What types of heart surgeries are there? Operations on the heart and blood vessels: types, features. Amazing discovery in the treatment of hypertension

Operation on open heart is one of the methods of treating 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 disease heart disease, which occurs due to the development of atherosclerosis, in which a narrowing of the vessels supplying blood to the myocardium occurs 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 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, works around.

Coronary artery bypass grafting

Today, taking into account progress in medicine, for surgical treatment of 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.

Patients spend the first night after heart surgery and all medical procedures 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 chest due to the incision (this risk is especially high for people who are obese, have diabetes, or have repeated surgery);
myocardial infarction, ischemic stroke;
heart rhythm disturbances;
thromboembolism;
increased body temperature for a long time;
cardiac discomfort of any nature;
pain of various types 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 which 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, and 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.

Duration 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 each patient is able to speed up this rehabilitation process, while avoiding new heart ailments, which reduces the risk of reoperation. To do this, it is recommended to take the following measures:

follow the diet and special diet prescribed by your doctor;
limit salty, fatty, sweet foods);
devote time to physical therapy, walks in the fresh air;
stop frequent drinking of alcohol;
monitor blood cholesterol levels;
track arterial pressure.

If these measures are followed, the postoperative period 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.

Operations on the heart and blood vessels are performed by such a field of medicine as cardiac surgery.

With the help of cardiac surgeons, many vascular and heart diseases can be effectively treated, thereby significantly prolonging the patient’s life.

Surgeries on the heart and blood vessels can significantly improve the general well-being of the patient.

They should be performed only after careful diagnosis and preparation of the patient.

It is very important to strictly follow all instructions from the specialist.

Regardless of what kind of disease was identified in a person, there are the following general indications for performing operations on the heart and blood vessels:

Rapid deterioration of the patient's condition and progression of the underlying heart or vascular disease.
Lack of positive dynamics from the use of traditional drug therapy, that is, when taking pills no longer helps a person maintain his condition normally.
Availability acute symptoms worsening of the underlying myocardial disease, which cannot be eliminated with conventional analgesics or antispasmodics.
Neglect of the underlying disease, in which the patient delayed contacting a doctor, which led to very severe symptoms diseases.

These procedures are indicated for patients with heart defects (regardless of whether they are congenital or acquired). Moreover, thanks to current techniques this disease can be treated even in newborns, thereby ensuring them a further healthy life.

The next common indication is myocardial ischemia. In this case, surgery may be required when the underlying disease is aggravated by a heart attack. In this state, the sooner it is carried out surgical intervention, the greater the chance that a person will survive.

A significant indication for the need for surgical intervention may be acute heart failure, which provokes improper contraction of the myocardial ventricles. It is important that the patient prepares for surgery in advance (to avoid postoperative complications in the form of a blood clot).

Often surgical intervention is required for myocardial valve defect, which was caused by injury or inflammatory process. Less commonly, other reasons contribute to its appearance.

A serious reason for urgent surgical intervention is the diagnosis of narrowing of the coronary artery valve, as well as endocarditis of infectious origin.

Additional diseases for which a person may require myocardial surgery are:

Severe aortic aneurysm, which may occur due to trauma or be congenital.
Rupture of a ventricle of the heart, which disrupts blood flow.
Different kinds arrhythmias that can be eliminated by introducing or replacing an already installed pacemaker. They are usually used when atrial fibrillation and bradycardia.
Diagnosis of an obstruction in the myocardium in the form of tamponade, due to which the heart cannot normally pump the required volume of blood. This condition can occur under the influence of viral infections, acute tuberculosis and heart attack.
Acute failure left ventricles of the myocardium.

Heart surgery is not always necessary for the indications described above. Each case is individual and only the attending physician can decide what will be best for a particular patient - traditional drug therapy or planned (urgent) surgery.

In addition, it should be noted that heart surgery may be required in case of exacerbation of the underlying disease, as well as if the first surgical intervention did not produce the expected results. In this case, the patient may require repeated manipulation. Its cost and preparation features (diet, medications) depend on the complexity of the operation.

Surgical interventions can be practiced both on open and closed myocardium, when the heart and its cavity are not completely affected. The first type of operation involves dissecting the chest and connecting the patient to artificial respiration equipment.

In open operations, surgeons artificially stop the heart for a while, so that they can perform the necessary surgical procedures on the organ within a few hours. These interventions are considered very dangerous and traumatic, but with their help even very complex myocardial diseases can be eliminated.

Operations closed type more secure. They are usually used to correct minor heart and vascular defects.

The following are the most common types of myocardial operations, which are most often practiced in cardiac surgery:

Installation of artificial valves.
Operations using the Glenn and Ross method.
Coronary artery bypass grafting and arterial stenting.
Radiofrequency ablation.

An operation called radiofrequency ablation is a low-impact procedure that can produce significant improvements in heart failure and different types arrhythmias. She rarely calls side effects and is well tolerated by patients.

RA is done using special catheters, which are inserted under X-ray control. In this case, the patient is given local anesthesia. During this operation, a catheter is inserted into the organ and, thanks to electrical impulses, the person's normal heart rhythm is restored.

The next type of surgery is heart valve replacement. This intervention is very often practiced, since such pathology as myocardial valve insufficiency is extremely common.

It should be noted that in the event of a severe disturbance in the patient’s heart rhythm, he may require the installation of a special device - a pacemaker. It is needed to normalize the heart rhythm.

When replacing heart valves, the following types of implants can be used:

Mechanical prostheses, which are made of metal or plastic. They serve for a very long time (several decades), but require a person to constantly take blood thinners, because due to the introduction foreign object the body actively develops a tendency to form blood clots.
Biological implants are made from animal tissue. They are very durable and do not require reception special drugs. Despite this, patients often require repeat surgery after a couple of decades.

Glenn and Ross operations are usually used to treat children with congenital myocardial defects. The essence of these interventions is to create a special connection for pulmonary artery. After this operation, the child can live a long time, with virtually no need for maintenance therapy.

During the Ross operation, the patient's diseased myocardial valve is replaced with a healthy one, which will be removed from his own pulmonary valve.

Cardiac bypass surgery: indications and performance

Coronary artery bypass surgery is a surgical intervention on the heart, during which an additional vessel is sewn in to restore the impaired blood supply in blocked blood arteries.

Cardiac bypass surgery is practiced when the patient’s narrowed vessels are no longer amenable to drug treatment and blood cannot circulate normally in the heart, causing ischemic attacks.

A direct indication for cardiac bypass surgery is acute coronary aortic stenosis. Most often, its development is caused by an advanced form of atherosclerosis, which contributes to the clogging of blood vessels with cholesterol plaques.

Due to vasoconstriction, blood cannot circulate normally and deliver oxygen to myocardial cells. This leads to its defeat and the risk of a heart attack.

Today, cardiac bypass surgery can be performed both on a beating heart and on an artificially stopped one. It is worth noting that if bypass surgery is performed on a working myocardium, then the likelihood of developing postoperative complications much higher than when performing the procedure on stopped myocardium.

The course of this operation is to block the main aorta and implantation of artificial vessels into the affected coronary arteries. Usually a vessel in the leg is used for bypass surgery. It is used as a biological implant.

Contraindications to this surgical intervention may be an existing pacemaker or artificial valve in the heart, the functions of which may be impaired during such an operation. In general, the need for bypass surgery is determined individually by the doctor for each individual patient, based on the diagnostic data and symptoms of the patient.

After bypass surgery, the recovery period is usually quick, especially if the patient has no complications after the procedure. During the week after surgery, the patient must follow bed rest. Until the stitches are removed, the person needs to dress the wound daily.

After ten days, a person can get out of bed and begin to perform simple physical therapy movements to restore the body.

After the wound has completely healed, the patient is recommended to swim and regularly walk in the fresh air.

It should be noted that the wound after bypass surgery is stitched not with threads, but with special metal staples. This is justified by the fact that the dissection occurs on a large bone, so it needs to heal as carefully as possible and ensure rest.

To make it easier for a person to move after surgery, he is allowed to use special medical support bandages. They have the appearance of a corset and provide excellent seam support.

After surgery, due to blood loss, a person may experience anemia, which will be accompanied by weakness and dizziness. To eliminate this condition, the patient is recommended to eat properly and enrich his diet with beets, nuts, apples and other fruits.

To reduce the likelihood of re-narrowing of blood vessels, you need to completely exclude alcohol, fatty and fried foods from the menu.

Cardiac stenting surgery: indications and features

Arterial stenting is a low-traumatic angioplasty procedure that involves placing a stent into the lumen of the affected vessels.

The stent itself is similar to a regular spring. It is introduced into the vessel after it has been artificially dilated.

Indications for cardiac stenting surgery are:

IHD (coronary heart disease), which leads to poor circulation and oxygen starvation myocardium.
Myocardial infarction.
Clogging of blood vessels with cholesterol plaques, which lead to narrowing of their lumen.

Additional contraindications to this procedure are the patient’s individual intolerance to iodine, which is invariably used during stenting, as well as the case when the total size of the diseased artery is less than 2.5 mm (in this case, the surgeon simply will not be able to install a stent).

The operation of stenting the heart vessels is performed by introducing a special balloon, which will expand the lumen of the diseased vessel. Next, a filter is installed in this place, which prevents subsequent blood clots and stroke.

After this, a stent is introduced into the vessel; it will support the vessel from narrowing, serving as a certain frame.

The surgeon monitors the entire progress of the operation through a monitor. In this case, he will be able to clearly see the stent and the vessel, since at the beginning of the procedure the patient is injected with an iodine solution, which will highlight all the surgeon’s actions.

The advantage of stenting is that this operation has a low risk of complications. Moreover, it is carried out under local anesthesia and does not require a long period of hospitalization.

After stenting, the patient must remain in bed for a certain period of time (usually for a week). After this, if there are no complications, the person is allowed to go home.

It is very important to exercise regularly after this operation. physical therapy and do the exercises. At the same time, it is worth monitoring your condition and avoiding physical fatigue.

Every two weeks after the procedure, the patient must visit the doctor and undergo a follow-up examination. If pain occurs, a person should immediately report it to the doctor.

To recover faster, the patient should take all medications prescribed by the doctor. Sometimes drug therapy lasts for a long time, more than one month in a row.

After stenting, the patient must follow a diet.

It provides the following:

Complete cessation of drinking alcohol and smoking.
Ban on all animal fats. You should also not eat caviar, chocolate, fatty meat and sweet confectionery.
The basis of the diet should be vegetable soups, fruit mousses, cereals and greens.
You need to eat at least six times a day, but the portions should not be large.
You should completely limit your intake of salt and salted fish.
It is important to drink plenty of fluids to maintain normal fluid balance in the body. It is recommended to drink fruit compotes, juices and green tea. You can also use rosehip decoction.

In addition, a person needs to monitor their blood pressure and blood sugar levels. This is especially important in the presence of existing hypertension and diabetes mellitus, because these diseases can worsen the functioning of the heart.

Review

Open heart surgery is a surgical procedure that opens the chest and affects the muscles, valves, or arteries of the heart.

According to the US National Institute of Heart, Pulmonology, and Hematology (NHLBI), coronary artery bypass grafting is the most common heart surgery in adults. During this surgery, a healthy artery or vein is transplanted (attached) to a blocked coronary (heart) artery. As a result, the grafted artery delivers blood to the heart bypassing the blocked artery (NHLBI).

Open heart surgery is sometimes called traditional heart surgery. Today, many new heart procedures require only small incisions rather than large incisions. That is, the concept of open heart surgery can sometimes be misleading.

Causes

Open heart surgery allows for coronary artery bypass grafting. Coronary artery bypass grafting may be required in patients with coronary artery disease.

Coronary artery disease occurs when the vessels that carry blood and oxygen to the heart become narrow and inelastic. This disease is known as atherosclerosis.

Atherosclerosis occurs when fatty deposits create plaque on the walls of the coronary arteries. Plaques narrow the arteries, making it difficult for blood to pass through them. If blood does not flow to the heart properly, it may occur. heart attack.

Open heart surgery is also performed to:

repair or replace blood vessels, allowing blood to pass through the heart; repair damaged or abnormal areas of the heart; install medical devices that will help the heart function properly; replace a damaged heart with a donor one (transplantation).

Operation

According to the National Institutes of Health, coronary artery bypass grafting takes four to six hours. Let's look at what it is, step by step.

The patient receives general anesthesia. He falls asleep and does not feel pain from the operation. By making a 20 to 25 centimeter incision in the chest, the surgeon cuts through all or part of the chest bone to gain access to the heart. Once the heart opens, the patient is connected to a heart-lung machine. It diverts blood away from the heart so the surgeon can operate. Some new technologies make it possible to abandon this device. The surgeon uses a healthy vein or artery to create a new path around the blocked artery. The rib cage is held together with wires that remain inside the body. The initial incision is sutured. (NIH)

A chest plate is sometimes used in high-risk patients, especially in the elderly and in those who have had multiple surgeries. In this case, the breast bone is connected after surgery with small titanium plates.

Risks

Risks of coronary artery bypass grafting:

wound infection of the chest (most common in obesity, diabetes, repeated operations by bypass); heart attack or stroke; heart rhythm disturbance; damage to the lungs or kidneys; chest pain, low-grade fever bodies; memory loss or blurred memories; blood clots; blood loss; difficulty breathing.

According to the University Medical center Chicago (UCM), using a heart-lung machine increases risks. These risks will include stroke and memory problems (UCM).

Preparation

Tell your doctor about all the medications you take, including over-the-counter drugs, vitamins and herbs. Report any health problems, including herpes, infection, colds, flu, fever.

Two weeks before surgery, your doctor may ask you to avoid smoking and stop taking vasoconstrictor medications such as aspirin, ibuprofen, or naproxen.

On the eve of the operation, you will be asked to wash yourself with special soap. It kills bacteria on the skin and reduces the chance of infection after surgery. You may be asked not to eat or drink anything after midnight.

You will receive further instructions when you arrive at the hospital for surgery.

Rehabilitation

When you wake up after surgery, you will have two or three tubes in your chest. They are necessary to remove fluid from the area around the heart.

You may have intravenous tubes that will give you fluids.

You may have a catheter (thin tube) placed in your bladder to drain urine.

You may also have machines connected to you to monitor your heart function. Nurses will be nearby to help you if necessary.

You will most likely spend the first night in the intensive care unit. After three to seven days you will be transferred to a regular ward.

Long

You must be prepared for gradual recovery. Improvement will occur in about six weeks, and after about six months you will feel the full benefits of the operation. So, the outlook is optimistic for many people, the shunt can work for many years.

However, the operation does not exclude re-occlusion of the vessels. The following measures will help maintain your health:

proper nutrition; restriction of salty, fatty and sweet food; maintaining physical activity; to give up smoking; control high blood pressure and cholesterol levels.

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, the person feels unwell and serious complications begin to develop. 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.

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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 of drug therapy.

Such studies include:

Angiography. This is a method for which a contrast agent is used. It is injected into the heart cavity or vessel for accurate visualization and determination 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 necessary, and if not, what therapy is suitable for of this patient. Ventriculography. This is a study using an x-ray contrast method, which will determine the condition of the ventricles and the presence of pathology. All ventricular parameters can be studied, such as cavity volume measurements, cardiac output, measurements of cardiac relaxation and excitability.

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

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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 which method surgical treatment 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. To do this, use the femoral vein (right), a needle is inserted into it through which a conductor passes. The needle diameter becomes about 2 mm.

By doing invasive studies 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.

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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:

Valve replacement (prosthetics)

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

Valve implant placement

Plastic surgery of septal defects

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

Valvuloplasty

In this type of operation, implants are not used, but simply expand the lumen of the affected valve. In this case, a balloon is inserted into the lumen of the valve and inflated. It should be noted that such an operation is performed only on young people; as for older people, they are only entitled to open-heart surgery.

Balloon valvuloplasty

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.

Aortic dissection

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 portion of the 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.

Coronary artery bypass grafting

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.

Radiofrequency catheter ablation

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 performed in the neck area and there are 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 the inner shell; this is done with special stitches. 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, therapeutic diets, etc. are prescribed.

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 positioning 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 is needed, that is, maintenance therapy. 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

Name of the clinic Address and telephone Type of service Cost

Research Institute of SP named after. N. V. Sklifosovsky	Moscow, Bolshaya Sukharevskaya square, 3	CABG without IR CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valve plastic surgery	64300 rub. 76625 rub. 27155 rub. 76625 rub. 57726 rub. 64300 rub. 76625 rub.
KB MSMU im. Sechenov	Moscow, st. B. Pirogovskaya, 6	CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valvoplasty Aneurysm resection	132,000 rub. 185500 rub. 160,000-200,000 rub. 14300 rub. 132200 rub. 132200 rub. 132000-198000 rub.
FSCC FMBA	Moscow, Orekhovy Boulevard, 28	CABG Angioplasty and stenting of coronary arteries RFA Aortic stenting Valve replacement Valve plastic surgery	110000-140000 rub. 50,000 rub. 137,000 rub. 50,000 rub. 140,000 rub. 110000-130000 rub.
Research Institute of SP named after. I.I. Dzhanelidze	St. Petersburg, st. Budapestskaya, 3	CABG Angioplasty and stenting of coronary arteries Aortic stenting Valve replacement Valve plastics Multivalve replacement Probing of cardiac cavities	60,000 rub. 134400 rub. 25,000 rub. 60,000 rub. 50,000 rub. 75,000 rub. 17,000 rub.
St. Petersburg State Medical University named after. I.P. Pavlova	St. Petersburg, st. L. Tolstoy, 6/8	CABG Angioplasty and stenting of coronary arteries Valve replacement Multivalve replacement RFA	187000-220000 rub. 33,000 rub. 198000-220000 rub. 330,000 rub. 33,000 rub.
Sheba MC	Derech Shiba 2, Tel Hashomer, Ramat Gan	CABG Valve replacement	$30,000 $29,600
MedMira	Huttropstr. 60, 45138 Essen, Germany 49 1521 761 00 12	Angioplasty CABG Valve replacement Cardiac examination Coronary angiography with stenting	8000 euros 29000 euros 31600 euros 800-2500 euros 3500 euros
Greekomed	Central Russian office: Moscow, 109240, st. Verkhnyaya Radishchevskaya, house 9 A	CABG valve replacement	20910 euros 18000 euros

Do you still think that it is impossible to get rid of HEART DISEASE!?

Do you often experience discomfort in the heart area (pain, tingling, squeezing)? You may suddenly feel weak and tired... You constantly feel high blood pressure... There is nothing to say about shortness of breath after the slightest physical exertion... And you have been taking a bunch of medications for a long time, going on a diet and watching your weight...

Bondarenko Tatyana

Project expert DlyaSerdca.ru

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

Angiography is a method of examining blood vessels using x-rays and contrast fluid. It is used to identify damage and defects. Without it, the operation I am about 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 entire post.

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

Before the advent of the stenting method, which will be discussed, doctors only had surgical method bypass surgery, who became popularly famous thanks to Boris Nikolaevich Yeltsin’s heart surgery in 1996 in a round operating room. I remember this incident vividly (a childhood memory), although a similar operation was performed on many famous people.

Bypass surgery is a cavity operation. The person is given anesthesia, the chest is sawed open (they actually saw it, it can’t be done with just a scalpel), the heart is stopped and the artificial circulation system is started. The beating heart beats very hard and interferes with the operation, so it has to be stopped. To get to all the arteries and bypass, you need to take out the heart and turn it over. A shunt is a donor artery taken from the patient himself, for example, from the arm. Quite a stress for the body.

During stenting, the patient remains conscious (everything happens under local anesthesia), can hold his breath or do deep breaths at the doctor's request. Blood loss is minimal, and the incisions are tiny, because the arteries are penetrated through a catheter, which is usually installed in femoral artery. And a stent is placed - a mechanical dilator of blood vessels. All in all, an elegant operation (-:

The operation was performed on Sergei Iosifovich in three stages. I found myself on the final operation in the series. It is not possible to 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-ray images of the heart from different angles.

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

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

It works quite simply. There is an emitter installed at the bottom, and a converter at the top (a smile is glued to it), from which the signal with the image is already transmitted to the monitor. Scattering x-rays does not actually occur in space, but everyone present in the operating room is protected. About eight such operations are performed per day.

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

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

A 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 structure is no thicker than the conductor itself.

This is what the deployed stent looks like.

And this is a scale model of a different type of stent. In cases where the walls of blood vessels are damaged, those with a membrane are installed. They not only maintain the vessel in an open state, but also act as vessel walls.

An iodinated contrast agent is injected through the same catheter. With the blood flow it fills the coronary arteries. This allows the X-ray to visualize them and calculate the sites of blockage where stents will be placed.

This is what the Amazon basin looks like when you inject contrast.

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

After the stent is delivered to the site, the balloon on which it is attached must be inflated. This is done using a device with a pressure gauge (pressure meter). This device, similar to a large syringe, is visible in the photo with long conductor wires.

The stent is expanded and pressed into inner wall vessel. For full confidence Once 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 placed one after another overlapping.

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, underneath it. Due to the plaque, the blood flow is completely blocked.

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

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

The concept of expanding the affected areas of the vessel using a certain frame was proposed forty years ago by Charles Dotter. 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. It was only in 1993 that the effectiveness of the method for restoring the patency of the coronary artery and maintaining it in a new state in the future was proven.

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

The operation lasts about half an hour. A pressure bandage is applied to the arterial puncture site. From the operating room, the patient is sent to the intensive care ward, and two hours later to the general ward, from where he can write joyful text messages to his family with all his might. 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, and the person returns to ordinary life, and observation is carried out periodically by a doctor at the place of residence.

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

Disease 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 and then developed an uncomfortable feeling of tightness 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 advice from a therapist.

Thomas's high blood pressure, obesity and long history of smoking were enough reason to get an EKG. Her results showed the presence of coronary heart disease. Thomas was referred to a cardiac expert (a physician who specializes in heart problems - not a surgeon). Despite the drug treatment, the pain continued.

Tests confirmed the presence of the disease, including an angiogram (a test using dye injected into an artery to identify narrowing) that revealed a narrowing in the left main coronary artery, affecting both the left and right vessels. Because drug treatment was unsuccessful and angioplasty (stretching the narrowed vessel using a catheter) was not an option, Mr. Thomas was referred for surgery.

Monday

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

Tuesday

Early in the morning, Mr. Thomas is prepped for surgery.

7:05 Premedication and anesthesia

8:15 Mr. Thomas was premedicated 70 minutes ago and a ventilation tube is already in place. Airways. After applying anesthesia and paralyzing agents, his breathing is supported by a ventilator. Before Mr. Thomas is transferred to the operating room, the anesthesiologist monitors the venous and arterial blood flow.

8:16 The operating room is ready for Mr. Thomas. On the left is a table with instruments, on the right is a ready-to-use heart-lung apparatus.

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

8:40 Chest opening

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

8:48 The surgeon separates the breastbone with a pneumatic electric saw.

8:55 Artery and vein removal

View of the internal mammary artery in the mirror in the center of the surgical lamp. This artery is very elastic. The top end 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 elevate it and expose the mammary artery running along the sternum. inside breasts

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

9:05 Connection 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, and the rest are used as side pumps to transport the separated blood to prevent blood loss during surgery. The patient must be given heparin, a drug that thins the blood and prevents the formation of clots as it passes through plastic tubes.

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

Part of the heart-lung machine 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

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

A thorough check of the heart is performed to confirm the findings from the angiogram. It is clarified 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 incision is made using a surgical loop at the bypass site.

10:00 First bypass

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

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

Position of the first shunt performed. The lower end of the left internal mammary artery, a 3 mm blood vessel, is completely sutured to the left anterior descending artery.

10:22 Second bypass

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

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

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

11:18 Closing the chest

Blood circulation is restored, the heart contracts after the electric shock with a transition from ventricular fibrillation to sinus mode. Two drains are installed in the front and back parts hearts. The blood thinning effect of heparin was eliminated by the drug protamine. The surgeon stitches the separated halves of the sternum. He will close the skin with an internal absorbable suture.

The nurse places tape on the stitch and on the drainage tubes leading from the patient's chest. The patient will soon be admitted to the intensive care ward, where he will be observed.

The human body. Outside and inside. №1 2008