Open heart surgery. Types of heart operations - indications for performance. Types of artificial valves

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, by expanding the balloon, they 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 the X-ray surgery 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 venous 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.

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

Indications for surgical treatment

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

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

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

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

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

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

Operation types

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

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

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

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

• radiofrequency ablation;
• coronary artery bypass grafting;
• valve prosthetics;
• Operation Glenn and Operation Ross.

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

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

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

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

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

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

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

Such surgical manipulations are within the competence of cardiac surgeons, and are one of the most complex in nature. Heart surgery is a last resort in the treatment of serious cardiovascular diseases, which are resorted to in order to improve the quality of life of the patient, and sometimes even save his life.

In Russia, this type of surgical intervention is not practiced as often as, for example, in America or in European countries. First of all, this is due to the cost of such treatment: not every citizen of the Russian Federation is able to pay the costs of the operation out of his own pocket.

At the same time, this branch of medicine in domestic medical institutions is constantly developing, which makes it possible for patients to receive qualified advice and assistance when applying.

When is heart surgery performed - indications and timing

The main pathologies that may require surgical intervention are:

• Poor myocardial blood supply. A similar condition in medical circles is called coronary heart disease. IHD can lead to the formation of an aneurysm, extensive thrombosis. With all the described ailments, certain surgical procedures on the heart may be required.
• Heart defects that have both innate and acquired nature. Many defects in the structure of the heart valve are incompatible with life. Therefore, such pathologies are diagnosed even in the prenatal period, and the operation itself is carried out in the first days of the baby's life.
• Failures in the frequency, sequence and rhythm of heart contraction, - arrhythmias.

Common indications for heart surgery are the following pathological conditions:

1. Active deterioration of vital signs against the background of the development of underlying heart disease.
2. The inability of drug therapy to cope with the manifestations of the disease.
3. Noticeable deterioration in the functioning of the heart muscle that cannot be eliminated with medications.
4. advanced stage of the disease. This happens when the patient does not seek qualified help in time.

It should also be taken into account that any surgical manipulations on the heart carry a risk and are fraught with the development of a number of exacerbations in the rehabilitation period. Doctors turn to such treatment when other measures do not bring the desired effect.

In addition, heart surgery requires a comprehensive examination of the patient and careful preparation for the operation. This will ensure a successful recovery and minimize the likelihood of postoperative complications.

Based on the patient's condition, the type of surgical intervention under consideration is:

• emergency. In such a situation, examination and preparation are carried out in a minimal amount, and the operation itself is carried out as soon as possible. This type of manipulation is prescribed for life-threatening conditions, when every minute counts: with aneurysm rupture, extensive myocardial infarction. Often, emergency interventions on the heart are performed on newborns with complex heart disease.
• Urgent. There is time for diagnostic and preparatory measures, but not much. After receiving the results of the examination, surgical treatment of the heart disease is carried out.
• planned. In some medical sources, this type of operation is called elective. After a detailed study of the patient's condition by a cardiac surgeon, a final decision is made on the need for surgical intervention. Together with the patient or his parents (when operating on a child), the exact date of the operation is agreed.

Closed and open heart surgeries - how they are performed and to whom they are prescribed

Based on the type of defect that needs to be eliminated, various methods of surgical intervention are used:

Note!

Not so long ago, a new direction in the treatment of heart defects began to be applied in cardiac surgery - X-ray surgery. In essence, they are minimally invasive - the doctor makes small incisions or punctures, and brings special instruments to the heart zone through the catheter. An access point can be, incl. and femoral vessels. Using cans, you can increase the diameter of the narrowed valve - or reduce it by opening the patch (its design is similar to an umbrella). With the help of expanding tubules, vascular stenosis is eliminated.

The progress of the entire procedure is monitored through the monitor screen - this ensures the effectiveness of the operation, as well as its safety for the patient. In addition, during the manipulation under consideration, general anesthesia is not used: the doctor is limited to anesthesia with mini-accesses.

X-ray surgery can be both the main and auxiliary methods of treating errors in the work of the heart.

Most popular types of heart surgery

To date, the following operations are used in cardiac surgery practice:

1. With coronary heart disease:

2. In case of diagnosing heart disease:

3. In the presence of arrhythmia:

In cases where the treatment of individual anatomical structures of the heart is impossible or ineffective, and the main organ for pumping blood cannot cope with its main function, they perform heart transplant .

This operation is fraught with a number of complications, among which is graft rejection.

Today, scientists are conducting research to maximize the life extension of those who have survived heart transplants.

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 below the site of 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.