Straight to the heart

I KNOW very little about him except that he is Russian and in his 70s, but I look him straight in the heart. The man, let's call him Ivan Ivanovich, is having open heart surgery similar to that proposed for President Yeltsin next week.

I stand just 18 inches away as leading Moscow surgeon Leo Bokeria performs the intricate operation. "Don't touch anything green," Bokeria's colleague Sergei Nikonov sternly advises me. A green tube lies perilously close to my right foot. I freeze instantly and realise that the greenest thing in the room is my own face.

The operating theatre is no bigger than an average to small living room, its door open to a corridor. Now and then people pop in and out to see how things are proceeding. All, including your reporter, are dressed in green (untouchable?) overalls, little blue tie on hats, white surgical masks and sterilised plastic shoe covers.

Fortunately the opening up of the chest has taken place before my arrival and a vein has been removed from one of his legs to replace his narrowed arteries.

Leonid Antonovich Bokeria (Laureate of the Lenin and State Prizes of the USSR) enters with all the panache of a great hero from an epic poem by Pushkin. Miniature binoculars are strapped to his forehead, and an electronic scalpel relays his every move to medical students deep in the bowels of the "Scientific Centre for Cardio Vascular Surgery named for A.M. Bakulev on Moscow's Leninsky Prospekt. The major part of the operation has begun.

Ivan Ivanovich's heart has been stopped. He has been placed on a heart lung machine, little wavy green lines dancing across a monitor as ice is applied to his heart to cool it to a temperature of between six and eight degrees celsius.

A small, shoulder high curtain is draped two thirds the way across the room dividing the surgical team in the larger section from the visitors: myself and Dr Mikhail Kukulevich from the medical newspaper Bolnitsa.

Ivan Ivanovich's head is poking through to our territory, his arms, legs and torso on the surgical side of the barrier. He just lies there, his torso covered by a sheet with a square hole to match the hole in his chest. Gloved fingers confidently dip into the surprisingly deep, red pool which contains his troubled heart.

His aged face lies motionless on our side of the barrier.

"Somebody's father and grandfather," I think. Somewhere deep in Russia, his wife, his grown up children, his little grandchildren are tensely awaiting news.

The bonding process has begun. Now he is "my patient", I am cheering him on, urging him in my mind to get through, as Leo Bokeria works away with his deft, precise fingers.

IVAN Ivanovich makes it. Soon he will he like the policeman who, in another section of the clinic, is feeling better than ever and eagerly waiting to hoard his nine hour flight home to Khabarovsk in the Russian far east, across the straits from Japan. I am as happy for Ivan Ivanovich as I would be for my own father.

But not all patients at the Bakulev Centre get through. The fatality rate is as high as 10 per cent. This is explained by the fact that the centre takes on only more complicated operations: no single bypasses and a very limited number of double bypass operations. Triple and quadruple bypass surgery is the norm.

For Leo Bokeria it was a typical day. He and his team faced 20 heart operations. There were nine for congenital heart disease, three valvular operations, two by passes, two surgical procedures for aneurysms, a couple of pacemaker jobs, two angioplasty procedures and one operation for the, extraction of a foreign body from the heart.

Downstairs from the main theatre western equipment, mainly German and Dutch, is on display. Prof Amiran Revishvili is working with the latest equipment, for "closed heart technology" by which electrodes measure and repair damage to the heart by means of long, flexible and controllable catheters.

In the computer room pictures of patient's hearts (angiografi in Russian) on a Phillips monitor show the hearts of real patients in "virtual reality". Before my eyes pulses the heart of one V.K. Chaplin, doctors pointing, in their preparation for surgery, to where arteries had narrowed.

Equipment is up to date, but like all technology these days, will soon be outdated. The Bakulev centre is to stage an exhibition of state of the art electronic aids to surgery in Moscow in December and by this means to get its hands on some of the newest hardware. Its aim is to provide ordinary Russians, who do not have to pay, with the same service that President Yeltsin will soon receive.