Band surgery on the heart. Heart surgery: necessary recommendations. When is surgery indicated?

• 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.

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

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

age-related changes in the aortic valve

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Preparing for valve replacement surgery

Preparation for surgery begins with a thorough examination, including:

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

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

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

Technique for heart valve replacement surgery

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

prosthetic heart valve

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

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

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

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

endovascular aortic valve replacement

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

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

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

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

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

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

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

Postoperative period and rehabilitation

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

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

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

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

Drug therapy after valve replacement includes:

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

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

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

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

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

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

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

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

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

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

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

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

Video: a new method for replacing heart valves

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

When is valve replacement scheduled?

It is indicated for symptoms suggestive of heart failure:

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

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

The indications for it are:

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

The operation is recognized as effective and safe.

aortic valve

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

Congenital or acquired defects provoke a danger:

The combination of these factors causes heart defects.

Aortic heart disease

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

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

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

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

Failure

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

Deficiency indicators for surgery:

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

An open method of intervention with general anesthesia is practiced.

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

mitral valve

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

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

Correction methods

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

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

Types of artificial valves

They differ in composition and method of manufacture.

Biological

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

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

Disadvantage: quick wear (12-15 years).

Mechanical

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

Advantages: durability, stability.

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

Donor valves are rarely practiced.

Features of preparation for surgery

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

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

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

Priority for surgery and its cost

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

Paid options are faster, but they are expensive.

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

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

Operation sequence

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

Difficulty in aortic valve replacement

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

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

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

Operation steps

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

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

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

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

Recovery after surgery

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

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

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

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

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

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

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

Annual surveys

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

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

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

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

Diet after surgery

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

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

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

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

Physical exercise

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

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

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

Complications and consequences of the operation

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

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

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

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

On the appointment of disability and forecasts

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

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

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

Contraindications for surgery

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

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

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

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

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

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

Postoperative complications

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

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

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

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

Death statistics during surgery

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

Mortality during heart valve replacement surgery:

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

A startling discovery in the treatment of hypertension

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

Complications after surgery

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

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

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

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

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

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

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

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

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

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

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

• constant weakness;
• persistent fatigue and lethargy.

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

What valves to put (video)

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

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

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

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

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

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

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

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

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

Valve arrangement

Structure and functions

When is valve replacement necessary?

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

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

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

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

• chest pain;
• fainting;
• dyspnea.

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

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

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

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

Contraindications

The operation cannot be performed with such pathologies:

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

Types of artificial valves, their features

They can be divided into two groups:

1. Mechanical.
2. Biological.

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

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

Advantages and disadvantages of biological prostheses:

Advantages and disadvantages of mechanical prostheses:

The feasibility of using different valves:

How is the operation performed

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

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

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

Carrying out heart surgery using a heart-lung machine

The operation is done in several stages:

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

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

Postoperative period

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

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

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

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

Possible Complications

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

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

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

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

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

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

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

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

Life after surgery

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

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

Throughout life, you must follow these rules:

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

Physical exercise

Competitive sports and hard work are contraindicated.

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

Precautions for future surgeries

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I was in the hospital in (Sklifa)

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

Thank you very clearly written in simple words

In contact with

Let's try to lift the veil of the mystery of their work and find out what types of heart surgeries exist and are carried out today. Is it also possible to perform heart surgery without opening the chest?

When the heart is in the palm of your hand or open surgeries

Open heart surgery is so called because the cardiac surgeon "opens" the patient's chest, cuts through the sternum and all soft tissues, and makes an opening of the chest. Such interventions, as a rule, are performed with the connection of a heart-lung machine (hereinafter referred to as AIC), which is a temporary replacement for the heart and lungs of the operated person. This apparatus is a complex device of rather impressive dimensions, which continues to pump blood through the body when the patient's heart is artificially stopped.

Thanks to AIC, open-heart surgery can be extended for many hours if necessary. Open surgeries are used for valve replacement, coronary artery bypass grafting can also be performed in this way, many heart defects are eliminated by open interventions. It should be noted that AIC is not always used during their implementation.

The body can not always tolerate the intervention of a foreign heart substitute: the use of AIC is fraught with complications such as renal failure, impaired cerebral blood flow, inflammatory processes, and impaired blood rheology. Therefore, some operations on the open heart are carried out in the conditions of his work, without the connection of the AIC.

Such interventions on a beating heart include coronary artery bypass grafting, during this operation on a beating heart, the area of ​​\u200b\u200bthe heart that the surgeon needs is temporarily switched off from work, and the rest of the heart continues to work. Such manipulations require high qualifications and skills of the surgeon, and also have a much lower risk of complications, they are perfect for people over 75 years old, patients with a large arsenal of chronic diseases, patients with diabetes mellitus than operations on an organ that is turned off from the blood circulation.

But all the pros and cons, of course, are determined by the cardiac surgeon. Only the doctor decides to keep the heart working, or stop it for a while. Open surgeries are the most traumatic, having a higher percentage of complications; after surgery, a scar remains on the patient's chest. But sometimes only such an operation can save a person's life, improve his health, return him to a full, happy life.

Intact heart or closed surgeries

If the sternum, heart chambers and the heart muscle itself were not opened during surgery, then these are closed heart surgeries. During such operations, the surgical scalpel does not affect the heart, and the surgeon's work consists in the surgical treatment of large vessels, cardiac arteries and aorta, the chest is also not opened, only a small incision is made on the chest.

Thus, a pacemaker can be installed, heart valve correction, balloon angioplasty, shunting, vascular stenting can be performed. Closed operations are less traumatic, have a lower percentage of complications, unlike open ones. Closed vascular surgery can often be the first step before subsequent heart surgery.

Indications for their conduct is always determined by the doctor.

Achievements of modern cardiac surgery or minimally invasive operations

Cardiac surgery is steadily moving forward, and an indicator of this is the increasing percentage of low-traumatic, high-tech manipulations that allow you to get rid of the pathology of the heart and blood vessels with minimal intervention and impact on the human body. What are minimally invasive interventions? These are surgical operations performed by introducing instruments or special devices, through mini-accesses - 3-4 cm incisions, or without incisions at all: during endoscopic operations, incisions are replaced by punctures.

When performing minimally invasive manipulations, the path to the heart and blood vessels can lie through the femoral vessels, for example - these operations are called endovascular, they are performed under x-ray control. Elimination of congenital malformations, prosthetic heart valves, all operations on vessels (from removal of a blood clot to expansion of the lumen) - all these interventions can be performed using minimally invasive technologies. Emphasis is placed on them in modern cardiac surgery, since a low risk of complications, minimal impact on the body are those huge advantages that patients can appreciate literally on the operating table.

Anesthesia during endoscopic procedures is not required, it is enough just to anesthetize the puncture site. Recovery after heart surgery performed using a minimally invasive technique is ten times faster. Such methods are also indispensable in diagnostics - coronary angiography, a method for examining the vessels of the heart by introducing contrast and subsequent x-ray control. In parallel with the diagnosis according to the indications, the cardiac surgeon can also perform therapeutic manipulations on the vessels - the installation of a stent, balloon dilation in a narrowed vessel.

And diagnosis and treatment by puncture on the femoral artery? Isn't this a miracle? Such miracles for cardiac surgeons are becoming routine. The contribution of endovascular methods of treatment is also invaluable in cases where the threat to the life of the patient is especially acute and minutes count. These are situations of acute coronary syndrome, thromboembolism, aneurysm. In many cases, the availability of the necessary equipment and qualified personnel can save the lives of patients.

When is the operation indicated?

It is up to an experienced cardiac surgeon or a council of doctors to decide whether an operation is indicated, as well as to determine the type of surgical intervention on the heart and blood vessels. The doctor can make a conclusion after a thorough examination, familiarization with the history of the development of the disease, monitoring the patient. The doctor should know the ins and outs of the disease very well: how long the patient has been suffering from cardiac pathology, what medications he takes, what chronic diseases he has, when he felt worse ... After evaluating all the pros and cons, the doctor makes his verdict: whether to have surgery or not. If the situation develops according to the above scheme, then we are dealing with a planned cardiac surgery.

It is shown to the following people:

• lack of effect from adequate drug therapy;
• rapidly progressive deterioration of well-being against the background of ongoing treatment with pills and injections;
• severe arrhythmias, angina pectoris, cardiomyopathy, congenital and acquired heart defects requiring correction.

But there are situations when there is no time for reflection, questioning and analysis of the medical history. We are talking about life-threatening conditions - a blood clot broke off, an aneurysm exfoliated, a heart attack occurred. When the time goes by for minutes, emergency cardiac surgery is performed. Stenting, coronary artery bypass grafting, thrombectomy of the coronary arteries, radiofrequency ablation can be performed urgently.

Consider the most common types of heart surgery

1. CABG - coronary artery bypass grafting "on hearing" in many, probably because it is performed for coronary heart disease, which is extremely common among the population. CABG can be performed both open and closed, and combined techniques with endoscopic inclusions are also performed. The essence of the operation is to create bypass routes of blood flow through the vessels of the heart, restoring normal blood supply to the myocardium, which leads to a better supply of oxygen to the heart muscle.
2. RFA - radiofrequency ablation. This type of surgical intervention is used to eliminate persistent arrhythmias, when drug therapy is powerless in the fight against arrhythmias. This is a minimally invasive intervention, which is performed under local anesthesia, a special conductor is inserted through the femoral or subclavian vein, which supplies an electrode to the focus of pathological impulses in the heart, the current flowing through the electrode to the pathological focus destroys it. And the absence of a focus of pathological impulses means the absence of arrhythmia. 12 hours after the manipulation, the patient is already allowed to get up.
3. Prosthetic or plastic heart valves. Prosthetics means complete valve replacement, the prosthesis can be mechanical or biological. And plastic implies the elimination of defects in the "native" valve or valve apparatus. There are certain indications for these interventions, which are clearly known to cardiac surgeons.
4. Installing a pacemaker. Cardiac arrhythmias, severe bradycardia may be indications for installation, which, thanks to modern technology, can also be performed endoscopically.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This is what an open stent looks like.

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

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

Here is such an Amazon basin obtained by injecting contrast.

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

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

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

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

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

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

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

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

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

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

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