What is an operation on the heart through a vein called? Heart surgery: necessary recommendations. Operations Glenn and Ross

Tuesday is surgery day. The team is preparing for a long morning work. During the operation, the chest is opened and the heart is prepared for vessel transplantation.

Medical history

Mr. Thomas, a 59-year-old tanker driver, is married with two adult children. He had shingles on the right side of his neck, followed by an uncomfortable constriction in his throat, accompanied by sweating and nausea. He first felt these symptoms while walking up the steps of his truck. They continued, and Thomas decided to seek the advice of a therapist.

Thomas's high blood pressure, obesity, and long history of smoking were reason enough for an ECG. Her results showed the presence of coronary heart disease. Thomas was referred to a cardiac expert (a cardiac internist, not a surgeon). Despite the applied medical treatment, the pain continued.

Tests confirmed the presence of the disease, in particular an angiogram (a test using a dye injected into the artery to detect narrowing) revealed a narrowing in the left main coronary artery with damage to the left and right vessels. Since medical treatment was unsuccessful and angioplasty (stretching a narrowed vessel using a catheter) was not an option, Mr. Thomas was referred for surgery.

Monday

Mr. Thomas is hospitalized. His anamnesis, data of examinations and tests were analyzed. Two units of blood for transfusion are tested for compatibility. The patient is explained the essence of the operation and warned about the risk associated with it. Obtain written consent for CABG.

Tuesday

Early in the morning, Mr. Thomas is being prepared for the operation.

7:05 Premedication and anesthesia

8:15 a.m. Mr. Thomas was sedated 70 minutes ago and a ventilation tube has already been placed in his airway. After the application of anesthesia and paralyzing agents, his breathing is supported by a ventilator. Prior to transferring Mr. Thomas to the operating room, the anesthesiologist establishes monitoring of venous and arterial blood flow.

8:16 OR Mr. Thomas is set up. On the left - a table with instruments, on the right - a ready-to-use heart-lung apparatus.

8:25 Patient in the operating room. The skin of his chest and legs are treated with an antiseptic solution to reduce the risk of infection.

8:40 Opening of the chest

The skin has already been processed, the patient is dressed in sterile clothes. One of the surgeons makes an incision in the leg to extract the vein, and the second cuts the skin on the chest. After a preliminary incision with an ordinary scalpel, he uses an electric one, which cuts the vessels, stopping the bleeding.

8:48 The surgeon cuts the sternum bone with an electric saw with a pneumatic drive.

8:55 Artery and vein removal

View of the internal thoracic (mammary) artery in the mirror in the center of the surgical lamp. This artery is very elastic. The top end of it will remain in place, it will be cut off at the bottom and then connected to the coronary artery.

An angled retractor is placed along the left edge of the sternum to lift it and expose the mammary artery that runs along the inside of the chest.

At the same time, one of the main veins on the leg - the great saphenous vein - is prepared for transplantation. It is almost completely removed from the left thigh.

9:05 Connecting to the heart-lung machine

The heart-lung machine is not yet connected to the patient. One of the five rotating pumps circulates the blood, while the rest are used as side pumps to transport separated blood to prevent blood loss during surgery. The patient needs to enter heparin - a means to thin the blood and prevent the formation of clots during its passage through plastic tubes.

Tubes to the heart-lung apparatus. On the left, with bright red blood, is the arterial return line, which carries blood back into the patient's aorta. On the right - two tubes that drain blood from the inferior and superior vena cava under the influence of gravity. The incision in the sternum is fixed with a spacer.

Part of the heart-lung apparatus is a membrane oxygenating device that maintains blood circulation in the patient's body. At the moment, the device is filled with blood, carbon dioxide is removed from it. The blood is re-oxygenated and returned to the patient's body.

An arterial return tube is inserted into the aorta (the main artery of the body) and two venous drains are inserted into the vena cava (the main vein of the body).

9:25 Cardiac arrest

On the main artery - the aorta - a clamp is placed to isolate the heart from artificial blood circulation. Chilled fluid is injected into the isolated aorta to stop the heart. The surgeon puts on special glasses for microsurgery with loupes that give a magnification of 2.5 times. The blood vessels he will transplant are 2-3 mm in diameter, and the sutures are the diameter of a human hair.

A thorough examination of the heart is carried out to confirm the data obtained using the angiogram. It is specified which coronary arteries need to be bypassed. It was decided to make two shunts.

After stopping the blood flow in the left anterior descending artery, a 1 cm long incision is made at the bypass site using a surgical loop.

10:00 First bypass

Close-up of the heart. The left internal mammary (mammary) artery - in the upper left corner - is sutured to the left anterior descending artery so that blood flow to the heart is restored. Arteries are hidden by epicardial fat.

The end of the left internal mammary artery is sutured laterally to the left anterior descending artery. This forms the first bypass shunt.

The position of the first performed shunt. The end of the lower part of the left internal mammary artery - a blood vessel with a diameter of 3 mm - is completely sutured to the left anterior descending artery.

10:22 Second bypass

The second bypass shunt is sutured with the upper end to the aorta, and with the lower end to the right posterior descending artery. The transverse clamp is removed, blood flow through the heart is restored.

The upper end of the venous shunt is connected to the aorta. Part of the aorta is isolated with an arcuate clamp and a hole is made into which a vein is sutured.

End of both bypass processes. The second shunt, shown on the left side of the diagram, is formed from the saphenous vein of the leg.

11:18 Chest closure

Circulation is restored, the heart contracts after an electric shock with the transition from ventricular fibrillation to sinus mode. Two drains are installed in the anterior and posterior parts of the heart. The blood thinning effect of heparin was eliminated by the drug protamine. The surgeon sews the separated halves of the sternum together. The skin will be closed with an internal absorbable suture.

The nurse applies tape to the suture and to the drainage tubes leading from the patient's chest. Soon the patient will be placed in the intensive care unit, where he will be observed.

The human body. Outside and inside. №1 2008

How are operations performed?

An operation is an intervention in the human body with a violation of its integrity. Each disease requires an individual approach, which naturally affects the way the operation is performed.

How heart surgery is done: preparation for surgery

Heart surgery (cardiac surgery) is one of the most difficult to perform, dangerous and responsible type of surgical intervention.

Planned operations are usually carried out in the morning. Therefore, the patient is not allowed to eat or drink in the evening (for 8-10 hours), and immediately before the operation, a cleansing enema is given. This is necessary in order for the anesthesia to work as it should.

The place where operations are performed must be sterile. In medical institutions, special rooms are used for these purposes - operating rooms, which are regularly sterilized by quartz treatment and special antiseptics. In addition, all medical personnel who take part in the operation wash themselves before the procedure (you even have to rinse your mouth with an antiseptic solution), and also change into special sterile clothes, put on sterile gloves on your hands.

The patient is also put on shoe covers, a cap on his head, and the operation field is treated with an antiseptic. If necessary, before the operation, the patient's hair is shaved if the surgical field is covered with it. All these manipulations are necessary to avoid infection of the surgical wound with bacteria or other dangerous active microorganisms.

Narcosis or anesthesia

Anesthesia is a general anesthesia of the body with its immersion in drug-induced sleep. During surgical interventions on the heart, general anesthesia is used, and in some cases, during endovideosurgical operations, spinal anesthesia, in which a puncture is made into the spinal cord at the level of the lower back. Substances that cause pain relief can be administered in various ways - intravenously, through the respiratory tract (inhalation anesthesia), intramuscularly or in combination.

Course of open heart surgery

After the person goes into medical sleep and ceases to feel pain, the operation itself begins. The surgeon uses a scalpel to open the skin and soft tissues on the chest. Cardiac surgery may also require an “opening” of the chest. To do this, with the help of special surgical instruments, the ribs are sawn. Thus, doctors “get” to the operated organ and put special dilators on the wound, which provide better access to the heart. Junior medical staff, using suction, removes blood from the surgical field, and also cauterizes cut capillaries and blood vessels so that they do not bleed.

If necessary, the patient is connected to an artificial heart machine, which will temporarily pump blood through the body, while the operated organ is artificially suspended. Depending on what kind of heart surgery is performed (what kind of damage is eliminated), appropriate manipulations are carried out: it can be the replacement of blocked coronary arteries, the replacement of heart valves in case of defects, vein bypass surgery or the replacement of an entire organ.

Extreme care is required from the surgeon and all staff, as the life of the patient depends on it. It should also be added that during the operation, blood pressure and some other indicators are constantly monitored, which indicate the patient's condition.

Endovideosurgery: stenosis and angioplasty

Today, more and more often, heart surgery is performed not by an open method - with a chest incision, but with access through the femoral artery on the leg, under the control of an X-ray machine and a microscopic video camera. After preparing for operation, which is similar for all types of surgical interventions, and putting the patient into a medical sleep, access to the femoral artery is opened through an incision in the leg. A catheter and a probe with a video camera at the end are inserted into it, thanks to which access to the heart is provided.

In this way, angioplasty with stenosis of blood vessels is carried out in cardiac surgery, which is necessary for blockage of the coronary vessels that feed the heart itself with blood. Special stands are installed in the narrowed vessels - cylindrical implants that do not allow the arteries to clog anymore, which prevents the possibility of developing coronary disease.

After the main part of the operation is over and the heart is on its own again functions, stitching of damaged nerves, vessels and tissues is performed. The wound is again treated with an antiseptic, the surgical field is closed, soft tissues and skin are sutured with special threads. A medical bandage is applied to the external wound. After the end of all these procedures, the patient is taken out of anesthesia.

Other types of transactions

In addition to the abdominal operations described above, there are also operations performed in a less traumatic way:

• Laparoscopy - is performed using a laparoscope, which is inserted through 1-2 cm incisions in the skin. Most often used in gynecology, gastrectomy and other operations in the abdominal cavity. You can read more about this
• Laser surgery - is carried out using a special laser beam. Usually, operations are performed in this way on the eyes, when removing skin formations, etc. You can read more about the method

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.

1. You will be offered operation, as the only way out, and doctors believe that it needs to be done urgently.
2. You are offered an operation, but they say that it can be postponed for a while.
3. 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.

Cardiovascular diseases, unfortunately, occupy one of the first places in terms of mortality in our country. But cardiology does not stand still, but is constantly being improved. In this area, new methods of treatment are constantly emerging and the most modern technologies are being introduced. Naturally, people suffering from severe heart diseases are interested in all the innovations in cardiology, and therefore in various methods of surgical interventions.

When is Cardiac Surgery Used?

Absolutely not any violation in the work of cardiac activity entails surgical intervention. There are absolutely clear criteria on which the attending physician relies, recommending this or that cardiological operation. Such indications may be:

• Significant and rapidly progressive deterioration of the patient's condition associated with chronic heart failure.
• Acute conditions that threaten the life of the patient.
• Extremely low efficiency of simple drug treatment with clear dynamics to the deterioration of the general condition.
• The presence of advanced cardiac pathologies that developed against the background of a late visit to the doctor and the lack of adequate treatment.
• both congenital and acquired.
• Ischemic pathologies leading to the development of a heart attack.

Types of heart surgery

Today, there are many different surgical manipulations on the human heart. All these operations can be divided according to several basic principles.

• Urgency.
• Technique.

Operations differing in urgency

Any surgical intervention will fall into one of the following groups:

1. emergency operations. The surgeon performs such heart operations if there is a real threat to the patient's life. It can be a sudden thrombosis, myocardial infarction, the onset of aortic dissection, heart injury. In all these situations, the patient is sent to the operating table immediately after the diagnosis is made, usually even without further tests and examinations.
2. Urgent. In this situation, there is no such urgency, it is possible to conduct clarifying examinations, but it is also impossible to postpone the operation, as a critical situation may develop in the near future.
3. Planned. After a long observation by the attending cardiologist, the patient receives a referral to the hospital. Here he undergoes all the necessary examinations and preparation procedures before surgery. The cardiac surgeon clearly sets the time of the operation. In case of problems, for example, a cold, it can be postponed to another day or even a month. There is no threat to life in such a situation.

Differences in technique

In this group, all operations can be divided into ongoing:

1. Opening the chest. This is a classic method that is used in the most severe cases. The surgeon makes an incision from the neck to the navel and opens the chest completely. Thus, the doctor gets direct access to the heart. Such manipulation is carried out under general anesthesia and the patient is transferred to the cardiopulmonary bypass system. As a result of the fact that the surgeon works with a "dry" heart, he can eliminate even the most severe pathologies with a minimal risk of complications. This method is resorted to in the presence of problems with the coronary artery, aorta and other great vessels, with severe atrial fibrillation and other problems.
2. Without opening the chest. This type of surgical intervention belongs to the so-called minimally invasive techniques. There is absolutely no need for open access to the heart. These techniques are much less traumatic for the patient, but they are not suitable in all cases.
3. X-ray surgical technique. This method in medicine is relatively new, but it has already proven itself very well. The main advantage is that after these manipulations the patient recovers very quickly and complications are extremely rare. The essence of this technique lies in the fact that a device similar to a balloon is introduced to the patient using a catheter to expand the vessel and eliminate its defect. This whole procedure is carried out using a monitor and the progress of the probe can be clearly controlled.

The difference in the amount of assistance provided

All surgical manipulations in people with heart problems can be divided both in terms of the volume and direction of the problems to be eliminated.

1. Correction is palliative. Such surgical intervention can be attributed to auxiliary techniques. All manipulations will be aimed at bringing blood flow back to normal. This may be the end goal or preparation of the vessel for further surgical procedures. These procedures are not aimed at eliminating the existing pathology, but only eliminate its consequences and prepare the patient for full treatment.
2. radical intervention. With such manipulations, the surgeon sets himself the goal - if possible, the complete elimination of the developed pathology.

Most common heart surgeries

People with problems of the cardiovascular system are often interested in what types of heart surgeries are and how long they last. Let's look at some of them.

RF ablation

A fairly large number of people have problems with a violation in the direction of its increase - tachycardia. In difficult situations today, cardiac surgeons offer radiofrequency ablation, or "cautery of the heart." This is a minimally invasive procedure that does not require an open heart. It is performed using X-ray surgery. The pathological part of the heart is affected by radio frequency signals, which damage it, and therefore eliminate the additional path along which the impulses pass. Normal pathways are at the same time fully preserved, and the heart rate gradually returns to normal.

Coronary artery bypass grafting

With age or due to other circumstances, atherosclerotic plaques can form in the arteries, which narrow the lumen for blood flow. Thus, the flow of blood to the heart is greatly impaired, which inevitably leads to very deplorable results. In the event that the narrowing of the lumen reaches a critical state, surgery recommends that the patient undergo coronary artery bypass grafting.

This type of surgery involves creating a bypass from the aorta to the artery using a shunt. The shunt will allow blood to bypass the narrowed area and normalize blood flow to the heart. Sometimes it is required to install not one, but several shunts at once. The operation is quite traumatic, like any other, performed at the opening of the chest and lasts a long time, up to six hours. Coronary artery bypass surgery is usually performed on the open heart, but today alternative methods are gaining more and more popularity - coronary angioplasty (insertion of an expanding balloon through a vein) and stenting.

Like the previous method, it is used to increase the lumen of the arteries. It is referred to as a minimally invasive, endovascular technique.

The essence of the method consists in introducing an inflated balloon in a special metal frame into the artery into the pathology zone, using a special catheter. The balloon inflates and opens the stent - the vessel also expands to the desired size. Next, the surgeon removes the balloon, the metal structure remains, creating a strong skeleton of the artery. Throughout the procedure, the doctor monitors the progress of the stent on the screen of the X-ray monitor.

The operation is practically painless and does not require long and special rehabilitation.

Heart valve replacement

With congenital or acquired pathology of the heart valves, the patient is often shown their prosthetics. Regardless of what type of prosthesis will be installed, surgery most often takes place on the open heart. The patient is put to sleep under general anesthesia and transferred to the cardiopulmonary bypass system. Given this, the recovery process will be long and fraught with a number of complications.

An exception to the procedure for valvular replacement is aortic valve replacement. This procedure can be performed using a gentle endovascular technique. The surgeon inserts a biological prosthesis through the femoral vein and places it in the aorta.

Operations Ross and Glenn

Often, heart surgery is performed on children who are diagnosed with congenital heart defects. Most often, operations are performed according to the methods of Ross and Glenn.

The essence of the Ross system is to replace the aortic valve with the pulmonary valve of the patient. The biggest advantage of such a replacement can be considered that there will be no threat of rejection, like any other valve taken from a donor. In addition, the annulus will grow with the child's body and can last a lifetime. But, unfortunately, an implant must be placed in place of the removed pulmonary valve. It is important that the implant at the site of the pulmonary valve lasts much longer without replacement than the same one at the site of the aortic valve.

The Glenn technique was developed for the treatment of children with pathology of the circulatory system. This is a technology that allows you to create an anastomosis to connect the right pulmonary artery and the superior vena cava, which normalizes the movement of blood flow through the systemic and pulmonary circulation.

Despite the fact that surgical intervention significantly prolongs the life of the patient and improves its quality, it is still mostly an extreme case.

Any doctor will try to do everything possible so that the treatment is conservative, but, unfortunately, sometimes this is completely impossible. It is important to understand that any surgical intervention in the work of the heart is a very difficult procedure for the patient, and it will require high-quality rehabilitation, sometimes quite lengthy.

Recovery time

Rehabilitation after heart surgery is a very important stage in the treatment of patients.

The success of the operation can only be judged after the end, which can last quite a long time. This is especially true for patients who underwent open heart surgery. Here it is extremely important to follow the recommendations of doctors as accurately as possible and have a positive attitude.

After surgery with an opening of the chest, the patient is discharged home in about a week or two. The doctor makes clear instructions for further treatment at home - it is especially important to follow them.

trip home

Already at this stage, it is important to take measures so that you do not have to go back to the hospital urgently. It is important to remember here that all movements should be as slow and smooth as possible. In the event that the road takes more than one hour, you need to periodically stop and get out of the car. This must be done to avoid stagnation of blood in the vessels.

Relations with relatives

Both relatives and the patient need to understand that people who have undergone major operations under general anesthesia are extremely prone to irritability and mood swings. These problems will pass with time, you just need to treat each other with maximum understanding.

Taking medications

This is one of the most important moments in life after heart surgery. It is important for the patient to always have all the necessary medicines with him. It is especially important not to show excessive self-activity and not to take drugs that are not prescribed. In addition, you should not stop taking medication prescribed by your doctor.

seam care

The patient should calmly perceive a temporary sensation of discomfort in the suture area. In the beginning, it can be pain, a feeling of tightness and itching. Painkillers can be prescribed by a doctor to relieve pain; special ointments or gels can be used to relieve other symptoms, but only after consulting a surgeon.

The seam should be dry, without excessive redness or swelling. This needs to be watched closely. The place of the seam must be constantly treated with brilliant green, and the first water procedures are allowed to be taken after about two weeks. Such patients are allowed only a shower, and taking a bath and sudden changes in temperature are contraindicated. It is recommended to wash the seam only with ordinary soap and gently blot with a towel.

In a situation where the patient's temperature rises sharply to 38 degrees, severe swelling appears with redness at the site of the suture, fluid is released or severe pain is disturbing, you should immediately consult a doctor.

It is important for a person who has undergone heart surgery to set a goal - maximum recovery. But the main thing here is not to rush, but to do everything gradually and very carefully.

In the first days after returning home, you need to try to do everything as smoothly and slowly as possible, gradually increasing the load. For example, in the early days, you can try to walk from one hundred to five hundred meters, but if fatigue appears, you should rest. Then the distance should be gradually increased. It is best to walk outdoors and on flat terrain. After a week of walking, you should try to climb the stairs for 1-2 flights. At the same time, you can try to do simple housework.

Approximately two months later, the cardiologist will perform a stitch healing test and give permission to increase physical activity. The patient may begin to swim or play tennis. He will be allowed to work lightly in the garden with the lifting of small weights. Another test the cardiologist should conduct in three or four months. By this time, it is desirable for the patient to restore all the basic motor activity.

Diet

This aspect of rehabilitation also needs to be paid close attention.

The first time after the operation, the patient often lacks appetite and at this time any restrictions are not very relevant. But over time, a person recovers and his desire to eat familiar foods is restored. Unfortunately, there are a number of strict restrictions that will now always have to be observed. In the diet, you will have to severely limit fatty, spicy, salty and sweet. Cardiologists advise what you can eat after heart surgery - vegetables, fruits, various cereals, fish and lean meat. It is extremely important for such people to monitor their weight, and hence the caloric content of food.

Bad habits

Patients who have undergone heart surgery, of course, are strictly prohibited from smoking and using drugs. Drinking alcohol during the rehabilitation period is also prohibited.

Life after surgery can become full and rich. After a period of rehabilitation, many patients return to life without pain, shortness of breath and, most importantly, fear.

The operation on the heart, which at one time was compared with the first manned flight into space, is exactly 50 years old. It is very pleasant that our surgeon Vasily Kolesov conceived and executed it. Now it is one of the most common procedures in the world to prevent a heart attack and bears the name of its developer.

"The Soviet surgeon dared to raise his hand on his heart" - in 1964 this news outraged the entire world medical community. No one believed that coronary heart disease could be treated with surgery. Numerous experiments on animals ended unsuccessfully. But Vasily Ivanovich Kolesov, a professor at the Leningrad Medical University, proves that operating on a healthy heart in dogs and a diseased heart in humans is not the same thing, and he decides on a bold experiment.

Stanislav Pudyakov then assisted the surgeon. He recalls: a 44-year-old patient was tormented by severe pain in the region of the heart.

“His idea, if compared historically, is similar to the thoughts of Tsiolkovsky, who said that tomorrow we will be on the moon. They didn’t believe him until they really flew. And until Vasily Ivanovich did this first operation, no one believed in it” - says Stanislav Pudyakov.

The surgeon operated on a beating heart, which was also hard to believe. No one had done this before Kolesov, neither in our country nor in the world. Moreover, the doctor literally felt the sore spot with his hands. The equipment for diagnosing heart diseases simply did not exist then.

To restore the normal blood supply to the heart, Kolesov singled out the internal thoracic artery and sewed it to the coronary artery below the narrowing caused by the so-called atherosclerotic plaque. The blood flow went around, the patient was saved from a heart attack.

After the operation, people quickly returned to normal life and forgot about the pills forever. About operations that saved people from heart attacks and pains in the heart, they started talking abroad as a sensation. American magazines wrote about Kolesov: "Pioneer of coronary surgery."

“There were confessions among colleagues, among foreigners. A lot of Americans, Germans, French came, they looked at these operations with great curiosity and really wanted to continue what was started here,” says surgeon Alexander Nemkov.

Vasily Kolesov immediately warned: it would not be easy for young surgeons to repeat this. From now on, operations must be performed on a stopped heart. The advice was regarded as a guide to action. In 1967, American surgeons put them on stream.

The method of treatment of coronary heart disease, proposed by Vasily Ivanovich Kolesov, is considered the most effective after 50 years. Operations are performed by the best cardiac surgeons in clinics around the world. This is aerobatics, because, in fact, doctors must restart the main human organ.

“Speaking specifically about the operation of Vasily Ivanovich Kolesov, it is now being performed widely on a beating heart. What he did is incredible. The range of suture material that we use has changed, the needle holders that we use have changed incredibly. We use special magnifying lenses and we see this artery magnificently, which can be a millimeter, a millimeter and a half,” says surgeon Leo Bokeria.

Like half a century ago, coronary heart disease is the most common disease in the world. Now we can say with confidence that doctors have learned to deal with it. Thanks to the revolutionary method of Vasily Kolesov, even the most difficult patients can be saved.