Heart surgery: necessary recommendations. Features of heart surgery Replacement of blood vessels on the heart operation is called

But now, the diagnosis has been made and the doctors understand what needs to be done next. I would like you to understand well by this moment, what will be discussed when they will explain everything in detail to you, what was found during the examination, what diagnosis was made, what needs to be done and when to choose the best way of treatment.

Here and now the main questions are being decided, and you must exactly imagine what you want to know before you make a decision on which a lot depends.

There are several options for conversation.

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

You need to understand what is being said and prepare for the conversation. Try to be calm and confident in yourself and in the doctors who want to help you. You must be together, on the same side, in the fight for the future of the child. Discuss everything, but your questions should be literate. Believe me, a lot depends on this too.

What do you need to know about in order to ask the right question? What are the operations? What should the child do? How will it all be? Who will do it? Let's talk about it calmly.

Today, all interventions, or operations, for congenital heart defects can be divided into three categories: "closed" operations, "open" and "X-ray surgery".

✔ Closed Operations These are surgical interventions in which the heart itself is not affected. They are performed outside of it, and therefore do not require the use of any special equipment other than conventional surgical instruments. The cavities of the heart are not “opened” with them, which is why they are called “closed”, and they are widely performed as the first stage of surgical intervention.

✔ Open Operations- These are surgical interventions in which it is necessary to open the cavities of the heart in order to eliminate the existing defect. For this, a special apparatus is used - a heart-lung machine (AIC), or "heart-lungs". For the period of the operation, both the heart and the lungs are switched off from the circulation, and the surgeon gets the opportunity to perform any operation on the so-called "dry", stopped heart.

All the patient's venous blood is sent to the apparatus, where, passing through an oxygenator (artificial lung), it is saturated with oxygen and gives off carbon dioxide, turning into arterial. Then the arterial blood is pumped into the patient's aorta by a pump, i.e. into the systemic circulation. Modern technologies allow all the internal parts of the device (including the oxygenator), with which the patient's blood comes into contact, to be made "disposable", i.e. use them only once and only for one patient. This dramatically reduces the number of possible complications.

Today, thanks to AIC, it is possible without much risk to turn off the heart and lungs from work for several hours (and the surgeon has the opportunity to operate on the most complex defects).

✔ X-ray surgery appeared relatively recently, but, thanks to the incredible progress of modern technologies, they have already taken their rightful place in the arsenal of cardiac surgery. More and more doctors are now using thin catheters, the ends of which are fitted with balloons, patches, or expandable tubes (folded like a folding umbrella). With the help of a catheter, these devices are carried into the cavity of the heart, or into the lumen of the vessel, and then, expanding the balloon, break the narrowed valve with pressure, increase or create a defect in the septum, or, conversely, by opening the patch umbrella, this defect is closed. The tubes are inserted into the lumen of the desired vessel and create a wider lumen. In adults, they even try to pass an artificial aortic valve through the catheter in this way, but so far these are only attempts. Doctors monitor the course of an X-ray surgical operation on the monitor screen and clearly control all manipulations with the probe, and therefore the advantage of such operations is not only less trauma, but also high safety and efficiency. X-ray surgery has not yet supplanted traditional surgical methods, but it is gaining more and more space both as an independent method and as an “auxiliary”, i.e. which can be applied not instead of, but together with the usual operation, sometimes simplifying and supplementing it in many ways.

Depending on the type of defect and the condition of the child, surgical operations can be emergency, urgent and elective, i.e. planned.

emergency heart surgery are the ones that should be done immediately after the diagnosis is made, because any delay threatens the life of the child. With congenital malformations, such situations are not uncommon, especially when it comes to newborns. Here the question of life is often decided by hours and minutes.

Emergency operations- those for whom there is no such insane urgency. The operation does not need to be done right now, but you can calmly wait a few days, prepare both you and the child, but it must be done urgently, because then it may be too late.

Planned, or elective, operation- this is an intervention made at the time chosen by you and the surgeons, when the child's condition does not inspire fear, but the operation, nevertheless, should not be postponed.

No cardiac surgeon will ever suggest surgery if it can be avoided. So, anyway, it should be.

Depending on the approach to surgical treatment, radical and palliative operations are distinguished.

✔ Radical heart surgery is a correction that completely eliminates the defect. It can be done with an open ductus arteriosus, septal defects, complete transposition of the main vessels, abnormal pulmonary vein drainage, atrioventricular communication, Fallot's tetrad and some other defects, in which the heart is fully formed, and the surgeon has the opportunity to completely separate the circulatory circles, while maintaining normal anatomical relationships. Those. the atria will connect to their ventricles through correctly positioned valves, and the corresponding great vessels will depart from the ventricles.

✔ Palliative heart surgery- auxiliary, “facilitating”, aimed at normalizing or improving blood circulation and preparing the vascular bed for radical correction. Palliative operations do not eliminate the disease itself, but significantly improve the child's condition. With some very complex defects, which until recently were generally inoperable, the child will have one, and sometimes two palliative operations, before the final radical stage becomes possible.

During a palliative operation, another "defect" is surgically created, which the child does not initially have, but due to which the circulatory pathways disturbed by the defect in the large and small circles are changed. These include surgical expansion of the atrial septal defect, all variants of intervascular anastomoses - i.e. additional shunts, messages between circles. The Fontan operation is the most “radical” of all such methods, after which a person lives without a right ventricle at all. With some of the most complex heart defects, it is impossible to correct the anatomically, and surgical treatment aimed at correcting blood flow can be called the “final” palliative correction, but by no means a radical operation.

In other words, with heart defects, when the intracardiac anatomy - the structure of the ventricles, the condition of the atrioventricular valves, the location of the aorta and the pulmonary trunk - are so changed that they do not allow for a real radical correction, today's surgery follows the path of eliminating poorly compatible with life of circulatory disorders, and then - long-term palliation. The first stage of this path is saving lives and preparing for further treatment, and protection from future complications, the second is the final stage of treatment. All together - this is a long way to the final operation, and on it one, two, and sometimes three steps must be overcome, but, ultimately, to make the child healthy enough for him to develop, learn, lead a normal life, which this long-term palliation will provide him. Check it out, not so long ago - 20-25 years ago it was simply impossible, and children born with the defects of this group were doomed to death.

Such a “final palliation” is the only way out in many cases; although it does not correct the defect itself, it provides the child with an almost normal life by improving the mixing of arterial and venous blood flows, the complete separation of circles, and the elimination of obstructions to blood flow.

Obviously, the very concept of radical and palliative treatment for some complex congenital heart defects is largely arbitrary, and the boundaries are erased.

May God grant everyone to live a long life so that the surgeon's scalpel never touches his heart. However, not always cardiac surgery can be replaced by therapy.

When is surgery necessary?

1. When conservative therapy does not give the desired result.
2. When, despite all the ongoing treatment, the patient's condition continues to deteriorate.
3. When there are severe congenital heart defects, severe arrhythmia, cardiomyopathy.

By urgency, cardiosurgical operations are emergency and planned.

1. Emergencies are carried out when a person's life is in serious danger. This happens when a myocardial infarction occurs, a blood clot suddenly breaks off, or aortic dissection begins. They do not tolerate delay in surgery when the heart is injured. The consequences of delay are severe.
2. Planned are carried out in accordance with the developed plan for the correction of the patient's health. The date of the operation may be postponed depending on the circumstances. For example: with a cold, to avoid additional stress on the heart, or when the pressure suddenly dropped.

Surgical intervention differs in the technique of execution. There are such types of heart operations:

• with the opening of the chest;
• without opening the chest.

open heart surgery

Chest opening operations

Such surgical intervention is used in especially severe cases, when full accessibility of the heart is required during the operation.

Opening of the chest is performed with such pathologies:

• tetralogy of Fallot (the so-called congenital heart disease with four serious violations of the anatomical structure);
• serious anomalies of intracardiac partitions, valves, aorta and coronary arteries;
• heart tumors.

The patient arrives at the hospital one day before the operation. Passes inspection, gives written consent. Be sure to wash with antibacterial soap and shave your hair. Where do you shave your body hair? The hair will be shaved at the site of the proposed incision. If you are going to have a coronary bypass surgery, you will have to shave your legs and groin. In the case of a heart valve replacement, it is necessary to shave the hair in the lower abdomen and in the groin area.

The surgery is performed under general anesthesia. To gain access to the heart, the surgeon opens the chest of the person being operated on. The patient is connected to an artificial lung ventilation apparatus, the heart stops for a while and surgical manipulations are performed with the organ.

How long the operation takes depends on the severity of the pathology. On average, several hours.

Tetralogy of Fallot

Open heart surgery has two advantages.

1. The surgeon has full access to the patient's heart.
2. Such a surgical intervention is possible without state-of-the-art medical equipment.

However, there are also significant drawbacks.

1. Surgical manipulations with the heart last several hours, which leads to fatigue of the operating team, during the operation there is a higher probability of making an erroneous action.
2. Opening the chest is fraught with various injuries.
3. There is a noticeable scar after heart surgery.
4. Various complications are not excluded:

• myocardial infarction,
• thromboembolism,
• bleeding,
• infections;
• coma after surgery.

1. A long recovery is required with significant limitations in the patient's activities.

In most cases, when surgery is performed with an opening of the chest, disability is given after heart surgery, as after a heart attack.

What operations and under what pathologies are performed on the open heart?

Pathologies of the coronary arteries

Coronary artery bypass grafting is done in case of serious atherosclerotic lesions of the coronary arteries, which led to a severe form of coronary heart disease. The essence of shunting is to create a bypass for blood flow to the heart using a shunt, for which an artery or vein taken from the patient is used. For example: mammary coronary artery bypass grafting (MCB) is performed using the internal mammary (mammary) artery.

Operation Ross

Heart valve defects

Today, valves made from the patient's biological material are used to replace damaged valves.

1. The Ross procedure involves using the patient's own valvular pulmonary artery to replace a diseased aortic valve. An implant is placed in place of the pulmonary valve. Eliminates complications associated with rejection of a valve made of foreign material. Made for both adults and children.
2. The Ozaki operation involves the use of the patient's own tissue. Only in this case, the replacement of the aortic valve is performed with a valve made from the patient's pericardium. Complications with valve rejection are not observed for the same reason.

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;
• a 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 determining 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.

A startling discovery in the treatment of hypertension

It has long been widely believed that It is impossible to get rid of HYPERTENSION permanently. To feel relief, you need to continuously drink expensive pharmaceuticals. Is it really? Let's figure it out!

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

Surgical interventions on the heart are necessary in the treatment of many pathologies of the cardiovascular system that are not amenable to standard drug therapy. With the implementation of surgical treatment, it becomes possible to improve the general condition of the patient and prolong his life. But depending on the pathology, there are different heart operations, which differ in their technique.

Show all

Operations classification

Cardiac surgery is aimed at the treatment of cardiac pathologies through indirect or direct effects on this organ. There are such types of heart operations:

• Closed, while the heart itself is not affected. Such operations are performed outside the heart, so they do not need to use special equipment, with the exception of classical surgical instruments. The cavities of the heart remain closed, hence the name of this category.
• Open, they require opening the cavities of the heart, which requires the use of special equipment, such as a heart-lung machine. At the time when such a surgical intervention is performed, the heart and lungs are not functioning, which allows the specialist to work with a stopped heart.
• X-ray surgery, in which special catheters and devices attached to them are used, they are inserted into the cavity of the heart or the lumen of the vessel to correct the defect. The progress of such an operation is controlled using the monitor screen.

In addition, the types of surgical interventions in cardiac surgery are classified according to the patient's condition and type of defect, as well as the approach to treatment.

According to the patient's condition and the type of defect, there are:

• Emergency operations - when you need to act immediately after the diagnosis has become clear, otherwise the pathology threatens the patient's life.
• Urgent - they do not require a lightning-fast reaction and a quick start of action. They are prepared for several days, but not longer, due to the high risks of complications or death.
• Planned - interventions, the implementation of which is desirable, but not essential in the near future. They are prescribed by surgeons after consultation with patients.

Depending on what approach requires surgical treatment:

• Radical - they are aimed at the complete elimination of vices.
• Palliative - they are additional or auxiliary, their goal is to improve the patient's condition or prepare him for a radical intervention.



RF ablation

Such surgical intervention as radiofrequency ablation refers to X-ray surgical procedures. It is carried out to improve the condition of the patient suffering from heart failure and arrhythmia, and is characterized by low rates of side effects and complications.

Manipulations during the operation are carried out with special catheters, which are introduced to the patient under local anesthesia. The place of introduction of the catheter, remote from the heart itself, therefore, local anesthesia is carried out at the site of the future introduction of the catheter. In most cases, it is injected into the inguinal vein or femoral artery. After entering the organ, the catheters give electrical impulses to restore the heart rhythm.



Due to such a supply of impulses that eliminate a small area of ​​​​cardiac tissue that causes pathological excitation of the myocardium, the technique received a second name - cauterization of the heart.



Valve prosthetics

Prosthetic heart valves are used when a valve is insufficiency or stenosis, which interferes with the normal passage of blood through it. Valve replacement can be performed during open surgery, endovascular or mini-access.

In the first case, the patient under general anesthesia is treated with the anterior surface of the chest, the sternum is dissected longitudinally, and the pericardial cavity is opened. To disconnect the heart from blood circulation, the patient is connected to a heart-lung machine, and the myocardium is systematically treated with cold saline during the entire operation in order to avoid its hypoxia.



To install the prosthesis, a longitudinal incision is made, opening the cavity of the heart, the modified structures of the valve are removed, it is replaced with an artificial one, and the myocardium is sutured. After that, the surgeon "starts" the heart with an electrical impulse or by performing a direct heart massage, and turns off the heart-lung machine.

After examining the postoperative view of the heart, pericardium and pleura, blood is removed from the cavities and the surgical wound is sutured in layers.

With endovascular surgery, there is no need to "disconnect" the heart from blood circulation. It is carried out through the leg, namely by introducing a catheter with implantable valves into the femoral artery or vein. After fragments of the damaged valve are destroyed and removed, a prosthesis is put in its place, which straightens itself, having a flexible stent frame.



If the option with a mini-access was chosen, then the surgeon makes an incision 2-5.5 cm long on the anterior wall of the sternum in the area of ​​the projection of the apex of the heart. Then, through the apex of the heart, a catheter is inserted into the organ, advancing it to the affected valve, and replacing it.

In the case of valve replacement, there are several types of implants:

• Mechanical - they are made of metal or plastic. When choosing such an implant, the patient in the future will need to constantly take blood thinners.
• Biological - they consist of animal tissues and do not require further use of drugs, but after a few decades they need to be replaced.



Installing a pacemaker

In the event that the patient suffers from heart failure, cardiomyopathy and cardiac arrhythmias, the specialist may prescribe a minor operation to install a pacemaker.



The technique for performing such an operation is simple. On the right or left under the left clavicle, local anesthesia is performed with novocaine or lidocaine, after which an incision is made in the skin and subclavian vein to insert a conductor into it, and through it into the superior vena cava and into the heart - an electrode. When the tip of the electrode enters the cavity of the right atrium, the doctor chooses a convenient place for optimal stimulation of the heart muscle, during the search he constantly records ECG changes. When a place is found, the electrode is fixed in the myocardial wall from the inside with the help of antennae or a corkscrew-like attachment. After fixation, it is required to hem a titanium case under the patient's arm, which is installed in the thickness of the pectoral muscle on the left. The wound is sutured and an aseptic bandage is applied.

Coronary artery bypass grafting

Coronary artery bypass grafting is a common heart surgery. It is prescribed when atherosclerotic plaques accumulate on the inner walls of the coronary vessels that feed the heart, disrupting blood flow. In addition, indications can be:

• Stable angina 3-4 functional class.
• Acute coronary syndrome.
• Acute myocardial infarction within the first 4–6 hours of onset of pain.
• Severe ischemia without pain.



Before the operation, the patient is intravenously administered sedatives and tranquilizers, and the intervention itself is carried out under general anesthesia. Operative access is done by dissection of the sternum or from a mini-access, making an incision in the intercostal space on the left in the area of ​​the projection of the heart. Manipulation can be carried out both with the connection of the patient to the heart-lung machine, and without it.

The aorta is clamped and connected to the machine, then a vessel is isolated, which will become a bypass. This vessel is brought to the affected coronary artery and its other end is sutured to the aorta. As a result, from the aorta, bypassing the area affected by plaques, the blood will go to the coronary arteries without difficulty.

Depending on how many arteries supplying the heart are affected and at what intervals, the number of shunts can vary from 2 to 5.



When the shunts are fixed, metal staples are applied to the edges of the sternum, soft tissues are sutured and an aseptic dressing is applied. In addition, drainage is removed from the pericardial cavity so that there is an outflow of hemorrhagic fluid.

Operations Glenn and Ross

The Glenn operation is otherwise known as a bidirectional cavopulmonary connection. In this case, anastomosis of the upper part of the superior vena cava with the right pulmonary artery is performed according to the "end to side" principle.

Ross surgery is the replacement of a patient's damaged aortic valve with his pulmonary valve, and the removed pulmonary valve is replaced with a prosthesis.

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.