Emergency heart surgery consequences. The main types of surgical intervention on the heart. When is heart surgery performed - indications and timing

Heart surgery helps to cure many diseases of the cardiovascular system that are not amenable to standard therapeutic methods. Surgical treatment can be carried out in different ways, depending on the individual pathology and the general condition of the patient.

Indications for surgical treatment

Cardiac surgery is a field of medicine in which physicians specialize in studying, inventing methods and performing operations on the heart. The most complex and dangerous cardiac surgery is heart transplantation. Regardless of what type of surgery will be performed, there are general indications:

the rapid progress of the disease of the cardiovascular system; ineffectiveness of conservative therapy; untimely visit to the doctor.

Heart surgery makes it possible to improve the general condition of the patient and eliminate the symptoms that disturb him. Surgical treatment is carried out after a complete medical examination and the establishment of an accurate diagnosis.

Heart disease

Do operations for congenital heart defects or acquired. A congenital defect is detected in a newborn immediately after birth or before birth on an ultrasound examination. Thanks to modern technologies and techniques, in many cases it is possible to detect and cure heart disease in newborns in time.

An indication for surgical intervention can also be coronary disease, which is sometimes accompanied by such a serious complication as myocardial infarction. Another reason for surgery may be a violation of the heart rhythm, since this disease tends to cause ventricular fibrillation (scattered contraction of fibers). The doctor should tell the patient how to properly prepare for heart surgery in order to avoid negative consequences and complications (such as a blood clot).

Advice: proper preparation for heart surgery is the key to a successful recovery of the patient and prevention of postoperative complications, such as a blood clot or occlusion of the vessel.

Operation types

Cardiac surgeries can be performed on an open heart as well as on a beating heart. Closed heart surgery is usually performed without affecting the organ itself and its cavity. Open heart surgery involves opening the chest and connecting the patient to a ventilator.

Endovascular intervention

During open heart surgery, a temporary cardiac arrest is performed for several hours, which allows you to perform the necessary manipulations. This technique makes it possible to cure complex heart disease, but is considered more traumatic.

Surgery on a beating heart uses special equipment so that the heart continues to contract and pump blood during surgery. The advantages of this surgery include the absence of such complications as embolism, stroke, pulmonary edema, etc.

There are the following types of heart operations, which are considered the most common in cardiology practice:

radiofrequency ablation; coronary artery bypass grafting; stenting of coronary arteries; valve prosthetics; Operation Glenn and Operation Ross.

If surgery is performed with access through a vessel or vein, endovascular surgery (stenting, angioplasty) is used. Endovascular surgery is a branch of medicine that allows for surgical intervention under X-ray control and using miniature instruments.

Endovascular surgery makes it possible to cure the defect and avoid the complications that abdominal surgery gives, helps in the treatment of arrhythmias and rarely gives such a complication as a thrombus.

Advice: Surgical treatment of heart pathologies has its advantages and disadvantages, therefore, the most suitable type of operation is selected for each patient, which carries fewer complications for him.

RF ablation

Radiofrequency or catheter ablation (RFA) is a minimally invasive surgical intervention that has a high therapeutic effect and minimal side effects. Such treatment is shown for atrial fibrillation, tachycardia, heart failure and other cardiac pathologies.

By itself, arrhythmia is not a serious pathology requiring surgical intervention, but can lead to serious complications. Thanks to RFA, it is possible to restore a normal heart rhythm and eliminate the main cause of its violations.

RFA is performed using catheter technology and under x-ray control. Heart surgery takes place under local anesthesia and consists in bringing a catheter to the necessary part of the organ, which sets the wrong rhythm. Through an electrical impulse under the action of RFA, the normal rhythm of the heart is restored.

Coronary artery bypass grafting

Coronary artery bypass grafting (CABG) helps to restore blood supply to the heart muscle. Unlike the RFA technique, such treatment gives a high result due to the formation of a new passage for the blood flow. This is necessary in order to bypass the affected vessels with special shunts. To do this, take a vein or artery of the patient from the lower limb or arm.

Such heart surgery helps prevent the development of myocardial infarction and atherosclerotic plaques. Its essence lies in the fact that sclerosed vessels are replaced by healthy ones. Often, after shunting, an angioplasty technique is used, when a tube is inserted through the vessels (femoral artery) with a balloon into the damaged vessel. Pressurized air exerts pressure on the actorosclerotic plaques (thrombus) in the aorta or artery and assists in their removal or advancement.

Stenting of the coronary arteries

Stenting

Together with angioplasty, stenting can be performed, during which a special stent is installed. It pushes the narrowed lumen in the aorta or other vessel and helps prevent blood clots and remove atherosclerotic plaque, as well as normalize blood flow. All these manipulations can be carried out simultaneously, so that repeated surgical intervention is not prescribed.

The most common heart disease is valve narrowing or insufficiency. Treatment of such a pathology should always be radical and consist in the correction of valvular lesions. Its essence lies in the prosthetics of the mitral valve. An indication for heart valve replacement surgery may be severe valvular insufficiency or leaflet fibrosis.

With a serious violation of the heart rhythm and the presence of atrial fibrillation, there is a serious need to install a special device called a pacemaker. A pacemaker is needed to normalize the rhythm and heart rate, which can be disturbed during arrhythmias. To normalize the heart rhythm, a defibrillator can be installed, which has the same type of action as a pacemaker.

Heart valve replacement

A patient who has a pacemaker has to undergo frequent medical examinations.

During surgery, a mechanical or biological implant is placed. Patients who have a pacemaker have to adhere to certain restrictions in life. A blood clot or other complication may appear some time after the installation, so lifelong use of special medications is often prescribed.

Operation Glenn and Operation Ross

Glenn's operation is included in the stage of complex correction of children who have congenital heart disease. Its essence is to create an anastomosis connecting the superior vena cava and the right pulmonary artery. Through the time after the treatment was carried out, the patient can live a full life.

The Ross operation involves replacing the patient's damaged aortic valve with his own pulmonic valve.

Laser cautery can also be used to treat arrhythmias. Cauterization can be performed using ultrasound or high frequency current. Cauterization helps to completely eliminate the signs of arrhythmia, tachycardia and heart failure.

Thanks to modern technology and the development of medicine, it has become possible to effectively treat arrhythmia, eliminate heart disease in newborns, or cure other pathologies with heart surgery. In the time after such an operation, many people can live their usual lives, which have only some restrictions.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

DlyaSerdca → Symptoms and treatment → Surgery and invasive heart examinations

Heart surgeries are very common these days. Modern cardiac surgery and vascular surgery are very advanced. Surgical intervention is prescribed in the case when conservative drug treatment does not help, and, accordingly, the normalization of the patient's condition is impossible without surgery.

For example, heart disease can only be cured by surgery, this is necessary in the case when blood circulation is severely disturbed due to pathology.

And as a result, a person feels bad and severe complications begin to develop. These complications can lead not only to disability, but also to death.

Often prescribed surgical treatment of coronary heart disease. Since it can lead to myocardial infarction. Due to a heart attack, the walls of the cavities of the heart or aorta become thinner and protrusion appears. This pathology can also be cured only by surgery. Quite often, operations are performed due to disturbed heart rhythm (RFA).

They also perform heart transplantation, that is, a transplant. This is necessary when there is a complex of pathologies due to which the myocardium is not able to function. Today, such an operation prolongs the life of the patient by an average of 5 years. After such an operation, the patient is put on disability.

Operations can be carried out urgently, urgently, or a planned intervention is prescribed. It depends on the severity of the patient's condition. An emergency operation is performed immediately, immediately after the diagnosis is established. If such an intervention is not carried out, then the death of the patient may occur.

Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes are important.

Urgent operations do not require fast execution. In this case, the patient is prepared for some time. As a rule, it is several days.

A planned operation is prescribed if at this time there is no danger to life, but it must be carried out to prevent complications. Doctors prescribe surgery on the myocardium only if it is necessary.

Invasive Research

Invasive methods for examining the heart are to conduct catheterization. That is, the study is carried out through a catheter, which can be installed both in the cavity of the heart and in the vessel. With the help of these studies, you can determine some indicators of the work of the heart.

For example, blood pressure in any part of the myocardium, as well as determine how much oxygen is in the blood, evaluate cardiac output, vascular resistance.

Invasive methods allow you to study the pathology of the valves, their size and degree of damage. This study takes place without opening the chest. Cardiac catheterization allows you to take an intracardiac electrocardiogram and phonocardiogram. This method is also used to monitor the effectiveness of drug therapy.

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Such studies include:

Angiography. This is a method for which a contrast agent is used. It is injected into the cavity of the heart or vessel for accurate visualization and detection of pathologies. coronary angiography. This study allows you to assess the degree of damage to the coronary vessels, it helps doctors understand whether surgery is needed, and if not, what therapy is suitable for this patient. Ventriculography. This is a radiopaque study that will determine the condition of the ventricles, the presence of pathology. All ventricular parameters can be studied, such as cavity volume, cardiac output, cardiac relaxation and excitability measurements.

With selective coronary angiography, contrast is injected into one of the coronary arteries (right or left).

Coronary angiography is often performed in patients with angina pectoris 3-4 functional class. In this case, it is resistant to drug therapy. Doctors need to decide what type of surgical treatment is needed. It is also important to carry out this procedure for unstable angina.

Also, invasive procedures include punctures and probing of the heart cavities. With the help of probing, it is possible to diagnose heart defects and pathologies in the LV, for example, it can be tumors, or thrombosis. To do this, use the femoral vein (right), a needle is inserted into it through which the conductor passes. The needle diameter becomes about 2 mm.

When performing invasive studies, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the desired vein for the installation of the catheter.

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Surgery for heart disease

Heart defects include

stenosis of the heart valves; insufficiency of heart valves; septal defects (interventricular, interatrial).

valve stenosis

These pathologies lead to many disorders in the work of the heart, that is, the goals of operations for defects are to relieve the load from the heart muscle, restore the normal functioning of the ventricle, as well as restore contractile function and reduce pressure in the heart cavities.

To eliminate these defects, the following surgical interventions are performed:

Valve replacement (prosthetics)

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This type of operation is done on the open heart, that is, after opening the chest. In this case, the patient is connected to a special apparatus for cardiopulmonary bypass. The operation consists in replacing the affected valve with an implant. They can be mechanical (in the form of a disk or ball in a grid, they are made of synthetic materials) and biological (made from animal biological material).

Valve implant placement

Plastic defects of partitions

It can be carried out in 2 options, for example, suturing a defect or its plastic. Suturing is carried out if the size of the hole is less than 3 cm. Plastic surgery is performed using synthetic tissue or autopericardium.

Valvuloplasty

With this type of operation, implants are not used, but simply expand the lumen of the affected valve. At the same time, a balloon is introduced into the lumen of the valve, which is inflated. It should be noted that such an operation is performed only on young people, as for the elderly, they are only entitled to open-heart intervention.

Balloon valvuloplasty

Often, after heart disease surgery, a person is given a disability.

Operations on the aorta

Open surgeries include:

Prosthetics of the ascending aorta. At the same time, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve. Prosthetics of the ascending aorta, while the aortic valve is not implanted. Prosthetics of the ascending artery and its arch. Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.

Prosthetics of the ascending aorta is the replacement of this section of the artery. This is necessary in order to prevent serious consequences, for example, a break. To do this, prosthetics are used by opening the chest, and endovascular or intravascular interventions are also performed. In this case, a special stent is installed in the affected area.

Of course, open-heart surgery is more effective, since in addition to the main pathology - aortic aneurysm, it is possible to correct the accompanying one, for example, stenosis or valve insufficiency, etc. And the endovascular procedure gives a temporary effect.

Aortic dissection

When prosthetics of the aortic arch are used:

Open distal anastomosis. This is when the prosthesis is installed, so that it does not affect its branches; Arc semi-replacement. This operation consists in replacing the artery where the ascending aorta passes into the arch and, if required, replacing the concave surface of the arch; Subtotal prosthetics. This is when the replacement of branches (1 or 2) is required during prosthetics of the arterial arch; Complete prosthetics. In this case, the arch is prosthetized together with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, a person is given a disability.

Coronary artery bypass grafting (ACS)

CABG is open-heart surgery that uses a patient's vessel as a shunt. This heart operation is needed in order to create a bypass for the blood, which will not affect the occlusive section of the coronary artery.

That is, this shunt is installed on the aorta and brought to the area of the coronary artery not affected by atherosclerosis.

This method is quite effective in the treatment of coronary heart disease. Due to the installed shunt, the blood flow to the heart increases, which means that ischemia and angina pectoris do not appear.

CABG is prescribed if there is angina pectoris, in which even the smallest loads cause seizures. Also, indications for CABG are lesions of all coronary arteries, and if an aneurysm of the heart has formed.

Coronary artery bypass grafting

During CABG, the patient is put into general anesthesia, and then, after opening the chest, all manipulations are performed. This operation can be performed with or without cardiac arrest. And also, depending on the severity of the pathology, the doctor decides whether it is necessary to connect the patient to a heart-lung machine. The duration of CABG can be 3-6 hours, it all depends on the number of shunts, that is, on the number of anastomoses.

As a rule, the role of the shunt is performed by a vein from the lower limb, and sometimes a part of the internal thoracic vein, the radial artery, is also used.

Today, CABG is performed, which is performed with minimal access to the heart, while the heart continues to work. Such an intervention is considered not as traumatic as the others. In this case, the chest is not opened, the incision is made between the ribs and a special expander is also used so as not to affect the bones. This type of CABG lasts 1 to 2 hours.

The operation is performed by 2 surgeons, while one makes an incision and opens the sternum, the other operates on the limb to take a vein.

After carrying out all the necessary manipulations, the doctor installs drains and closes the chest.

CABG significantly reduces the likelihood of a heart attack. Angina pectoris does not appear after surgery, which means that the quality and duration of the patient's life increase.

Radiofrequency ablation (RFA)

RFA is a procedure that is performed under local anesthesia, since the basis is catheterization. Such a procedure is carried out in order to exfoliate the cells that cause arrhythmia, that is, the focus. This happens through a catheter-conductor, which conducts an electric current. As a result, tissue formations are removed by RFA.

RF catheter ablation

After conducting an electrophysical study, the doctor determines where the source is located, which causes a rapid heartbeat. These sources can be formed along the conducting paths, as a result of which an anomaly of the rhythm manifests itself. It is RFA that neutralizes this anomaly.

RFA is carried out in case of:

when drug therapy does not affect the arrhythmia, and also if such therapy causes side effects. If the patient has Wolff-Parkinson-White syndrome. This pathology is perfectly neutralized by RFA. If a complication may occur, such as cardiac arrest.

It should be noted that RFA is well tolerated by patients, since there are no large incisions and opening of the sternum.

The catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is anesthetized.

The guide catheter reaches the myocardium, and then a contrast agent is injected. With the help of contrast, the affected areas become visible, and the doctor directs the electrode to them. After the electrode acted on the source, the tissues are scarred, which means that they will not be able to conduct the impulse. After RFA, a bandage is not needed.

Carotid surgery

There are such types of operations on the carotid artery:

Prosthetics (used with a large lesion); Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent; Eversion endarterectomy - at the same time, atherosclerotic plaques are removed along with the inner lining of the carotid artery; Carotid endarectomy.

These operations are performed under both general and local anesthesia. More often under general anesthesia, as the procedure is performed in the neck and there are discomfort.

The carotid artery is occluded, and in order to continue the blood supply, shunts are installed, which are bypass routes.

Classical endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is peeled off and removed. Next, the vessel is washed. Sometimes it is still necessary to fix the inner shell, this is done with special seams. At the end, the artery is sutured with a special synthetic medical material.

Endarterectomy of the carotid arteries

Eversion endartectomy is performed in such a way that the inner layer of the carotid artery at the site of the plaque is removed. And after that they fix, that is, sew. For this operation, the plaque should be no more than 2.5 cm.

Stenting is performed using a balloon catheter. This is a minimally invasive procedure. When the catheter is located at the site of stenosis, it inflates and thereby expands the lumen.

Rehabilitation

The period after heart surgery is no less important than the operation itself. At this time, the patient's condition is monitored by doctors, and in some cases, cardio training, therapeutic diets, etc. are prescribed.

Other recovery measures are also needed, such as wearing a bandage. The bandage at the same time fixes the seam after the operation, and of course the entire chest, which is very important. Such a bandage should be worn only if the operation is performed on the open heart. The cost of these items may vary.

The bandage that is worn after heart surgery looks like a T-shirt with tightness clamps. You can purchase male and female versions of this bandage. The bandage is important to prevent lung congestion by coughing regularly.

Such prevention of stagnation is quite dangerous because the seams can disperse, the bandage in this case will protect the seams and contribute to strong scarring.

Also, the bandage will help prevent swelling and bruising, promotes the correct location of organs after heart surgery. And the bandage helps to relieve the load from the organs.

After heart surgery, the patient needs rehabilitation. How long it will last depends on the severity of the lesion and the severity of the operation. For example, after CABG, immediately after heart surgery, you need to start rehabilitation, this is a simple exercise therapy and massage.

After all types of heart surgery, medical rehabilitation, that is, supportive therapy, is needed. In almost all situations, the use of antiplatelet agents is mandatory.

If there is high blood pressure, then ACE inhibitors and beta-blockers are prescribed, as well as drugs to lower blood cholesterol (statins). Sometimes the patient is prescribed physical procedures.

Disability

It should be noted that disability is given to people with diseases of the cardiovascular system even before surgery. There must be evidence for this. From medical practice, it can be noted that they necessarily give disability after coronary artery bypass grafting. Moreover, there may be a disability of both 1 and 3 groups. It all depends on the severity of the pathology.

People who have circulatory disorders, grade 3 coronary insufficiency, or have had a myocardial infarction are also entitled to disability.

Regardless of whether the operation was performed or not yet. Patients with grade 3 heart defects and combined defects can apply for disability if there are persistent circulatory disorders.

Clinics

NII SP im. N. V. Sklifosovsky	Moscow, Bolshaya Sukharevskaya sq., 3	CABG without IR CABG with valve replacement Angioplasty and coronary artery stenting RFA Aortic stenting Valve replacement Valve repair	64300 rub. 76625 rub. 27155 rub. 76625 rub. 57726 rub. 64300 rub. 76625 rub.
KB MGMU them. Sechenov	Moscow, st. B. Pirogovskaya, 6	CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Prosthetic valves Valve repair Aneurysm resection	132000 rub. 185500 rub. 160000-200000 rub. 14300 rub. 132200 rub. 132200 rub. 132000-198000 rub.
FSCC FMBA	Moscow, Orekhovy Boulevard, 28	CABG Angioplasty and stenting of the coronary arteries RFA Aortic stenting Prosthetic valves Valve repair	110000-140000 rub. 50000 rub. 137000 rub. 50000 rub. 140000 rub. 110000-130000 rub.
NII SP im. I.I. Janelidze	St. Petersburg, st. Budapestskaya, 3	CABG Angioplasty and stenting of the coronary arteries Aortic stenting Prosthetic valves Valve plasty Multivalve prosthetics Probing of the heart cavities	60000 rub. 134400 rub. 25000 rub. 60000 rub. 50000 rub. 75000 rub. 17000 rub.
SPGMU them. I.P. Pavlova	St. Petersburg, st. L. Tolstoy, 6/8	CABG Angioplasty and coronary artery stenting Prosthetic valve replacement Multivalve prosthetic RFA	187000-220000 rub. 33000 rub. 198000-220000 rub. 330000 rub. 33000 rub.
MC "Shiba"	Derech Sheba 2, Tel Hashomer, Ramat Gan	CABG Prosthetic valves	30000 USD 29600 USD
MedMira	Huttropstr. 60, 45138 Essen, Germany 49 1521 761 00 12	Angioplasty CABG Prosthetic valves Cardiac examination Coronary angiography with stenting	EUR 8000 EUR 29000 EUR 31600 EUR 800-2500 EUR 3500
Greekomed	Central Russian office: Moscow, 109240, st. Upper Radishchevskaya, house 9 A	AKSH valve replacement	20910 euros 18000 euros

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The treatment of heart diseases using surgery is the field of surgery and cardiology, which is called cardiac surgery. To date, cardiac surgery is the most effective method of treating certain types of heart defects, coronary heart disease and helps prevent the development of myocardial infarction, as well as eliminate its consequences - aneurysms.
Surgical intervention is used only in cases where conservative methods of treatment cease to help and the patient's condition worsens. The untimely appeal of the patient to the doctor can also lead to heart surgery, when only surgical intervention remains the only way to help.

Today, cardiac surgery is one of the most actively developing and technically equipped branches of medicine. Every year, 700 patients undergo open heart surgery. The bulk of operations are in the United States. In Europe, the number of operations is 4 times less. In Asian countries, cardiac surgery is practically absent. In Russia, the number of heart surgeries is below the required minimum. This statistic is due to the fact that heart surgeries are expensive. In addition to open heart surgery, surgical intervention is also carried out without opening parts of the heart (for example, implantation of pacemakers, angioplasty).

Surgery is required for diseases such as:

1. Ischemic heart disease and its consequences (myocardial infarction);
2. Heart defects.
3. Violation of the heart rhythm.

Cardiac ischemia

Ischemic heart disease occurs as a result of insufficient blood supply to the working myocardium. The main cause of coronary heart disease is atherosclerosis (plaque formation on the walls of blood vessels). A slight narrowing of the lumen of the vessel leads to angina pectoris (a person feels pain only when the heart's need for oxygen is increased, for example, during exercise). A strong narrowing of the lumen of the vessel causes pain even at rest, and the duration of pain attacks can also become more frequent and increase - unstable angina. With a strong violation of the coronary blood flow, the death of the muscle fibers of the heart occurs - this is a myocardial infarction.

One of the severe complications of myocardial infarction is the formation of a post-infarction aneurysm of the left ventricle. An aneurysm is a bubble-like bulge. It is formed due to the fact that dead tissue is replaced by scar tissue, which in turn is not able to contract. Under the pressure of healthy contracting fibers, the scar tissue swells, part of the blood is retained in the ventricle in the area of aneurysmal expansion. With each contraction, organs and tissues receive less blood in an amount equal to the volume of the aneurysm. This is its main negative meaning. Very often, blood clots form in the aneurysm area, which can break off and be transferred with the blood flow to any organs, causing their heart attack (death of part or all of the organ). When a blood clot enters the brain, a stroke occurs.

Surgical intervention (heart surgery) for coronary heart disease is aimed at restoring the normal nutrition of all parts of the heart. The degree of damage to the coronary arteries will depend on what kind of operation should be done. An analysis of the state of the vessels is carried out using coronary angiography - this is an X-ray contrast research method that allows you to determine the location, nature and degree of narrowing of the coronary artery. Most often, stenting of the coronary artery, which causes pain, is done. In the case of severe atherosclerotic lesions of the coronary vessels, the patient needs coronary artery bypass grafting.

Types of surgery for coronary heart disease

Angioplasty and stenting of the coronary arteries

Angioplasty and stenosis is aimed at removing obstructions to blood flow by expanding the artery from the inside.
The operation is carried out as follows: with the help of special equipment, a catheter is inserted through a puncture in the thigh area under the control of a fluorographic preparation into the artery that feeds the heart. It must reach the site of narrowing of the artery, where a special balloon is inflated with a stent - a device that does not allow the artery to subside. The stent remains in the artery, and the catheter is brought out through the same hole in the thigh.

Coronary artery bypass grafting (ACS)

Coronary artery bypass grafting - restoring the blood supply to the heart muscle by creating a new blood flow path around the affected area of the coronary vessel using shunts - pieces of arteries or veins taken from the patient himself (for example, in the limb area). This operation is aimed at preventing myocardial infarction. To date, CABG operations are performed both with the use of a heart-lung machine and on a beating heart (cardiac immobility is only in the operated area).
One of the types of coronary artery bypass surgery is mammary coronary artery bypass grafting (MCB). The internal mammary artery is used as a shunt. The use of this vessel is beneficial, since in this case no additional incisions are needed due to the close location of the thoracic artery and the heart, and also because atherosclerotic plaques do not form in the artery, and therefore, the service life of such a shunt is quite long.

Plastic surgery of postinfarction aneurysm of the left ventricle

The essence of the intervention is to reduce the volume of the left ventricle by delimiting the area of aneurysmal expansion and the healthy part of the left ventricle. The surgeon removes the blood clots that have arisen in the area of the aneurysm, then sews a septum made of dense elastic human tissue across the cavity of the left ventricle. Two cavities are formed: one with normal, actively contracting walls, the other - from scar tissue that is not able to contract, but does not interfere with the normal functioning of the heart. Thus, blood circulation is restored and the risk of a blood clot breaking off is eliminated.

Heart defects

Heart disease is called defects in the structure of the heart, which lead to disruption of normal blood circulation, there is stagnation of blood in the pulmonary or systemic circulation.
The following violations are distinguished:

- stenosis (narrowing) of the valvular apparatus;
With valve stenosis, it stops passing the required volume of blood through the reduced opening.
- insufficiency of the valvular apparatus;
The valve leaflets cannot close tightly and allow blood to pass in the direction opposite to normal blood flow.

-defects of the interventricular and interatrial septum;
With defects in these partitions, blood enters from a cavity with high pressure into a cavity with less pressure, and venous blood, poor in oxygen, mixes with oxygenated arterial blood, which leads to oxygen starvation of tissues.
Heart defects can be congenital or acquired. Most of them do not require surgery. Sometimes the disease proceeds unnoticed by the patient. Congenital heart disease can disappear with age, but if this does not happen and signs of heart failure increase, then surgery is required.

Treatment of heart defects is aimed at correcting the existing mechanical defect in the functioning of the heart.

There are the following types of surgical intervention:

Prosthetics and plastic heart valves

Operations to install prostheses are performed on the open heart, using a heart-lung machine.
Valve prostheses are mechanical and biological.

Mechanical valves

Mechanical valves are made of metal and plastic. The validity period of such prostheses is about 80 years. However, when using them, a person has to take anticoagulants daily, since blood clots are easily formed on the prostheses, which contribute to the formation of blood clots. In rare cases, a breakdown of a mechanical prosthesis is possible, which most often leads to the death of the patient. Mechanical valve prostheses can be in the form
- rotating disk
The disc completely covers the hole, but is fixed at one end only. Blood moving in the right direction presses on the disc, turns it on the hinge and opens the hole; when the blood moves back, the disc completely covers the hole.
- built on the principle of a ball in a grid
The blood flow in the right direction pushes the ball out of the hole, pressing it to the bottom of the mesh and thereby creating the possibility of further passage of blood; the reverse flow pushes the ball into the hole, which is thus closed and does not allow blood to pass through.

biological valves

Biological prostheses, usually made from animal heart tissue, are considered more efficient. After their installation, treatment with anticoagulants, which have many contraindications, is not necessary. Such a prosthesis works from 10 to 20 years, its aging occurs gradually and you can prepare in advance for its replacement in a planned manner. Of course, in this case, a second operation is needed.
Biological valves do not require mandatory anticoagulation (although it is often recommended), but wear out faster than mechanical valves.

Plastic defects of the interatrial and interventricular septum

If the structure of the septum is violated, with a small defect (the size of the hole is not more than 3 cm), it is sutured, and with a significant size, a plastic patch is performed (using synthetic tissues or autopericardium)

Heart rhythm disorder

Cardiac arrhythmias are violations of the sequence, rhythm and frequency of contractions of the heart. Arrhythmias can occur as a result of metabolic disorders, for example, endocrine and autonomic, or the effects of certain drugs. They are also often caused by heart disease, and sometimes - intoxication.
The danger of arrhythmia is that it can lead to ventricular fibrillation (scattered contraction of fibers).
For the treatment of arrhythmias, drugs, catheter ablation, or a pacemaker (pacemaker) are implanted.

Surgical methods for the treatment of arrhythmias:

RF ablation

This is a minimally invasive surgical method that is used for:
- high heart rate with a pronounced pulse deficit;
- atrial fibrillation;
- progressive heart failure;
- supraventricular tachycardia.

The method of radiofrequency ablation consists in passing a special catheter to the area of the heart that causes an abnormal pathological rhythm. An electrical impulse is applied to this department, which destroys the tissue site that sets the wrong rhythm.
Ablation restores normal heart rhythm.

Pacemaker implantation

The operation is done in patients with heart rhythm disturbances that threaten life. The pacemaker aims to control and restore the normal contraction of the heart.
Doctors implant a special device under the skin or under the pectoral muscle. Two or three electrodes depart from the pacemaker, which are connected to the chambers of the heart to transmit an electrical impulse to them.

Defibrillator implantation

The principle of operation of a defibrillator is similar to a pacemaker. Its distinctive feature is the elimination of too fast and too slow heart rate. The heart rate is assessed using electrodes. Installing a defibrillator is similar to installing a pacemaker.

Installing a defibrillator is indicated for ventricular tachycardia.

Heart transplant

In critical cases, when the heart cannot perform its function and does not respond to any treatment, they resort to a heart transplant. Thanks to this operation, doctors prolong the life of the patient for a period of about 5 years. Research is currently underway to extend the life of people who have undergone heart transplants.

Postoperative recovery period

An important stage of recovery after surgery is the period of postoperative recovery. Strict monitoring of human health is necessary. This period is different and individual for each patient. Patients are prescribed special cardio training, diets. Emotional calm is needed.

Heart surgeries are dangerous due to their complications. The main signs of complications are fever, pain in the operated area, tachycardia, drop in blood pressure, shortness of breath. The ECG shows characteristic changes. The recovery period lasts six months - a year.

An example of monitoring the health of postoperative patients is the work of the doctor of medical sciences, professor, arrhythmologist Andrey Vyacheslavovich Ardashev. He does over 200 surgeries a year. Postoperative monitoring of patients began in 2011 with the help of the project. The doctor controls both the conclusion of the cardiovisor and the ECG itself in postoperative patients. Using the site service helps to monitor the recovery of the health of operated people via the Internet. This is a huge plus, since a large number of patients come to Moscow from all over Russia in order to have heart surgery. They pass the postoperative period already at home. Using the Cardiovisor allows you to take ECG readings at home and send them to the doctor using the site.

Rostislav Zhadeiko, especially for the project .

Morning. Petroverigsky lane, 10. At this Moscow address in the Kitay-Gorod area, I arrived at the angiography.su federal center for the diagnosis and treatment of cardiovascular diseases, which is part of the state research center for preventive medicine, to put on a sterile suit again and visit in the operating room.

Angiography is a method of examining blood vessels using x-rays and contrast fluid. It is used to detect damage and defects. Without it, the operation that I am going to talk about - stenting - would not have been possible.

There will still be some blood. I think I should warn impressionable people about this before they open the post in its entirety.

Who has never heard of cholesterol plaques, he did not watch the show of Elena Malysheva. Plaques are deposits on the inner walls of blood vessels that have accumulated over the years. They are similar in texture to thick wax. The plaque consists not only of cholesterol, calcium in the blood sticks to it, making the deposits even more dense. And this whole structure slowly but surely clogs the vessels, preventing our fiery motor, or rather the pump, from delivering nutrients and oxygen to various organs, including the heart itself.

Before the advent of the stenting method, which will be discussed, the doctors were armed with only the surgical method of bypass surgery, which became popularly famous thanks to Boris Nikolayevich Yeltsin's heart surgery in 1996 in a round operating room. I remember this case vividly (a memory from childhood), although a lot of famous people have done a similar operation.

Shunting is an abdominal operation. A person is given anesthesia, they cut the chest (they cut it, they can’t do it with one scalpel), they stop the heart and start the artificial circulation system. The beating heart beats very strongly and interferes with the operation, so it has to be stopped. To get to all the arteries and shunt, you need to get the heart and turn it over. A shunt is a donor artery taken from the patient himself, for example, from the arm. A lot of stress on the body.

During stenting, the patient remains conscious (everything happens under local anesthesia), can hold his breath or take deep breaths at the request of the doctor. Blood loss is minimal, and the incisions are tiny, because the arteries are entered through a catheter, which is usually inserted into the femoral artery. And they put a stent - a mechanical vasodilator. All in all, an elegant operation (-:

The operation for Sergei Iosifovich was done in three stages. I ended up on the final operation in the series. You cannot place all stents at once.

The surgical table and the angiograph (a semicircular device hanging over the patient) form a single mechanism that works together. The table moves back and forth, and the machine rotates around the table to take x-rays of the heart from different angles.

The patient is placed on the table, fixed and connected to the heart monitor.

To make it clear the device of the angiograph, I will show it separately. It's a small angiograph, not as big as the ones in the operating room. If necessary, it can even be brought to the ward.

It works quite simply. An emitter is installed below, a converter is installed at the top (a smile is pasted on it), from which a signal with an image is already transmitted to the monitor. Scattering of X-rays in space does not actually occur, however, everyone present in the operating room is protected. About eight such operations are performed per day.

Through a vessel on the arm or thigh, as in our case, a special catheter is inserted.

A thin metal wire, a conductor, is inserted through the catheter into the artery to deliver the stent to the site of the blockage. I was amazed at its length!

The stent - a mesh cylinder - is attached to the end of this wire in a compressed state. It is mounted on a balloon that will be inflated at the right time to deploy the stent. Initially, this design is not thicker than the conductor itself.

This is what an open stent looks like.

And this is a scale model of a different type of stent. In the case when the walls of the vessels are damaged, they are installed with a membrane. They not only support the vessel in the open state, but also serve as the walls of the vessels.

All through the same catheter, an iodine-containing contrast agent is injected. With the blood flow, it fills the coronary arteries. This allows the x-ray to visualize them and calculate the blockage sites, on which stents will be placed.

Here is such an Amazon basin obtained by injecting contrast.

All eyes on monitors! The entire stent placement process is observed through X-ray television.

After the stent is delivered into place, the balloon on which it is attached must be inflated. This is done using a device with a manometer (pressure meter). This device, which looks like a large syringe, is visible in the photo with long conductor wires.

The stent expands and is pressed into the inner wall of the vessel. To ensure that the stent has expanded correctly, the balloon remains inflated for twenty to thirty seconds. It is then deflated and pulled out of the artery on a wire. The stent remains and maintains the lumen of the vessel.

Depending on the size of the affected vessel, one or more stents may be used. In this case, they are overlapped one after the other.

And here's how the stent works. Below are screenshots from the X-ray TV. In the first picture, we see only one artery, a curly one. But another one should be visible, below it. Because of the plaque, the blood flow is completely blocked.

The thick sausage on the second is a stent that has just been deployed. The arteries are not visible because the contrast is not running in them, but the wires are just visible.

The third one shows the result. An artery appeared, blood flowed. Now compare the first picture with the third one again.

The concept of expanding the affected areas of the vessel with the help of a certain frame was proposed by Charles Dotter forty years ago. The development of the method took a long time, the first operation using this technology was performed by a group of French surgeons only in 1986. And only in 1993, the effectiveness of the method was proven to restore the patency of the coronary artery and keep it in a new state in the future.

Currently, foreign companies have developed about 400 different models of stents. In our case, this is Cordis from Johnson & Johnson. Artem Shanoyan, head of the department of X-ray endovascular diagnostic and treatment methods at the center, answered my question about Russian stent manufacturers that they simply do not exist.

The operation takes about half an hour. A pressure bandage is applied to the puncture site. From the operating room, the patient is sent to the intensive care unit, and two hours later to the general ward, from where you can already scribble joyful SMS to relatives. And in a few days they will be able to see each other at home.

Lifestyle restrictions typical for heart patients are usually removed after stenting, the person returns to normal life, and observation is carried out periodically by a doctor at the place of residence.

Heart surgery is performed only when other methods of therapy cannot help the patient's condition. Heart surgery can prevent death in a patient, but the risk of an adverse outcome remains quite high.

Despite the fact that cardiac surgery does not stand still and develops, heart surgery is very difficult to perform. The best specialists in cardiac surgery are engaged in it. But even this important fact cannot shield the operated person from complex consequences.

Complications in the postoperative period can even lead to death.

Indications for surgery

As mentioned earlier, cardiac surgery is used in cases where there are no other options to save the patient's life. Heart surgery requires a very serious approach.

Heart transplantation is considered the most complex and serious surgical intervention. The operation is carried out under the strict supervision of highly qualified specialists.

Indications for heart surgery of any complexity are as follows:

transient development of ailments of the cardiovascular system;
in the absence of results with drug treatment;
late referral to a medical facility.

Heart surgery helps to improve the general condition of the patient and eliminate the symptoms of a tormenting disease.

Cardiac cavity surgery is performed only after a complete diagnostic study and an accurate diagnosis by a cardio specialist.

Methods of surgical interventions

What are heart surgeries?

This is a pretty important question if you are going to have this major surgery. You will also need to know how the operation goes and how it is done.

This is necessary in order to make, perhaps, the main decision in your life, on which all future fate will depend.

Closed Interventions

This is a heart operation that does not affect the organ itself. It is done without touching the heart. For its implementation, there is no need for special equipment, except for such as the instruments of the surgeon.

The heart cavity does not "open". That is why it is called "closed".

Such an intervention is performed at the initial stage of the development of the disease, when the patient's condition can only be improved by operations.

Open Interventions

There is also open surgery. This type of operation requires the opening of the heart cavities in order to eradicate the existing pathology.

Open heart surgery is performed using a special device - heart-lung machine or heart-lung machine.

With an open intervention, the cavities are open, the heart and pulmonary organs are disconnected from blood circulation. This makes it possible to intervene on a "dry" organ.

All blood through the vein goes to specialized surgical equipment. There they pass through artificial lungs, enriched with oxygen and release carbon dioxide, transforming from the blood of a vein into an arterial one. Then it is driven by a special pump into the aorta of the operated person, in other words, into the systemic circulation.

Innovative techniques help to create all the "insides" of the equipment (also an artificial lung), with which the patient's blood comes into contact, "disposable", that is, once for one person. This will reduce the possible disastrous consequences.

Today, the heart-lung machine helps to stop the functioning of the heart organ and lungs for several hours. Thereby allowing to carry out the hardest operations of open character.

X-ray surgical interventions

This type of intervention began to be used quite recently. But thanks to innovative equipment, they occupy an important place in heart surgery.

With the help of a special catheter, surgical instruments are inserted into a strip section of the cardiac organ, or into the opening of the vessel. Further, with the help of the pressure that the device creates, the valves of the abdominal incisions are opened. They amplify or distort the partitions, or vice versa, using the device, the distortion is eliminated.

Special tubes are introduced into the lumen of the necessary vessel, thereby helping to slightly open it.

The process during such operations is carefully monitored by a special computer and control is made over each action. Thanks to this, operations are performed with less risk of injury and with a greater likelihood of a favorable outcome.

If you have had an X-ray surgery, the effectiveness of it is higher.

Action plan before surgery

Before surgery on the cardiac organ, preparation is necessary. If you have enough time, at least a few days or weeks, you need to take care of your body. Eat healthy, nutrient-rich foods.

Get plenty of rest, walk in the fresh air, do physical exercises that the treating specialist recommended to you.

Proper nutrition

Try to eat only natural foods every day and more than once, even if you have no appetite. Your body needs to consume plenty of proteins, vitamins and minerals.

Thanks to a healthy diet, the surgical intervention itself and the rehabilitation period are more favorable.

Rest

Do not force your body to overwork before surgery. The more you rest, the stronger and stronger your body will become.

If you want to visit relatives or invite you to visit, say that you need to gain strength before a difficult process. Relatives will always understand you and will not be offended.

Nicotine use

It's no secret for everyone that smoking affects negatively even the body of a completely healthy person. What can we say about patients with cardiac pathology.

Nicotine affects the heart in the following negative way: it develops arteriosclerosis, increases pressure in the blood vessels, and makes the heart vessels tighten. It also narrows blood-forming arteries and increases the concentration of mucous fluid in the pulmonary organs.

This leads to more difficult adaptation after surgery.

rehabilitation period

After a surgical intervention on the cardiac organ, if an insufficient amount of time has passed, it is even forbidden to get out of the ward bed. The entire rehabilitation period, the patient is in the intensive care unit.

This department is intended for patients who have a risk of death.

A special dietary diet plays a huge role in rehabilitation. His attending specialist appoints individually for each patient. You can start eating only with lean gruels and vegetable broths, but after a few days the diet increases significantly.

After the patient is transferred to a regular ward, as a rule, the attending physician will allow the use of the following products:

cereals from coarse grinding (barley, barley groats, unpolished rice). You can also include oatmeal in the diet 2-3 times a week;
dairy production: fat-free curd mass, cheese with a fat content of not more than 20%;
vegetables and fruits: fresh, steamed and in various salads;
small pieces of boiled chicken, turkey and rabbit. As well as homemade steamed cutlets;
various varieties of fish: herring, salmon, capelin, etc.;
all soups without fried ingredients and without fat content.

Under no circumstances should the following foods be consumed.

But now, the diagnosis has been made and the doctors understand what needs to be done next. I would like you to understand well by this moment, what will be discussed when they will explain everything in detail to you, what was found during the examination, what diagnosis was made, what needs to be done and when to choose the best way of treatment.

Here and now the main questions are being decided, and you must exactly imagine what you want to know before you make a decision on which a lot depends.

There are several options for conversation.

You will be offered operation, as the only way out, and doctors believe that it needs to be done urgently.
You are offered an operation, but they say that it can be postponed for a while.
You are denied an operation for a variety of reasons.

You need to understand what is being said and prepare for the conversation. Try to be calm and confident in yourself and in the doctors who want to help you. You must be together, on the same side, in the fight for the future of the child. Discuss everything, but your questions should be literate. Believe me, a lot depends on this too.

What do you need to know about in order to ask the right question? What are the operations? What should the child do? How will it all be? Who will do it? Let's talk about it calmly.

Today, all interventions, or operations, for congenital heart defects can be divided into three categories: "closed" operations, "open" and "X-ray surgery".

✔ Closed Operations These are surgical interventions in which the heart itself is not affected. They are performed outside of it, and therefore do not require the use of any special equipment other than conventional surgical instruments. The cavities of the heart are not “opened” with them, which is why they are called “closed”, and they are widely performed as the first stage of surgical intervention.

✔ Open Operations- These are surgical interventions in which it is necessary to open the cavities of the heart in order to eliminate the existing defect. For this, a special apparatus is used - a heart-lung machine (AIC), or "heart-lungs". For the period of the operation, both the heart and the lungs are switched off from the circulation, and the surgeon gets the opportunity to perform any operation on the so-called "dry", stopped heart.

All the patient's venous blood is sent to the apparatus, where, passing through an oxygenator (artificial lung), it is saturated with oxygen and gives off carbon dioxide, turning into arterial. Then the arterial blood is pumped into the patient's aorta by a pump, i.e. into the systemic circulation. Modern technologies allow all the internal parts of the device (including the oxygenator), with which the patient's blood comes into contact, to be made "disposable", i.e. use them only once and only for one patient. This dramatically reduces the number of possible complications.

Today, thanks to AIC, it is possible without much risk to turn off the heart and lungs from work for several hours (and the surgeon has the opportunity to operate on the most complex defects).

✔ X-ray surgery appeared relatively recently, but, thanks to the incredible progress of modern technologies, they have already taken their rightful place in the arsenal of cardiac surgery. More and more doctors are now using thin catheters, the ends of which are fitted with balloons, patches, or expandable tubes (folded like a folding umbrella). With the help of a catheter, these devices are carried into the cavity of the heart, or into the lumen of the vessel, and then, expanding the balloon, break the narrowed valve with pressure, increase or create a defect in the septum, or, conversely, by opening the patch umbrella, this defect is closed. The tubes are inserted into the lumen of the desired vessel and create a wider lumen. In adults, they even try to pass an artificial aortic valve through the catheter in this way, but so far these are only attempts. Doctors monitor the course of an X-ray surgical operation on the monitor screen and clearly control all manipulations with the probe, and therefore the advantage of such operations is not only less trauma, but also high safety and efficiency. X-ray surgery has not yet supplanted traditional surgical methods, but it is gaining more and more space both as an independent method and as an “auxiliary”, i.e. which can be applied not instead of, but together with the usual operation, sometimes simplifying and supplementing it in many ways.

Depending on the type of defect and the condition of the child, surgical operations can be emergency, urgent and elective, i.e. planned.

emergency heart surgery are the ones that should be done immediately after the diagnosis is made, because any delay threatens the life of the child. With congenital malformations, such situations are not uncommon, especially when it comes to newborns. Here the question of life is often decided by hours and minutes.

Emergency operations- those for whom there is no such insane urgency. The operation does not need to be done right now, but you can calmly wait a few days, prepare both you and the child, but it must be done urgently, because then it may be too late.

Planned, or elective, operation- this is an intervention made at the time chosen by you and the surgeons, when the child's condition does not inspire fear, but the operation, nevertheless, should not be postponed.

No cardiac surgeon will ever suggest surgery if it can be avoided. So, anyway, it should be.

Depending on the approach to surgical treatment, radical and palliative operations are distinguished.

✔ Radical heart surgery is a correction that completely eliminates the defect. It can be done with an open ductus arteriosus, septal defects, complete transposition of the main vessels, abnormal pulmonary vein drainage, atrioventricular communication, Fallot's tetrad and some other defects, in which the heart is fully formed, and the surgeon has the opportunity to completely separate the circulatory circles, while maintaining normal anatomical relationships. Those. the atria will connect to their ventricles through correctly positioned valves, and the corresponding great vessels will depart from the ventricles.

✔ Palliative heart surgery- auxiliary, “facilitating”, aimed at normalizing or improving blood circulation and preparing the vascular bed for radical correction. Palliative operations do not eliminate the disease itself, but significantly improve the child's condition. With some very complex defects, which until recently were generally inoperable, the child will have one, and sometimes two palliative operations, before the final radical stage becomes possible.

During a palliative operation, another "defect" is surgically created, which the child does not initially have, but due to which the circulatory pathways disturbed by the defect in the large and small circles are changed. These include surgical expansion of the atrial septal defect, all variants of intervascular anastomoses - i.e. additional shunts, messages between circles. The Fontan operation is the most “radical” of all such methods, after which a person lives without a right ventricle at all. With some of the most complex heart defects, it is impossible to correct the anatomically, and surgical treatment aimed at correcting blood flow can be called the “final” palliative correction, but by no means a radical operation.

In other words, with heart defects, when the intracardiac anatomy - the structure of the ventricles, the condition of the atrioventricular valves, the location of the aorta and the pulmonary trunk - are so changed that they do not allow for a real radical correction, today's surgery follows the path of eliminating poorly compatible with life of circulatory disorders, and then - long-term palliation. The first stage of this path is saving lives and preparing for further treatment, and protection from future complications, the second is the final stage of treatment. All together - this is a long way to the final operation, and on it one, two, and sometimes three steps must be overcome, but, ultimately, to make the child healthy enough for him to develop, learn, lead a normal life, which this long-term palliation will provide him. Check it out, not so long ago - 20-25 years ago it was simply impossible, and children born with the defects of this group were doomed to death.

Such a “final palliation” is the only way out in many cases; although it does not correct the defect itself, it provides the child with an almost normal life by improving the mixing of arterial and venous blood flows, the complete separation of circles, and the elimination of obstructions to blood flow.

Obviously, the very concept of radical and palliative treatment for some complex congenital heart defects is largely arbitrary, and the boundaries are erased.