Replacement of blood vessels on the heart operation is called. Types of heart operations - indications for performance. Angioplasty and stenting of the coronary arteries

How are operations performed?

An operation is an intervention in the human body with a violation of its integrity. Each disease requires an individual approach, which naturally affects the way the operation is performed.

How heart surgery is done: preparation for surgery

Heart surgery (cardiac surgery) is one of the most difficult to perform, dangerous and responsible type of surgical intervention.

Planned operations are usually carried out in the morning. Therefore, the patient is not allowed to eat or drink in the evening (for 8-10 hours), and immediately before the operation, a cleansing enema is given. This is necessary in order for the anesthesia to work as it should.

The place where operations are performed must be sterile. In medical institutions, special rooms are used for these purposes - operating rooms, which are regularly sterilized by quartz treatment and special antiseptics. In addition, all medical personnel who take part in the operation wash themselves before the procedure (you even have to rinse your mouth with an antiseptic solution), and also change into special sterile clothes, put on sterile gloves on your hands.

The patient is also put on shoe covers, a cap on his head, and the operation field is treated with an antiseptic. If necessary, before the operation, the patient's hair is shaved if the surgical field is covered with it. All these manipulations are necessary to avoid infection of the surgical wound with bacteria or other dangerous active microorganisms.

Narcosis or anesthesia

Anesthesia is a general anesthesia of the body with its immersion in drug-induced sleep. During surgical interventions on the heart, general anesthesia is used, and in some cases, during endovideosurgical operations, spinal anesthesia, in which a puncture is made into the spinal cord at the level of the lower back. Substances that cause pain relief can be administered in various ways - intravenously, through the respiratory tract (inhalation anesthesia), intramuscularly or in combination.

Course of open heart surgery

After the person goes into medical sleep and ceases to feel pain, the operation itself begins. The surgeon uses a scalpel to open the skin and soft tissues on the chest. Cardiac surgery may also require an “opening” of the chest. To do this, with the help of special surgical instruments, the ribs are sawn. Thus, doctors “get” to the operated organ and put special dilators on the wound, which provide better access to the heart. Junior medical staff, using suction, removes blood from the surgical field, and also cauterizes cut capillaries and blood vessels so that they do not bleed.

If necessary, the patient is connected to an artificial heart machine, which will temporarily pump blood through the body, while the operated organ is artificially suspended. Depending on what kind of heart surgery is performed (what kind of damage is eliminated), appropriate manipulations are carried out: it can be the replacement of blocked coronary arteries, the replacement of heart valves in case of defects, vein bypass surgery or the replacement of an entire organ.

Extreme care is required from the surgeon and all staff, as the life of the patient depends on it. It should also be added that during the operation, blood pressure and some other indicators are constantly monitored, which indicate the patient's condition.

Endovideosurgery: stenosis and angioplasty

Today, more and more often, heart surgery is performed not by an open method - with a chest incision, but with access through the femoral artery on the leg, under the control of an X-ray machine and a microscopic video camera. After preparing for operation, which is similar for all types of surgical interventions, and putting the patient into a medical sleep, access to the femoral artery is opened through an incision in the leg. A catheter and a probe with a video camera at the end are inserted into it, thanks to which access to the heart is provided.

In this way, angioplasty with stenosis of blood vessels is carried out in cardiac surgery, which is necessary for blockage of the coronary vessels that feed the heart itself with blood. Special stands are installed in the narrowed vessels - cylindrical implants that do not allow the arteries to clog anymore, which prevents the possibility of developing coronary disease.

After the main part of the operation is over and the heart is on its own again functions, stitching of damaged nerves, vessels and tissues is performed. The wound is again treated with an antiseptic, the surgical field is closed, soft tissues and skin are sutured with special threads. A medical bandage is applied to the external wound. After the end of all these procedures, the patient is taken out of anesthesia.

Other types of operations

In addition to the abdominal operations described above, there are also operations performed in a less traumatic way:

Laparoscopy - is performed using a laparoscope, which is inserted through 1-2 cm incisions in the skin. Most often used in gynecology, gastrectomy and other operations in the abdominal cavity. You can read more about this
Laser surgery - is carried out using a special laser beam. Usually, operations are performed in this way on the eyes, when removing skin formations, etc. You can read more about the method

Heart valve replacement
- Possible complications and recommendations for care

Heart surgery is performed only when necessary. The most common of these are heart valve replacement and coronary artery bypass grafting. The first is necessary if the patient is concerned about valvular stenosis. It should be noted that heart surgeries pose a serious risk to the life of the patient, they are carried out with maximum precision and caution. Heart surgery sometimes leads to numerous problems and complications, in order to avoid this, you can use an alternative technique - valvuloplasty.

The procedure can replace replacement surgery, help normalize the activity of the heart muscles. In the process, a special balloon is inserted into the opening of the aortic valve, at the end this balloon is inflated. It is worth considering: if a person is in old age, valvuloplasty does not give a lasting effect.

Heart valve replacement

To decide on such a procedure, it is necessary to establish a diagnosis.

The operation is carried out immediately or some time after the test.

In some situations, the results indicate that a person needs bypass surgery. Valve replacement is an open procedure that can be performed using minimally invasive surgery. It should be remembered that heart valve replacement is a very complicated procedure, despite this, it is carried out very often.

Back to index

Stages of the procedure and further rehabilitation

First you need to open the chest. Next, the doctor connects the patient to a special apparatus that provides artificial circulation. The device temporarily replaces the heart. The patient's circulatory system is connected to the device, after which the natural valve is removed and replaced. When this manipulation is completed, the device is turned off. In most cases, heart surgery goes well, but a scar forms on the organ.

After recovery from anesthesia, the breathing tube is removed from the lungs. If you want to remove excess fluid, such a tube should be left for a while. After a day, it is allowed to drink water and liquid, you can walk only after two days. After such an operation, pain in the chest area can be felt, and on the fifth day the patient is completely discharged. If there is a risk of complications, the hospital stay must be extended by 6 days.

Back to index

Can there be complications after valve replacement?

A person can face such problems at different stages of the disease. During the operation, there is a risk of heavy bleeding, in addition, difficulties with anesthesia may arise. Possible risk factors include internal bleeding, seizures, possible infections. A heart attack can also happen, but this happens very rarely. As for the greatest danger, it lies in the appearance of tamponade of the pericardial cavity. This phenomenon occurs when blood fills its heart sac. This causes serious malfunctions in the functioning of the heart. Operations on the heart cannot but affect the general condition of a person. During the rehabilitation period, strict medical supervision is required. The need to visit the surgeon arises after 3-4 weeks after the operation. It is important to maintain the general well-being of the patient. An optimal dose of physical activity should be prescribed, it is important to stick to a diet.

Back to index

What is coronary artery bypass grafting?

Coronary artery bypass grafting is a type of surgery that restores blood flow in the arteries. The procedure is necessary to eliminate coronary heart disease. The disease manifests itself when the lumen of the coronary vessels narrows, as a result of which an insufficient amount of oxygen enters the heart muscle. Coronary artery bypass surgery aims to prevent changes in the myocardium (heart muscle). After the operation, he should fully recover and contract better. It is necessary to restore the affected area of the muscle, for this the following procedure is carried out: everyday shunts are applied between the aorta and the coronary vessel that is affected. Thus, the formation of new coronary arteries occurs. They are designed to replace the narrowed ones. After the shunt is applied, blood from the aorta flows through a healthy vessel, thanks to which the heart produces a normal blood flow.

Back to index

What is the operation for?

This procedure will be required if the left coronary artery of the vessel that provides flow to the heart is affected. It is also needed if all coronary vessels are damaged. The procedure can be double, triple, single - it all depends on how many shunts the doctor needs. With coronary heart disease, the patient may need one shunt, in some cases two or three. Bypass surgery is a procedure that is often used for atherosclerosis of the heart vessels. This happens when angioplasty is not possible. As a rule, a shunt can serve for a long time, its functional suitability is 12-14 years.

Back to index

Carrying out coronary artery bypass grafting

The duration of the operation is 3-4 hours. The procedure requires maximum concentration and attention. The doctor needs to gain access to the heart, for this it is necessary to dissect the soft tissues, then open the sternum and perform a stenotomy. During the operation, a procedure is carried out that is necessary for temporary, it is called cardioplegia. The heart must be cooled with very cold water, then a special solution should be injected into the arteries. To attach shunts, the aorta must be temporarily blocked. To do this, it is necessary to pinch it and connect the heart-lung machine for 90 minutes. Plastic tubes should be placed in the right atrium. Next, the doctor performs procedures that contribute to the flow of blood into the body.

What is routine vascular bypass surgery? This method involves the implantation of special implants into the coronary vessels outside the obstruction, the end of the shunt is sutured to the aorta. In order to be able to use the internal mammary arteries, it is necessary to carry out the procedure with the expenditure of more time. This is due to the need to separate the arteries from the chest wall. Upon completion of the operation, the doctor carefully fastens the chest, for this a special wire is used. With its help, a soft tissue incision is sutured, then drainage tubes are applied to remove residual blood.

Sometimes bleeding occurs after the operation, it continues throughout the day. The installed drainage tubes should be removed after 12-17 hours after the procedure. At the end of the operation, the breathing tube must be removed. On the second day, the patient can get out of bed and move around. Restoration of the heart rhythm takes place in 25% of patients. As a rule, it lasts for five days. As for arrhythmia, this disease can be eliminated within 30 days after surgery, for this conservative methods of therapy are used.

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

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

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

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

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

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

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

Intact heart or closed surgeries

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

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

Indications for their conduct is always determined by the doctor.

Achievements of modern cardiac surgery or minimally invasive operations

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

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

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

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

When is the operation indicated?

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

It is shown to the following people:

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

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

Consider the most common types of heart surgery

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

Heart surgery helps to cure many diseases of the cardiovascular system that are not amenable to standard therapeutic methods. Surgical treatment can be carried out in different ways, depending on the individual pathology and the general condition of the patient.

Indications for surgical treatment

Cardiac surgery is a field of medicine in which physicians specialize in studying, inventing methods and performing operations on the heart. The most complex and dangerous cardiac surgery is heart transplantation. Regardless of what type of surgery will be performed, there are general indications:

the rapid progress of the disease of the cardiovascular system; ineffectiveness of conservative therapy; untimely visit to the doctor.

Heart surgery makes it possible to improve the general condition of the patient and eliminate the symptoms that disturb him. Surgical treatment is carried out after a complete medical examination and the establishment of an accurate diagnosis.

Heart disease

Do operations for congenital heart defects or acquired. A congenital defect is detected in a newborn immediately after birth or before birth on an ultrasound examination. Thanks to modern technologies and techniques, in many cases it is possible to detect and cure heart disease in newborns in time.

An indication for surgical intervention can also be coronary disease, which is sometimes accompanied by such a serious complication as myocardial infarction. Another reason for surgery may be a violation of the heart rhythm, since this disease tends to cause ventricular fibrillation (scattered contraction of fibers). The doctor should tell the patient how to properly prepare for heart surgery in order to avoid negative consequences and complications (such as a blood clot).

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

Operation types

Cardiac surgeries can be performed on an open heart as well as on a beating heart. Closed heart surgery is usually performed without affecting the organ itself and its cavity. Open heart surgery involves opening the chest and connecting the patient to a ventilator.

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

RF ablation

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

By itself, arrhythmia is not a serious pathology requiring surgical intervention, but can lead to serious complications. Thanks to RFA, it is possible to restore a normal heart rhythm and eliminate the main cause of its violations.

RFA is performed using catheter technology and under x-ray control. Heart surgery takes place under local anesthesia and consists in bringing a catheter to the necessary part of the organ, which sets the wrong rhythm. Through an electrical impulse under the action of RFA, the normal rhythm of the heart is restored.

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 the lower limb or arm.

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. An indication for heart valve replacement surgery 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

Glenn's 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.

Laser cautery can also be used to treat arrhythmias. 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 has become possible to effectively treat arrhythmia, eliminate heart disease in newborns, or cure other pathologies with heart surgery. In the time after such an operation, many people can live their usual lives, which have only some restrictions.

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

DlyaSerdca → Symptoms and treatment → Surgery and invasive heart examinations

Heart surgeries are very common these days. Modern cardiac surgery and vascular surgery are very advanced. Surgical intervention is prescribed in the case when conservative drug treatment does not help, and, accordingly, the normalization of the patient's condition is impossible without surgery.

For example, heart disease can only be cured by surgery, this is necessary in the case when blood circulation is severely disturbed due to pathology.

And as a result, a person feels bad and severe complications begin to develop. These complications can lead not only to disability, but also to death.

Often prescribed surgical treatment of coronary heart disease. Since it can lead to myocardial infarction. Due to a heart attack, the walls of the cavities of the heart or aorta become thinner and protrusion appears. This pathology can also be cured only by surgery. Quite often, operations are performed due to disturbed heart rhythm (RFA).

They also perform heart transplantation, that is, a transplant. This is necessary when there is a complex of pathologies due to which the myocardium is not able to function. Today, such an operation prolongs the life of the patient by an average of 5 years. After such an operation, the patient is put on disability.

Operations can be carried out urgently, urgently, or a planned intervention is prescribed. It depends on the severity of the patient's condition. An emergency operation is performed immediately, immediately after the diagnosis is established. If such an intervention is not carried out, then the death of the patient may occur.

Such operations are often performed on newborns immediately after birth with congenital heart disease. In this case, even minutes are important.

Urgent operations do not require fast execution. In this case, the patient is prepared for some time. As a rule, it is several days.

A planned operation is prescribed if at this time there is no danger to life, but it must be carried out to prevent complications. Doctors prescribe surgery on the myocardium only if it is necessary.

Invasive Research

Invasive methods for examining the heart are to conduct catheterization. That is, the study is carried out through a catheter, which can be installed both in the cavity of the heart and in the vessel. With the help of these studies, you can determine some indicators of the work of the heart.

For example, blood pressure in any part of the myocardium, as well as determine how much oxygen is in the blood, evaluate cardiac output, vascular resistance.

Invasive methods allow you to study the pathology of the valves, their size and degree of damage. This study takes place without opening the chest. Cardiac catheterization allows you to take an intracardiac electrocardiogram and phonocardiogram. This method is also used to monitor the effectiveness of drug therapy.

For the treatment of cardiovascular diseases, Elena Malysheva recommends a new method based on Monastic tea.

It contains 8 useful medicinal plants that are extremely effective in the treatment and prevention of arrhythmia, heart failure, atherosclerosis, coronary artery disease, myocardial infarction, and many other diseases. In this case, only natural ingredients are used, no chemicals and hormones!

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

When performing invasive studies, local anesthesia is used. The incision is small, about 1-2 cm. This is necessary to expose the desired vein for the installation of the catheter.

Having studied the methods of Elena Malysheva in the treatment of HEART DISEASE, as well as the restoration and cleaning of VESSELS - we decided to bring it to your attention ...

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)

Feedback from our reader Victoria Mirnova

I recently read an article that talks about Monastic tea for the treatment of heart disease. With the help of this tea, you can FOREVER cure arrhythmia, heart failure, atherosclerosis, coronary heart disease, myocardial infarction and many other diseases of the heart and blood vessels at home.

I was not used to trusting any information, but I decided to check and ordered a bag. I noticed the changes within a week: the constant pain and tingling in my heart that had tormented me before receded, and after 2 weeks they disappeared completely. Try it and you, and if anyone is interested, then below is a link to the article.

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 from animal biological material).

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 size of the hole is less than 3 cm. Plastic surgery is performed using synthetic tissue 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 that they will not be able to conduct the impulse. After RFA, a bandage is not needed.

Carotid surgery

There are such types of operations on the carotid artery:

Prosthetics (used with a large lesion); Stenting is performed if stenosis is diagnosed. In this case, the lumen is increased by installing a stent; Eversion endarterectomy - at the same time, atherosclerotic plaques are removed along with the inner lining of the carotid artery; Carotid endarectomy.

These operations are performed under both general and local anesthesia. More often under general anesthesia, as the procedure is performed in the neck and there are discomfort.

The carotid artery is occluded, and in order to continue the blood supply, shunts are installed, which are bypass routes.

Classical endarterectomy is done if long plaque lesions are diagnosed. During this operation, the plaque is peeled off and removed. Next, the vessel is washed. Sometimes it is still necessary to fix the inner shell, this is done with special seams. At the end, the artery is sutured with a special synthetic medical material.

Endarterectomy of the carotid arteries

Eversion endartectomy is performed in such a way that the inner layer of the carotid artery at the site of the plaque is removed. And after that they fix, that is, sew. For this operation, the plaque should be no more than 2.5 cm.

Stenting is performed using a balloon catheter. This is a minimally invasive procedure. When the catheter is located at the site of stenosis, it inflates and thereby expands the lumen.

Rehabilitation

The period after heart surgery is no less important than the operation itself. At this time, the patient's condition is monitored by doctors, and in some cases, cardio training, therapeutic diets, etc. are prescribed.

Other recovery measures are also needed, such as wearing a bandage. The bandage at the same time fixes the seam after the operation, and of course the entire chest, which is very important. Such a bandage should be worn only if the operation is performed on the open heart. The cost of these items may vary.

The bandage that is worn after heart surgery looks like a T-shirt with tightness clamps. You can purchase male and female versions of this bandage. The bandage is important to prevent lung congestion by coughing regularly.

Such prevention of stagnation is quite dangerous because the seams can disperse, the bandage in this case will protect the seams and contribute to strong scarring.

Also, the bandage will help prevent swelling and bruising, promotes the correct location of organs after heart surgery. And the bandage helps to relieve the load from the organs.

After heart surgery, the patient needs rehabilitation. How long it will last depends on the severity of the lesion and the severity of the operation. For example, after CABG, immediately after heart surgery, you need to start rehabilitation, this is a simple exercise therapy and massage.

After all types of heart surgery, medical rehabilitation, that is, supportive therapy, is needed. In almost all situations, the use of antiplatelet agents is mandatory.

If there is high blood pressure, then ACE inhibitors and beta-blockers are prescribed, as well as drugs to lower blood cholesterol (statins). Sometimes the patient is prescribed physical procedures.

Disability

It should be noted that disability is given to people with diseases of the cardiovascular system even before surgery. There must be evidence for this. From medical practice, it can be noted that they necessarily give disability after coronary artery bypass grafting. Moreover, there may be a disability of both 1 and 3 groups. It all depends on the severity of the pathology.

People who have circulatory disorders, grade 3 coronary insufficiency, or have had a myocardial infarction are also entitled to disability.

Regardless of whether the operation was performed or not yet. Patients with grade 3 heart defects and combined defects can apply for disability if there are persistent circulatory disorders.

Clinics

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 Multivalve 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 valve replacement Multivalve prosthetic 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… You constantly feel 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 an effective remedy for cardiovascular diseases. >>>

Let us know about it -

rate

Cardiac surgery is a branch of medicine dedicated to the surgical treatment of the heart. With pathologies of the cardiovascular system, such intervention is an extreme measure. 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 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 in the lead, in this case, surgery is considered the most effective method of treatment. Also in the heart area there are: impaired blood circulation, stenosis or valve insufficiency, heart attack, pericardial pathology and others.

Heart surgery is prescribed in situations where conservative treatment does not help the patient, the disease progresses rapidly and threatens life, with pathologies that require urgent and urgent 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. They identify chronic diseases, stages of the disease, assess the risks, in which case they talk about a planned operation. If emergency assistance is needed, for example, when a blood clot is torn off or an aneurysm is exfoliated, minimal diagnostics are performed. In any case, the function of the heart is restored surgically, its departments are rehabilitated, blood flow and rhythm are normalized. In severe situations, the organ or its parts are no longer amenable to correction, then prosthetics or transplantation is prescribed.

Classification of heart operations

In the area of the heart muscle, there can be dozens of different diseases, these are: insufficiency, narrowing of the lumen, ruptures of 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 the 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 "disconnected" 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 a closed type of operation. 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. Complex operations can be avoided with periodic inspections. 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 in serious condition, the situation may worsen at any time - 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 of the mitral valve and stenosis of a vessel, the vessel is first 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, a low-fat, spicy, and fried diet is also prescribed. 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, an AIC is connected. 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 cause of this can be hereditary pathologies, bad habits of 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 with mechanical damage to the 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 has constant attacks of angina pectoris, and an acute one is 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 activity are 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, computed tomography, x-ray examinations are prescribed. Such visits are scheduled once a month for six months, then the doctor will see you once every 6 months.

Often, in addition to surgical care, medications are prescribed. 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.