Patient-as-provider profile: A.J. Cardounel, M.D.

Bypass surgery gives Pauley Heart Center cardiothoracic surgeon a unique perspective

“There is no better place to get treatment for heart disease than VCU Health Pauley Heart Center,” said Arturo “A.J.” Cardounel, M.D., Ph.D., a cardiothoracic surgeon at Pauley. Cardounel does not simply stake his reputation on the statement — he bet his life on it when he underwent bypass surgery at the center.

Cardounel, who has an extensive history of first-degree relatives with heart disease, recognized the initial signs of heart disease during his first few months as a VCU Health surgeon. At first, the 48-year-old, who regularly exercised and ate well, assumed it was relatively minor — a slight chest tightness he attributed to asthma.

“You get a little shortness of breath during activities, and think, maybe I’m just getting a little bit older,” he said. “For the first several months that I had these symptoms, I minimized them and thought it was just exacerbations of other things, maybe some reflux disease.”

But when Cardounel was physically active, the pain continued to worsen and would cease when he was at rest, indicating what he recognized as the signs of angina, a severe pain in the chest that is a symptom of coronary artery disease. It was a red flag, different from the initial, often vague, indicators of heart disease.

Cardounel took a cardiac stress test, during which he was quickly winded. For further insight, he underwent cardiac catheterization the following morning at Pauley — testing that confirmed he had triple-vessel coronary artery disease, the most severe form of coronary artery disease. All the major blood vessels leading to Cardounel’s heart were damaged from cholesterol deposits.

Severe lesions in his arteries indicated that bypass surgery, which routes blood around arterial blockages, granted the best guarantee of long-term survival. Surgeons remove a healthy blood vessel from the chest, arm or leg and attach it above and below the damage, creating an alternate channel for blood flow. The procedure isn’t a cure for coronary artery disease, but it can improve heart function and reduce symptoms.

He trusted his long-time mentor Vigneshwar Kasirajan, M.D., the Stuart McGuire Professor and chair of cardiothoracic surgery at VCU, to perform the surgery. “I went straight from the cath lab to the operating room,” he said.

Cardounel, who was back on duty three months after his surgery, advises healthy patients with a family history of heart disease to stay vigilant. His father underwent bypass surgery at VCU in the 1970s, at the age of 51, a few years older than when his son faced the same health crisis. Cardounel’s brother also had bypass surgery at the age of 48.

“We  have high cholesterol that’s not really driven by diet,” Cardounel said. “You try to make lifestyle modifications to see if it helps, but ultimately, it’s a genetic problem. It’s a problem with how we metabolize cholesterol.”

‘A light at the end’

It’s often said doctors make the worst patients. But Cardounel says he was happy to take a back seat during his care at VCU Health. “I had no interest in seeing my X-rays and labs,” he said. “Everyone has a role, and my role was not to be the doctor; it was to be the patient. I liked the fact that I didn’t have to think about my own care because someone else was managing it.”

He added that he appreciates the multiple VCU Health teams involved in his pre- and post-operative care. “My colleagues in my own department all rounded on me,” he said. “All of them were intimately involved in my postoperative care. And the nursing staff is second to none.”

Kasirajan added, “We are honored that Dr. Cardounel chose us for his own care.”

Cardounel gained a lot from the experience. In addition to greater awareness of his health, he has become a more compassionate surgeon, who can provide a firsthand account to his patients scheduled for bypass surgery.

“We educate our patients about the risks and benefits and what we can offer them. And then together, we make an informed decision,” he said. “The fact that I tell my patients that I have been through this and survived it, and that there is a light at the end of the tunnel, is encouraging. They value my opinion, and I value their autonomy in the decision-making process.”