Vietnamese Tran Huu Phuong rarely fell ill and even when he did, he never made a fuss. So when he complained of chest pains one day, his family did not hesitate to go the extra mile to get treatment – 677 miles to be exact, to Singapore.

When 73-year old Tran Huu Phuong retired about 20 years ago, he took the opportunity to spend most of his time indulging in his favourite past-time – fishing. He certainly didn’t mind that a river teaming with freshwater fish was located close to his home in Ho Chin Minh City.

With his two daughters and two sons all grown up, Tran, a former construction engineer with a cement manufacturing company, would pass the hours away trying to outsmart his river-dwelling targets. Even a mild stroke several years ago could not pull him away from the river’s edge.

Reveals his 32-year old son, Tran Phuong Luan, a regional service engineer for a medical equipment company based in Singapore, “Any time of the day, you could find him at the river fishing. He was addicted to it.”

Unfortunately, that was not the only thing the elder Tran was addicted to. He had been a heavy smoker for many years. Though he seldom fell ill, the effects of his years of smoking were to contribute a big part to the chest pains he felt one day in May 2007.

Phuong Luan recounts, “He was clutching his chest and looked pale. He struggled to walk and could barely stand upright. We were all shocked and worried because we have never seen him like that before. He was always a strong man.”

Tran’s family quickly rushed him to the medical centre in the city where the doctors there examined and sent him for a Computed Tomography (CT) scan. It revealed that he had a blood clot in his brain. A subsequent Magnetic Resonance Imaging (MRI) test and ultrasound scan confirmed it and also found that he had problems with his right carotid artery (one of two major blood vessels supplying the head and neck with oxygenated blood) and aorta (largest artery in the body).

It didn’t look good for Tran. The doctors in Vietnam warned that a major stroke was impending and that it would have serious to lethal consequences for Tran. Surgery was his only option but his advance age meant that the doctors there were reluctant to proceed with it.

“In any case, even if they agreed to operate we did not want to have the surgery done there. While they have the diagnostic equipment, the facilities and expertise to carry out such a complex surgery was another thing. We just did not feel convinced and comfortable,” admits Phuong Luan.

No Hesitation

With his mother’s successful treatment in Singapore for colon problems two years ago still fresh on his mind, Phuong Luan enquired if it was possible to have his father referred to a doctor in the island-state.

He shares, “The doctor in Vietnam was very helpful and readily offered to make an appointment to see a Singaporean surgeon who was renowned in the field. Coincidentally, he was at the National University Hospital (NUH), the same place my mother went to previously.”

Without any delay, Phuong Luan made arrangements to have his father consult with cardiothoracic surgeon, Professor Lee Chuen Neng, who is Chief and Senior Consultant at the NUH’s Department of Cardiac, Thoracic & Vascular Surgery.

In late June, armed with medical reports, Phuong Luan brought his father to Singapore to see Prof Lee. They were accompanied by Tran’s eldest daughter, Tran Thi Phuong Khanh.

Weighing The Risks

The first thing Prof Lee wanted to make sure was that Tran’s condition was consistent with the reports he was presented with.

He offers, “Besides the usual tests, we have to check if the patient is suitable for the surgery and determine the safety of this operation. So we checked his heart and did an angiogram to confirm the blockages.”

During the investigation, Prof Lee discovered that four of Tran’s major arteries supplying blood to the heart muscles were between 75 to 100 per cent blocked. Also, the inside lining of the abdominal section of Tran’s aorta had an aneurysm (bulge) that was threatening to burst.

Prof Lee, who was trained at the renowned Mayo Clinic in the United States, elaborates, “It was clear that he had an abdominal aortic aneurysm (AAA) and coronary heart disease. His aneurysm was 5.6 cm in size.”

According to him, any aneurysm greater than 5 cm has a much higher risk (of bursting) than the surgery to repair it. If it bursts, one would be dead in three to four minutes.

“Tran had some brain damage but it was small. So even though the risk of operating was there, about five per cent to be precise, it was not as risky as giving him medication alone. With the latter, the chance of him living beyond a few months was very small. There was a good chance that surgery would prolong his life another ten years or more,” asserts Prof Lee.

Heart-Stopping Moments

Initially, the plan was to undertake two procedures one immediately after the other. Tran needed surgery to treat the AAA as well as another to clear up his blocked arteries.

However with more accurate information about the blockages now known, this was no longer ideal. Prof Lee decided to split the procedures two months apart – to operate on the four blocked arteries first and thereafter, to repair the aneurysm.

“The purpose of this is to prolong his life and to make him fit enough to go through the second stage of operating on his AAA,” clarifies Prof Lee.

Stenting was also out of the question because with 100 per cent blockage in one of the four vessels, the stent would not be able to go through. So a coronary artery bypass graft surgery (CABG) was the best option.

During the four-hour long open surgery, Prof Lee had to redirect blood supply from the four blocked arteries. Using a graft, blood-flow to the heart was bypassed.

At critical periods during the complex procedure, Tran’s heart was stopped for 72 minutes using a heart-lung machine to bypass his heart and lungs and take over both the pumping of the blood and its oxygenation.

The surgery went without a hitch and a week later, although still weak, Tran showed signs of a quicker-than-expected recovery. Tran attributes this to the ‘excellent nursing care’ he received in the Intensive Care Unit over his three-day stay there. He spent another two weeks in the hospital recovering before he was discharged.

On The Horizon

Although not yet out of the woods and needing to go under the knife again in two months to repair his aneurysm, Prof Lee is confident Tran will have ‘many good years’ ahead of him thereafter.

“In general, the complications that can arise after a CABG include death from stroke, infection, breathing difficulties and irregular heart rhythm. There is only a small chance of this occurring and moreover, in an elective CABG such as in Tran’s case, there is a 98 to 99 per cent success rate,” discloses Prof Lee, who had previously prolonged by seven years, the life of a former 92-year old patient of his.

Notwithstanding, Tran has to ensure that he take steps to change his lifestyle, in particular, to kick his smoking habit. Smoking, accords Prof Lee, tends to promote atherosclerosis, a condition where cholesterol accumulates on the walls of the arteries.

Phuong Khanh, Tran’s daughter expresses, “My father is really grateful to Prof Lee and all the other doctors and nurses at NUH because he has been treated so well. Everything was explained clearly and it made us confident. Even the nurses made sure he understood what he has to do to keep healthy.”

She adds, “We came to Singapore worried but now we are so happy my father is feeling better. His appetite is slowly coming back and he is getting stronger.”

Tran declares, his son translates, “They are so organised and efficient here and they have done miracles. I hope one day Vietnam can have the same level of expertise.”

With renewed hope and confidence, he is actually looking forward to returning to Singapore for his second operation.

From the edge of death, Tran is now contemplating a return to the river’s edge. Granted he has to first wait until he fully recovers and regains his strength, there is the distinct sense that Tran knows the fish will be waiting for him.