan- and arterial diseases here, but
swered questions, Prof Rich- research funding for cardiovas-
ards is intent on finding these cular research was dispropor-
answers at the Cardiovascular tionately small compared to
Research Institute (CVRI) – the that going to other biomedical
research arm of NUHCS, where domains,” Prof Richards said in
he has led as Director since itsobservation when he was part
inception in 2009. of the Cardiovascular Disease
Taskforce to develop research
Hailing from New Zealand, roadmaps for Singapore.
Prof Richards has built CVRI
from ground up with a hand- Singapore has a high rate of
ful of researchers to a centre diabetes which is the key back-
with about 100 dedicated ground contributing factor to
staff working in an advanced heart diseases in people here.
research centre equipped The combination of diabetes
with specialised lab equip- with risk factors such as high
24PULSE | ISSUE 37 | FACES OF NUHCS
blood pressure appears to be rebuilding and regenerating able to encourage institutes
far more toxic to the heart in the heart. in Singapore to collaborate,
Singapore than in western which not only avoids duplica-
countries. “It’s very ambitious but kind tion of resources but combines
of aspirational. It is the foun- institutional strengths and has
“We don’t really understand the dational mission for our work, fostered communication and
problem,” he let on. “Rather and directs the advances we closer working ties between
than focus solely on the heart have made,” he said. the different institutes.
organ, we need to think about
the things that injure it – such Some of the work that have “I don’t think this has happened
as diabetes, blood pressure, come out of CVRI include the in other countries,” said Prof
hypertension, all of which are design and development of a Richards.
very prevalent here.” new heart replacement valve
made from natural materials; Looking ahead, he is hopeful
In the race for answers, he the re-engineering of a protein that CVRI will expand to tackle
said, “One of the next steps from a bacterium to encap- the multitude of cardiovascular
for me, is to encourage cardi- sulate another protein for issues confounding experts. He
ovascular research. We could targeted purposes, and identi- also sees the institute progress-
have another five or six senior fying new biomarkers that can ing further into the research
research investigators who predict heart failure after a which they have made head-
could bring CVRI to a heart attack. way.
critical mass, where
it can really keep CVRI performs clinical trials in He chimed, “We have a whole
its momentum, collaboration with other insti- atlas of biomarkers now that
have lots of tutes in Singapore and in other we would like to explore from
cross-polli- countries on related studies our previous work. We want to
such as looking into the asso- see if they do actually work for
ciation of poor sleep and coro- prognostic or diagnostic uses
nary heart disease to address a in the clinic and whether they
patient’s survival rate. point to entirely new treat-
ments. There is a lot going on!”
Having been here for over a
decade, Prof Richards acknowl-
edged that Singapore has some
unique strengths conducive for
medical research such as the
high education and good work
ethics of the talent pool.
“People here typically really When you get on the trail
want to do a good job and take of asking questions and
things to the next level.” finding answers, and
nation of ideas He further commented on the
making discoveries, you
with each other, research support structure in tend to stay on the path.
share facilities and Singapore which he thought Prof Arthur Mark Richards, Deputy Director,
NUHCS and Director, CVRI
generate more synergy.” was “far-sighted”. The govern-
ment provides grants to support
CVRI has been paying atten- junior clinician scientists to
tion to heart failure, focus- pursue research whilst they
ing on a broad spectrum from continue with clinical work.
pure prevention to complete Grants are also made avail-
25PULSE | ISSUE 37 | FACES OF NUHCS
THE
ACCIDENTAL
CAREER
Perfusion Week highlights critical role of perfusionists
The first week of May is dedi-
cated as Perfusion Week to Ms Clara Anne Lim
bring about awareness of the Perfusionist,
Department of CTVS,
perfusionist’s role in cardiovas- NUHCS
cular surgery and extracorpor-
eal membrane oxygenation
(ECMO). What got you interested in the What do you like best about
job of a perfusionist? being a perfusionist?
Many cardiovascular surger-
Clara: It was a recruiter from I love the challenges I face in
ies need the heart to be still in
whom I first heard about this fast-paced job. It requires
order to be operated on. This
the job of a perfusionist. I quick thinking on your feet,
is where perfusionists step in.
had to google it as it was and is also demanding as we
They are specially trained to
my first time hearing about are required to support the
operate, maintain and record
this job! However, the job various number of surgeries
the output of the heart-lung
piqued my interest as it was going on.
machine, designed to maintain
related to my studies – car-
the circulation of blood and It is a very rewarding job,
diac technology and bio-
oxygen through the body. when I play a part in help-
medical sciences. I decided
to take up the challenge as ing someone survive surgery
Outside the operating theatres that will help him or her
the human heart has always
(OT), perfusionists also provide lead a better quality of life.
fascinated me.
cardiac and respiratory sup-
port with the ECMO machines, On the day of my inter- What are the most challenging
which are smaller heart-lung view, I remember a senior aspects of the job?
machines designed for long- perfusionist sprung a sur-
term life support. prise tour to the OT where I There are some days which
would need to work in, and can be more physically and
Working as a perfusionist observed my response to mentally challenging than
within the Department of Car- being present during open others.
diac, Thoracic and Vascular Sur- heart surgeries. I certainly We are rostered to be on
gery (CTVS) at the National did not expect that. Luckily, I call 24 hours to respond to
University Heart Centre, Singa- did not faint or I would have medical emergencies. When
pore (NUHCS), Ms Clara Anne been rejected. these situations occur, it
Lim shares more about the
could mean long hours as
profession.
26PULSE | ISSUE 37 | FACES OF NUHCS
emergency procedures can and machinery to be smaller the patient once they are
be very complicated. which also meant that we on bypass, constantly mon-
need to be very precise in itoring and responding to
There was one difficult night managing these cases. In haemodynamic, brain func-
call during the Covid-19 addition, congenital car- tion, and blood gas changes,
Circuit Breaker in 2020. A diac surgeries on paediatrics making clinical decisions on
patient had a heart attack tend to be more complex as patient management during
and went into cardiogenic they could have different the surgery.
shock. He was also a sus- anatomies and physiologies
pected Covid-19 case which compared to adults. Any tips for aspiring
required the procedure to perfusionists?
be done in isolation, and for What are some common
us to don on full personal Understand the anatomy
misconceptions about and physiology of the entire
protection equipment (PPE). perfusionists? human body, and not just
This meant that we could Like me at the start of my the heart. We perfuse the
not leave the OT even for career, many people have entire body which has a crit-
a toilet break, as the PPE not heard about perfusion- ical impact on the functions
made it a hassle. Since it was ists. They think the job is of other organs, including
an emergency, the entire related to perfumes, when it the brain and kidneys.
team was basically stuck in is actually about the body’s
the room the entire night as circulatory system.
ARTICLE BY
there was no backup team! Mr Goh Si Guim
Senior Principal
Another misconception is Perfusionist, Department
In general, I find paediat- that people liken our job of CTVS, NUHCS
ric cases more stressful and to a technician operating Mr Goh joined a team of three
demanding, especially when a machine. However, our perfusionists at the National
they are fragile newborns. responsibility goes beyond
University Hospital (NUH) to help support the
Department of CTVS in 1993. With the expansion
They are much smaller in that. We take over the oxy- and growth of cardiovascular surgical procedures
at NUH, the Perfusion Service team has likewise
size, requiring our circuits genation and perfusion of grown in parallel to a team of 12, to date. He was
previously trained to become a qualified perfusion-
ist at the Singapore General Hospital and holds a
Bachelor’s in Biological Sciences.
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