Simple heart surgery. How are operations performed? Heart rhythm disorder
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.
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
- 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.
- 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.
- 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.
- Installing a pacemaker. Cardiac arrhythmias, severe bradycardia may be indications for installation, which, thanks to modern technology, can also be performed endoscopically.
Cardiovascular diseases, unfortunately, occupy one of the first places in terms of mortality in our country. But cardiology does not stand still, but is constantly being improved. In this area, new methods of treatment are constantly emerging and the most modern technologies are being introduced. Naturally, people suffering from severe heart diseases are interested in all the innovations in cardiology, and therefore in various methods of surgical interventions.
When is Cardiac Surgery Used?
Absolutely not any violation in the work of cardiac activity entails surgical intervention. There are absolutely clear criteria on which the attending physician relies, recommending this or that cardiological operation. Such indications may be:
- Significant and rapidly progressive deterioration of the patient's condition associated with chronic heart failure.
- Acute conditions that threaten the life of the patient.
- Extremely low efficiency of simple drug treatment with clear dynamics to the deterioration of the general condition.
- The presence of advanced cardiac pathologies that developed against the background of a late visit to the doctor and the lack of adequate treatment.
- both congenital and acquired.
- Ischemic pathologies leading to the development of a heart attack.
Types of heart surgery
Today, there are many different surgical manipulations on the human heart. All these operations can be divided according to several basic principles.
- Urgency.
- Technique.
Operations differing in urgency
Any surgical intervention will fall into one of the following groups:
- emergency operations. The surgeon performs such heart operations if there is a real threat to the patient's life. It can be a sudden thrombosis, myocardial infarction, the onset of aortic dissection, heart injury. In all these situations, the patient is sent to the operating table immediately after the diagnosis is made, usually even without further tests and examinations.
- Urgent. In this situation, there is no such urgency, it is possible to conduct clarifying examinations, but it is also impossible to postpone the operation, as a critical situation may develop in the near future.
- Planned. After a long observation by the attending cardiologist, the patient receives a referral to the hospital. Here he undergoes all the necessary examinations and preparation procedures before surgery. The cardiac surgeon clearly sets the time of the operation. In case of problems, for example, a cold, it can be postponed to another day or even a month. There is no threat to life in such a situation.
Differences in technique
In this group, all operations can be divided into ongoing:
- Opening the chest. This is a classic method that is used in the most severe cases. The surgeon makes an incision from the neck to the navel and opens the chest completely. Thus, the doctor gets direct access to the heart. Such manipulation is carried out under general anesthesia and the patient is transferred to the cardiopulmonary bypass system. As a result of the fact that the surgeon works with a "dry" heart, he can eliminate even the most severe pathologies with a minimal risk of complications. This method is resorted to in the presence of problems with the coronary artery, aorta and other great vessels, with severe atrial fibrillation and other problems.
- Without opening the chest. This type of surgical intervention belongs to the so-called minimally invasive techniques. There is absolutely no need for open access to the heart. These techniques are much less traumatic for the patient, but they are not suitable in all cases.
- X-ray surgical technique. This method in medicine is relatively new, but it has already proven itself very well. The main advantage is that after these manipulations the patient recovers very quickly and complications are extremely rare. The essence of this technique lies in the fact that a device similar to a balloon is introduced to the patient using a catheter to expand the vessel and eliminate its defect. This whole procedure is carried out using a monitor and the progress of the probe can be clearly controlled.
The difference in the amount of assistance provided
All surgical manipulations in people with heart problems can be divided both in terms of the volume and direction of the problems to be eliminated.
- Correction is palliative. Such surgical intervention can be attributed to auxiliary techniques. All manipulations will be aimed at bringing blood flow back to normal. This may be the end goal or preparation of the vessel for further surgical procedures. These procedures are not aimed at eliminating the existing pathology, but only eliminate its consequences and prepare the patient for full treatment.
- radical intervention. With such manipulations, the surgeon sets himself the goal - if possible, the complete elimination of the developed pathology.
Most common heart surgeries
People with problems of the cardiovascular system are often interested in what types of heart surgeries are and how long they last. Let's look at some of them.
RF ablation
A fairly large number of people have problems with a violation in the direction of its increase - tachycardia. In difficult situations today, cardiac surgeons offer radiofrequency ablation, or "cautery of the heart." This is a minimally invasive procedure that does not require an open heart. It is performed using X-ray surgery. The pathological part of the heart is affected by radio frequency signals, which damage it, and therefore eliminate the additional path along which the impulses pass. Normal pathways are at the same time fully preserved, and the heart rate gradually returns to normal.
Coronary artery bypass grafting
With age or due to other circumstances, atherosclerotic plaques can form in the arteries, which narrow the lumen for blood flow. Thus, the flow of blood to the heart is greatly impaired, which inevitably leads to very deplorable results. In the event that the narrowing of the lumen reaches a critical state, surgery recommends that the patient undergo coronary artery bypass grafting.
This type of surgery involves creating a bypass from the aorta to the artery using a shunt. The shunt will allow blood to bypass the narrowed area and normalize blood flow to the heart. Sometimes it is required to install not one, but several shunts at once. The operation is quite traumatic, like any other, performed at the opening of the chest and lasts a long time, up to six hours. Coronary artery bypass surgery is usually performed on the open heart, but today alternative methods are gaining more and more popularity - coronary angioplasty (insertion of an expanding balloon through a vein) and stenting.
Like the previous method, it is used to increase the lumen of the arteries. It is referred to as a minimally invasive, endovascular technique.
The essence of the method consists in introducing an inflated balloon in a special metal frame into the artery into the pathology zone, using a special catheter. The balloon inflates and opens the stent - the vessel also expands to the desired size. Next, the surgeon removes the balloon, the metal structure remains, creating a strong skeleton of the artery. Throughout the procedure, the doctor monitors the progress of the stent on the screen of the X-ray monitor.
The operation is practically painless and does not require long and special rehabilitation.
Heart valve replacement
With congenital or acquired pathology of the heart valves, the patient is often shown their prosthetics. Regardless of what type of prosthesis will be installed, surgery most often takes place on the open heart. The patient is put to sleep under general anesthesia and transferred to the cardiopulmonary bypass system. Given this, the recovery process will be long and fraught with a number of complications.
An exception to the procedure for valvular replacement is aortic valve replacement. This procedure can be performed using a gentle endovascular technique. The surgeon inserts a biological prosthesis through the femoral vein and places it in the aorta.
Operations Ross and Glenn
Often, heart surgery is performed on children who are diagnosed with congenital heart defects. Most often, operations are performed according to the methods of Ross and Glenn.
The essence of the Ross system is to replace the aortic valve with the pulmonary valve of the patient. The biggest advantage of such a replacement can be considered that there will be no threat of rejection, like any other valve taken from a donor. In addition, the annulus will grow with the child's body and can last a lifetime. But, unfortunately, an implant must be placed in place of the removed pulmonary valve. It is important that the implant at the site of the pulmonary valve lasts much longer without replacement than the same one at the site of the aortic valve.
The Glenn technique was developed for the treatment of children with pathology of the circulatory system. This is a technology that allows you to create an anastomosis to connect the right pulmonary artery and the superior vena cava, which normalizes the movement of blood flow through the systemic and pulmonary circulation.
Despite the fact that surgical intervention significantly prolongs the life of the patient and improves its quality, it is still mostly an extreme case.
Any doctor will try to do everything possible so that the treatment is conservative, but, unfortunately, sometimes this is completely impossible. It is important to understand that any surgical intervention in the work of the heart is a very difficult procedure for the patient, and it will require high-quality rehabilitation, sometimes quite lengthy.
Recovery time
Rehabilitation after heart surgery is a very important stage in the treatment of patients.
The success of the operation can only be judged after the end, which can last quite a long time. This is especially true for patients who underwent open heart surgery. Here it is extremely important to follow the recommendations of doctors as accurately as possible and have a positive attitude.
After surgery with an opening of the chest, the patient is discharged home in about a week or two. The doctor makes clear instructions for further treatment at home - it is especially important to follow them.
trip home
Already at this stage, it is important to take measures so that you do not have to go back to the hospital urgently. It is important to remember here that all movements should be as slow and smooth as possible. In the event that the road takes more than one hour, you need to periodically stop and get out of the car. This must be done to avoid stagnation of blood in the vessels.
Relations with relatives
Both relatives and the patient need to understand that people who have undergone major operations under general anesthesia are extremely prone to irritability and mood swings. These problems will pass with time, you just need to treat each other with maximum understanding.
Taking medications
This is one of the most important moments in life after heart surgery. It is important for the patient to always have all the necessary medicines with him. It is especially important not to show excessive self-activity and not to take drugs that are not prescribed. In addition, you should not stop taking medication prescribed by your doctor.
seam care
The patient should calmly perceive a temporary sensation of discomfort in the suture area. In the beginning, it can be pain, a feeling of tightness and itching. Painkillers can be prescribed by a doctor to relieve pain; special ointments or gels can be used to relieve other symptoms, but only after consulting a surgeon.
The seam should be dry, without excessive redness or swelling. This needs to be watched closely. The place of the seam must be constantly treated with brilliant green, and the first water procedures are allowed to be taken after about two weeks. Such patients are allowed only a shower, and taking a bath and sudden changes in temperature are contraindicated. It is recommended to wash the seam only with ordinary soap and gently blot with a towel.
In a situation where the patient's temperature rises sharply to 38 degrees, severe swelling appears with redness at the site of the suture, fluid is released or severe pain is disturbing, you should immediately consult a doctor.
It is important for a person who has undergone heart surgery to set a goal - maximum recovery. But the main thing here is not to rush, but to do everything gradually and very carefully.
In the first days after returning home, you need to try to do everything as smoothly and slowly as possible, gradually increasing the load. For example, in the early days, you can try to walk from one hundred to five hundred meters, but if fatigue appears, you should rest. Then the distance should be gradually increased. It is best to walk outdoors and on flat terrain. After a week of walking, you should try to climb the stairs for 1-2 flights. At the same time, you can try to do simple housework.
Approximately two months later, the cardiologist will perform a stitch healing test and give permission to increase physical activity. The patient may begin to swim or play tennis. He will be allowed to work lightly in the garden with the lifting of small weights. Another test the cardiologist should conduct in three or four months. By this time, it is desirable for the patient to restore all the basic motor activity.
Diet
This aspect of rehabilitation also needs to be paid close attention.
The first time after the operation, the patient often lacks appetite and at this time any restrictions are not very relevant. But over time, a person recovers and his desire to eat familiar foods is restored. Unfortunately, there are a number of strict restrictions that will now always have to be observed. In the diet, you will have to severely limit fatty, spicy, salty and sweet. Cardiologists advise what you can eat after heart surgery - vegetables, fruits, various cereals, fish and lean meat. It is extremely important for such people to monitor their weight, and hence the caloric content of food.
Bad habits
Patients who have undergone heart surgery, of course, are strictly prohibited from smoking and using drugs. Drinking alcohol during the rehabilitation period is also prohibited.
Life after surgery can become full and rich. After a period of rehabilitation, many patients return to life without pain, shortness of breath and, most importantly, fear.
Heart surgery helps to cure many diseases of the cardiovascular system that are not amenable to standard therapeutic methods. Surgical treatment can be carried out in different ways, depending on the individual pathology and the general condition of the patient.
Indications for surgical treatment
Cardiac surgery is a field of medicine in which physicians specialize in studying, inventing methods and performing operations on the heart. The most complex and dangerous cardiac surgery is heart transplantation. Regardless of what type of surgery will be performed, there are general indications:
- the rapid progress of the disease of the cardiovascular system;
- ineffectiveness of conservative therapy;
- untimely visit to the doctor.
Heart surgery makes it possible to improve the general condition of the patient and eliminate the symptoms that disturb him. Surgical treatment is carried out after a complete medical examination and the establishment of an accurate diagnosis.
Do operations for congenital heart defects or acquired. A congenital defect is detected in a newborn immediately after birth or before birth on an ultrasound examination. Thanks to modern technologies and techniques, in many cases it is possible to detect and cure heart disease in newborns in time.
An indication for surgical intervention can also be coronary disease, which is sometimes accompanied by such a serious complication as myocardial infarction. Another reason for surgery may be a violation of the heart rhythm, since this disease tends to cause ventricular fibrillation (scattered contraction of fibers). The doctor should tell the patient how to properly prepare for heart surgery in order to avoid negative consequences and complications (such as a blood clot).
Advice: proper preparation for heart surgery is the key to a successful recovery of the patient and prevention of postoperative complications, such as a blood clot or occlusion of the vessel.
Operation types
Cardiac surgeries can be performed on an open heart as well as on a beating heart. Closed heart surgery is usually performed without affecting the organ itself and its cavity. Open heart surgery involves opening the chest and connecting the patient to a ventilator.
During open heart surgery, a temporary cardiac arrest is performed for several hours, which allows you to perform the necessary manipulations. This technique makes it possible to cure complex heart disease, but is considered more traumatic.
Surgery on a beating heart uses special equipment so that the heart continues to contract and pump blood during surgery. The advantages of this surgery include the absence of such complications as embolism, stroke, pulmonary edema, etc.
There are the following types of heart operations, which are considered the most common in cardiology practice:
- radiofrequency ablation;
- coronary artery bypass grafting;
- valve prosthetics;
- Operation Glenn and Operation Ross.
If surgery is performed with access through a vessel or vein, endovascular surgery (stenting, angioplasty) is used. Endovascular surgery is a branch of medicine that allows for surgical intervention under X-ray control and using miniature instruments.
Endovascular surgery makes it possible to cure the defect and avoid the complications that abdominal surgery gives, helps in the treatment of arrhythmias and rarely gives such a complication as a thrombus.
Advice: Surgical treatment of heart pathologies has its advantages and disadvantages, therefore, the most suitable type of operation is selected for each patient, which carries fewer complications for him.
Radiofrequency or catheter ablation (RFA) is a minimally invasive surgical intervention that has a high therapeutic effect and minimal side effects. Such treatment is shown for atrial fibrillation, tachycardia, heart failure and other cardiac pathologies.
By itself, arrhythmia is not a serious pathology requiring surgical intervention, but can lead to serious complications. Thanks to RFA, it is possible to restore a normal heart rhythm and eliminate the main cause of its violations.
RFA is performed using catheter technology and under x-ray control. Heart surgery takes place under local anesthesia and consists in bringing a catheter to the necessary part of the organ, which sets the wrong rhythm. Through an electrical impulse under the action of RFA, the normal rhythm of the heart is restored.
Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!
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