Сardiac surgery is the field of surgery and cardiology involved in the treatment of the heart diseases using surgery. To date, cardiac surgery is the most effective way to treat certain types of heart diseases, coronary heart disease and helps prevent the development of myocardial infarction, also eliminate its consequences - the aneurysm.
Surgical intervention is used only in the cases when conservative treatment is non-effective, and the level of patient’s health has become worse. Heart surgery is preceded by delayed patient’s visit to doctor, when the only way to help is the surgery.
Today, cardiac surgery is one of the fastest growing and technologically advanced branches of medicine. Each year, open-heart surgery made to 700 patients. The major part of the operations is made in USA. In Europe, the number of transactions is 4 times less. In Asian countries, cardiac surgery is virtually nonexistent. In Russia, the number of operations carried out on the heart, is below the required minimum. These statistics are related to the fact that heart surgery is expensive. In addition to open-heart surgery there are surgery performed without opening the heart (such as implantation of pacemakers, angioplasty).
Surgical intervention is required for diseases such as:
Coronary artery disease is the result of insufficient blood supply to the functioning myocardium. The main cause of coronary heart disease is atherosclerosis (plaque formation on the walls of blood vessels). Slight narrowing of the vessel lumen leads to angina (the person feels pain only when the oxygen requirements of the heart increases, for example during exercise). Severe narrowing of the vessel causes pain even at rest, the duration of pain attacks can increase and become more frequent, this is known as unstable angina. In strong impairment of the coronary blood flow the death of heart muscle fibers occurs, this is known as myocardial infarction.
One of the major complications of myocardial infarction is the formation of post-infarction left ventricular aneurysm. An aneurysm is a balloon-like bulge. It is formed due to the necrotic tissue is replaced by scar tissue, which in turn is unable to contract. Under the pressure of healthy twitch fibers scar tissue protrudes, the blood in the ventricle is delayed in the aneurysmal extension. With each heart contraction organs and tissues get less blood volume decreased by the volume of the aneurysm. This is the main negative effect of the aneurysm. Very often in the clots can be formed on the aneurysm, they can escape from the aneurysm and carried through the blood vessels to other organs, causing infarction (death of the part or the whole organ). If clots block the brain vessels they can cause a stroke.
Surgery (heart surgery) in coronary artery disease is aimed to restore normal circulation in all parts of the heart. The degree of coronary artery disease will determine what action should be done. Analysis of the condition of vessels is performed using angiography - is radiographic contrast study to determine the location, nature and extent of coronary artery narrowing. Coronary artery disease is causing pain, that is why this artery is often stented. In case of severe atherosclerotic impairment patients need coronary bypass surgery.
Types of surgery for coronary artery disease
Angioplasty and stenting are aimed at the clearance of the obstacles to blood flow through the artery expansion from within.
The operation is as follows: with the help of special equipment a catheter is introduced into the artery supplying the heart through a puncture in the femoral region controlled by fluorography drug. The catheter needs to reach the artery narrowing place, where a special balloon is inflated with a stent - a device which does not allow the artery to subside. The stent stays in the artery, and the catheter is pulled out through the same hole in the thigh.
Coronary artery bypass graft is the restoring of the heart muscle blood supply due to a new way of blood flow around the affected area of the coronary vessel with grafts - pieces of arteries or veins taken from the patient (for example, in the extremities). The operation is aimed to prevent heart attacks. To date, bypass surgery is performed both with the use of the heart-lung bypass machine (“on-pump” surgery), and on a beating heart, with stabilized heart portion in the treated area (off-pump or beating heart bypass surgery).
One variety of coronary artery bypass surgery is internal mammary artery coronary bypass. As a shunt the internal mammary artery is used. The use of this vessel is advantageous because in this case there is no need to make additional cuts due to the proximity of the mammary artery and heart. Also in the artery atherosclerotic plaques are not formed. And that shunt’s life span is long enough.
The essence of the surgery is to reduce the volume of the left ventricle due to separation of the aneurysmal expansion and healthy part of the left ventricle. The surgeon removes clots occurred in the area of the aneurysm, and then sew the wall of dense elastic tissue across the left ventricular. Two cavities are formed, one with normally contracted walls, the other is from the scar tissue, unable to contract, but do not interfere with the normal heart function. Thus, the blood circulation is normalized, and the risk of thrombus separation is reduced.
Heart defect are defects in the heart structure, leading to impairment of normal blood flow, there is congestion of blood in the pulmonary or systemic circulation.
There are following violations:
- Valve stenosis (narrowing);
In valve stenosis there is a decreased amount of blood passed through the reduced opening.
- Valvular insufficiency;
The cusps can not close tightly and passes blood in the opposite direction.
- Defects of interventricular and interatrial septa;
For these defects blood is passing from the cavity with high pressure into the cavity with less pressure. Venous oxygen-poor blood is mixed with oxygenated arterial blood, which leads to tissue hypoxia.
Heart defects can be congenital or acquired. Most of them do not require surgical intervention. Sometimes the disease is not noticeable to the patient. Congenital heart disease can pass with age, but if this does not happen and the growing signs of heart failure, it requires surgery.
Treatment of heart diseases is aimed at correcting of the existing mechanical defect in the heart functioning.
The following types of surgery:
Prosthetic fitting operations are carried out on the open heart with cardiopulmonary bypass.
Valve prostheses are mechanical and biological.
Mechanical valves are made of metal and plastic. The duration of such implants is for about 80 years. However, daily use of it requires anticoagulants, as the prosthesis easily formed blood clots that contribute to the formation of blood clots. In rare cases, the mechanical prosthesis may break which often leads to the patient‘s death. Mechanical valve prosthesis can be in the form of:
The disk completely opening and fastened at one end only. Blood moving in the right direction press the disc, turn it on hinges and opens a hole, with the reverse movement of the blood drive completely covers the opening.
Blood flow in the right direction pushes the ball out of the hole, pressing it to the bottom of the grid, and thus making able of blood passage, reverse circulation pushes the ball into the hole, which is thus effectively closed and does not pass the blood.
Biological prostheses are usually made from the heart tissue of animals and are considered to be more effective. After their installation there is no need anticoagulant treatment, which has many contraindications. The prosthesis duration is 10 to 20 years, aging is gradual and it is possible to prepare beforehand for its replacement in a planned manner. Of course, in this case an extra surgery will be necessary.
Biological valves do not require the use of anticoagulants (although it is often recommended), but they wear out faster than mechanical ones.
In septa defect of small size (less than 3 cm) suture plication is used. Significant sized defects requires the use of patch plastic (synthetic fabric or autopericardium)
Arrhythmia is impaired sequence, rhythm and frequency of heart contractions. Arrhythmias can occur as a consequence of metabolic disorders, such as endocrine and autonomic, or the effects of certain drugs. They are also often the cause of heart disease, and sometimes intoxication.
Arrhythmia is dangerous because it can cause ventricular fibrillation (disordered fibers contraction).
Arrhythmia treatment includes drugs, catheter ablation, or implanted pacemaker.
Surgical methods of treatment of arrhythmias:
This is a minimally invasive surgical technique that is used for:
Radiofrequency ablation method includes holding of special catheter to the site of the heart, causing irregular abnormal rhythm. An electrical impulse destroys tissue area that makes abnormal rhythm.
Due to ablation normal heart rhythm is restored.
The operation is performed in patients with cardiac arrhythmias, which are life threatening. Pacemaker aims to control and restore normal heartbeat.
The doctors implanted a special device under the skin or under the pectoral muscle. Two or three electrodes from the pacemaker are connected to the heart chambers in order to send the electric pulse there.
The principle of functioning of pacemaker and defibrillator are similar. A distinctive feature of it is the elimination of too rapid and too slow heart rate. The electrodes evaluate the heart rhythm. Defibrillator’s installation is similar to installing a pacemaker.
The defibrillator is installed for ventricular tachycardia.
In extreme cases, when the heart can not function properly and any treatment is non-effective, heart transplantation is used. Due to this operation, the doctors prolong the patient's life for a period of 5 years. Currently research is underway to extend the lives of people who have had heart transplants.
An important stage of recovery after surgery is post-operative recovery period. It requires strict control of the person’s health. This period is different and unique for each patient. Special cardio trainings and diets are administered to patients. Emotional calm is necessary.
Heart surgery is dangerous for its complications. The main signs of complications are fever, pain in the operated area, tachycardia, low pressure, shortness of breath. ECG records reveals characteristic changes. The recovery period is six months up to year.
Invaluable help in the postoperative period could be services offered by Kardi.ru. An example of the health monitoring in postoperative patients is the work of doctor of medical sciences, professor, doctor of arrhythmology Andrei Vyacheslavovich Ardashev. He makes more than 200 operations per year. Postoperative monitoring of patients started in 2011 with the help of ecg4me.com project. The physician controls both the Cardiovisor’s conclusion, and ECG of postoperative patients. The Kardi.ru service helps to monitor the restoring of the surgery patient health on the Internet. This is sound andvantage, as a lot of patients coming to Moscow from all over Russia to do heart surgery. Postoperative period they are at home. Development of the Internet, allows you to monitor patients with Kardi.ru, wherever the patient is. Cardiovisor using makes able to read ECG at home and send it to the doctor with help of Kardi.ru.