Band surgery on the heart. Operations on the heart and blood vessels: types, features. Surgical methods for the treatment of arrhythmias
How are operations performed?
An operation is an intervention in the human body with a violation of its integrity. Each disease requires an individual approach, which naturally affects the way the operation is performed.
How heart surgery is done: preparation for surgery
Heart surgery (cardiac surgery) is one of the most difficult to perform, dangerous and responsible type of surgical intervention.
Planned operations are usually carried out in the morning. Therefore, the patient is not allowed to eat or drink in the evening (for 8-10 hours), and immediately before the operation, a cleansing enema is made. This is necessary in order for the anesthesia to work as it should.
The place where operations are performed must be sterile. In medical institutions, special rooms are used for these purposes - operating rooms, which are regularly sterilized by quartz treatment and special antiseptics. In addition, all medical personnel who take part in the operation wash themselves before the procedure (you even have to rinse your mouth with an antiseptic solution), and also change into special sterile clothes, put on sterile gloves on your hands.
The patient is also put on shoe covers, a cap on his head, and the operation field is treated with an antiseptic. If necessary, before the operation, the patient's hair is shaved if the surgical field is covered with it. All these manipulations are necessary to avoid infection of the surgical wound with bacteria or other dangerous active microorganisms.
Narcosis or anesthesia
Anesthesia is a general anesthesia of the body with its immersion in drug-induced sleep. 
During surgical interventions on the heart, general anesthesia is used, and in some cases, during endovideosurgical operations, spinal anesthesia, in which a puncture is made into the spinal cord at the level of the lower back. Substances that cause pain relief can be administered in various ways - intravenously, through the respiratory tract (inhalation anesthesia), intramuscularly or in combination.
Course of open heart surgery
After the person goes into medical sleep and ceases to feel pain, the operation itself begins. The surgeon uses a scalpel to open the skin and soft tissues on the chest. Cardiac surgery may also require an “opening” of the chest. To do this, with the help of special surgical instruments, the ribs are sawn. Thus, doctors “get” to the operated organ and put special dilators on the wound, which provide better access to the heart. Junior medical staff, using suction, removes blood from the surgical field, and also cauterizes cut capillaries and blood vessels so that they do not bleed. 
If necessary, the patient is connected to an artificial heart machine, which will temporarily pump blood through the body, while the operated organ is artificially suspended. Depending on what kind of heart surgery is performed (what kind of damage is eliminated), appropriate manipulations are carried out: it can be the replacement of blocked coronary arteries, the replacement of heart valves in case of defects, vein bypass surgery or the replacement of an entire organ.
Extreme care is required from the surgeon and all staff, as the life of the patient depends on it. It should also be added that during the operation, blood pressure and some other indicators are constantly monitored, which indicate the patient's condition.
Endovideosurgery: stenosis and angioplasty
Today, more and more often, heart surgery is performed not by an open method - with a chest incision, but with access through the femoral artery on the leg, under the control of an X-ray machine and a microscopic video camera. After preparing for 
operation, which is similar for all types of surgical interventions, and putting the patient into a medical sleep, access to the femoral artery is opened through an incision in the leg. A catheter and a probe with a video camera at the end are inserted into it, thanks to which access to the heart is provided.
In this way, angioplasty with stenosis of blood vessels is carried out in cardiac surgery, which is necessary for blockage of the coronary vessels that feed the heart itself with blood. Special stands are installed in the narrowed vessels - cylindrical implants that do not allow the arteries to clog anymore, which prevents the possibility of developing coronary disease.
After the main part of the operation is over and the heart is on its own again 
functions, stitching of damaged nerves, vessels and tissues is performed. The wound is again treated with an antiseptic, the surgical field is closed, soft tissues and skin are sutured with special threads. A medical bandage is applied to the external wound. After the end of all these procedures, the patient is taken out of anesthesia.
Other types of transactions
In addition to the abdominal operations described above, there are also operations performed in a less traumatic way:
- Laparoscopy - is performed using a laparoscope, which is inserted through 1-2 cm incisions in the skin. Most often used in gynecology, gastrectomy and other operations in the abdominal cavity. You can read more about this
- Laser surgery - is carried out using a special laser beam. Usually, operations are performed in this way on the eyes, when removing skin formations, etc. You can read more about the method
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 heart 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, "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 plenty 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.
Heart surgeries are very common these days. Modern cardiac surgery and vascular surgery are very advanced. Surgical intervention is prescribed in the case when conservative drug treatment does not help, and, accordingly, the normalization of the patient's condition is impossible without surgery.
For example, heart disease can only be cured by surgery, this is necessary in the case when blood circulation is severely disturbed due to pathology.
And as a result, a person feels bad and severe complications begin to develop. These complications can lead not only to disability, but also to death.
Often prescribed surgical treatment of coronary heart disease. Since it can lead to myocardial infarction. Due to a heart attack, the walls of the cavities of the heart or aorta become thinner and protrusion appears. This pathology can also be cured only by surgery. Quite often, operations are performed due to disturbed heart rhythm (RFA).
They also perform heart transplantation, that is, a transplant. This is necessary when there is a complex of pathologies due to which the myocardium is not able to function. Today, such an operation prolongs the life of the patient by an average of 5 years. After such an operation, the patient is put on disability.
Operations can be carried out urgently, urgently, or a planned intervention is prescribed. It depends on the severity of the patient's condition. An emergency operation is performed immediately, immediately after the diagnosis is established. If such an intervention is not carried out, then the death of the patient may occur.
Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes are important.
Urgent operations do not require fast execution. In this case, the patient is prepared for some time. As a rule, it is several days.
A planned operation is prescribed if at this time there is no danger to life, but it must be carried out to prevent complications. Doctors prescribe surgery on the myocardium only if it is necessary.
Invasive Research
Invasive methods for examining the heart are to conduct catheterization. That is, the study is carried out through a catheter, which can be installed both in the cavity of the heart and in the vessel. With the help of these studies, you can determine some indicators of the work of the heart.
For example, blood pressure in any part of the myocardium, as well as determine how much oxygen is in the blood, evaluate cardiac output, vascular resistance.
Invasive methods allow you to study the pathology of the valves, their size and degree of damage. This study takes place without opening the chest. Cardiac catheterization allows you to take an intracardiac electrocardiogram and phonocardiogram. This method is also used to monitor the effectiveness of drug therapy.
Such studies include:
With selective coronary angiography, contrast is injected into one of the coronary arteries (right or left).
Coronary angiography is often performed in patients with angina pectoris 3-4 functional class. In this case, it is resistant to drug therapy. Doctors need to decide what type of surgical treatment is needed. It is also important to carry out this procedure for unstable angina.
Also, invasive procedures include punctures and probing of the heart cavities. With the help of probing, it is possible to diagnose heart defects and pathologies in the LV, for example, it can be tumors, or thrombosis. To do this, use the femoral vein (right), a needle is inserted into it through which the conductor passes. The needle diameter becomes about 2 mm.
When performing invasive studies, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the desired vein for the installation of the catheter.
These studies are carried out in different clinics and their cost is quite high.
Surgery for heart disease
Heart defects include
- stenosis of the heart valves;
- insufficiency of heart valves;
- septal defects (interventricular, interatrial).
valve stenosis
These pathologies lead to many disorders in the work of the heart, that is, the goals of operations for defects are to relieve the load from the heart muscle, restore the normal functioning of the ventricle, as well as restore contractile function and reduce pressure in the heart cavities.
To eliminate these defects, the following surgical interventions are performed:
Often, after heart disease surgery, a person is given a disability.
Operations on the aorta
Open surgeries include:
- Prosthetics of the ascending aorta. At the same time, a valve-containing conduit is installed; this prosthesis has a mechanical aortic valve.
- Prosthetics of the ascending aorta, while the aortic valve is not implanted.
- Prosthetics of the ascending artery and its arch.
- Surgery to implant a stent graft in the ascending aorta. This is an endovascular intervention.
Prosthetics of the ascending aorta is the replacement of this section of the artery. This is necessary in order to prevent serious consequences, for example, a break. To do this, prosthetics are used by opening the chest, and endovascular or intravascular interventions are also performed. In this case, a special stent is installed in the affected area.
Of course, open-heart surgery is more effective, since in addition to the main pathology - aortic aneurysm, it is possible to correct the concomitant one, for example, stenosis or valve insufficiency, etc. And the endovascular procedure gives a temporary effect.
When prosthetics of the aortic arch are used:
- Open distal anastomosis. This is when the prosthesis is installed, so that it does not affect its branches;
- Arc semi-replacement. This operation consists in replacing the artery where the ascending aorta passes into the arch and, if required, replacing the concave surface of the arch;
- Subtotal prosthetics. This is when the replacement of branches (1 or 2) is required during prosthetics of the arterial arch;
- Complete prosthetics. In this case, the arch is prosthetized together with all supra-aortic vessels. This is a complex intervention that can cause neurological complications. After such an intervention, a person is given a disability.
Coronary artery bypass grafting (ACS)
CABG is open-heart surgery that uses a patient's vessel as a shunt. This heart operation is needed in order to create a bypass for the blood, which will not affect the occlusive section of the coronary artery.
That is, this shunt is installed on the aorta and brought to the area of the coronary artery not affected by atherosclerosis.
This method is quite effective in the treatment of coronary heart disease. Due to the installed shunt, the blood flow to the heart increases, which means that ischemia and angina pectoris do not appear.
CABG is prescribed if there is angina pectoris, in which even the smallest loads cause seizures. Also, indications for CABG are lesions of all coronary arteries, and if an aneurysm of the heart has formed.
During CABG, the patient is put into general anesthesia, and then, after opening the chest, all manipulations are performed. This operation can be performed with or without cardiac arrest. And also, depending on the severity of the pathology, the doctor decides whether it is necessary to connect the patient to a heart-lung machine. The duration of CABG can be 3-6 hours, it all depends on the number of shunts, that is, on the number of anastomoses.
As a rule, the role of the shunt is performed by a vein from the lower limb, and sometimes a part of the internal thoracic vein, the radial artery, is also used.
Today, CABG is performed, which is performed with minimal access to the heart, while the heart continues to work. Such an intervention is considered not as traumatic as the others. In this case, the chest is not opened, the incision is made between the ribs and a special expander is also used so as not to affect the bones. This type of CABG lasts 1 to 2 hours.
The operation is performed by 2 surgeons, while one makes an incision and opens the sternum, the other operates on the limb to take a vein.
After carrying out all the necessary manipulations, the doctor installs drains and closes the chest.
CABG significantly reduces the likelihood of a heart attack. Angina pectoris does not appear after surgery, which means that the quality and duration of the patient's life increase.
Radiofrequency ablation (RFA)
RFA is a procedure that is performed under local anesthesia, since the basis is catheterization. Such a procedure is carried out in order to exfoliate the cells that cause arrhythmia, that is, the focus. This happens through a catheter-conductor, which conducts an electric current. As a result, tissue formations are removed by RFA.
After conducting an electrophysical study, the doctor determines where the source is located, which causes a rapid heartbeat. These sources can be formed along the conducting paths, as a result of which an anomaly of the rhythm manifests itself. It is RFA that neutralizes this anomaly.
RFA is carried out in case of:
- when drug therapy does not affect the arrhythmia, and also if such therapy causes side effects.
- If the patient has Wolff-Parkinson-White syndrome. This pathology is perfectly neutralized by RFA.
- If a complication may occur, such as cardiac arrest.
It should be noted that RFA is well tolerated by patients, since there are no large incisions and opening of the sternum.
The catheter is inserted through a puncture in the thigh. Only the area through which the catheter is inserted is anesthetized.
The guide catheter reaches the myocardium, and then a contrast agent is injected. With the help of contrast, the affected areas become visible, and the doctor directs the electrode to them. After the electrode acted on the source, the tissues are scarred, which means that they will not be able to conduct the impulse. After RFA, a bandage is not needed.
Carotid surgery
There are such types of operations on the carotid artery:
- Prosthetics (used with a large lesion);
- Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent;
- Eversion endarterectomy - at the same time, atherosclerotic plaques are removed along with the inner lining of the carotid artery;
- Carotid endarectomy.
These operations are performed under both general and local anesthesia. More often under general anesthesia, as the procedure is performed in the neck and there are discomfort.
The carotid artery is occluded, and in order to continue the blood supply, shunts are installed, which are bypass routes.
Classical endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is peeled off and removed. Next, the vessel is washed. Sometimes it is still necessary to fix the inner shell, this is done with special seams. At the end, the artery is sutured with a special synthetic medical material.
Endarterectomy of the carotid arteries
Eversion endartectomy is performed in such a way that the inner layer of the carotid artery at the site of the plaque is removed. And after that they fix, that is, sew. For this operation, the plaque should be no more than 2.5 cm.
Stenting is performed using a balloon catheter. This is a minimally invasive procedure. When the catheter is located at the site of stenosis, it inflates and thereby expands the lumen.
Rehabilitation
The period after heart surgery is no less important than the operation itself. At this time, the patient's condition is monitored by doctors, and in some cases, cardio training, therapeutic diets, etc. are prescribed.
Other recovery measures are also needed, such as wearing a bandage. The bandage at the same time fixes the seam after the operation, and of course the entire chest, which is very important. Such a bandage should be worn only if the operation is performed on the open heart. The cost of these items may vary.
The bandage that is worn after heart surgery looks like a T-shirt with tightness clamps. You can purchase male and female versions of this bandage. The bandage is important to prevent lung congestion by coughing regularly.
Such prevention of stagnation is quite dangerous because the seams can disperse, the bandage in this case will protect the seams and contribute to strong scarring.
Also, the bandage will help prevent swelling and bruising, promotes the correct location of organs after heart surgery. And the bandage helps to relieve the load from the organs.
After heart surgery, the patient needs rehabilitation. How long it will last depends on the severity of the lesion and the severity of the operation. For example, after CABG, immediately after heart surgery, you need to start rehabilitation, this is a simple exercise therapy and massage.
After all types of heart surgery, medical rehabilitation, that is, supportive therapy, is needed. In almost all situations, the use of antiplatelet agents is mandatory.
If there is high blood pressure, then ACE inhibitors and beta-blockers are prescribed, as well as drugs to lower blood cholesterol (statins). Sometimes the patient is prescribed physical procedures.
Disability
It should be noted that disability is given to people with diseases of the cardiovascular system even before surgery. There must be evidence for this. From medical practice, it can be noted that they necessarily give disability after coronary artery bypass grafting. Moreover, there may be a disability of both 1 and 3 groups. It all depends on the severity of the pathology.
People who have circulatory disorders, grade 3 coronary insufficiency, or have had a myocardial infarction are also entitled to disability.
Regardless of whether the operation was performed or not yet. Patients with grade 3 heart defects and combined defects can apply for disability if there are persistent circulatory disorders.
Clinics
| Clinic name | Address and phone | Type of service | Price |
|---|---|---|---|
| NII SP im. N. V. Sklifosovsky | Moscow, Bolshaya Sukharevskaya sq., 3 |
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| KB MGMU them. Sechenov | Moscow, st. B. Pirogovskaya, 6 |
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| FSCC FMBA | Moscow, Orekhovy Boulevard, 28 |
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| NII SP im. I.I. Janelidze | St. Petersburg, st. Budapestskaya, 3 |
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| SPGMU them. I.P. Pavlova | St. Petersburg, st. L. Tolstoy, 6/8 |
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| MC "Shiba" | Derech Sheba 2, Tel Hashomer, Ramat Gan |
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| link to article.
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:
- Rapid deterioration of the patient's condition and progression of the underlying disease of the heart or blood vessels.
- 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.
- The presence of acute signs of deterioration of the underlying myocardial disease, which cannot be eliminated by conventional analgesics or antispasmodics.
- 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:
- 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.
- 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:
- IHD (ischemic heart disease), which leads to impaired blood circulation and oxygen starvation of the myocardium.
- Myocardial infarction.
- 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.
- Heart valve replacement
- Possible complications and recommendations for care
Heart surgery is performed only when necessary. The most common of these are heart valve replacement and coronary artery bypass grafting. The first is necessary if the patient is concerned about valvular stenosis. It should be noted that heart surgeries pose a serious risk to the life of the patient, they are carried out with maximum precision and caution. Heart surgery sometimes leads to numerous problems and complications, in order to avoid this, you can use an alternative technique - valvuloplasty.
The procedure can replace replacement surgery, help normalize the activity of the heart muscles. In the process, a special balloon is inserted into the opening of the aortic valve, at the end this balloon is inflated. It is worth considering: if a person is in old age, valvuloplasty does not give a lasting effect.
Heart valve replacement
To decide on such a procedure, it is necessary to establish a diagnosis.
The operation is carried out immediately or some time after the test.
In some situations, the results indicate that a person needs bypass surgery. Valve replacement is an open procedure that can be performed using minimally invasive surgery. It should be remembered that heart valve replacement is a very complicated procedure, despite this, it is carried out very often.
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Stages of the procedure and further rehabilitation
First you need to open the chest. Next, the doctor connects the patient to a special apparatus that provides artificial circulation. The device temporarily replaces the heart. The patient's circulatory system is connected to the device, after which the natural valve is removed and replaced. When this manipulation is completed, the device is turned off. In most cases, heart surgery goes well, but a scar forms on the organ.
After recovery from anesthesia, the breathing tube is removed from the lungs. If you want to remove excess fluid, such a tube should be left for a while. After a day, it is allowed to drink water and liquid, you can walk only after two days. After such an operation, pain in the chest area can be felt, and on the fifth day the patient is completely discharged. If there is a risk of complications, the hospital stay must be extended by 6 days.
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Can there be complications after valve replacement?
A person can face such problems at different stages of the disease. During the operation, there is a risk of heavy bleeding, in addition, difficulties with anesthesia may arise. Possible risk factors include internal bleeding, seizures, possible infections. A heart attack can also happen, but this happens very rarely. As for the greatest danger, it lies in the appearance of tamponade of the pericardial cavity. This phenomenon occurs when blood fills its heart sac. This causes serious malfunctions in the functioning of the heart. Operations on the heart cannot but affect the general condition of a person. During the rehabilitation period, strict medical supervision is required. The need to visit the surgeon arises after 3-4 weeks after the operation. It is important to maintain the general well-being of the patient. An optimal dose of physical activity should be prescribed, it is important to stick to a diet.
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What is coronary artery bypass grafting?
Coronary artery bypass grafting is a type of surgery that restores blood flow in the arteries. The procedure is necessary to eliminate coronary heart disease. The disease manifests itself when the lumen of the coronary vessels narrows, as a result of which an insufficient amount of oxygen enters the heart muscle. Coronary artery bypass surgery aims to prevent changes in the myocardium (heart muscle). After the operation, he should fully recover and contract better. It is necessary to restore the affected area of the muscle, for this the following procedure is carried out: everyday shunts are applied between the aorta and the coronary vessel that is affected. Thus, the formation of new coronary arteries occurs. They are designed to replace the narrowed ones. After the shunt is applied, blood from the aorta flows through a healthy vessel, thanks to which the heart produces a normal blood flow.
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What is the operation for?
This procedure will be required if the left coronary artery of the vessel that provides flow to the heart is affected. It is also needed if all coronary vessels are damaged. The procedure can be double, triple, single - it all depends on how many shunts the doctor needs. With coronary heart disease, the patient may need one shunt, in some cases two or three. Bypass surgery is a procedure that is often used for atherosclerosis of the heart vessels. This happens when angioplasty is not possible. As a rule, a shunt can serve for a long time, its functional suitability is 12-14 years.
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Carrying out coronary artery bypass grafting
The duration of the operation is 3-4 hours. The procedure requires maximum concentration and attention. The doctor needs to gain access to the heart, for this it is necessary to dissect the soft tissues, then open the sternum and perform a stenotomy. During the operation, a procedure is carried out that is necessary for temporary, it is called cardioplegia. The heart must be cooled with very cold water, then a special solution should be injected into the arteries. To attach shunts, the aorta must be temporarily blocked. To do this, it is necessary to pinch it and connect the heart-lung machine for 90 minutes. Plastic tubes should be placed in the right atrium. Next, the doctor performs procedures that contribute to the flow of blood into the body.
What is routine vascular bypass surgery? This method involves the implantation of special implants into the coronary vessels outside the obstruction, the end of the shunt is sutured to the aorta. In order to be able to use the internal mammary arteries, it is necessary to carry out the procedure with the expenditure of more time. This is due to the need to separate the arteries from the chest wall. Upon completion of the operation, the doctor carefully fastens the chest, for this a special wire is used. With its help, a soft tissue incision is sutured, then drainage tubes are applied to remove residual blood.
Sometimes bleeding occurs after the operation, it continues throughout the day. The installed drainage tubes should be removed after 12-17 hours after the procedure. At the end of the operation, the breathing tube must be removed. On the second day, the patient can get out of bed and move around. Restoration of the heart rhythm takes place in 25% of patients. As a rule, it lasts for five days. As for arrhythmia, this disease can be eliminated within 30 days after surgery, for this conservative methods of therapy are used.