Open heart surgery, stages and recovery period. How is heart surgery performed using stenting? How is heart surgery performed?

Heart surgery can cure many diseases of cardio-vascular system, which are not amenable to standard therapeutic techniques. Surgical treatment may be performed different ways, depending on the individual pathology and general condition of the patient.

Indications for surgical treatment

Cardiac surgery is a field of medicine in which doctors specialize who study, invent methods and perform operations on the heart. Heart transplantation is considered the most complex and dangerous cardiac surgery. No matter what type surgical intervention will be carried out, there are general indications:

rapid progression of cardiovascular disease;
ineffectiveness of conservative therapy;
failure to consult a doctor in a timely manner.

Heart surgery provides an opportunity to improve general state the patient and eliminate the symptoms that bother him. Held surgery after complete medical examination and establishing an accurate diagnosis.

Surgeries are performed for congenital or acquired heart defects. A congenital defect is detected in a newborn immediately after birth or before birth. ultrasound examination. Thanks to modern technologies and techniques, in many cases it is possible to detect and treat heart defects in newborns in a timely manner.

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 surgical intervention may be a violation heart rate, 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 blood clots).

Advice: proper preparation to heart surgery is the key to successful recovery of the patient and prevention postoperative complications, such as a blood clot or blockage of a vessel.

Types of operations

Cardiac surgeries can be performed on open heart, as well as on a beating heart. Closed operation on the heart 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, the heart is temporarily stopped for several hours to allow the necessary manipulations to be performed. This technique makes it possible to cure complex heart defects, but is considered more traumatic.

During beating heart surgery, special equipment is used so that the heart continues to contract and pump blood during surgery. The advantages of this surgical intervention include the absence of complications such as embolism, stroke, pulmonary edema, etc.

There are the following types of heart surgeries, which are considered the most common in cardiological practice:

radiofrequency ablation;
coronary artery bypass grafting;
valve replacement;
Glenn operation and Ross operation.

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 surgery to be performed under X-ray guidance 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 arrhythmia and rarely causes such a complication as a blood clot.

Advice: surgical treatment Heart pathologies have their advantages and disadvantages, so the most suitable type of operation is selected for each patient, which carries fewer complications specifically for him.

Radiofrequency or catheter ablation (RFA) is a minimally invasive surgical intervention that has a high therapeutic effect and has a minimal amount of side effects. This treatment is indicated for atrial fibrillation, tachycardia, heart failure and other cardiac pathologies.

Arrhythmia itself is not a serious pathology requiring surgical intervention, but can lead to serious complications. Thanks to RFA, it is possible to restore normal heart rhythm and eliminate main reason his violations.

RFA is performed using catheter technology and under X-ray control. Heart surgery is underway local anesthesia and consists of placing a catheter to the required area of the organ that sets the wrong rhythm. Through an electrical impulse under the influence 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 your doctor!

Heart surgery, which at one time was compared to the first human flight into space, is exactly 50 years old. It’s very nice that our surgeon Vasily Kolesov conceived and executed it. Now it is one of the most common procedures in the world to prevent heart attacks and bears the name of its developer.

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

Stanislav Pudyakov then assisted the surgeon. Recalls: a 44-year-old patient was tortured severe pain in the area of the heart.

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

The surgeon operated on a beating heart, which was also hard to believe. No one had done this before Kolesov, either in our country or in the world. Moreover, the doctor literally felt the sore spot with his hands. There simply was no equipment to diagnose heart disease at that time.

To restore normal blood supply to the heart, Kolesov isolated the internal mammary artery and sutured it to the coronary artery below the site of narrowing caused by the so-called atherosclerotic plaque. The blood flow was bypassed, the patient was saved from a heart attack.

After surgery, people quickly returned to normal life and forever forgot about the pills. Operations that saved people from heart attacks and heart pain were talked about abroad as a sensation. American magazines wrote about Kolesov: “Pioneer of coronary surgery.”

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

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

Treatment method coronary disease hearts, proposed by Vasily Ivanovich Kolesov, and 50 years later is considered the most effective. The operations are performed by the best cardiac surgeons in clinics around the world. This is aerobatics, because, in fact, doctors must restart the main human organ.

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

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

Tuesday is the day of the operation. The team is preparing for a long morning of work. During the operation, the chest is opened and the heart is prepared for vessel transplantation.

Disease history

Mr. Thomas, a 59-year-old tanker driver, is married with two adult children. He had shingles with right side neck, and then there was an uncomfortable feeling of constriction in the throat, accompanied by sweating and nausea. He first felt these symptoms while walking up the steps of his truck. They continued, and Thomas decided to seek advice from a therapist.

Thomas's high blood pressure, obesity and long history of smoking were enough reason to get an EKG. Her results showed the presence of coronary heart disease. Thomas was referred to a cardiac expert (a physician who specializes in heart problems - not a surgeon). Despite the drug treatment, the pain continued.

Tests confirmed the presence of the disease, including an angiogram (a test using dye injected into an artery to identify narrowing) that revealed a narrowing in the left main coronary artery, affecting both the left and right vessels. Because drug treatment was unsuccessful and angioplasty (stretching the narrowed vessel using a catheter) was not an option, Mr. Thomas was referred for surgery.

Monday

Mr. Thomas is hospitalized. His anamnesis, examination and test data were analyzed. Two units of blood for transfusion are examined for compatibility. The patient is explained the essence of the operation and warned about the risks associated with it. Obtain written consent for CABG.

Tuesday

Early in the morning, Mr. Thomas is prepped for surgery.

7:05 Premedication and anesthesia

8:15 Mr. Thomas was premedicated 70 minutes ago and a ventilation tube is already in place. Airways. After applying anesthesia and paralyzing agents, his breathing is supported by a ventilator. Before Mr. Thomas is transferred to the operating room, the anesthesiologist monitors venous and arterial blood flow.

8:16 The operating room is ready for Mr. Thomas. On the left is a table with instruments, on the right is a ready-to-use heart-lung apparatus.

8:25 Patient in the operating room. Skin his chest and legs are treated antiseptic solution to reduce the risk of infection.

8:40 Chest opening

The skin has already been treated, the patient is dressed in sterile clothing. One of the surgeons makes an incision in the leg to remove the vein, and the second one cuts the skin on the chest. After making a preliminary cut with a regular scalpel, he uses an electric one, which cuts the vessels, stopping the bleeding.

8:48 The surgeon separates the breastbone with an air-powered electric saw.

8:55 Artery and vein removal

View of the internal mammary artery in the mirror in the center of the surgical lamp. This artery is very elastic. The top end will remain in place, it will be cut off at the bottom and then connected to the coronary artery.

An angled retractor is placed along the left edge of the sternum to elevate it and expose the mammary artery running along the sternum. inside breasts

At the same time, one of the main veins in the leg - the great saphenous vein - is prepared for transplantation. It was almost completely removed from the left thigh.

9:05 Connection to the heart-lung machine

The heart-lung machine is not yet connected to the patient. One of the five rotating pumps circulates the blood, and the rest are used as side pumps to transport the separated blood to prevent blood loss during surgery. The patient must be given heparin, a drug that thins the blood and prevents the formation of clots as it passes through plastic tubes.

Tubes for the heart-lung machine. On the left - with bright red blood - is the arterial return line, along which blood is flowing back into the patient's aorta. On the right are two tubes that drain blood from the inferior and superior vena cava under the influence of gravity. The incision in the sternum is secured with a spacer.

Part of the heart-lung machine is a membrane oxygenating device that maintains blood circulation in the patient's body. IN this moment the device is filled with blood, carbon dioxide is removed from it. The blood is re-oxygenated and returned to the patient's body.

An arterial return tube is inserted into the aorta (the main artery of the body) and two venous drains are inserted into the vena cava (the main vein of the body).

9:25 Cardiac arrest

A clamp is placed on the main artery, the aorta, isolating the heart from artificial blood circulation. A cooled fluid is injected into the isolated aorta to stop the heart. The surgeon puts on special glasses for microsurgery with magnifying glasses that provide 2.5 times magnification. The blood vessels he will transplant have a diameter of 2-3 mm, and the sutures are the diameter of a human hair.

A thorough check of the heart is performed to confirm the findings from the angiogram. It is clarified which coronary arteries need to be bypassed. It was decided to make two shunts.

After stopping the blood flow in the left anterior descending artery, a 1 cm incision is made using a surgical loop at the bypass site.

10:00 First bypass

Close-up of a heart. The left internal mammary artery - in the upper left corner - is sutured to the left anterior descending artery so that blood flow to the heart is restored. The arteries are hidden by epicardial fat.

The end of the left internal mammary artery is sutured laterally to the left anterior descending artery. This creates the first bypass shunt.

Position of the first shunt performed. The lower end of the left internal mammary artery, a 3 mm diameter blood vessel, is completely sutured to the left anterior descending artery.

10:22 Second bypass

The second bypass shunt is sewn with its upper end to the aorta, and its lower end to the right posterior descending artery. The cross clamp is removed and blood flow through the heart is restored.

The upper end of the venous shunt connects to the aorta. Part of the aorta is isolated with an arc-shaped clamp, and a hole is made into which the vein is sutured.

End of both bypass processes. The second shunt, shown on the left side of the diagram, is formed from saphenous vein shins.

11:18 Closing the chest

Blood circulation is restored, the heart contracts after the electric shock with a transition from ventricular fibrillation to sinus mode. Two drains are installed in the front and back parts hearts. The blood thinning effect of heparin was eliminated by the drug protamine. The surgeon stitches the separated halves of the sternum. He will close the skin with an internal absorbable suture.

The nurse places tape on the stitch and on the drainage tubes leading from the patient's chest. The patient will soon be admitted to the ward intensive care where it will be observed.

The human body. Outside and inside. №1 2008

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

When is cardiac surgery used?

Absolutely not any disturbance in cardiac activity entails surgical intervention. There are very clear criteria on which the attending physician relies when recommending this or that cardiac operation. Such indications may be:

Significant and rapidly progressive deterioration of the patient's condition associated with chronic heart failure.
Acute conditions, life threatening sick.
Extremely low efficiency of simple drug treatment with obvious dynamics towards a deterioration in general condition.
The presence of advanced cardiac pathologies that developed due to late consultation with a doctor and lack of adequate treatment.
both congenital and acquired.
Ischemic pathologies leading to the development of heart attack.

Types of heart surgery

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

Urgency.
Technique.

Operations varying 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. This could be sudden thrombosis, myocardial infarction, incipient aortic dissection, or cardiac injury. In all these situations, the patient is sent to the operating table immediately after diagnosis, usually even without further tests and examinations.
Urgent. In this situation there is no such urgency, clarifying examinations can be carried out, but the operation cannot be postponed either, as a critical situation may develop in the near future.
Planned. After long-term observation by the attending cardiologist, the patient is referred to the hospital. Here he undergoes all the necessary examinations and preparation procedures before surgery. The heart surgeon clearly sets the time for the operation. If problems arise, such as 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:

With an opening of the chest. This classic method, which is used in the most severe cases. The surgeon makes an incision from the neck to the navel and opens the entire chest. This gives the doctor direct access to the heart. This manipulation is carried out under general anesthesia and the patient is transferred to the artificial circulation system. As a result of the fact that the surgeon works with a “dry” heart, he can eliminate even the most severe pathologies with minimal risk development of complications. This method is used if there are problems with the coronary artery, aorta and other main vessels, with severe atrial fibrillation and other problems.
Without opening the chest. This type of surgery 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 occur extremely rarely. The essence of this technique is that a device similar to a balloon is inserted into the patient using a catheter to dilate the vessel and eliminate its defect. This entire procedure is carried out using a monitor and the progress of the probe can be clearly controlled.

Difference in the amount of assistance provided

All surgical procedures for people with heart problems can be divided according to the volume and direction of the problems being eliminated.

The correction is palliative. Such surgical intervention can be classified as auxiliary techniques. All manipulations will be aimed at bringing blood flow back to normal. This may be the final goal or preparation of the vessel for further surgical procedures. These procedures are not aimed at eliminating the existing pathology, but only eliminating its consequences and preparing the patient for full treatment.
Radical intervention. With such manipulations, the surgeon sets himself the goal of completely eliminating the developed pathology if possible.

Most frequently performed heart surgeries

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

Radiofrequency ablation

Enough a 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 “cauterization 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 area of the heart is exposed to radiofrequency signals, which damage it, and therefore eliminate the additional path along which the impulses pass. Normal pathways, at the same time, are completely preserved, and the heart rhythm 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 disastrous results. If the narrowing of the lumens reaches a critical state, surgery recommends coronary artery bypass surgery to the patient.

This type of operation involves creating a bypass path 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 necessary to install not one, but several shunts at once. The operation is quite traumatic, like any other, performed when opening the chest and lasts a long time, up to six hours. Coronary artery bypass grafting usually performed on an open heart, but today they are gaining more and more popularity alternative methods– 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 classified as a minimally invasive, endovascular technique.

The essence of the method is to insert an inflating 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 frame for the artery. Throughout the procedure, the doctor monitors the progress of the stent on 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 indicated for their replacement. Regardless of what type of prosthesis will be installed, surgery most often takes place on an open heart. The patient is put to sleep under general anesthesia and transferred to a cardiopulmonary bypass system. Taking this into account, the recovery process will be long and fraught with a number of complications.

An exception to the procedure for heart valve replacement is the replacement of the aortic valve. This procedure can be performed using a gentle endovascular method. Through femoral vein the surgeon inserts a biological prosthesis and places it in the aorta.

Operations Ross and Glenn

Heart surgery is often performed on children diagnosed with birth defects cardiac system. The most frequently performed operations are the Ross and Glenn techniques.

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

Glenn's technique was developed for the treatment of children with pathologies 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 surgery significantly prolongs the patient's life and improves its quality, it is still mostly a last resort.

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

Rehabilitation 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 completion, which can last quite a long time. This is most true for patients who have undergone open-heart surgery. Here it is extremely important to follow the doctors’ recommendations as closely as possible and have a positive attitude.

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

Ride home

Already at this stage, it is important to take measures so that you do not have to return back to the hospital urgently. It is important to remember here that all movements should be as slow and smooth as possible. If the journey 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.

Relationships with family

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 over time, you just need to treat each other with maximum understanding.

Taking medications

This is one of the most important points in life after heart surgery. It is important for the patient to always have all the necessary medications with him. It is especially important not to be excessively active and not to take medications that are not prescribed. In addition, you should not stop taking medications prescribed by your doctor.

Seam care

The patient should calmly accept the temporary feeling of discomfort in the suture area. At the beginning it may be painful sensations, feeling of tightness and itching. To relieve pain, your doctor may prescribe painkillers; to relieve other symptoms, you can use special ointments or gels, but only after consultation with a surgeon.

The seam should be dry, without excessive redness or swelling. This needs to be monitored closely. The seam area must be constantly treated with brilliant green, and the first water treatments allowed to be taken after about two weeks. Such patients are only allowed to shower, and to take baths and sharp changes temperatures are contraindicated. It is recommended to wash the seam only with ordinary soap and gently blot it with a towel.

In a situation where the patient’s temperature rises sharply to 38 degrees, severe swelling with redness appears at the suture site, fluid is discharged, or severe pain occurs, it is necessary to urgently consult a doctor.

It is important for a person who has undergone heart surgery to set a goal for 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 first days you can try to walk from one hundred to five hundred meters, but if fatigue appears, you should rest. Then the distance must be gradually increased. It's best to walk on fresh air and on flat terrain. After a week of starting walks, you should try to climb 1-2 flights of stairs. At the same time, you can try to do simple housework.

After about two months, the cardiologist will test the healing of the sutures and give permission to increase physical activity. The patient may begin to swim or play tennis. He will be allowed to do light gardening work with light lifting. The cardiologist should conduct another test in three to four months. By this time, it is advisable for the patient to restore all basic motor activity.

Diet

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

The first time after surgery, the patient quite often has no appetite and at this time any restrictions are not very relevant. But over time, the person recovers and his desire to eat food is restored. familiar products. Unfortunately, there are a number of strict restrictions that will now always have to be observed. You will have to greatly limit fatty, spicy, salty and sweet foods in your diet. 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 therefore the calorie content of their food.

Bad habits

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

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

The treatment of heart disease using surgery is the field of surgery and cardiology, which is called cardiac surgery. Today, cardiac surgery is the most effective method treatment of certain types of heart defects, coronary heart disease and helps prevent the development of myocardial infarction, as well as eliminate its consequences - aneurysms.
Surgery used only in cases where conservative methods Treatments no longer help and the patient’s condition worsens. A patient’s failure to see a doctor in a timely manner can also lead to heart surgery. the only way The only solution left is surgery.

Today, cardiac surgery is one of the most actively developing and technically equipped branches of medicine. Open heart surgery is performed on 700 patients every year. The bulk of operations are in the United States. In Europe, the number of operations is 4 times less. In Asian countries, cardiac surgery is practically absent. In Russia, the number of heart surgeries performed is below the required minimum. This statistic is due to the fact that heart surgery is expensive. In addition to open-heart surgery, surgery is also performed without opening the parts of the heart (for example, implantation of pacemakers, angioplasty).

Surgical intervention is required for diseases such as:

1. Coronary heart disease and its consequences (myocardial infarction);
2. Heart defects.
3. Heart rhythm disturbance.

Cardiac ischemia

Coronary heart disease occurs as a result of insufficient blood supply to the working myocardium. The main reason for the development of coronary heart disease is atherosclerosis (the formation of plaques on the walls blood vessels). A slight narrowing of the lumen of the vessel leads to angina pectoris (a person feels pain only when the heart’s need for oxygen increases, for example, when physical activity). A strong narrowing of the lumen of the vessel causes pain even at rest, and the duration of painful attacks can also become more frequent and longer - unstable angina. If coronary blood flow is severely impaired, the muscle fibers of the heart die - this is myocardial infarction.

One of severe complications myocardial infarction is the formation of a post-infarction aneurysm of the left ventricle. An aneurysm is a bubble-like protrusion. It forms when dead tissue is replaced by scar tissue, which in turn is unable to contract. Under the pressure of healthy contracting fibers, the scar tissue bulges, and some of the blood is retained in the ventricle in the area of the aneurysmal dilatation. With each contraction, organs and tissues receive less blood in an amount equal to the volume of the aneurysm. This is its main negative meaning. Very often, blood clots form in the area of the aneurysm, which can break off and be carried by the bloodstream to any organ, causing a heart attack (death of part or all of the organ). When a blood clot enters the brain, a stroke occurs.

Surgical intervention (heart surgery) for coronary heart disease is aimed at restoring normal nutrition to all parts of the heart. The degree of damage to the coronary arteries will determine what kind of surgery should be done. Analysis of the condition of the vessels is carried out using coronary angiography - this is a radiopaque research method that allows you to determine the location, nature and degree of narrowing of the coronary artery. Most often, stenting is performed on the coronary artery that causes pain syndrome. In case of severe atherosclerotic damage to the coronary vessels, the patient requires coronary artery bypass surgery.

Types of surgery for coronary heart disease

Angioplasty and stenting of coronary arteries

Angioplasty and stenting are aimed at removing obstructions to blood flow by widening the artery from the inside.
The operation is carried out as follows: using special equipment, a catheter is inserted through a puncture in the thigh area under the control of a fluorographic drug into the artery that feeds the heart. It must reach the site of narrowing of the artery, where a special balloon with a stent is inflated - a device that does not allow the artery to collapse. The stent remains in the artery, and the catheter is brought out through the same hole in the thigh.

Coronary artery bypass grafting (CABG)

Coronary artery bypass surgery - restoration of blood supply to the heart muscle by creating a new path for blood flow bypassing the affected area coronary vessel using shunts - pieces of arteries or veins taken from the patient himself (for example, in the area of a limb). This operation is aimed at preventing myocardial infarction. Today, CABG operations are performed both using a heart-lung machine and on a beating heart (immobility of the heart only in the operated area).
One of the types of coronary bypass surgery is mammary coronary artery bypass grafting (MCBG). The internal mammary artery is used as a shunt. The use of this vessel is advantageous, since in this case there is no need to make additional incisions due to the close location of the thoracic artery and the heart, and also because atherosclerotic plaques do not form in the artery, and therefore the service life of such a shunt is quite long.

Repair of post-infarction left ventricular aneurysm

The essence of the intervention is to reduce the volume of the left ventricle by delineating the area of aneurysmal dilatation and the healthy part of the left ventricle. The surgeon removes the resulting blood clots in the area of the aneurysm, then sews a septum made of dense elastic human tissue across the cavity of the left ventricle. Two cavities are formed: one with normal, actively contracting walls, the other - from scar tissue that is not capable of contracting, but does not interfere with the normal functioning of the heart. Thus, blood circulation is restored and the danger of blood clot rupture is eliminated.

Heart defects

Heart defects are defects in the structure of the heart that lead to disruption of normal blood circulation, causing stagnation of blood in the small or big circle blood circulation
The following violations are identified:

- stenosis (narrowing) of the valve apparatus;
With valve stenosis, it stops allowing the required volume of blood through the reduced opening.
- insufficiency of the valve apparatus;
The valve flaps cannot close tightly and allow blood to flow in the opposite direction to normal blood flow.

-defects of the interventricular and interatrial septum;
If these septa are defective, blood enters from a cavity with high pressure into a cavity with lower pressure, and deoxygenated blood, poor in oxygen, mixes with oxygenated arterial, which leads to oxygen starvation fabrics.
Heart defects can be congenital or acquired. Most of them do not require surgery. Sometimes the disease progresses unnoticed by the patient. Congenital heart disease can improve with age, but if this does not happen and signs of heart failure increase, then surgical intervention is required.

Treatment of heart defects is aimed at correcting the existing mechanical defect in the functioning of the heart.

The following types of surgical intervention are distinguished:

Prosthetics and plastic surgery of heart valves

Operations to install prostheses are performed on an open heart, using a heart-lung machine.
Valve prostheses can be mechanical or biological.

Mechanical valves

Mechanical valves are made of metal and plastic. The validity period of such prostheses is about 80 years. However, when using them, a person has to take anticoagulants daily, since blood clots easily form on prostheses, which contribute to the formation of blood clots. In rare cases, a mechanical prosthesis may break, which most often leads to the death of the patient. Mechanical valve prostheses can be in the form
- rotating disk
The disc completely covers the hole, but is secured only at one end. Blood moving in the right direction presses on the disc, rotates it on a hinge and opens the hole; when the blood flows back, the disc completely blocks the hole.
- built on the principle of a ball in a grid
The blood flow in the right direction pushes the ball out of the hole, pressing it to the bottom of the mesh and thereby creating the possibility of further passage of blood; reverse blood flow pushes the ball into the hole, which is thus closed and does not allow blood to pass through.

Biological valves

Biological prostheses are usually made from animal heart tissue and are considered more effective. After their installation, there is no need for treatment with anticoagulants, which have many contraindications. Such a prosthesis lasts from 10 to 20 years, its aging occurs gradually and you can prepare in advance for its replacement as planned. Of course, in this case a repeat operation is needed.
Biological valves do not necessarily require the use of anticoagulants (although it is often recommended), but they wear out faster than mechanical valves.

Plastic surgery of atrial and interventricular septal defects

If the structure of the septum is damaged and the size of the defect is small (the hole size is no more than 3 cm), it is sutured, and if it is large, it is repaired with a patch (using synthetic fabrics or autopericardium)

Heart rhythm disturbance

Cardiac arrhythmias are disturbances in the sequence, rhythm and frequency of contractions of the heart. Arrhythmias may occur as a consequence metabolic disorders, for example, endocrine and vegetative, or the influences of certain medicines. They are also often caused by heart disease, and sometimes by intoxication.
The danger of arrhythmia is that it can lead to ventricular fibrillation (disjointed contraction of fibers).
Used to treat arrhythmia medicines, catheter ablation, or a pacemaker (pacemaker) is implanted.

Surgical methods for treating arrhythmias:

Radiofrequency ablation

It is minimally invasive surgical method, which is used for:
- high heart rate with pronounced pulse deficit;
- atrial fibrillation;
- progressive heart failure;
- supraventricular tachycardia.

The radiofrequency ablation method involves passing a special catheter to the area of the heart that causes an abnormal pathological rhythm. An electrical impulse is applied to this section, which destroys the area of tissue that sets the wrong rhythm.
Thanks to ablation, normal heart rhythm is restored.

Pacemaker implantation

The operation is performed on patients with heart rhythm disturbances that are life-threatening. A pacemaker aims to control and restore normal heart contraction.
Doctors implant a special device under the skin or under the pectoral muscle. Two or three electrodes extend from the pacemaker and connect to the chambers of the heart to transmit an electrical impulse to them.

Defibrillator implantation

The principle of operation of a defibrillator is similar to a pacemaker. Distinctive feature it is to eliminate too fast and too slow heart rates. Heart rhythm is assessed using electrodes. Installing a defibrillator is similar to installing a pacemaker.

Installation of a defibrillator is indicated for ventricular tachycardia.

Heart transplant

In critical cases, when the heart cannot perform its function and does not respond to any treatment, a heart transplant is resorted to. Thanks to this operation, doctors prolong the patient’s life by about 5 years. Research is currently underway to prolong the life of people who have had heart transplants.

Postoperative recovery period

An important stage of recovery after surgery is the period postoperative recovery. Strict monitoring of human health is necessary. This period is different and individual for each patient. Patients are prescribed special cardio training and diets. Emotional calm is necessary.

Heart surgery is dangerous due to its complications. The main signs of complications are fever, pain in the operated area, tachycardia, falling blood pressure, shortness of breath. The ECG records characteristic changes. The recovery period lasts six months to a year.

An example of monitoring the health of postoperative patients is the work of a doctor medical sciences, professor, arrhythmologist Andrei Vyacheslavovich Ardashev. He performs more than 200 surgeries a year. Postoperative monitoring of patients began in 2011 using the project. The doctor monitors both the cardiovisor conclusion and the ECG itself in postoperative patients. Using the website service helps monitor the recovery of the health of operated people via the Internet. This is a huge plus, since a large number of patients come to Moscow from all over Russia to undergo heart surgery. They pass the postoperative period at home. Using the Cardiovisor allows you to take ECG readings at home and send them to the doctor using the website.

Rostislav Zhadeiko, especially for the project.