Surgeries and invasive studies of the heart. Main types of heart surgery Open heart surgery how it is done
Heart surgery helps cure many diseases of the cardiovascular system that do not respond to standard therapeutic methods. Surgical treatment may be performed different ways, depending on the individual pathology and general condition of the patient.
Indications for surgical treatment
Cardiac surgery is a field of medicine in which doctors specialize who study, invent methods and perform operations on the heart. Heart transplantation is considered the most complex and dangerous cardiac surgery. No matter what type surgical intervention will be carried out, there are general indications:
- rapid progression of cardiovascular disease;
- ineffectiveness of conservative therapy;
- failure to consult a doctor in a timely manner.
Heart surgery provides an opportunity to improve general state the patient and eliminate the symptoms that bother him. Surgical treatment is performed after complete medical examination and establishing an accurate diagnosis.
They perform operations when congenital defects hearts or acquired. A congenital defect is detected in a newborn immediately after birth or before birth. ultrasound examination. Thanks to modern technologies and methods in many cases manage to detect and treat heart defects in newborns in time.
An indication for surgical intervention may also be ischemic disease, which is sometimes accompanied by such a serious complication as myocardial infarction. Another reason for surgical intervention heart rhythm disturbance may occur, since this disease tends to cause ventricular fibrillation (disjointed 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 blood clots).
Advice: proper preparation to heart surgery is the key to successful recovery of the patient and prevention postoperative complications, such as a blood clot or blockage of a vessel.
Types of operations
Cardiac surgeries can be performed on 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 chest and connecting the patient to a ventilator.
During open heart surgery, the heart is temporarily stopped for several hours to allow the necessary manipulations to be performed. This technique makes it possible to cure complex heart defects, but is considered more traumatic.
During beating heart surgery, special equipment is used so that the heart continues to contract and pump blood during surgery. The advantages of this surgical intervention include the absence of complications such as embolism, stroke, pulmonary edema, etc.
There are the following types of heart surgeries, which are considered the most common in cardiological practice:
- radiofrequency ablation;
- coronary artery bypass grafting;
- valve replacement;
- Glenn operation and Ross operation.
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 surgery to be performed under X-ray guidance 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 arrhythmia and rarely causes such a complication as a blood clot.
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 specifically for him.
Radiofrequency or catheter ablation (RFA) is a minimally invasive surgical intervention that has a high therapeutic effect and has a minimal amount of side effects. This treatment is indicated for atrial fibrillation, tachycardia, heart failure and other cardiac pathologies.
Arrhythmia itself is not a serious pathology requiring surgical intervention, but can lead to serious complications. Thanks to RFA, it is possible to restore normal heart rhythm and eliminate main reason his violations.
RFA is performed using catheter technology and under X-ray control. Heart surgery is performed under local anesthesia and involves inserting a catheter to the required area of the organ that sets the abnormal rhythm. Through an electrical impulse under the influence of RFA, the normal rhythm of the heart is restored.
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 your doctor!
Open heart surgery is one of the treatment options cardiovascular diseases, in which special surgical procedures are performed. General principle boils down to the fact that there is interference in human body for the purpose of carrying out necessary measures on an open heart. In other words, this is an operation during which an opening or dissection of the human sternum area is performed, affecting the tissues of the organ itself and its vessels.
Open heart surgery
Statistics say that the most common intervention of this type among adults is an operation that creates artificial blood flow from the aorta to healthy areas coronary arteries– coronary artery bypass grafting.
This operation is performed to treat severe coronary heart disease, which occurs due to the development of atherosclerosis, in which the vessels supplying blood to the myocardium narrow and their elasticity decreases.
The general principle of the operation: the patient’s own biomaterial (a fragment of an artery or vein) is taken and sewn into the area between the aorta and the coronary vessel in order to bypass the area affected by atherosclerosis, in which blood circulation is impaired. After the operation is performed, the blood supply to a certain area of the heart muscle is restored. This artery/vein supplies the heart with the necessary blood flow, while the artery in which it flows pathological process, costs.
Coronary artery bypass grafting Today, taking into account progress in medicine, to carry out surgical treatment on the heart it is enough to make only small incisions in the appropriate area. Another intervention, more complex, will not be needed. Therefore, the concept of “open heart surgery” sometimes misleads people.
Reasons for prescribing open heart surgery
- The need to replace or restore the patency of blood vessels for the correct flow of blood into the heart.
- The need to restore defective areas in the heart (for example, valves).
- The need to place special medical devices to maintain heart function.
- The need for transplantation operations.
What do you need to know about coronary artery bypass surgery?
Time spending
According to medical data, this type of operation takes at least four and no more than six hours. In rare, especially severe cases, when the operation requires a larger volume of work (creation of several shunts), an increase in this period may be observed.
The first night after heart surgery and all medical manipulations patients spend in the department intensive care. After three to seven days have passed (the exact number of days is determined by the patient’s well-being), the person is transferred to a regular ward.
Dangers during surgery
Despite the qualifications of doctors, no one is immune from unplanned situations. What is the danger of surgical intervention, and what risk can it carry:
- infection of the chest due to the incision (this risk is especially high for people who are obese, diabetes mellitus or perform the operation again);
- myocardial infarction, ischemic stroke;
- heart rhythm disturbances;
- thromboembolism;
- increased body temperature for a long time;
- cardiac discomfort of any nature;
- pain of various nature in the chest area;
- pulmonary edema;
- short-term amnesia and other transient memory problems;
- loss of a significant amount of blood.
Data Negative consequences, as statistics show, occur much more often when using an artificial blood supply apparatus.
Risk unpleasant consequences always present Preparation period
In order for the planned operation and general treatment were successful, it is important not to miss anything significant before they begin. To do this, the patient must tell the doctor:
- ABOUT medicines that are currently in use. These may include medications prescribed by another doctor, or those that the patient purchases himself, including dietary supplements, vitamins, etc. This important information, and it must be announced before surgery.
- About all chronic and past diseases, health deviations available on this moment(runny nose, herpes on the lips, upset stomach, elevated temperature, sore throat, fluctuations in blood pressure, etc.).
The patient should be prepared for the fact that two weeks before the operation the doctor will ask him to refrain from smoking, overuse alcohol, drinking vasoconstrictor drugs(for example, nasal drops, ibuprofen, etc.).
On the day of the operation, the patient will be asked to use a special bactericidal soap, which significantly reduces the risk of infection during the procedure. In addition, several hours before the intervention you should not eat or drink water.
Carrying out the operation
When open heart surgery is performed, the following steps are performed sequentially:
- The patient is placed on the operating table.
- He is given general anesthesia.
- When the anesthesia begins to take effect and the patient falls asleep, the doctor opens the chest. To do this, he makes an incision in the appropriate area (usually it is no more than 25 centimeters in length).
- The doctor cuts the sternum, partially or completely. This allows access to the heart and aorta.
- Once access is secured, the patient's heart is stopped and connected to a heart-lung machine. This allows the surgeon to calmly perform all manipulations. Today, technologies are used that in some cases make it possible to perform this operation without stopping the heartbeat, while the number of complications is lower. than with traditional intervention.
- The doctor creates a shunt to bypass the damaged section of the artery.
- The cut part of the chest is secured with a special material, most often a special wire, but in some cases plates are used. These plates are often used for elderly people or for people who have undergone frequent surgical operations.
- After the surgery is performed, the incision is sutured.
Postoperative period
After the operation is completed and the patient awakens, he will find two or three tubes in his chest. The role of these tubes is to drain excess fluid from the area around the heart (drainage) into a special vessel. In addition, an intravenous tube is installed to allow therapeutic and nutritional solutions to enter the body and a catheter into bladder to remove urine. In addition to tubes, devices are connected to the patient to monitor heart function.
The patient should not worry; in case of questions or discomfort, he can always contact medical workers, which will be assigned to monitor him and promptly respond if necessary.
The duration of the recovery period depends not only on physiology, but also on the person himself Every patient should understand that rehabilitation after surgery is not a quick process. After six weeks of treatment, some improvements can be observed, and only after six months will all the benefits of the operation become visible.
But every patient is able to speed up this rehabilitation process, while avoiding new heart diseases, which reduces the risk of reoperation. To do this, it is recommended to take the following measures:
- follow a diet and special diet prescribed by the attending physician;
- limit salty, fatty, sweet foods);
- spend time physical therapy, walks on fresh air;
- stop frequent drinking of alcohol;
- monitor blood cholesterol levels;
- track arterial pressure.
If these measures are followed postoperative period It will pass quickly and without complications. But don't rely on general recommendations, much advice is more valuable your attending physician, who has studied your medical history in detail and is able to create an action plan and diet during the recovery period.
Heart surgery is performed only when other methods of therapy cannot help the patient's condition. Heart surgery can prevent death in the patient, but the risk of an unfavorable outcome remains quite high.
Despite the fact that cardiac surgery does not stand still and is developing, heart surgery is very difficult to perform. They are doing her the best specialists cardiac surgery. But even this important fact cannot protect the operated patient 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 procedure. The operation is carried out under the strict supervision of highly qualified specialists.
Indications for cardiac surgery of any complexity are as follows:
- rapid development of diseases of the cardiovascular system;
- in case of lack of results with drug treatment;
- late contact with a medical facility.
Heart surgery helps improve the general condition of the patient and eliminate the symptoms of a painful disease.
Abdominal heart surgery is performed only after complete diagnostic study and making an accurate diagnosis by a cardio specialist.
Methods of surgical interventions
What types of heart surgeries are there?
It's pretty important question if you are having this major surgery. You will also need to know how the operation is performed and how it is done.
This is necessary in order to make, perhaps, the main decision in your life, on which your entire future fate will depend.
Closed interventions
This is a heart operation that does not affect the organ itself. It is performed without touching the heart. To carry it out, there is no need for special equipment other than surgeon's instruments.
The heart cavity does not “open”. This is why it is called “closed”.
This intervention is performed on initial stage development of the disease, when the patient’s condition can only be improved by surgery.
Open interventions
There is also open surgery. This type of surgery requires opening the heart cavities in order to eradicate the existing pathology.
Open heart surgeries are performed using a special device - heart-lung or heart-lung equipment.
At open intervention the cavities are open, the heart and pulmonary organs are disconnected from the blood circulation. This makes it possible to intervene on a “dry” organ.
All blood goes through a vein to specialized surgical equipment. There they pass through artificial lungs, are enriched with oxygen and release carbon dioxide, transforming from vein blood to arterial blood. Then it is driven with a special pump into the aorta of the person being operated on, in other words, into big circle blood circulation
Innovative techniques help all the “insides” of the equipment (also artificial lung) with which the patient’s blood comes into contact, create “disposable” ones, that is, once for one person. This will reduce possible disastrous consequences.
Today, a heart-lung machine helps stop the functioning of the heart organ and lungs for several hours. Thus allowing the most difficult open operations to be carried out.
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.
Using a special catheter, surgical instruments are inserted into a strip section of the heart organ or into the opening of a vessel. Next, using the pressure created by the device, the valves of the cavity incisions are opened. They enhance or distort the partitions, or vice versa, using a device to eliminate the distortion.
Special tubes are inserted into the lumen of the required vessel, thereby helping to open it slightly.
The process of such operations is carefully monitored by a special computer and every action is monitored. Thanks to this, operations are performed with less risk of injury and a greater likelihood of a favorable outcome.
If you have undergone X-ray surgery, it is more effective.
Action plan before surgery
Before surgery on a heart 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, rich useful elements food.
Get plenty of rest, walk in the fresh air, do physical exercise, which was recommended to you by your treating specialist.
Proper nutrition
Try to use only natural products meals every day and more than once, even if there is no appetite. Your body needs to consume a large number of proteins, vitamins and minerals.
Thanks to healthy eating, the surgery itself and rehabilitation period pass more favourably.
Rest
Don't overwork your body before surgery. The more you rest, the stronger and stronger your body will become.
If your loved ones want to visit you or invite you to visit, say that you need to gain strength before a difficult process. Your family will always understand you and will not be offended.
Nicotine use
It has long been no secret to everyone that smoking has a negative effect even on the body. 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 causes the heart vessels to strain. It also narrows the 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 surgery on a cardiac organ, if not enough time has passed, it is forbidden to even get out of the ward bed. During the entire rehabilitation period, the patient is in the intensive care unit.
This department is intended for patients who are at risk of death.
A special diet plays a huge role in rehabilitation. The treating specialist prescribes it individually for each patient. You can start eating only with lean porridges 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:
- coarse porridge (barley, barley, unpolished rice). You can also include in your diet oatmeal 2-3 times a week;
- dairy production: low-fat curd mass, cheese with a fat content of no more than 20%;
- vegetable and fruit crops: fresh, steamed and in various salads;
- small pieces boiled chicken, turkey and rabbit. As well as homemade steamed cutlets;
- various varieties of fish: herring, salmon, capelin, etc.;
- All soups are free of fried ingredients and contain no fat.
Under no circumstances should you use following products nutrition.
Heart operations are performed very often today. Modern cardiac surgery And vascular surgery very developed. Surgical intervention is prescribed when conservative drug treatment does not help, and accordingly, normalization of the patient’s condition is impossible without surgery.
For example, a heart defect can only be cured surgically, this is necessary in the case when blood circulation is severely impaired due to pathology.
And as a result of this, the person feels unwell and begins to develop severe complications. These complications can lead not only to disability, but also to death.
Surgical treatment of coronary heart disease is often prescribed. Since it can lead to myocardial infarction. As a result of 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. Surgeries are often performed due to abnormal heart rhythm (RFA).
They also perform heart transplantation, that is, transplantation. This is necessary in the case when there is a complex of pathologies due to which the myocardium is not able to function. Today, such an operation prolongs the patient’s life by an average of 5 years. After such an operation, the patient is entitled to disability.
Operations can be performed urgently, urgently, or scheduled intervention. This depends on the severity of the patient's condition. Emergency surgery carried out immediately, immediately after diagnosis. If such intervention is not carried out, the patient may die.
Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes matter.
Emergency operations do not require quick implementation. In this case, the patient is prepared for some time. As a rule, this is several days.
A planned operation is prescribed if there is no danger to life at this time, but it must be carried out in order to prevent complications. Doctors prescribe myocardial surgery only if it is necessary.
Invasive research
Invasive methods for examining the heart involve catheterization. That is, the study is carried out through a catheter, which can be installed both in the heart cavity and in a vessel. Using these studies, you can determine some indicators of heart function.
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 make it possible to study the pathology of the valves, their size and the 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 drug therapy.
Such studies include:
In 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 of functional class 3-4. In this case, it is resistant to drug therapy. Doctors need to decide what kind of surgical treatment is needed. It is also important to carry out this procedure in case of unstable angina.
Invasive procedures also include punctures and probing of the heart cavities. Using sounding, you can diagnose heart defects and pathologies in the left ventricle, for example, these could be tumors or thrombosis. For this they use femoral vein(right), a needle is inserted into it through which a conductor passes. The needle diameter becomes about 2 mm.
When performing invasive examinations, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the right vein for catheter installation.
These studies are carried out in different clinics and their cost is quite high.
Surgery for heart disease
Heart defects include
- heart valve stenosis;
- heart valve insufficiency;
- septal defects (interventricular, interatrial).
Valve stenosis
These pathologies lead to many disturbances in the functioning of the heart, that is, the goals of operations for defects are to relieve the load on the heart muscle, restore the normal functioning of the ventricle, as well as restore contractile function and reduce pressure in the cavities of the heart.
To eliminate these defects, the following surgical interventions are performed:
Often, after surgery for a heart defect, a person is given disability.
Surgeries on the aorta
Open surgical interventions include:
- Prosthetics of the ascending aorta. In this case, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve.
- Prosthetic replacement of the ascending aorta, without the aortic valve being implanted.
- Prosthetics of the ascending artery and its arch.
- Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.
Ascending aorta replacement is the replacement of this section of the artery. This is necessary in order to prevent serious consequences, such as rupture. 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. But the endovascular procedure gives a temporary effect.
When replacing the aortic arch, the following is used:
- Open distal anastomosis. This is when the prosthesis is installed so that its branches are not affected;
- Half-replacement of the arc. This operation consists of replacing the artery where the ascending aorta meets the arch and, if required, replacing the concave surface of the arch;
- Subtotal prosthetics. This is when, when replacing an artery arch, replacement of branches (1 or 2) is required;
- Complete prosthetics. In this case, the arch is prosthetic along with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, the person is entitled to disability.
Coronary artery bypass grafting (CABG)
CABG is an open-heart surgery that uses the patient's blood vessel as a shunt. This heart surgery is needed to create a bypass for blood that will not affect the occlusive area coronary artery.
That is, this shunt is installed on the aorta and brought to a section of the coronary artery unaffected by atherosclerosis.
This method is quite effective in the treatment of coronary heart disease. Due to the installed shunt, blood flow to the heart increases, which means ischemia and angina pectoris do not occur.
CABG is prescribed if there is angina pectoris in which even the smallest loads cause attacks. Also, indications for CABG are lesions of all coronary arteries, and if a cardiac aneurysm has formed.
When performing CABG, the patient is put under general anesthesia, and then after opening the chest, all manipulations are carried out. This operation can be performed with or without cardiac arrest. And also, depending on the severity of the pathology, the doctor decides whether the patient needs to be connected 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 a shunt is performed by a vein from lower limb, also sometimes use part of the internal mammary vein, radial artery.
Today, CABG is performed, which is performed with minimal access to the heart and at the same time the heart continues to beat. This intervention is considered not as traumatic as others. In this case, the chest is not opened; an incision is made between the ribs and a special expander is used so as not to affect the bones. This type of CABG lasts from 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 the patient’s quality and life expectancy increases.
Radiofrequency ablation (RFA)
RFA is a procedure performed under local anesthesia, as the basis is catheterization. This procedure is carried out in order to exfoliate the cells that cause arrhythmia, that is, the focus. This occurs through a guide catheter that conducts electricity. As a result, tissue formations are removed using RFA.
After conducting an electrophysical study, the doctor determines where the source that causes the rapid heartbeat is located. These sources can be formed along pathways, resulting in a rhythm anomaly. It is RFA that neutralizes this anomaly.
RFA is performed in the following cases:
- When drug therapy does not affect 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 such as cardiac arrest may occur.
It should be noted that RFA is well tolerated by patients, since there are no large incisions or opening of the sternum.
A catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is numbed.
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 points an electrode at them. After the electrode has acted on the source, the tissues become scarred, which means they will not be able to conduct the impulse. After RFA, a bandage is not needed.
Carotid artery surgery
These types of operations are distinguished into carotid artery:
- Prosthetics (used for large lesions);
- Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent;
- Eversion endarterectomy - in this case, atherosclerotic plaques are removed along with the inner lining of the carotid artery;
- Carotid endarectomy.
Such operations are performed under both general and local anesthesia. More often under general anesthesia, since the procedure is carried out in the neck area and there is discomfort.
The carotid artery is pinched, and in order for the blood supply to continue, shunts are installed, which are bypass routes.
Classic endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is detached and removed. Next, the vessel is washed. Sometimes it is still necessary to fix inner shell, this is done with special seams. Finally, the artery is sutured using a special synthetic medical material.
Carotid endarterectomy
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 it, that is, sew it on. To perform 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 is prescribed, therapeutic diets etc.
Other recovery measures are also needed, for example, you need to wear a bandage. The bandage secures the suture after the operation, and of course the entire chest, which is very important. This type of bandage should only be worn if open heart surgery is performed. The cost of these products may vary.
The bandage worn after heart surgery looks like a T-shirt with tightness fixers. You can purchase men's and female options this bandage. The bandage is important because it is necessary to prevent congestion of the lungs, for this you need to cough regularly.
Such prevention of stagnation is quite dangerous because the seams can come apart; in this case, the bandage will protect the seams and promote durable scarring.
The bandage will also help prevent swelling and hematomas, and promote the correct location of organs after heart surgery. And the bandage helps relieve stress on 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 begin rehabilitation, this is simple exercise therapy and massage.
After all types of heart surgery, drug rehabilitation, that is, maintenance therapy, is needed. In almost all situations, the use of antiplatelet agents is mandatory.
If there is high blood pressure, then prescribe ACE inhibitors and beta-blockers, as well as drugs to lower blood cholesterol (statins). Sometimes the patient is prescribed physical therapy.
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 disability is necessarily given after coronary artery bypass grafting. Moreover, there may be a disability of both groups 1 and 3. It all depends on the severity of the pathology.
People who have circulatory disorders, stage 3 coronary insufficiency, or have suffered a myocardial infarction are also entitled to disability.
Regardless of whether the operation has been performed or not yet. Patients with heart defects of the 3rd degree and combined defects can apply for disability if there are persistent circulatory disorders.
Clinics
| Clinic name | Address and telephone | Type of service | Price |
|---|---|---|---|
| Research Institute of SP named after. N.V. Sklifosovsky | Moscow, Bolshaya Sukharevskaya square, 3 |
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| KB MSMU im. Sechenov | Moscow, st. B. Pirogovskaya, 6 |
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| FSCC FMBA | Moscow, Orekhovy Boulevard, 28 |
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| Research Institute of SP named after. I.I. Dzhanelidze | St. Petersburg, st. Budapestskaya, 3 |
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| St. Petersburg State Medical University named after. I.P. Pavlova | St. Petersburg, st. L. Tolstoy, 6/8 |
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| Sheba MC | Derech Shiba 2, Tel Hashomer, Ramat Gan |
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| link to article.
Cardiac surgery is a branch of medicine dedicated to surgical treatment hearts. In case of pathologies of the cardiovascular system, such intervention is a last resort. Doctors try to restore the patient’s health without surgery, but in some cases only cardiac surgery can save the patient. Today, this field of cardiology uses the latest advances in science to return the patient to health and a full life.
Indications for operations
Invasive cardiac interventions are complex and risky work; it requires skill and experience, and the patient – preparation and implementation of recommendations. Because such operations involve risks, they are performed only when absolutely necessary. In most cases, they try to rehabilitate the patient with the help of medications and medical procedures. But in cases where such methods do not help, heart surgery is needed. The surgery is performed in a hospital setting and in complete sterility, the patient being operated on is under anesthesia and under the control of the surgical team.
Such interventions are needed for congenital or acquired heart defects. The first include pathologies in the anatomy of the organ: defects of the valves, ventricles, impaired blood circulation. Most often they are discovered during pregnancy. Heart defect It is also diagnosed in newborns; often such pathologies need to be eliminated urgently in order to save the baby’s life. Among acquired diseases, coronary disease is the leader; in this case, surgery is considered the most effective method treatment. Also in the heart area there are: impaired blood circulation, stenosis or valve insufficiency, heart attack, pericardial pathologies and others.
Heart surgery is prescribed in situations where conservative treatment does not help the patient, the disease progresses quickly and threatens life, in case of pathologies that require urgent and immediate correction, and in advanced forms of the disease, a late visit to the doctor.
The decision to prescribe an operation is made by a council of doctors or. The patient must be examined to establish an accurate diagnosis and type of surgical intervention. Reveal chronic diseases, stages of the disease, assess the risks, in this case they talk about elective surgery. If needed emergency help, for example, when a blood clot breaks off or an aneurysm dissects, minimal diagnostics are performed. In any case, the function of the heart is surgically restored, its parts are rehabilitated, and blood flow and rhythm are normalized. IN difficult situations, the organ or its parts can no longer be corrected, then prosthetics or transplantation are prescribed.
Classification of heart operations
There can be dozens of different diseases in the area of the heart muscle, these are: failure, narrowing of the lumens, ruptures of blood vessels, stretching of the ventricles or atria, purulent formations in the pericardium and much more. To solve each problem, surgery has several types of operations. They are distinguished by urgency, effectiveness and method of influencing the heart.
The general classification divides them into operations:
- Buried - used to treat arteries, large vessels, aorta. During such interventions, the chest of the person being operated on is not opened, and the heart itself is also not touched by the surgeon. That’s why they are called “closed” - the heart muscle remains intact. Instead of a strip opening, the doctor makes a small incision in the chest, most often between the ribs. TO closed views refers to: bypass surgery, balloon angioplasty, stenting of blood vessels. All these manipulations are designed to restore blood circulation; sometimes they are prescribed to prepare for future open surgery.
- Open – carried out after opening the sternum and sawing the bones. The heart itself can also be opened during such manipulations to get to problem area. Typically, the heart and lungs must be stopped for such operations. To do this, they connect the artificial blood circulation machine - AIK, it compensates for the work of the “disabled” organs. This allows the surgeon to carry out the work carefully, and the procedure under AI control takes longer, which is necessary when eliminating complex pathologies. During open operations, the AIK may not be connected, but only the desired zone of the heart is stopped, for example, when coronary artery bypass grafting. Opening the chest is necessary to replace valves, prosthetics, and eliminate tumors.
- X-ray surgery - similar to closed type operations. The essence of this method is that the doctor blood vessels moves a thin catheter and gets to the very heart. The chest is not opened; the catheter is placed in the thigh or shoulder. A contrast agent is supplied through the catheter, which stains the vessels. The catheter is advanced under X-ray control, and the video image is transmitted to the monitor. Using this method, the lumen in the vessels is restored: at the end of the catheter there is a so-called balloon and a stent. At the site of narrowing, this balloon is inflated with a stent, restoring normal patency of the vessel.
The safest are minimally invasive methods, that is, x-ray surgery and closed type operations. With such work there is the least risk of complications, the patient recovers faster after them, but they cannot always help the patient. To avoid complex operations possible with periodic inspection. The earlier the problem is identified, the easier it is for the doctor to solve it.
Depending on the patient’s condition, there are:
- Planned surgery. It is carried out after a detailed examination, within a specified time frame. Planned intervention is prescribed when the pathology does not pose any particular danger, but it cannot be postponed.
- Emergency are operations that need to be done in the next few days. During this time, the patient is prepared and all the necessary studies are carried out. The date is set immediately after receiving the necessary data.
- Emergency. If the patient is already in in serious condition, at any moment the situation can worsen - surgery is prescribed immediately. Before it, only the most important examinations and preparations are carried out.
In addition, surgical assistance can be radical or auxiliary. The first implies complete elimination of the problem, the second - elimination of only part of the disease, improving the patient’s well-being. For example, if a patient has a pathology mitral valve and stenosis of a vessel, first the vessel is restored (auxiliary), and after some time valve plastic surgery is prescribed (radical).
How are surgeries done?
The course and duration of the operation depends on the pathology being treated, the patient’s condition, and the presence of concomitant diseases. The procedure may take half an hour or may take 8 hours or more. Most often, such interventions last 3 hours, take place under general anesthesia and control of an artificial cardiologist. First, the patient is prescribed a chest ultrasound, urine and blood tests, an ECG, and consultation with specialists. After receiving all the data, the degree and location of the pathology is determined, and it is decided whether there will be an operation.
As part of the preparation, a diet with low content, fatty, spicy and fried. 6-8 hours before the procedure, it is recommended to refuse food and drink less. In the operating room, the doctor assesses the patient’s well-being and puts the patient into medical sleep. For minimally invasive interventions, local anesthesia is sufficient, for example during X-ray surgery. When the anesthesia or anesthesia takes effect, the main actions begin.
Heart valve surgery
The heart muscle has four valves, all of which serve as a passage for blood from one chamber to another. The most commonly operated valves are the mitral and tricuspid valves, which connect the ventricles to the atria. Stenosis of the passages occurs when the valves are insufficiently widened, and blood flows poorly from one section to another. Valve insufficiency is a poor closure of the valves of the passage, and there is an outflow of blood back.
The plastic surgery is performed openly or closed; during the operation, special rings or sutures are applied manually along the diameter of the valve, which restore normal lumen and narrowing of the passage. Manipulations last on average 3 hours, with open views connect the AIK. After the procedure, the patient remains under the supervision of doctors for at least a week. The result is normal blood circulation and functioning of the heart valves. In severe cases, the original valves are replaced with artificial or biological implants.
Elimination of heart defects
In most cases, defects are congenital, the reason for this may be hereditary pathologies, bad habits parents, infections and fever during pregnancy. At the same time, children may have different anatomical abnormalities in the heart area; often such anomalies are poorly compatible with life. The urgency and type of surgery depend on the child’s condition, but they are often prescribed as early as possible. For children, heart surgery is performed only under general anesthesia and under the supervision of medical equipment.
At older ages, heart defects develop due to atrial septal defects. This happens when mechanical damage chest, infectious diseases, due to concomitant heart diseases. To fix this problem you also need open surgery, often with artificial cardiac arrest.
During the manipulations, the surgeon can “patch” the septum using a patch, or sutured the defective part.
Bypass surgery
Coronary artery disease (IHD) is a very common pathology, affecting mainly the generation over 50 years of age. Appears due to impaired blood flow in the coronary artery, which leads to oxygen starvation myocardium. Distinguish chronic form, in which the patient constant attacks angina, and acute – myocardial infarction. They try to eliminate chronic ones conservatively or using minimally invasive techniques. Acute requires urgent intervention.
To prevent complications or alleviate the disease, use:
- coronary artery bypass grafting;
- balloon angioplasty;
- transmyocardial laser revascularization;
- coronary artery stenting.
All these methods are aimed at restoring normal blood flow. As a result, enough oxygen is supplied to the myocardium with blood, the risk of heart attack is reduced, and angina is eliminated.
If it is necessary to restore normal patency, angioplasty or stenting is sufficient, in which the catheter is moved through the vessels to the heart. Before such an intervention, coronary angiography is performed to accurately determine the blocked area. Sometimes blood flow is restored bypassing the affected area, while a bio-shunt (often a section of the patient’s own vein from the arm or leg) is sutured to the artery.
Recovery after interventions
After surgery, the patient remains in the hospital for another 1-3 weeks, during which time doctors will evaluate his condition. The patient is discharged after verification and approval by the cardiologist.
The first month after surgical procedures is called the early postoperative period; during this time it is very important to follow all the doctor’s recommendations: diet, a calm and measured lifestyle. Nicotine, alcohol, junk food and exercise are prohibited regardless of the type of intervention.
The doctor's recommendations must also contain a warning about dangers and complications. Upon discharge, the doctor will set a date for the next appointment, but you need to seek help unscheduled if the following symptoms occur:
- sudden fever;
- redness and swelling at the incision site;
- discharge from the wound;
- constant chest pain;
- frequent dizziness;
- nausea, bloating and stool disorders;
- difficulty breathing.
During routine examinations, the cardiologist will listen to your heartbeat, measure your blood pressure, and listen to your complaints. To check the effectiveness of the operation, ultrasound is prescribed, CT scan, X-ray studies. Such visits are scheduled once a month for six months, then the doctor will see you once every 6 months.
Often except surgical care prescribe medications. For example, when replacing valves with artificial implants, the patient takes anticoagulants for life.
In the postoperative period, it is important not to self-medicate, since the interaction of permanent medications and other medications can give a negative result. Even regular painkillers need to be discussed with. To keep fit and restore health faster, it is recommended to spend more time in the fresh air and walk.
Life after heart surgery will gradually return to normal; full recovery is predicted within a year.
Cardiac surgery offers a variety of methods for cardiac rehabilitation. Such operations are designed to restore physical and moral strength to the patient. There is no need to be afraid or avoid such procedures; on the contrary, the sooner they are carried out, the greater the chances of success.