Cardiac surgery - a section of medicine dedicated to surgical treatment of the heart. With pathologies of the cardiovascular system, such an 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 achievements of science to restore the patient’s health and full life.
Indications for operations
Invasive heart interventions are complex and risky work, it requires skill and experience from the surgeon, and preparation and implementation of recommendations from the patient. Since such operations are fraught with risk, they are carried out only when absolutely necessary. In most cases, they try to rehabilitate the patient with the help of medicines and medical procedures. But in cases where such methods do not help, heart surgery is needed. Surgery is performed in a hospital and under complete sterility; the operated person is under anesthesia and under the supervision of a surgical team.
Such interventions are needed for congenital heart defects or acquired. The first include pathologies in the anatomy of the organ: defects in valves, ventricles, impaired blood circulation. Most often they are found during the bearing of a child. Heart disease is also diagnosed in newborns, often such pathologies must be eliminated urgently in order to save the baby's life. Among the acquired diseases, ischemic disease leads, in this case, surgery is considered the most effective treatment. Also in the area of the heart there are: impaired circulation, stenosis or insufficiency of valves, 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 the disease, a later call to the doctor.
The decision to appoint an operation is made by a consultation of doctors or a heart surgeon. The patient must be examined to establish an accurate diagnosis and type of surgical intervention. Identify chronic diseases, stages of the disease, assess the risks, in which case they talk about a planned operation. If emergency help is needed, for example, with a blood clot or aneurysm stratification, a minimal diagnosis is performed. In any case, the function of the heart is surgically restored, its departments are rehabilitated, blood flow and rhythm normalize. In difficult situations, the organ or its parts can no longer be corrected, then prosthetics or transplantation are prescribed.
Classification of heart surgery
In the area of the heart muscle, there can be dozens of different diseases, these are: insufficiency, narrowing of the lumens, ruptures of blood vessels, sprains 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 exposure to 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 does not open, and the heart itself is not affected by the surgeon. Therefore, they are called "closed" - the heart muscle remains intact. Instead of opening a strip, the doctor makes a small incision in the chest, most often between the ribs. Closed species include: bypass surgery, balloon angioplasty, stenosis of blood vessels. All these manipulations are designed to restore blood circulation, sometimes they are prescribed to prepare for future open surgery.
- Open - carried out after opening the sternum, sawing bones. The heart itself during such manipulations can also be opened to get to the problem area. As a rule, to perform such operations, the heart and lungs need to be stopped. To do this, connect the heart-lung machine - AIK, it compensates for the work of "disabled" organs. This makes it possible for the surgeon to accurately carry out the work, in addition, the procedure under the control of the AIK takes longer, which is necessary when eliminating complex pathologies. During open operations, AICs may not connect, but stop only the desired area of the heart, for example, with coronary artery bypass grafting. An autopsy of the chest is necessary to replace the valves, prosthetics, and eliminate tumors.
- X-ray surgical - 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 heart. The chest does not open, the catheter is placed in the thigh or shoulder. A contrast agent is supplied through the catheter, which stains the vessels. The advancement of the catheter occurs under the control of x-rays, the video image is transmitted to the monitor. Using this method, the lumen in the vessels is restored: there is a so-called balloon and stent at the end of the catheter. At the narrowing point, this balloon inflates with the stent, restoring the normal patency of the vessel.
Minimally invasive methods, that is, x-ray surgery and a closed type of surgery, are the safest. With such work, the risk of complications is the least, the patient after them recovers faster, but they can not always help the patient. Complex operations can be avoided with a periodic examination by a cardiologist. The sooner the problem is identified, the easier it is for the doctor to solve it.
Depending on the condition of the patient, distinguish:
- Scheduled operation. It is carried out after a detailed examination, on time. A planned intervention is prescribed when the pathology is not particularly dangerous, but it can not 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, at any moment 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 involves the complete elimination of the problem, the second - the elimination of only part of the disease, improving the well-being of the patient. For example, if a patient has a pathology of the mitral valve and stenosis of a vessel, the vessel (auxiliary) is first restored, and after some time valve plastic (radical) is prescribed.
How do operations
The course and duration of the operation depends on the pathology to be eliminated, the patient's condition, and the presence of concomitant diseases. The procedure may take half an hour, and may stretch for 8 hours or more. Most often, such interventions last 3 hours, pass under general anesthesia and AIK control. First, the patient is prescribed an ultrasound of the chest, urine and blood tests, ECG, specialist advice. After receiving all the data, determine the degree and place of the pathology, decide whether the operation will be.
The preparation also prescribes a diet low in salt, fatty, spicy and fried. 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, the anesthetist introduces the patient into medical sleep. With minimally invasive interventions, sufficient local anesthesia, for example, with x-ray surgery. When anesthesia or anesthesia works, the main actions begin.
Heart valve surgery
There are four valves in the heart muscle, all of which serve as a passage for blood from one chamber to another. Most often, mitral and tricuspid valves are operated, 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 valves of the passage, while there is an outflow of blood back.
Plastic surgery is performed openly or closed. During the operation, special rings or seams are manually applied along the valve diameter, which restore normal clearance and narrowing of the passage. Manipulations last an average of 3 hours, with open views, AICs are connected. After the procedure, the patient remains under the supervision of doctors for at least a week. The result is normal blood circulation and heart valve function. In severe cases, native valves are replaced with artificial or biological implants.
Elimination of heart defects
In most cases, malformations are congenital, the reason for this can be hereditary pathologies, bad habits of parents, infections and fever during pregnancy. In this case, children may have different anatomical abnormalities in the region of the heart, often such anomalies are poorly compatible with life. The urgency and type of operation depends on the condition of the child, but they are often prescribed as soon as possible. For children, heart surgery is carried out only under general anesthesia, and under the supervision of medical equipment.
At an older age, heart defects develop with atrial septal defects. This happens with mechanical damage to the chest, infectious diseases, due to concomitant heart diseases. To eliminate such a problem, an open operation is also needed, more often with artificial cardiac arrest.
During the manipulation, the surgeon can "patch" the septum with a patch, or suture the defective part.
Coronary heart disease (CHD) is a very common pathology, affecting mainly a generation older than 50 years. Appears due to impaired blood flow in the coronary artery, which leads to oxygen starvation of the myocardium. There are a chronic form in which the patient has constant bouts of angina pectoris, and the acute one is myocardial infarction. They try to eliminate the chronic conservatively or with the help of minimally invasive techniques. Acute requires urgent intervention.
To prevent complications or alleviate the disease, apply:
- coronary artery bypass grafting;
- balloon angioplasty;
- transmyocardial laser revascularization;
- coronary artery stenting.
All these methods are aimed at restoring normal blood flow. As a result, enough oxygen enters the myocardium with blood, the risk of a heart attack decreases, and angina is eliminated.
If it is necessary to restore normal patency, angioplasty or stenting is sufficient, in which the catheter is moved through the vessels to the heart. Before such an intervention, coronary angiography is performed to accurately determine the clogged area. Sometimes blood flow is restored bypassing the affected area, while a bio-shunt (often this is a section of the patient’s 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 evaluate his condition. The patient is prescribed after checking and approval by a cardiologist.
The first month after surgical procedures is called the early postoperative period, at which time it is very important to follow all the doctor's recommendations: diet, a calm and measured lifestyle. Nicotine, alcohol, heavy foods and exercise 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 such symptoms occur:
- sudden fever;
- redness and swelling at the site of the incisions;
- discharge from the wound;
- persistent chest pain;
- frequent dizziness;
- nausea, bloating, and upset stools;
- difficulty breathing.
At scheduled examinations, the cardiologist listens to the heartbeat, measures the pressure, and listens to complaints. To check the effectiveness of the operation, ultrasound, computed tomography, and x-ray studies are prescribed. Such visits are prescribed once a month for six months, then the doctor will receive an appointment once every 6 months.
Often, in addition to surgical care, medications are prescribed. For example, when prosthetics of valves with artificial implants, 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 medicines can give a negative result. Even regular painkillers need to be discussed with the therapist. To maintain shape and restore health faster, it is recommended to visit the fresh air more often, to walk.
Life after heart surgery will gradually return to its previous course, a full recovery is predicted within a year.
Cardiac surgery offers a ton of cardiac rehabilitation methods. Such operations are designed to return the patient to 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.