Operations on the heart and blood vessels: types, features. Open Heart Surgery Where is Heart Surgery Performed?

Heart valve replacement has been carried out everywhere for many years and has proven to be a safe and very effective operation to restore normal hemodynamics in the heart and the body as a whole.

Throughout life, valves are in constant operation, opening and closing billions of times. By old age, some wear of their tissues may occur, but its degree does not reach critical. Much more damage to the state of the valvular apparatus is caused by various diseases - atherosclerosis, rheumatic endocarditis, bacterial damage to the valves.

age-related changes in the aortic valve

Valvular lesions are most common among the elderly, the cause of which is atherosclerosis, accompanied by deposition of fat-protein masses in the valves, their compaction, calcification. The continuously recurrent nature of the pathology causes periods of exacerbations with damage to the valve tissues, microthrombosis, ulceration, which are replaced by remission and sclerosis. The proliferation of connective tissue ultimately leads to deformation, shortening, compaction and reduced mobility of the valve leaflets - a defect is formed.

Among young patients in need of artificial valve transplantation, mostly patients rheumatism. The infectious-inflammatory process on the valves is accompanied by ulceration, local thrombosis (warty endocarditis), necrosis of the connective tissue that forms the basis of the valve. As a result of irreversible sclerosis, the valve changes its anatomical configuration and becomes unable to perform its function.

Defects of the valvular apparatus of the heart lead to a total violation of hemodynamics in one or both circles of blood circulation at once. With the narrowing of these openings (stenosis), there is no complete emptying of the cavities of the heart, which are forced to work in an enhanced mode, hypertrophying, then depleting and expanding. In case of valve insufficiency, when its valves do not close completely, part of the blood returns in the opposite direction and also overloads the myocardium.

An increase in heart failure, stagnation in a large or small circle of blood flow provoke secondary changes in the internal organs, and are also dangerous for acute heart failure, therefore, if measures are not taken in time to normalize intracardiac blood flow, the patient will be doomed to death from decompensated heart failure.

The traditional valve replacement technique involves open access to the heart and its temporary shutdown from circulation. Today, more gentle, minimally invasive methods of surgical correction are widely used in cardiac surgery, which are less risky and as effective as open surgery.

Modern medicine offers not only alternative methods of operations, but also more modern designs of the valves themselves, and also guarantees their safety, durability and full compliance with the requirements of the patient's body.

Heart surgeries, no matter how they are performed, carry certain risks, are technically complex and require the participation of highly qualified cardiac surgeons working in a well-equipped operating room, so they are not performed just like that. With heart disease, for some time, the organ itself copes with the increased load, as its functional abilities are weakened, drug therapy is prescribed, and only if conservative measures are ineffective, the need for surgery arises. Indications for prosthetic heart valves are:

• Severe stenosis (narrowing) of the valve opening, which cannot be eliminated by simple dissection of the valves;
• Stenosis or insufficiency of the valve due to sclerosis, fibrosis, calcium salt deposits, ulceration, shortening of the valves, their wrinkling, limitation of mobility for the above reasons;
• Sclerosis of the tendon chords, disrupting the movement of the valves.

Thus, the reason for surgical correction is any irreversible structural change in the components of the valve, which makes the correct unidirectional blood flow impossible.

There are also contraindications for heart valve replacement surgery. Among them are the serious condition of the patient, the pathology of other internal organs, making the operation dangerous for the life of the patient, severe blood clotting disorders. An obstacle to surgical treatment may be the patient's refusal to operate, as well as the neglect of the defect, when intervention is inappropriate.

The mitral and aortic valves are most often replaced, they are also usually affected by atherosclerosis, rheumatism, and a bacterial inflammatory process.

Depending on the composition, the heart valve prosthesis is mechanical and biological. Mechanical valves made entirely of synthetic materials, they are metal structures with semicircular doors moving in one direction.

The advantages of mechanical valves are their strength, durability and wear resistance, the disadvantages are the need for lifelong anticoagulant therapy and the possibility of implantation only with open access to the heart.

biological valves consist of animal tissues - elements of the pericardium of a bull, valves of pigs, which are fixed on a synthetic ring that is installed in the place where the heart valve is attached. Animal tissues in the manufacture of biological prostheses are treated with special compounds that prevent immune rejection after implantation.

The advantages of a biological artificial valve are the possibility of implantation during endovascular intervention, the limitation of the period of taking anticoagulants within three months. Rapid wear is considered a significant drawback, especially if the mitral valve is replaced with such a prosthesis. On average, a biological valve works for about 12-15 years.

The aortic valve is easier to replace with any type of prosthesis than the mitral valve, therefore, when the mitral valve is damaged, different types of plasty (commissurotomy) are first resorted to, and only if they are ineffective or impossible, the possibility of a total valve replacement is decided.

Preparing for valve replacement surgery

Preparation for surgery begins with a thorough examination, including:

1. General and biochemical blood tests;
2. Urinalysis;
3. Determination of blood clotting;
4. electrocardiography;
5. Ultrasound examination of the heart;
6. Chest X-ray.

Depending on the accompanying changes, the list of diagnostic procedures may include coronary angiography, vascular ultrasound, and others. Mandatory consultations of narrow specialists, conclusions of a cardiologist and therapist.

On the eve of the operation, the patient talks with the surgeon, the anesthetist, takes a shower, dinner - no later than 8 hours before the start of the intervention. It is advisable to calm down and get enough sleep, many patients are helped by talking with the attending physician, clarifying all questions of interest, knowing the technique of the upcoming operation and getting to know the staff.

Technique for heart valve replacement surgery

Heart valve replacement can be performed through open access and in a minimally invasive way without incision of the sternum. Open operation performed under general anesthesia. After immersing the patient in anesthesia, the surgeon treats the operating field - the anterior surface of the chest, dissects the sternum in the longitudinal direction, opens the pericardial cavity, followed by manipulations on the heart.

prosthetic heart valve

To disconnect the organ from the blood flow, a heart-lung machine is used, which allows implanting valves on a non-working heart. In order to prevent hypoxic damage to the myocardium, it is treated with cold saline throughout the operation.

To install the prosthesis, the necessary cavity of the heart is opened using a longitudinal incision, the altered structures of its own valve are removed, an artificial valve is installed in its place, after which the myocardium is sutured. The heart is “started” with an electrical impulse or with direct massage, artificial circulation is turned off.

After the artificial heart valve is installed and the heart is sutured, the surgeon examines the cavity of the pericardium and pleura, removes blood and sutures the surgical wound in layers. To connect the halves of the sternum, metal brackets, wire, screws can be used. Ordinary sutures or cosmetic intradermal sutures with self-absorbable threads are applied to the skin.

Open surgery is very traumatic, so the operational risk is high, and postoperative recovery takes a long time.

endovascular aortic valve replacement

Endovascular technique valve replacement shows very good results, it does not require general anesthesia, so it is quite feasible for patients with severe comorbidities. The absence of a large incision allows you to minimize the stay in the hospital and subsequent rehabilitation. An important advantage of endovascular prosthetics is the possibility of performing surgery on a beating heart without the use of a heart-lung machine.

With endovascular prosthetics, a catheter with an implantable valve is inserted into the femoral vessels (artery or vein, depending on which cavity of the heart needs to be penetrated). After the destruction and removal of fragments of your own damaged valve, a prosthesis is installed in its place, which straightens itself thanks to a flexible stent-frame.

After installing the valve, stenting of the coronary vessels can also be performed. This possibility is very relevant for patients in whom both valves and vessels are affected by atherosclerosis, and in the process of one manipulation two problems can be solved at once.

The third option for prosthetics is from a mini-access. This method is also minimally invasive, but an incision of about 2-2.5 cm is made on the anterior chest wall in the projection of the apex of the heart, a catheter is inserted through it and the apex of the organ to the affected valve. Otherwise, the technique is similar to that for endovascular prosthetics.

Heart valve transplantation is in many cases an alternative to heart valve transplantation, which can significantly improve well-being and increase life expectancy. The choice of one of the listed methods of operation and the type of prosthesis depends both on the patient's condition and on the technical capabilities of the clinic.

Open surgery is the most dangerous, and endovascular technique is the most expensive, but, having significant advantages, it is the most preferable for both young and elderly patients. Even if there are no specialists and conditions for endovascular treatment in a particular city, but the patient has the financial opportunity to go to another clinic, then it should be used.

If aortic valve replacement is required, mini-access and endovascular surgery are preferred, while mitral valve replacement is more often performed by an open method due to its location inside the heart.

Postoperative period and rehabilitation

The operation to replace the heart valve is very painstaking and time-consuming, it lasts at least two hours. After its completion, the operated person is placed in the intensive care unit for further observation. After a day and with a favorable condition, the patient is transferred to a regular ward.

After an open operation, the sutures are processed daily, they are removed on the 7-10th day. All this period requires a stay in the hospital. With endovascular surgery, you can go home already for 3-4 days. Most patients note a rapid improvement in well-being, a surge of strength and energy, ease in performing ordinary household activities - eating, drinking, walking, showering, which previously provoked shortness of breath and severe fatigue.

If during prosthetics there was an incision in the sternum, then the pain can be felt for quite a long time - up to several weeks. With strong discomfort, you can take an analgesic, but if swelling, redness progresses in the area of ​​\u200b\u200bthe seam, pathological discharge appears, then you should not hesitate to visit the doctor.

The rehabilitation period takes on average about six months, during which the patient regains strength, physical activity, gets used to taking certain medications (anticoagulants) and regular monitoring of blood clotting. It is strictly forbidden to cancel, independently prescribe or change the dosage of drugs; this should be done by a cardiologist or therapist.

Drug therapy after valve replacement includes:

• Anticoagulants (warfarin, clopidogrel) - for life with mechanical prostheses and up to three months with biological ones under constant coagulation monitoring (INR);
• Antibiotics for rheumatic malformations and the risk of infectious complications;
• Treatment of concomitant angina pectoris, arrhythmias, hypertension, etc. - beta-blockers, calcium antagonists, ACE inhibitors, diuretics (most of them are already well known to the patient, and he simply continues to take them).

Anticoagulants with an implanted mechanical valve make it possible to avoid thrombosis and embolism, which are provoked by a foreign body in the heart, but there is also a side effect of taking them - the risk of bleeding, stroke, therefore regular monitoring of INR (2.5-3.5) is an indispensable condition for life with a prosthesis.

Among the consequences of artificial heart valve transplantation, the most dangerous are thromboembolism, which is prevented by taking anticoagulants, as well as bacterial endocarditis - inflammation of the inner layer of the heart, when antibiotics are required.

At the rehabilitation stage, some disturbances in well-being are possible, which usually disappear after a few months - six months. These include depression and emotional lability, insomnia, temporary visual disturbances, discomfort in the chest and the area of ​​the postoperative suture.

Life after the operation, subject to successful recovery, is no different from that of other people: the valve works well, the heart too, there are no signs of its insufficiency. However, the presence of a prosthesis in the heart will require changes in lifestyle, habits, regular visits to the cardiologist and control of hemostasis.

The first control examination by a cardiologist is carried out about a month after prosthetics. At the same time, blood and urine tests are taken, an ECG is taken. If the patient's condition is good, then in the future the doctor should be visited once a year, in other cases - more often, depending on the patient's condition. If you need to undergo other types of treatment or examinations, you should always warn in advance about the presence of a prosthetic valve.

Lifestyle after valve replacement requires giving up bad habits. First of all, you should stop smoking, and it is better to do this even before the operation. The diet does not dictate significant restrictions, but it is better to reduce the amount of salt and liquid consumed so as not to increase the load on the heart. In addition, the proportion of foods containing calcium should be reduced, as well as the amount of animal fats, fried foods, smoked meats in favor of vegetables, lean meats and fish.

High-quality rehabilitation after heart valve prosthetics is impossible without adequate physical activity. Exercise helps to increase overall tone and train the cardiovascular system. In the first weeks, do not be too zealous. It is better to start with feasible exercises that will serve as a prevention of complications without overloading the heart. Gradually, the volume of loads can be increased.

So that physical activity does not go to the detriment, experts recommend undergoing rehabilitation in sanatoriums, where exercise therapy instructors will help create an individual physical education program. If this is not possible, then all questions regarding sports activities will be clarified by a cardiologist at the place of residence.

The prognosis after transplantation of an artificial valve is favorable. Within a few weeks, the state of health is restored, and patients return to normal life and work. If the work activity is associated with intensive loads, then a transfer to lighter work may be required. In some cases, the patient receives a disability group, but it is not associated with the operation itself, but with the functioning of the heart as a whole and the ability to perform one or another type of activity.

Patient reviews after heart valve replacement surgery are more often positive. The duration of recovery is different for everyone, but most notice a positive trend already in the first six months, and relatives are grateful to surgeons for the opportunity to extend the life of a loved one. Relatively young patients feel good, some, according to the words, even forget about the presence of a prosthetic valve. Older people have a harder time, but they also notice a significant improvement.

Heart valve transplantation can be done free of charge, at the expense of the state. In this case, the patient is put on a waiting list, and preference is given to those who need an operation urgently or urgently. Paid treatment is also possible, but, of course, it is not cheap. The valve itself, depending on the design, composition and manufacturer, can cost up to one and a half thousand dollars, the operation - starting from 20 thousand rubles. It is difficult to determine the upper threshold for the cost of the operation: some clinics charge 150-400 thousand, in others the price of the entire treatment reaches one and a half million rubles.

Video: a new method for replacing heart valves

With certain cardiac pathologies, a person is recommended prompt elimination of the problem. For example, taking into account individual indications, a heart valve is replaced. Surgical correction (implantation, etc.) is widespread.

When is valve replacement scheduled?

It is indicated for symptoms suggestive of heart failure:

• the occurrence of shortness of breath;
• cardiac edema, pain;
• tachycardia;
• asthmatic manifestations.

If the effect of therapeutic treatment is insufficient, heart surgery is recommended to restore blood circulation.

The indications for it are:

• birth defects;
• defeat as a result of infection;
• lack of required density;
• violations in the valves (wrinkling, shortening, narrowing of the holes);
• the presence of scar tissue (fibrosis);
• inability to cut adhesions.

The operation is recognized as effective and safe.

aortic valve

This anatomical formation contributes to the cessation of the communication of the left ventricle (LV) with the aorta during the period of relaxation of the heart muscle (diastole). The leaflets of this valve close tightly during the impact of the blood stream, preventing its movement from the aorta back into the ventricle. Its area is normally 3-4 cm².

Congenital or acquired defects provoke a danger:

The combination of these factors causes heart defects.

Aortic heart disease

With deviations from the norm, aortic defects occur: combined, stenosis, insufficiency.

The valve leaflets are spliced ​​to reduce the opening. The removal of blood from the ventricle is difficult.

• LV hypertrophy with the exclusion of arterial hypertension and a septal size of 15 mm or more;
• reduction of the hole area to 1 cm or less.

The pressure in the area between the aorta and the ventricle is more than 40 units.

Failure

The leaflets cannot close completely due to damage, and blood from the aorta is able to penetrate back into the ventricle.

Deficiency indicators for surgery:

• the volume of blood ejection into the aorta is less than 50%;
• the volume of reverse blood flow is more than 60 ml during the period of cardiac contraction;
• expansion of the cavity of the left ventricle up to 75 mm.

An open method of intervention with general anesthesia is practiced.

The combined defect arises as a result of a combination of a stenosis with insufficiency.

mitral valve

It is presented in the form of two valves between the atrium and the left ventricle. Blood flows from the first to the second. When the ventricle is compressed, the valve is closed. Blood at this moment is not pushed into the atrium, but through the aorta into the region of the vessels.

Replacing it with minimally invasive methods takes about three hours.. The open method is used in severe cases.

Correction methods

The endovascular method involves the introduction of a catheter with a prosthesis into the incisions of the femoral artery (or brachial) with local anesthesia. For dangerous defects, endovascular replacement is not applicable.

A minithoracotomy is a replacement of the mitral valve. In this case, a heart-lung machine is used. The chest is not completely opened, only a few incisions are made. Anesthesia is prescribed general.

Types of artificial valves

They differ in composition and method of manufacture.

Biological

The biological valve is made from natural tissues of pigs and other animals and is introduced for up to 15 years. After that, the replacement is repeated.

Advantages: no opening of the chest is required, the appointment of anticoagulants is provided only for 3 months.

Disadvantage: quick wear (12-15 years).

Mechanical

It is specially made using hypoallergenic materials such as plastic and metal. Such valves are installed indefinitely.

Advantages: durability, stability.

Disadvantages: obligatory provision of open access to the heart, lifelong anticoagulant therapy.

Donor valves are rarely practiced.

Features of preparation for surgery

In preparation for the operation, the following recommendations should be followed:

1. Conduct appropriate diagnostics, which may include:
   • echocardiography;
   • laboratory tests of urine, blood (general and biochemical tests);
   • chest x-ray;
   • blood clotting test;
   • Ultrasound of the heart.
2. Take advantage of the advice of specialists who will be directly involved in the operational process:
   • anesthetist;
   • cardiologist;
   • surgeon;
   • specialist in respiratory therapy;
   • middle medical staff.
3. For 8 hours before the operation, completely refuse food. Before this, during the day, eat light food to avoid overloading the heart.
4. Prepare psychologically, enlist the support of relatives.

Before the operation, you should rest, sleep. Take a shower no later than 8 hours before the intervention.

Priority for surgery and its cost

Prosthetic heart valves can be done free of charge, at the expense of the state. But for this you need to register in the queue. Benefits are available for emergencies.

Paid options are faster, but they are expensive.

The average cost of an implant is about one and a half thousand dollars, the operation itself is estimated from 70 to 400 thousand rubles, in some clinics and more.

Cardiac pathologies requiring surgical intervention are diseases subject to quotas. However, each clinic is issued by the Ministry of Health of the Russian Federation only a certain number of budget quotas, which are distributed by the commission.

Operation sequence

The operation to replace the heart valve begins after special preparation (breathing exercises, enema, etc.) and the introduction of anesthesia devices.

Difficulty in aortic valve replacement

Prosthetics of the aortic valve of the heart is carried out on an open organ. After opening the chest, the heart is connected to artificial blood flow. Without mandatory disclosure, the procedure is performed in a serious condition of the patient, unstable hemodynamics.

The methods of such surgical intervention provide access to the organ through the area of ​​the femoral vein. The process is monitored on a special screen using vessel contrasting.

The biological material allows, after taking anticoagulants for a three-month period after the operation, to subsequently do without them.

Operation steps

After special preparation (it is described above) and the introduction of general anesthesia, surgical intervention involves the following steps:

• processing of the surgical field;
• longitudinal dissection of the sternum, opening of the pericardial cavity;
• connection of the artificial blood circulation mechanism;
• manipulations on the heart (removal of the affected valve);
• installation (implantation) of an artificial prosthesis;
• control of the functions of the implanted prosthesis, checking the seams;
• turning off artificial blood flow, "starting" the heart;
• suturing.

The procedure takes place under general anesthesia. Myocardial treatment throughout the operation (at least 2 hours) is performed with cold saline.

At the end of the process, the operated person is sent to the intensive care unit. He is not allowed to get up for two days. Initially, pain behind the sternum persists, high fatigue. On the fifth day, the patient can be discharged. Seams are processed daily. They are removed for 7-10 days.

Recovery after surgery

Modern valve implantation operations are performed with minimal risk. A person is discharged from the hospital on the fifth or sixth day, if there are no complications. However, the person undergoing this procedure must change their lifestyle.

Rehabilitation after surgery is important. The motor mode should be gentle:

• when planting, keep your legs at a right angle in the area of ​​\u200b\u200bthe knees, do not cross them;
• before getting up from a chair, you should move to the edge;
• before getting out of bed, first roll onto your side;
• to lift objects from below, do not bend over, but sit down.

New movements should be added gradually, in a gentle mode. At first, the legs may swell, sleep and appetite may be disturbed, visual disturbances may occur.

Bouts of depression can be replaced by excessive cheerfulness. But these phenomena are temporary. Life after surgery quickly returns to normal.

With proper rehabilitation, after a few months (six months), the patient restores normal heart function and feels healthy.

It is important to undergo annual scheduled examinations, treatment, ensure proper dietary nutrition, and practice restorative physical education, which is important for breathing. For 2-4 weeks, you must follow the rehabilitation instructions prescribed by the doctor, control the fluid balance, and regularly monitor your health.

Annual surveys

They are shown to everyone who has gone through such an operation. Dispensary cardiological supervision includes:

• echocardiography (EchoCG);
• blood tests (clinical, biochemical);
• x-ray.

In addition, an INR test is performed monthly, reflecting the indicators of the blood coagulation system. During the consultation, the attending physician may prescribe medications, antibiotics, immunostimulants.

Foods and medicines rich in calcium are prohibited. In case of any deterioration in well-being, a doctor should be consulted without delay.

Diet after surgery

There are no strict restrictions in nutrition, but it is not recommended to abuse the intake of individual products.

• salt;
• coffee drinks;
• animal fats;
• carbohydrates.

• vegetable oils;
• fresh fruits and vegetables;
• fish.

In general, the diet is not strict, with standard recommendations. Alcohol consumption should be kept to a minimum. Smoking should also be limited.

Physical exercise

Activity in the post-rehabilitation period is practically unlimited. Only excessive loads and competitive sports should be excluded.

Consulting a doctor will help each individual in these matters. Recommended exercises, walking with increasing load, walking.

Physical activity has a positive effect on the state of blood vessels, the heart, strengthens the body as a whole. There are cases of returning to professional sports after surgery.

Complications and consequences of the operation

After surgical valve replacement, consequences and complications are possible. The most common are:

• instability of the surgical wound;
• migration of the implanted prosthesis;
• stroke, heart attack;
• complications due to prolonged immobility.

With any operation, there is a certain risk. To prevent thromboembolic complications and bleeding, anticoagulants with an individually selected dose are prescribed.

In any case, implanted prostheses are foreign bodies that can affect blood clotting and the formation of blood clots.

On the appointment of disability and forecasts

Non-working group II is determined for a period of one year after the completion of the operation to restore the myocardium. In the future, it is possible to transfer to group 3.

When establishing disability, cognitive deviations (reduction of mental abilities) are taken into account individually.

How long do they live with an artificial valve? The average life expectancy in this case is approximately 20 years. However, theoretically, the life of the valve is much longer (up to 300 years, according to doctors).

Contraindications for surgery

During surgery, there are always risks. Therefore, diseases of the internal organs can become an obstacle to the implementation of surgical intervention:

• severe heart disease;
• damage to the valve tissue of an infectious nature;
• thrombosis;
• exacerbation of rheumatism;
• complex valve deformity.

An obstacle may also be the patient's unwillingness, the neglect of the pathology. The main thing is to calculate the expediency and save life.

Heart valve surgeries are not uncommon these days. They are carried out regularly and successfully, thanks to the constant modernization of the process.

If the operation is performed out of time, there is a risk of developing pathologies due to the expansion of the left ventricle. This aggravates heart failure. With a quality operation, you will no longer have to experience pain. Forecasts are favorable. Only a scar will remind you of the transferred procedure.

Despite the fact that medical scientists are working to improve the technique of heart valve transplant surgery (biological and mechanical), and constantly create progressive versions of artificial valves, complications sometimes occur after heart valve replacement surgery.

Postoperative complications

Complications should not be confused with the process of wear of an artificial valve, which eventually becomes unusable. So, biological valves begin to function worse gradually, over 5–10 years, and mechanical valves can “work” without problems for 20–25 years, however, in this case, a person will have to constantly take anticoagulants (when transplanting biological valves, this is not required) .

Given the above trends, doctors recommend, in the process of treating heart disease, if necessary, that biological valves be transplanted to the elderly, for whom a ten-year valve life is acceptable, and besides, they do not have to drink additional drugs. Young patients are offered mechanical valves that do not fail for more than 20 years, although at the same time they have to prescribe drugs that prevent blood clotting .

Important: heart attack and stroke are the cause of almost 70% of all deaths in the world!

Hypertension and pressure surges caused by her in 89% of cases the patient is killed with a heart attack or stroke! Two-thirds of patients die in the first 5 years of the disease!

Death statistics during surgery

In people under 50 years of age, heart valve replacement surgery is usually uneventful, and the mortality rate does not exceed 1 percent. However, the older the patient, the higher the chance of dying during this heart surgery.

Mortality during heart valve replacement surgery:

Given the statistics and the fact that mechanical valves fail much less often, doctors decide which valve (biological or mechanical) to replace the “failed” patient's own heart valve.

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Complications after surgery

Any heart surgery is a complex surgical procedure that can sometimes become complicated, causing unforeseen problems.

Growth of scar tissue - in some patients, at the site of valve replacement, there is a rapid growth of fibrous scar tissue. This can happen with both a seated biological valve and a transplanted mechanical valve. This complication leads to thrombosis of the artificial valve and will require repeated emergency surgery. However, after 2008, there was no report of this complication, that is, modern methods for carrying out the transplant procedure make it possible to avoid this scourge.

Bleeding as a result of taking anticoagulants - in the people, anticoagulants are called drugs that "thinn" the blood, but to be precise, these pharmacological agents do not make the blood more "fluid", they prevent the formation of blood clots, increasing the time of blood clotting. This property of anticoagulants makes it possible for blood, in any case, even if a clot begins to form in close proximity to the valve, to “wash it away” from the valve before it turns into a blood clot.

However, it happens that people who take anticoagulants for valve transplantation begin to suffer from bleeding in other organs of their body, and most often this is the stomach. Therefore, all patients are strongly advised to monitor the color of urine and feces (in case of bleeding, they darken) and contact your doctor for any signs of gastric distress.

Thromboembolism - a serious complication caused by valve thrombosis. The symptoms of thromboembolism are:

• dyspnea;
• dizziness;
• clouding of consciousness;
• loss of vision and hearing;
• numbness and weakness all over the body.

If at least one of the above symptoms occurs, the patient should immediately consult a doctor or call an ambulance.

Prosthetic valve infection - any, the most sterile foreign object placed inside a living body, can be subjected to infection. Therefore, if you have a fever, long-term respiratory problems (more than two days), or any infectious diseases, you should consult a doctor who, through tests and other tests (for example, MRI of the heart), will determine whether an infection of the artificial heart valve has occurred, or whether everything went well.

In order to avoid the development of infection of the implant, people with artificial valves, when visiting a dentist, as well as during procedures such as colonoscopy, gastroscopy, angiography, cardiac catheterization, etc., should inform doctors that they have an artificial heart valve. .

You should also be careful with skin infection from any accidental wounds, cuts, abrasions and blisters from shoes.

Hemolytic anemia - this complication occurs extremely rarely and is expressed in damage to a large number of red blood globules in contact with the implanted valve. Symptoms that hemolytic anemia has developed are:

• constant weakness;
• persistent fatigue and lethargy.

Although the symptoms of hemolytic anemia are similar to those of the body's reaction to taking anticoagulants, these complications have completely different mechanics of occurrence and development. Therefore, the patient should not figure out for himself what caused the ailment, but should immediately consult a doctor who, having made a diagnosis, will provide the correct treatment.

What valves to put (video)

The Russian industry produces many different products of the highest quality, which have no analogues in the world. Unfortunately, the same cannot be said for artificial heart valves.

Today, one of the best mechanical heart valves is Carbomedics Tophead. There are other excellent foreign analogues. Unfortunately, this cannot be said about Russian products - they are not so reliable, and they fail and quickly fail. Therefore, if we are talking about a young patient, it is better to pay more and put a European implant.

True, there is hope that soon, on the market of medical products, mechanical heart valves will appear that are not inferior and even superior in quality to foreign ones.

From this article you will learn: how the valve is replaced on the heart, who is assigned this operation. Possible complications, rehabilitation period. Life after such an operation.

Valves are structures that ensure the correct direction of blood flow. There are four valves in the human heart:

1. Aortic.
2. Pulmonary.
3. Mitral.
4. Tricuspid.

Due to various medical conditions, surgery may be required to replace one or more of them. The decision to perform a surgical intervention is made by a cardiologist, and a cardiac surgeon performs the operation. The patient is treated by the attending cardiologist.

Briefly about heart valves: what are they and why are they needed

All valves open during myocardial contraction and close during relaxation of the heart.

Valve arrangement

Structure and functions

When is valve replacement necessary?

The most common indications for replacing any of the valves are:

• insufficiency (when the valve does not close completely, and blood can flow in the opposite direction);
• stenosis (narrowing, due to which it is not able to open normally, and not enough blood moves in the right direction).

Most often, replacement of the aortic or mitral valve is required. Malformations of the tricuspid (tricuspid) usually appear in combination with defects of other valves. This requires the replacement of all valves affected by the disease.

The operation is performed with such a degree of valve damage, in which blood circulation is significantly impaired. The following symptoms appear:

• chest pain;
• fainting;
• dyspnea.

The doctor can also inform the patient about the need for surgery without severe symptoms, based on EchoCG data.

What are the indications for a heart ultrasound to replace a valve?

Another indication for valve replacement is infective endocarditis. With this disease, surgery is needed if:

• two weeks of antibiotic treatment had no effect;
• rapidly progressing heart failure;
• an intracardiac abscess appeared;
• blood clots form in the heart.

Contraindications

The operation cannot be performed with such pathologies:

• acute myocardial infarction;
• stroke;
• exacerbation of severe chronic diseases (diabetes mellitus, bronchial asthma, etc.).

Types of artificial valves, their features

They can be divided into two groups:

1. Mechanical.
2. Biological.

The latter are produced from animal tissues: the endocardium of pigs or the pericardium of calves.

For aortic valve defects, the Ross operation is popular, when a pulmonary valve is installed in place of the aortic valve (it is replaced with a biological prosthesis).

Advantages and disadvantages of biological prostheses:

Advantages and disadvantages of mechanical prostheses:

The feasibility of using different valves:

How is the operation performed

On the eve of surgery to replace the valve, the patient is prescribed sedatives.

12 hours before the manipulation you can not eat. Also stop taking any medications.

The operation itself is performed under general anesthesia. Lasts 3-6 hours. The operation is performed on an open heart using a heart-lung machine.

Carrying out heart surgery using a heart-lung machine

The operation is done in several stages:

• preparatory actions (introduction of the patient into deep sleep, preparation of the surgical field, etc.);
• incision and opening of the sternum;
• connecting the patient to a heart-lung machine;
• removal of the diseased valve;
• installation of a mechanical or biological prosthesis;
• disconnection from the heart-lung machine;
• closure of the sternum and suturing.

For the first 2-4 weeks after the operation, you will stay in the clinic in the hospital.

Postoperative period

For the first two days, the patient is prescribed bed rest. During this time, you may have:

• chest pain;
• visual disturbances;
• poor appetite;
• insomnia and drowsiness;
• leg swelling.

Tell your doctor if these signs occur, but don't panic—the symptoms usually go away within a few weeks.

Talk to your doctor about any changes in how you feel.

Possible Complications

The most dangerous complication is the occurrence of blood clots. The risk is higher with a mechanical prosthesis, especially in place of a mitral or tricuspid valve.

To prevent this complication, a constant intake of anticoagulants (Aspirin, Warfarin), as well as injections of Heparin in the postoperative period is necessary.

Infective endocarditis of the installed valve is in second place in terms of frequency of occurrence. The risk is increased with the installation of a biological prosthesis. Endocarditis can also occur during the installation of a mechanical prosthesis. In this case, microorganisms from adjacent tissues penetrate the synthetic material and become even more difficult to reach. This complication is very dangerous and often fatal.

1. Chills.
2. Fever.
3. Violation of the established valve (again there are signs of heart failure).

Treatment of this complication involves antimicrobial therapy, and if it is ineffective, repeated surgical intervention.

To prevent endocarditis, all patients are prescribed antibiotics in the postoperative period.

The prognosis after such heart surgery is favorable. Surgery significantly reduces the risk of death from heart failure and improves quality of life.

Mortality after surgery is only 0.2%. The lethal outcome is mainly associated with thrombosis or endocarditis. Therefore, it is very important to take all the preventive drugs prescribed by the doctor.

Life after surgery

In the first year after valve replacement, you need to go to the doctor for a check-up every month. In the second year - once every six months. Thereafter, once a year.

During the examination, an ECG and EchoCG must be done.

Throughout life, you must follow these rules:

• Give up bad habits and drinking coffee.
• Take anticoagulants prescribed by your doctor.
• Follow a diet: give up fatty, fried, salty, eat more fruits, vegetables and dairy products.
• Work no more than 8 hours a day.
• Sleep at least 8 hours a day.
• Do not lead a sedentary lifestyle, walk more, spend at least 1-2 hours a day in the fresh air.

Physical exercise

Competitive sports and hard work are contraindicated.

It is possible and necessary to perform therapeutic exercises, agreed with the attending physician.

Precautions for future surgeries

Any surgical intervention, even dental, can provoke endocarditis. Therefore, be sure to inform the surgeon that you have undergone heart valve replacement surgery.

To prevent an inflammatory process in the heart, you need to take an antibiotic 30-60 minutes before the surgical procedure. It can be Amoxicillin, Azithromycin, Ampicillin or Cephalexin to choose from. Check this with your doctor first.

Hello! Last year, in October, I was diagnosed with heart disease. Tricuspid insufficiency of the heart valve, and pulmonary hypertension, besides, Raynaud's syndrome. They said for an operation, I went through all the medical examinations and tests. A few days later, I I was supposed to be sent for an operation. But I refused in the last minutes, I was very scared, I don’t know what will happen next. I also have a goiter. What should I do, please tell me, I am completely at a loss.

Hello, Natalia. If your local doctors suggest you have surgery, you need to decide, because over the years complications come, not improvements. But it's up to you to decide.

Good afternoon! Please tell us how to be! The husband is a dynamic patient for 5 years. In 2013, I was diagnosed with infection, endocorditis. I sent documents for valve replacement to the Novosibirsk clinic, but they refused. Now he is in the hospital, there was pulmonary edema. At present, the edema has been eliminated, he was transferred from the intensive care unit to the rheumatology department. There, the Doctor said that “edema is the beginning of the end”, that they can’t help and will be discharged. What should we do? HELP SAVE YOUR HUSBAND. Where can we turn for help?

Hello Veronica. I really sympathize with you, but our site does not keep links with any clinics. You need to search.

It has been 5 months since mitral and aortic valve replacement surgery. He had a long fever and cough, and there was congestion in his lungs and liver. After taking antibiotics for a long time, she coped with these problems. Now, against the background of not feeling bad, there are days when severe shortness of breath appears. Myrcative arrhythmia did not go away. I accept: nebivolol, tlrosemide, lazortan and xarelto. Bio valves. Age 60 years. Periodically, a burning sensation appears in the whole body, or as if under a current. What to do? Thank you.

Lussy, our site does not prescribe treatment, this is unacceptable via the Internet. Based on your comment, an additional face-to-face consultation with a cardiologist is needed regarding the adjustment of the medications taken.

Hello. My mom had heart surgery to replace her mitral valve with an artificial one. The operation was February 8, 2018. And the other day, she started to get really pissed off. What could it be?

Hello Nastya. This may be a circulatory disorder, vasospasm, increased pressure, etc. you need to contact your doctor.

Hello, in 2004 Tetrado fallo was operated on. Now there is insufficiency of the pulmonary valve (I don’t have it, there is a mono-cusp) operation is recommended. I’m very afraid, I have two small children. They said the risk of the operation is very high, I don’t know what to do and how much I can do without it? How dangerous is this operation?

Olga, if they offer help, you need to decide. Any operation is a risk. However, no one can accurately judge the outcome in advance. I wish you more optimism and everything will be fine!

Hello, I had an operation, I changed the valve. Thank you for your support too!

Hello Olga. We are very glad that you dared and changed your life for the better.

There are a lot of reasons for the development of intercostal neuralgia, these are: degenerative processes in the spinal column, especially in chronic or acute form, constant worries and stresses, poisoning of the body with various toxins or chemicals, an acute shortage of vitamin B, which in many cases occurs due to intestinal inability suck it up, etc. others

To eliminate neuralgia, you need to know the exact cause. Eliminates pain with antispasmodic and sedative. For example, spazmolgon plus phytosed.

Try drinking a decoction of several herbs: chamomile and lemon balm. They need to be taken in equal parts, pour boiling water and boil in a water bath for 15 minutes. Next, add a teaspoon of honey. Consume 2 times a day.

Good afternoon, my mother underwent mitral valve prosthetics with a mechanical valve, tricuspid valve plasty. The area of ​​the left atrioventricular orifice was 1.2 cm2, SV = 65. She had restenosis. For the first time in 2007, a closed commissurotomy was performed. As the surgeons said after the operation. She had a big heart (there was hypertrophy). She was operated on, she spoke normally, walked. Then, after 2 days, according to the doctors, her heart stopped, because of this, cerebral edema developed. She was immediately transferred to intensive care. Dad and I are not allowed into intensive care. Doctors say his condition is stable. Tell me please. What could cause cardiac arrest and cerebral edema? I am very worried about her, she is my life, my everything. ((((((((.

Hello Faridun. There can be many reasons for cardiac arrest and the development of cerebral edema, for example, a sharp violation of blood circulation. It is impossible to state such facts with certainty. You need to believe and hope that everything will work out.

The doctor replaced my mitral and aortic valves. The question in nutrition is whether spices can be eaten.

I was urgently shown an operation to replace the valve, for a year now I have been living without it, I am afraid and I have a job 12 in 12 will I be able to work? And how is the postoperative period?

Hello Victoria. You have to choose between work or health. With heart disease, work for 12 hours is contraindicated. You can't delay the operation. If the valve stops functioning properly, then the person develops heart failure. At the same time, the cardiac muscle wears out, blood stasis forms in all internal organs. As a result: the human body is depleted. Over time, these complications lead to death. Much depends on the professionalism of surgeons and the specific method of installing the prosthesis. The total time of the patient's stay in the cardiac surgery center: from 2 weeks to 1.5 months.
Be healthy!

My husband underwent heart surgery on January 31 to replace the methal valve with an artificial one. Discharged after 5 days with fever. The temperature is right now. They prescribed a drug for the temperature of the suppository Diclofenac or voltaren.
When you make candles, the temperature disappears. When will it be ok?
Maybe instead of Warfarin something better and inexpensive is needed. This drug gives a complication on the stomach. In short, they cut everyone out, but we are not doctors, I don’t know how to care.
The most difficult thing is that the pressure is low. At first it was 80/57, now it's 100/60 and there is an arrhythmia.
Help, plz.

I was in the hospital in (Sklifa)

Lyudmila, Ivanovna, blood pressure can decrease by removing the obstruction to normal blood flow (after mitral valve replacement), which should stabilize over time. In addition, patients after prosthetics receive a lot of drugs, and it is possible that among them there are also those that reduce blood pressure. Check all the drugs that have been prescribed, and if there is an antihypertensive, reduce its intake by 2 times. And for the causes of high body temperature after valve replacement surgery, there can be a lot. Most often it is infective endocarditis, the addition of a respiratory infection (pleurisy, pneumonia, acute respiratory viral infections, etc.), exacerbation of any chronic inflammatory process that exists before surgery. It is important to establish the cause. If the patient was examined by a specialist, the drugs were prescribed, do not change the medicines yourself, just try to give them to your husband after eating, then the effect of irritation of the mucous membrane will be the least.
Be healthy.

Thank you very clearly written in simple words

In contact with

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This is what an open stent looks like.

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

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

Here is such an Amazon basin obtained by injecting contrast.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It is very important to follow all the instructions of the specialist exactly.

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

1. Rapid deterioration of the patient's condition and progression of the underlying disease of the heart or blood vessels.
2. The lack of positive dynamics from the use of traditional drug therapy, that is, when taking pills no longer helps a person to maintain his condition in a normal way.
3. The presence of acute signs of deterioration of the underlying myocardial disease, which cannot be eliminated by conventional analgesics or antispasmodics.
4. The neglect of the underlying disease, in which the patient hesitated to contact the doctor, which led to very severe symptoms of the disease.

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 newborn babies, thereby providing them with a 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 condition, the sooner surgery is performed, the greater the chance that the person will survive.

A significant indication for the need for surgical intervention can be acute heart failure, which provokes abnormal contraction of the myocardial ventricles. At the same time, it is important that the patient prepares for the operation in advance (to avoid postoperative complications in the form of a blood clot).

Often, surgery is required for myocardial valve disease, which was triggered by trauma or an inflammatory process. Rarely, other causes contribute to its appearance.

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

Additional conditions that may require a person to have myocardial surgery include:

• Severe aortic aneurysm, which may result from trauma or be congenital.
• Rupture of the ventricle of the heart, because of which the blood flow was disturbed.
• Various types of arrhythmias that can be eliminated by inserting or replacing an already installed pacemaker. They are commonly used for atrial fibrillation and bradycardia.
• Diagnosis of an obstruction in the myocardium in the form of tamponade, due to which the heart cannot pump the required volume of blood normally. This condition can occur under the influence of viral infections, acute tuberculosis and heart attack.
• Acute insufficiency of the left ventricles of the myocardium.

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

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 give the expected results. In this case, the patient may need to repeat manipulation. Its cost and preparation features (diet, medication) depend on the complexity of the operation.

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

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

Closed type operations are more secure. They are usually used to correct minor heart and vascular defects.

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

• Installation of artificial valves.
• Operations according to the method of Glenn and Ross.
• Coronary artery bypass grafting and stenting of arteries.
• Ablation of radiofrequency type.

An operation called radiofrequency ablation is a low-traumatic procedure that allows you to achieve significant improvements in heart failure and various types of arrhythmias. It rarely causes side effects and is well tolerated by patients.

RA is performed using special catheters that are inserted under X-ray control. The patient is then given local anesthesia. During this operation, a catheter is inserted into the organ and, thanks to electrical impulses, the normal heart rhythm is restored to the person.

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

It should be noted that in the event of a severe failure in the patient's heart rhythm, he may need to install a special device - a pacemaker. It is needed to normalize the rhythm of the heart.

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

1. Mechanical prostheses that are made of metal or plastic. They serve for a very long time (for several decades), however, they require a person to constantly take drugs to thin the blood, because due to the introduction of a foreign object in the body, a tendency to form blood clots actively develops.
2. Biological implants are made from animal tissues. They are very durable and do not require special preparations. Despite this, patients after a couple of decades often require a second operation.

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

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

Cardiac bypass surgery: indications and conduct

Coronary artery bypass grafting is a surgical intervention on the heart, during which an additional vessel is sewn in order to restore the disturbed blood supply in the clogged blood arteries.

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

A direct indication for cardiac bypass surgery is acute coronary aortic stenosis. Most often, a neglected form of atherosclerosis leads to its development, which contributes to 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, heart vessel bypass surgery can be performed both on a beating heart and on an artificially stopped one. At the same time, it should be noted that if shunting is done on a working myocardium, then the likelihood of postoperative complications is much higher than when performing a procedure on a stopped myocardium.

The course of this operation consists in blocking the main aorta and implanting artificial vessels into the affected coronary arteries. Usually, a vessel in the leg is used for shunting. It is used as a biological implant.

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

After bypass surgery, the recovery period is usually fast, especially if the patient does not have any complications after the procedure. Within a week after the operation, the patient must comply with bed rest. Until the stitches are removed, a person needs to do wound dressings daily.

After ten days, a person can get out of bed and begin to perform simple movements of physiotherapy exercises in order to restore the body.

After the wound has completely healed, the patient is advised to go swimming and walk regularly in the fresh air.

It should be noted that the wound after shunting is not sewn with threads, but with special metal staples.. This is justified by the fact that the dissection falls on a large bone, so it needs to grow together as carefully as possible and ensure peace.

To make it easier for a person to move around after the operation, he is allowed to use special medical support bandages. They look like a corset and perfectly support the seams.

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 advised to eat right and enrich his diet with beets, nuts, apples and other fruits.

To reduce the likelihood of re-constriction of blood vessels, alcohol, fatty and fried foods should be completely excluded from the menu.

The operation of stenting of the vessels of the heart: indications and features of the conduct

Arterial stenting is a low-traumatic angioplasty procedure, which involves the imposition of a stent into the lumen of the affected vessels.

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

Indications for cardiac stenting surgery are:

1. IHD (ischemic heart disease), which leads to impaired blood circulation and oxygen starvation of the myocardium.
2. Myocardial infarction.
3. Clogging of blood vessels with cholesterol plaques, which lead to a 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 cannot install the stent).

An operation is performed to stent the vessels of the heart by introducing a special balloon that will expand the lumen of the diseased vessel. Further, a filter is installed in this place, which prevents subsequent blood clots and stroke.

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

The surgeon monitors the entire course of the operation through a monitor. At the same time, he will see the stent and the vessel well, since even at the beginning of the procedure, the patient is injected with an iodine solution, which will reflect all the actions of the surgeon.

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

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

It is very important to exercise regularly after this operation. At the same time, it is worth controlling your condition and not allowing physical overwork.

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

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

Be sure to follow a dietary diet after stenting.

It provides for the following:

• Complete abstinence from alcohol and smoking.
• Ban on all animal fats. Also, you can 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 at the same time, portions should not be large.
• You should completely limit the consumption of salt and salted fish.
• It is important to drink plenty of fluids to maintain normal water balance in the body. It is recommended to drink fruit compotes, juices and green tea. You can also use a rosehip decoction.

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

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

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

Surgery is required for diseases such as:

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

Cardiac ischemia

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

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

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

Types of surgery for coronary heart disease

Angioplasty and stenting of the coronary arteries

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

Coronary artery bypass grafting (ACS)

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

Plastic surgery of postinfarction aneurysm of the left ventricle

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

Heart defects

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

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

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

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

There are the following types of surgical intervention:

Prosthetics and plastic heart valves

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

Mechanical valves

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

biological valves

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

Plastic defects of the interatrial and interventricular septum

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

Heart rhythm disorder

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

Surgical methods for the treatment of arrhythmias:

RF ablation

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

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

Pacemaker implantation

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

Defibrillator implantation

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

Installing a defibrillator is indicated for ventricular tachycardia.

Heart transplant

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

Postoperative recovery period

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

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

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

Rostislav Zhadeiko, especially for the project .

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.

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, 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