Olmert to take PM duties on Thursday

Sharon's catheterization operation to be done under general anesthesia.

By HERB KEINON, JUDY SIEGEL
ehud olmert 88 (photo credit: )
ehud olmert 88
(photo credit: )
Deputy Prime Minister Ehud Olmert will assume stewardship of the country for a few hours Thursday morning when Prime Minister Ariel Sharon undergoes a medical procedure to close a small hole in his heart. The decision to transfer powers to Olmert was made by Attorney-General Menahem Mazuz in consultation with Cabinet Secretary Yisrael Maimon, Sharon and Olmert after the prime minister's doctors decided he would need to undergo a general anesthetic during the procedure to catheterize his heart. According to Sharon's office, the procedure is expected to take 30-45 minutes, and it will take another two to two-anda-half hours for him to come out of the anesthetic. If all goes well, Olmert - according to Sharon's office - is to hold the country's reins for no more than three hours. However, a senior Israeli anesthesiologist - who will not be involved in the procedure - told The Jerusalem Post it was impossible to predict how long Sharon would be under general anesthetic. "Any operation is unpredictable," he said. "When patients ask, we never tell them how long it will take. Sharon will be anesthetized from the moment the procedure starts until it ends. If, because of his weight, they have difficulty at first inserting the catheter and threading it to the heart, it will take longer. While they're there, they might look at coronary arteries from inside. Very likely it will be fine. But one can't say how long it will take." The prime minister's authorities will be transferred to Olmert as called for under clause 16b of the Basic Law: Government. According to the law, "Should the prime minister be temporarily unable to discharge his duties, his place will be filled by the deputy prime minister." Officials in Sharon's office said the doctors performing the procedure would determine when he was capable, after coming out of the anesthetic, to resume his duties. Sharon will convene a security cabinet meeting Wednesday to discuss a possible redeployment in Ghajar, as well as hold consultations regarding the upcoming Palestinian Authority elections and Israel's policy toward Hamas. According to the Prime Minister's Office, Sharon is expected to end his work day at 3 p.m. and return to his Negev ranch to rest before coming back to Jerusalem Thursday morning for the procedure, which will take place at Hadassah-University Hospital in Ein Kerem. If all goes well, Sharon is to be released from the hospital on Friday and return to his ranch for Shabbat. He is expected to return to work Sunday, although there will not likely be a cabinet meeting. On Monday, he is scheduled to meet visiting Japanese Prime Minister Junichiro Koizumi, whose visit was postponed a day because of Sharon's medical procedure. The catheterization of the 77-year-old Sharon's heart will be performed by a team of interventional cardiologists, anesthesiologists and other experts from three leading hospitals. They will use a tiny implant called a septal occluder to close a small hole between the two atria (upper chambers). The general anesthesia will be used so that an echocardiography scanner can be threaded down Sharon's esophagus to insert the implant. The interdisciplinary team will be headed by Prof. Chaim Lotan, who is chief of cardiology at Hadassah, and will include Prof. Avraham Lorber, head of pediatric cardiology at Rambam Hospital in Haifa, and Dr. Raphael Hirsch, of the congenital heart defects unit at the Rabin Medical Center-Beilinson Campus in Petah Tikva. Hadassah spokeswoman Yael Bossem-Levy did not say who among them would actually push the catheter from a small incision in the groin into the atria of his heart and dispatch the umbrella-like double clamp. Aside from high security, other patients and visitors will not be affected by the prime minister's being there, said Bossem-Levy. No other operations would be postponed. She did not say where in the hospital Sharon would be catheterized or recover, but it will not be in the internal medicine department where he was treated for a minor stroke on December 18, which reportedly left no residual motor or cognitive deficits. "We expect the prime minister's sons will be there before the procedure," Bossem-Levy said. "We will give him the best possible care." The implant, called Amplatzer septal occluder, is made by the AGA Medical Corporation in Minnesota and is approved by the US Food and Drug Administration and the Health Ministry. It is used to close an abnormal opening - called a foramen ovale - in the wall between the two upper chambers of the heart without using open-heart surgery. Sharon's atrial septal defect was formed before his birth, and in the majority of people it closes by itself when a baby begins breathing on his own. In most people with the defect, no harm is caused, but in a minority, the hole can cause a blood clot to pass between the atria and on to the brain and cause a stroke, rather than be filtered out by the lungs before the blood returns to the heart after oxygenation. Hadassah cardiologists and neurologists are not 100 percent certain that this hole caused the clot that triggered Sharon's stroke, but since he did not have fibrillation or clogged carotid arteries in his neck or the sides of his head, this is viewed as the likely cause. The septal occluder consists of two parts: a delivery system and a permanent implant. The delivery system helps transport the implant to the site of the defect in the heart. The implant - a self-expandable double disk made from wire mesh and polyester fabric - is the part of the device that remains in the heart to block the hole. A doctor makes a small incision in the groin and threads the catheter delivery system and implant through blood vessels to the heart. Inside the heart, the device is advanced to the site of the defect. When the doctor is certain the device is placed properly, the implant is released from the delivery system and opened so that the defect is blocked (or sandwiched) by the mesh discs. The implant remains in the heart and the delivery system is removed. Once the device is in place, tissue will grow over it closing the defect, and the device then becomes part of the wall of the heart. The Amplatzer should not be used in patients who have extensive cardiac anomalies and require open-heart surgery, have certain types of infections that do not respond to treatment, cannot take aspirin other blood-thinning drugs, have blood clots in or near the heart or are allergic to nickel. Sharon meets none of these conditions according to doctors who prescribed injec tions of anti-coagulants for weeks to pre vent a recurrent stroke before the hole closed. There has been some debate among cardiologists here and even abroad about whether the obese prime minister should undergo general anesthesia and have trans-esophageal echocardiogram (TEE) via his esophagus. Others, including cardiologists at Jerusalem's Shaare Zedek Hospital have suggested using sedation and the introduction of ultrasound via a second catheter through the groin, as general anes thesia poses a small risk and sedation allows the patient to breathe on his own. The Post consulted anesthesiologists New York University Medical Center who haven't seen Sharon's medical file but have been reading news reports about the prime minister. They said doing the procedure under a general anesthesia allow use of the TEE may be preferable, obesity is a risk factor for aspiration, but having an endotrachial tube inserted protects the lungs from aspirating foreign matter. With the drugs available today, they said, the recovery from anesthesia was very rapid. However, the NYU experts said using ultrasound via a catheter into the heart was also an option. transfer of authority overall health was fine