Indications for heart surgery, types of techniques. Features of heart surgery How heart surgery is performed

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

When is Cardiac Surgery Used?

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

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

Types of heart surgery

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

• Urgency.
• Technique.

Operations differing in urgency

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

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

Differences in technique

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

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

The difference in the amount of assistance provided

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

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

Most common heart surgeries

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

RF ablation

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

Coronary artery bypass grafting

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

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

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

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

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

Heart valve replacement

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

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

Operations Ross and Glenn

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

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

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

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

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

Recovery time

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

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

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

trip home

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

Relations with relatives

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

Taking medications

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

seam care

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

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

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

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

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

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

Diet

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

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

Bad habits

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

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

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. With 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 the patient is immersed in anesthesia, the surgeon treats the surgical field - the anterior surface of the chest, dissects the sternum in the longitudinal direction, opens the pericardial cavity, after which manipulations on the heart follow.

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 one 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, arrhythmia, 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 surgery, 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 valve prosthesis. 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 (reduced 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, ailments of 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), as well as constantly creating 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. Thus, 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 that, in the process of treating heart disease, if necessary, transplant biological valves to the elderly, for whom a ten-year valve life is acceptable, and besides, they will not have to drink additional drugs. Young patients are offered mechanical valves that do not fail for more than 20 years, although 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 with.

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 began 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, moreover, 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 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 monocusp) 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 inability of the intestine 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, and 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 obstacle 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 moment 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. Local anesthesia with novocaine or lidocaine is performed on the right or left under the left clavicle, 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, while searching, 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.

Heart surgery is performed only when other methods of therapy cannot help the patient's condition. Heart surgery can prevent death in a patient, but the risk of an adverse outcome remains quite high.

Despite the fact that cardiac surgery does not stand still and develops, heart surgery is very difficult to perform. The best specialists in cardiac surgery are engaged in it. But even this important fact cannot shield the operated person from complex consequences.

Complications in the postoperative period can even lead to death.

Indications for surgery

As mentioned earlier, cardiac surgery is used in cases where there are no other options to save the patient's life. Heart surgery requires a very serious approach.

Heart transplantation is considered the most complex and serious surgical intervention. The operation is carried out under the strict supervision of highly qualified specialists.

Indications for cardiac surgery of any complexity are as follows:

• transient development of ailments of the cardiovascular system;
• in the absence of results with drug treatment;
• late referral to a medical facility.

Heart surgery helps to improve the general condition of the patient and eliminate the symptoms of a tormenting disease.

Cardiac cavity surgery is performed only after a complete diagnostic study and an accurate diagnosis by a cardio specialist.

Methods of surgical interventions

What are heart surgeries?

This is a pretty important question if you are going to have this major surgery. You will also need to know how the operation goes and how it is done.

This is necessary in order to make, perhaps, the main decision in your life, on which all future fate will depend.

Closed Interventions

This is a heart operation that does not affect the organ itself. It is done without touching the heart. For its implementation, there is no need for special equipment, except for such as the instruments of the surgeon.

The heart cavity does not "open". That is why it is called "closed".

Such an intervention is performed at the initial stage of the development of the disease, when the patient's condition can only be improved by operations.

Open Interventions

There is also open surgery. This type of operation requires the opening of the heart cavities in order to eradicate the existing pathology.

Open heart surgery is performed using a special device - heart-lung machine or heart-lung machine.

With an open intervention, the cavities are open, the heart and pulmonary organs are disconnected from blood circulation. This makes it possible to intervene on a "dry" organ.

All blood through the vein goes to specialized surgical equipment. There they pass through artificial lungs, enriched with oxygen and release carbon dioxide, transforming from the blood of a vein into an arterial one. Then it is driven by a special pump into the aorta of the operated person, in other words, into the systemic circulation.

Innovative techniques help to create all the "insides" of the equipment (also an artificial lung), with which the patient's blood comes into contact, to create "disposable", that is, once for one person. This will reduce the possible disastrous consequences.

Today, the heart-lung machine helps to stop the functioning of the heart organ and lungs for several hours. Thereby allowing to carry out the hardest operations of open character.

X-ray surgical interventions

This type of intervention began to be used quite recently. But thanks to innovative equipment, they occupy an important place in heart surgery.

With the help of a special catheter, surgical instruments are inserted into a strip section of the cardiac organ, or into the opening of the vessel. Further, with the help of the pressure that the device creates, the valves of the abdominal incisions are opened. They amplify or distort the partitions, or vice versa, using the device, the distortion is eliminated.

Special tubes are introduced into the lumen of the necessary vessel, thereby helping to slightly open it.

The process during such operations is carefully monitored by a special computer and control is made over each action. Thanks to this, operations are performed with less risk of injury and with a greater likelihood of a favorable outcome.

If you have had an X-ray surgery, the effectiveness of it is higher.

Action plan before surgery

Before surgery on the cardiac organ, preparation is necessary. If you have enough time, at least a few days or weeks, you need to take care of your body. Eat healthy, nutrient-rich foods.

Get plenty of rest, walk in the fresh air, do physical exercises that the treating specialist recommended to you.

Proper nutrition

Try to eat only natural foods every day and more than once, even if you have no appetite. Your body needs to consume large amounts of proteins, vitamins and minerals.

Thanks to a healthy diet, the surgical intervention itself and the rehabilitation period are more favorable.

Relaxation

Do not force your body to overwork before surgery. The more you rest, the stronger and stronger your body will become.

If you want to visit relatives or invite you to visit, say that you need to gain strength before a difficult process. Relatives will always understand you and will not be offended.

Nicotine use

It's no secret for everyone that smoking affects negatively even the body of a completely healthy person. What can we say about patients with cardiac pathology.

Nicotine affects the heart in the following negative way: it develops arteriosclerosis, increases pressure in the blood vessels, and makes the heart vessels tighten. It also narrows blood-forming arteries and increases the concentration of mucous fluid in the pulmonary organs.

This leads to more difficult adaptation after surgery.

rehabilitation period

After a surgical intervention on the cardiac organ, if an insufficient amount of time has passed, it is even forbidden to get out of the ward bed. The entire rehabilitation period, the patient is in the intensive care unit.

This department is intended for patients who have a risk of death.

A special dietary diet plays a huge role in rehabilitation. His attending specialist appoints individually for each patient. You can start eating only with lean gruels and vegetable broths, but after a few days the diet increases significantly.

After the patient is transferred to a regular ward, as a rule, the attending physician will allow the use of the following products:

• cereals from coarse grinding (barley, barley groats, unpolished rice). You can also include oatmeal in the diet 2-3 times a week;
• dairy production: fat-free curd mass, cheese with a fat content of not more than 20%;
• vegetables and fruits: fresh, steamed and in various salads;
• small pieces of boiled chicken, turkey and rabbit. As well as homemade steamed cutlets;
• various varieties of fish: herring, salmon, capelin, etc.;
• all soups without fried ingredients and without fat content.

Under no circumstances should the following foods be consumed.

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

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

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

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

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

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

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

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

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

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

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

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