Types of plastic surgery on the heart. Features of cardiac surgery. Heart valve defects

Cardiac surgery is a branch of medicine dedicated to the surgical treatment of the heart. With pathologies of cardio-vascular system such intervention is a last resort. Doctors try to restore the patient's health without surgery, but in some cases only cardiac surgery can save the patient. Today, this field of cardiology uses the latest advances in science to return the patient to health and a fulfilling life.

Indications for operations

Invasive interventions on the heart is a complex and risky job, it requires skill and experience, and from the patient - preparation and implementation of recommendations. Since such operations are risky, they are carried out only when absolutely necessary. In most cases, the patient is trying to rehabilitate with the help of medicines and medical procedures. But in cases where such methods do not help, heart surgery is needed. Surgical intervention is carried out in a hospital and complete sterility, the operated is under anesthesia and the control of the surgical team.

Such interventions are needed for congenital heart defects or acquired. The former include pathologies in the anatomy of the organ: defects in valves, ventricles, impaired blood circulation. Most often they are discovered even during the bearing of a child. Heart disease is also diagnosed in newborns, often such pathologies need to be eliminated urgently in order to save the life of the baby. Among the acquired diseases, ischemic disease is the leader, in this case, the operation is considered the most effective method treatment. Also in the heart area there are: impaired blood circulation, stenosis or valve insufficiency, heart attack, pericardial pathology and others.

Heart surgery is indicated in situations where conservative treatment does not help the patient, the disease progresses rapidly and threatens life, with pathologies that require urgent and immediate correction, and in advanced forms of diseases, a late visit to the doctor.

The decision on the appointment of the operation is made by a council of doctors or. The patient must be examined to establish an accurate diagnosis and type of surgical intervention. Reveal chronic diseases, stages of the disease, assess the risks, in this case they talk about planned operation. If needed emergency help, for example, when a blood clot is torn off or an aneurysm is stratified, minimal diagnostics is carried out. Anyway surgically the function of the heart is restored, its departments are rehabilitated, blood flow and rhythm are normalized. IN difficult situations, the organ or its parts are no longer amenable to correction, then prosthetics or transplantation is prescribed.

Classification of heart operations

There can be dozens of different diseases in the area of the heart muscle, these are: insufficiency, narrowing of the gaps, tears blood vessels, stretching of the ventricles or atria, purulent formations in the pericardium and much more. To solve each problem, surgery has several types of operations. They are distinguished by urgency, effectiveness and method of influencing the heart.

The general classification divides them into operations:

Buried - used to treat arteries, large vessels, aorta. During such interventions, the chest of the operated person is not opened, the heart itself is also not affected by the surgeon. Therefore, they are called "closed" - the heart muscle remains intact. Instead of a strip opening, the doctor makes a small incision in the chest, most often between the ribs. Closed types include: shunting, balloon angioplasty, stenosis of blood vessels. All these manipulations are designed to restore blood circulation, sometimes they are prescribed to prepare for a future open operation.
Open - carried out after opening the sternum, sawing the bones. The heart itself during such manipulations can also be opened to get to problem area. As a rule, for such operations, the heart and lungs must be stopped. To do this, connect the heart-lung machine - AIC, it compensates for the work of "disabled" organs. This allows the surgeon to accurately perform the work, in addition, the procedure under the control of AIC takes longer, which is necessary when eliminating complex pathologies. During open operations, AIC may not be connected, but only the desired zone of the heart can be stopped, for example, during coronary artery bypass grafting. Opening the chest is necessary to replace valves, prosthetics, and eliminate tumors.
X-ray surgery - similar to closed type operations. The essence of this method is that the doctor moves a thin catheter through the blood vessels, and gets to the very heart. The chest is not opened, the catheter is placed in the thigh or shoulder. The catheter is injected with a contrast agent that stains the vessels. The catheter is advanced under X-ray control, the video image is transmitted to the monitor. Using this method, the lumen in the vessels is restored: at the end of the catheter there is a so-called balloon and a stent. At the site of narrowing, this balloon is inflated with a stent, restoring the normal patency of the vessel.

The safest are minimally invasive methods, that is, X-ray surgery and a closed type of surgery. With such work, the risk of complications is the least, the patient recovers faster after them, but they can not always help the patient. To avoid complex operations possible with periodic inspection at. The earlier the problem is identified, the easier it is for the doctor to solve it.

Depending on the condition of the patient, there are:

planned operation. It is carried out after a detailed examination, within the agreed time frame. A planned intervention is prescribed when the pathology does not pose a particular danger, but it cannot be postponed.
Urgent - these are operations that need to be done in the next few days. During this time, the patient is prepared, all the necessary studies are carried out. The date is set immediately after receiving the necessary data.
Emergency. If the patient is already serious condition, at any time the situation may worsen - an operation is prescribed immediately. Before her, only the most important examinations and preparations are carried out.

In addition, surgical care can be radical or auxiliary. The first implies the complete elimination of the problem, the second - the elimination of only part of the disease, improving the patient's well-being. For example, if a patient has a pathology mitral valve and stenosis of some vessel, first the vessel is restored (auxiliary), and after a while valve plastic surgery (radical) is prescribed.

How operations are done

The course and duration of the operation depends on the pathology being eliminated, the patient's condition, and the presence of concomitant diseases. The procedure can take half an hour, and can stretch for 8 hours or more. Most often, such interventions last 3 hours, are carried out under general anesthesia and AIC control. First, the patient is prescribed an ultrasound of the chest, urine and blood tests, an ECG, and a consultation with specialists. After receiving all the data, they determine the degree and place of the pathology, decide whether there will be an operation.

As part of the preparation, they also prescribe a diet with low content, fatty, spicy and fried. For 6-8 hours before the procedure, it is recommended to refuse food and drink less. In the operating room, the doctor assesses the well-being of the ward, introduces the patient into a medical sleep. With minimally invasive interventions, local anesthesia is sufficient, for example, during X-ray surgery. When anesthesia or anesthesia takes effect, the main actions begin.

Heart valve repair

There are four valves in the heart muscle, all of which serve as a passage for blood from one chamber to another. The most commonly operated valves are the mitral and tricuspid valves, which connect the ventricles to the atria. Stenosis of the passages occurs with insufficient expansion of the valves, while the blood does not flow well from one department to another. Valve insufficiency is a poor closure of the cusps of the passage, while there is an outflow of blood back.

Plastic surgery is carried out open or closed, during the operation, special rings or sutures are applied manually along the diameter of the valve, which restore the normal lumen and narrow the passage. Manipulations last an average of 3 hours, with open views connect AIC. After the procedure, the patient remains under the supervision of doctors for at least a week. The result is normal blood circulation and functioning of the heart valves. In severe cases, native leaflets are replaced with artificial or biological implants.

Elimination of heart defects

In most cases, defects are congenital, the reason for this can be hereditary pathologies, bad habits parents, infections and fever during pregnancy. At the same time, children may have various anatomical abnormalities in the region of the heart, often such anomalies are poorly compatible with life. The urgency and type of surgery depends on the condition of the child, but they are often prescribed as early as possible. For children, heart surgery is performed only under general anesthesia, and under the supervision of medical equipment.

At an older age, heart defects develop with defects in the interatrial septum. This happens when mechanical damage chest, infectious diseases due to concomitant heart disease. To eliminate such a problem, an open operation is also needed, more often with artificial cardiac arrest.

During manipulations, the surgeon can “patch” the septum with a patch, or suture the defective part.

Shunting

Coronary artery disease (CHD) is a very common pathology that affects mainly the generation over 50 years of age. Appears due to impaired blood flow in the coronary artery, which leads to oxygen starvation of the myocardium. There is a chronic form in which the patient constant attacks angina, and acute - a myocardial infarction. They try to eliminate chronic pain conservatively or with the help of minimally invasive techniques. Acute requires urgent intervention.

To prevent complications or alleviate the disease, apply:

aorto-coronary bypass;
balloon angioplasty;
transmyocardial laser revascularization;
stenting of a coronary artery.

All these methods are aimed at restoring normal blood flow. As a result, enough oxygen is supplied to the myocardium with blood, the risk of a heart attack is reduced, and angina pectoris is eliminated.

If you need to restore normal patency, angioplasty or stenting is enough, in which the catheter is moved through the vessels to the heart. Before such an intervention, coronary angiography is performed to accurately determine the blocked area. Sometimes blood flow is restored bypassing the affected area, while a bio-shunt (often a section of the patient's own vein from the arm or leg) is sutured to the artery.

Recovery after interventions

After surgery, the patient remains in the hospital for another 1-3 weeks, all this time the doctors will assess his condition. The patient is discharged after verification and approval by the cardiologist.

The first month after surgical procedures is called the early postoperative period, at this time it is very important to follow all the doctor's recommendations: diet, calm and measured lifestyle. Nicotine, alcohol, junk food and physical exercise prohibited regardless of the type of intervention.

The doctor's recommendations should also contain a warning about the dangers and complications. At discharge, the doctor will set the date for the next appointment, but you need to seek help and unscheduled if the following symptoms occur:

sudden fever;
redness and swelling at the incision site;
discharge from the wound;
persistent chest pain;
frequent dizziness;
nausea, bloating and stool disorders;
breathing difficulties.

At scheduled examinations, the cardiologist will listen to the heartbeat, measure the pressure, and listen to complaints. To check the effectiveness of the operation, ultrasound is prescribed, CT scan, x-ray studies. Such visits are scheduled once a month for six months, then the doctor will see you once every 6 months.

Often other than surgical care prescribe medications. For example, when prosthetic valves are artificially implanted, the patient drinks anticoagulants for life.

In the postoperative period, it is important not to self-medicate, since the interaction of permanent drugs and other medications can give a negative result. Even conventional painkillers need to be discussed with. To keep fit and restore health faster, it is recommended to be outdoors more often, walk on foot.

Life after heart surgery will gradually return to its previous course, a full recovery is predicted within a year.

Cardiac surgery offers many methods for the rehabilitation of the heart. Such operations are designed to restore the patient's physical and moral strength. You should not be afraid or avoid such procedures, on the contrary, the sooner they are carried out, the greater the chances of success.

Morning. Petroverigsky lane, house 10. At this Moscow address in the Kitay-Gorod area, I arrived at the federal center for diagnosis and treatment cardiovascular diseases angiography.su, which is part of the State Research Center for Preventive Medicine, to put on a sterile suit again and visit 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 inner walls 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 in various organs including the heart itself.

Before the advent of the stenting method, which will be discussed, doctors had only surgical method shunting, popularly famous thanks to the operation on the heart of Boris Nikolayevich Yeltsin 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, sawed chest(they cut 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), may hold their breath or do deep breaths at the request of the doctor. Blood loss is minimal, and the incisions are tiny, because the arteries are penetrated through a catheter, which is usually installed in 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 apparatus rotates around the table to make x-rays hearts 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 the 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. For complete confidence in 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 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 endovascular diagnostics and treatment methods at the center, to my question about Russian manufacturers stents replied that they simply did not exist.

The operation takes about half an hour. A pressure bandage is applied to the puncture site. From the operating room, the patient goes to the ward intensive care, 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 core patients are usually removed after stenting, the person returns to ordinary life, and observation is carried out periodically by a doctor at the place of residence.

Surgical interventions on the heart are necessary in the treatment of many pathologies of the cardiovascular system that are not amenable to standard drug therapy. When implementing surgical treatment it becomes possible to improve the general condition of the patient and prolong his life. But depending on the pathology, there are different heart operations, which differ in their technique.

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Operations classification

Cardiac surgery is aimed at the treatment of cardiac pathologies through indirect or direct effects on this organ. There are such types of heart operations:

Closed, while the heart itself is not affected. Such operations are performed outside the heart, so they do not need to use special equipment, with the exception of classical surgical instruments. The cavities of the heart remain closed, hence the name of this category.
Open, they require opening the cavities of the heart, which requires the use of special equipment, such as a heart-lung machine. At the time when such surgical intervention, the heart and lungs are not functioning, allowing the specialist to work with the cardiac arrest.
X-ray surgery, in which special catheters and devices attached to them are used, they are inserted into the cavity of the heart or the lumen of the vessel to correct the defect. The progress of such an operation is controlled by the monitor screen.

In addition, the types of surgical interventions in cardiac surgery are classified according to the patient's condition and the type of defect, as well as the approach to treatment.

According to the patient's condition and the type of defect, there are:

Emergency operations - when you need to act immediately after the diagnosis has become clear, otherwise the pathology threatens the patient's life.
Urgent - they do not require a lightning-fast reaction and a quick start of action. They are prepared for several days, but not longer, due to the high risks of complications or death.
Planned - interventions, the implementation of which is desirable, but not essential in the near future. They are prescribed by surgeons after consultation with patients.

Depending on what approach requires surgical treatment:

Radical - they are aimed at the complete elimination of vices.
Palliative - they are additional or auxiliary, their goal is to improve the patient's condition or prepare him for a radical intervention.

RF ablation

Such surgical intervention as radiofrequency ablation refers to X-ray surgical procedures. It is carried out to improve the condition of a patient suffering from heart failure and arrhythmia, and is characterized by low scores side effects and complications.

Manipulations during the operation are carried out with special catheters, which are introduced to the patient under local anesthesia. The place of introduction of the catheter, remote from the heart itself, therefore, local anesthesia is carried out at the site of the future introduction of the catheter. In most cases, it is injected into the inguinal vein or femoral artery. After entering the organ, the catheters give electrical impulses to restore the heart rhythm.

Due to such a supply of impulses that eliminate a small area of cardiac tissue that causes pathological excitation of the myocardium, the technique received a second name - cauterization of the heart.

Valve prosthetics

Prosthetic heart valves are used when a valve is insufficiency or stenosis, which interferes with the normal passage of blood through it. Valve replacement can be performed during open surgery, endovascular or mini-access.

In the first case, the patient general anesthesia treat the anterior surface of the chest, dissect the sternum longitudinally, open the pericardial cavity. To disconnect the heart from blood circulation, the patient is connected to a heart-lung machine, and the myocardium is systematically treated with cold saline during the entire operation in order to avoid its hypoxia.

To install the prosthesis, a longitudinal incision is made, opening the cavity of the heart, the modified structures of the valve are removed, it is replaced with an artificial one, and the myocardium is sutured. After that, the surgeon "starts" the heart with an electrical impulse or by performing a direct heart massage, and turns off the heart-lung machine.

After inspection postoperative view heart, pericardium and pleura, remove blood from the cavities and sew up the surgical wound in layers.

With endovascular surgery, there is no need to "disconnect" the heart from blood circulation. It is carried out through the leg, namely by introducing a catheter with implantable valves into the femoral artery or vein. After fragments of the damaged valve are destroyed and removed, a prosthesis is put in its place, which straightens itself, having a flexible stent frame.

If the option with a mini-access was chosen, then the surgeon makes an incision 2-5.5 cm long on the anterior wall of the sternum in the area of the projection of the apex of the heart. Then, through the apex of the heart, a catheter is inserted into the organ, advancing it to the affected valve, and replacing it.

In the case of valve replacement, there are several types of implants:

Mechanical - they are made of metal or plastic. When choosing such an implant, the patient in the future will need to constantly take blood thinners.
Biological - they consist of animal tissues and do not require further use of drugs, but after a few decades they need to be replaced.

Installing a pacemaker

In the event that the patient suffers from heart failure, cardiomyopathy and cardiac arrhythmias, the specialist may prescribe a minor operation to install a pacemaker.

The technique for performing such an operation is simple. On the right or left under the left clavicle, local anesthesia is performed with novocaine or lidocaine, after which an incision is made in the skin and subclavian vein to insert a conductor into it, and through it into the superior vena cava and into the heart - an electrode. When the tip of the electrode enters the cavity of the right atrium, the doctor chooses a convenient place for optimal stimulation of the heart muscle, during the search he constantly registers ECG changes. When a place is found, the electrode is fixed in the myocardial wall from the inside with the help of antennae or a corkscrew-like attachment. After fixation, it is required to hem a titanium case under the patient's arm, which is installed in the thickness of the pectoral muscle on the left. The wound is sutured and an aseptic bandage is applied.

Coronary artery bypass grafting

Coronary artery bypass grafting is a common heart surgery. It is prescribed when on the inner walls coronary vessels that feed the heart, atherosclerotic plaques accumulate, disrupting blood flow. In addition, indications can be:

Stable angina 3-4 functional class.
Acute coronary syndrome.
Acute myocardial infarction within the first 4–6 hours of onset of pain.
Severe ischemia without pain.

Before surgery, the patient is administered intravenously sedatives and tranquilizers, and the intervention itself is carried out under general anesthesia. Online access done by dissection of the sternum or from a mini-access, making an incision in the intercostal space on the left in the area of the projection of the heart. Manipulation can be carried out both with the connection of the patient to the heart-lung machine, and without it.

The aorta is clamped and connected to the machine, then a vessel is isolated, which will become a bypass. This vessel is brought to the affected coronary artery and its other end is sutured to the aorta. As a result, from the aorta, bypassing the area affected by plaques, the blood will go to the coronary arteries without difficulty.

Depending on how many arteries supplying the heart are affected and at what intervals, the number of shunts can vary from 2 to 5.

When the shunts are fixed, metal staples are applied to the edges of the sternum, soft tissues sutured and apply an aseptic bandage. In addition, drainage is removed from the pericardial cavity so that there is an outflow hemorrhagic fluid.

Operations Glenn and Ross

The Glenn operation is otherwise known as a bidirectional cavopulmonary connection. In this case, anastomosis of the upper part of the superior vena cava with the right pulmonary artery is performed according to the "end to side" principle.

Ross surgery is the replacement of a patient's damaged aortic valve with his pulmonary valve, and the removed pulmonary valve is replaced with a prosthesis.

Heart surgery helps to cure many diseases of the cardiovascular system that are not amenable to standard therapeutic methods. Surgical treatment may be 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:

rapid progress of the disease of the cardiovascular system; inefficiency 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.

Heart disease

Do operations for congenital heart defects or acquired. A congenital defect is detected in a newborn immediately after birth or before delivery on ultrasound examination. Thanks to modern technologies and methods 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 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 a blood clot).

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

Operation types

Cardiac surgery can be performed on open heart and also 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.

Endovascular intervention

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; stenting of coronary arteries; 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 pathologies of the heart has its advantages and disadvantages, therefore, for each patient, the most suitable type of operation is selected, which carries fewer complications for him.

RF ablation

Radiofrequency or catheter ablation (RFA) is a minimally invasive surgical intervention that has a high therapeutic effect and minimal side effects. This treatment has been shown 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 main reason his 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.

Coronary artery bypass grafting

Coronary artery bypass grafting (CABG) helps to restore blood supply to the heart muscle. Unlike the RFA technique, such treatment gives a high result due to the formation of a new passage for the blood flow. This is necessary in order to bypass the affected vessels with special shunts. To do this, take a vein or artery of the patient from lower limb or hands.

Such heart surgery helps prevent the development of myocardial infarction and atherosclerotic plaques. Its essence lies in the fact that sclerosed vessels are replaced by healthy ones. Often, after shunting, an angioplasty technique is used, when a tube is inserted through the vessels (femoral artery) with a balloon into the damaged vessel. Pressurized air exerts pressure on the actorosclerotic plaques (thrombus) in the aorta or artery and assists in their removal or advancement.

Stenting of the coronary arteries

Stenting

Together with angioplasty, stenting can be performed, during which a special stent is installed. It pushes the narrowed lumen in the aorta or other vessel and helps prevent blood clots and remove atherosclerotic plaque, as well as normalize blood flow. All these manipulations can be carried out simultaneously, so that repeated surgical intervention is not prescribed.

The most common heart disease is valve narrowing or insufficiency. Treatment of such a pathology should always be radical and consist in the correction of valvular lesions. Its essence lies in the prosthetics of the mitral valve. Indication for replacement surgery heart valve there may be severe valvular insufficiency or leaflet fibrosis.

With a serious violation of the heart rhythm and the presence of atrial fibrillation, there is a serious need to install a special device called a pacemaker. A pacemaker is needed to normalize the rhythm and heart rate, which can be disturbed during arrhythmias. To normalize the heart rhythm, a defibrillator can be installed, which has the same type of action as a pacemaker.

Heart valve replacement

A patient who has a pacemaker has to undergo frequent medical examinations.

During surgery, a mechanical or biological implant is placed. Patients who have a pacemaker have to adhere to certain restrictions in life. A blood clot or other complication may appear some time after the installation, so lifelong use of special medications is often prescribed.

Operation Glenn and Operation Ross

The Glenn operation is included in the stage of complex correction of children who have congenital heart disease. Its essence is to create an anastomosis connecting the superior vena cava and the right pulmonary artery. Through the time after the treatment was carried out, the patient can live a full life.

The Ross operation involves replacing the patient's damaged aortic valve with his own pulmonic valve.

Can also be used to treat arrhythmias laser cautery. Cauterization can be performed using ultrasound or high frequency current. Cauterization helps to completely eliminate the signs of arrhythmia, tachycardia and heart failure.

Thanks to modern technology and the development of medicine, it became possible to conduct effective treatment arrhythmias, eliminate a heart defect in newborns, or cure another pathology with heart surgery. After a while after such an operation, many people can live their usual lives, which have only some limitations.

Attention! The information on the site is provided by experts, but is for informational purposes and cannot be used for self-treatment. Be sure to consult a doctor!

DlyaSerdca → Symptoms and treatment → Surgery and invasive heart examinations

Heart surgeries are very common these days. Modern cardiac surgery And vascular surgery very developed. Surgery is indicated 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 begins to develop severe complications. 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 delivery with congenital defect hearts. 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.

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Such studies include:

Angiography. This is a method for which a contrast agent is used. It is injected into the cavity of the heart or vessel for accurate visualization and detection of pathologies. coronary angiography. This study allows you to assess the degree of damage to the coronary vessels, it helps doctors understand whether surgery is needed, and if not, what therapy is suitable for this patient. Ventriculography. This is a radiopaque study that will allow you to determine the condition of the ventricles, the presence of pathology. All ventricular parameters can be studied, such as cavity volume, cardiac output, cardiac relaxation and excitability measurements.

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. For this use femoral vein(right), a needle is inserted into it through which the conductor passes. The needle diameter becomes about 2 mm.

By doing invasive research local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose desired vein to place the catheter.

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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:

Valve replacement (prosthetics)

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This type of operation is done on the open heart, that is, after opening the chest. In this case, the patient is connected to a special apparatus for cardiopulmonary bypass. The operation consists in replacing the affected valve with an implant. They can be mechanical (in the form of a disk or ball in a grid, they are made of synthetic materials) and biological (made of biological material animals).

Valve implant placement

Plastic defects of partitions

It can be carried out in 2 options, for example, suturing a defect or its plastic. Suturing is carried out if the hole size is less than 3 cm. synthetic fabric or autopericardium.

Valvuloplasty

With this type of operation, implants are not used, but simply expand the lumen of the affected valve. At the same time, a balloon is introduced into the lumen of the valve, which is inflated. It should be noted that such an operation is performed only on young people, as for the elderly, they are only entitled to open-heart intervention.

Balloon valvuloplasty

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 accompanying one, for example, stenosis or valve insufficiency, etc. And the endovascular procedure gives a temporary effect.

Aortic dissection

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.

Coronary artery bypass grafting

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.

RF catheter ablation

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 they will not be able to conduct the impulse. After RFA, a bandage is not needed.

Carotid surgery

Allocate these types of operations to 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, since 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 you still need to fix 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 is prescribed, therapeutic diets etc.

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 an increase arterial pressure, then assign ACE inhibitors and beta-blockers, 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

NII SP im. N. V. Sklifosovsky	Moscow, Bolshaya Sukharevskaya sq., 3	CABG without IR CABG with valve replacement Angioplasty and coronary artery stenting RFA Aortic stenting Valve replacement Valve repair	64300 rub. 76625 rub. 27155 rub. 76625 rub. 57726 rub. 64300 rub. 76625 rub.
KB MGMU them. Sechenov	Moscow, st. B. Pirogovskaya, 6	CABG with valve replacement Angioplasty and stenting of coronary arteries RFA Aortic stenting Prosthetic valves Valve repair Aneurysm resection	132000 rub. 185500 rub. 160000-200000 rub. 14300 rub. 132200 rub. 132200 rub. 132000-198000 rub.
FSCC FMBA	Moscow, Orekhovy Boulevard, 28	CABG Angioplasty and stenting of the coronary arteries RFA Aortic stenting Prosthetic valves Valve repair	110000-140000 rub. 50000 rub. 137000 rub. 50000 rub. 140000 rub. 110000-130000 rub.
NII SP im. I.I. Janelidze	St. Petersburg, st. Budapestskaya, 3	CABG Angioplasty and stenting of the coronary arteries Aortic stenting Prosthetic valves Valve plasty Multivalvular prosthetics Probing of the heart cavities	60000 rub. 134400 rub. 25000 rub. 60000 rub. 50000 rub. 75000 rub. 17000 rub.
SPGMU them. I.P. Pavlova	St. Petersburg, st. L. Tolstoy, 6/8	CABG Angioplasty and coronary artery stenting Prosthetic valves Multivalve prosthetics RFA	187000-220000 rub. 33000 rub. 198000-220000 rub. 330000 rub. 33000 rub.
MC "Shiba"	Derech Sheba 2, Tel Hashomer, Ramat Gan	CABG Prosthetic valves	30000 USD 29600 USD
MedMira	Huttropstr. 60, 45138 Essen, Germany 49 1521 761 00 12	Angioplasty CABG Prosthetic valves Cardiac examination Coronary angiography with stenting	EUR 8000 EUR 29000 EUR 31600 EUR 800-2500 EUR 3500
Greekomed	Central Russian office: Moscow, 109240, st. Upper Radishchevskaya, house 9 A	AKSH valve replacement	20910 euros 18000 euros

Do you still think that getting rid of HEART DISEASES is impossible!?

Do you often experience discomfort in the area of the heart (pain, tingling, squeezing)? You may suddenly feel weak and tired... high blood pressure... There is nothing to say about shortness of breath after the slightest physical exertion ... And you have been taking a bunch of medications for a long time, dieting and watching your weight ...

But judging by the fact that you are reading these lines, victory is not on your side. That is why we recommend reading the story of Olga Markovich, who found effective remedy from cardiovascular diseases. >>>

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