Cardiovascular

Indications

A test can tell not only if a patient’s coronary arteries are clogged or have become narrowed, but also where and by how much. It is important to detect blockages because they can cause chest pains or even a heart attack if left untreated. Testing helps doctors to organize a patient-specific treatment plan specific to a patient’s needs and conditions, which may include an angioplasty, a stent or a coronary artery by-pass. Coronary angioplasty may be performed if a patient has :

• Had an instance of angina
• Unstable angina
• Aortic stenosis
• Atypical chest pains
• Received abnormal heart stress test results
• A high risk of coronary artery disease before surgery
• Had a heart failure diagnosis
• Had a heart attack diagnosis

How is it performed?

1. The patient will stay awake so that they are able to follow the doctor’s instructions but will take medicine to remain relaxed during the procedure.
2. Often, a coronary angiography is performed with a cardiac catheterization procedure.
3. The patient needs to lie on his/her back on a movable table near a camera.
4. A doctor will numb an area on the arm, groin, upper thigh or neck and insert a thin tube (catheter) into a peripheral artery and direct it towards the heart.
5. After the catheter is in place, the doctor will inject a special solution which passes through the catheter to highlight blockages. All blood vessels and heart chambers can then be seen on X-ray images.
6. By studying X-ray images, the doctor can see any problems with the patient’s coronary arteries.

Indications

Indications

• If the left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the heart’s left ventricle.
• At times when angioplasty is deemed unsuitable, such as when a previous stent placement has failed or restenosis has occurred.
• In emergency situations, such as when a heart attack has occurred, when one is likely to occur, or in cases of vessel injury.
• Neither surgeries or endovascular treatments cure the underlying heart disease which caused the blockages in the first place. These treatments treat only the outcome of the underlying condition.

Indications

How is it performed?

1. The doctor will take a healthy blood vessel from the patient’s chest, arm or leg. This is called a graft.
2. The doctor attaches one end of the healthy vein to an area of the heart above the blockage in the artery. The other end is attached to an area of the coronary artery below where it is clogged.
3. The difficulty with beating heart bypass surgery is that it is difficult to sew on a beating heart. To solve this, the surgeon uses a stabilization device to keep the heart steady and make it possible to work on it.

What Happens After My Off-Pump Bypass Surgery?

• Patients will complete their recovery time much earlier than patients who undergo a conventional by-pass surgery. Recovery time has been reported to be as short as 3-4 weeks. Since the patients are not placed on the heart lung machine, they experience quicker recoveries.
• Hospitalization time is generally shorter when compared to the traditional by pass. (approximatively 1 week)
• Risk of a stroke and the need for blood transfusions are reduced.

The heart is a pump distributing the blood to the whole body. It has a self-exciting muscle which regulates itself and it is capable of simultaneous rhythmic pulsations. It has a regulating center and four chambers separated by valves and a septum. The valves control blood flow direction during contractions and septum isolates the right and left circulation. These negative and positive pressures are responsible for creating contractions that pump blood throughout the body.

Heart Valve Surgery is performed with or without opening up the chest, and works to replace or repair heart valves which are not working correctly. The aortic valve and the mitral valve are the most commonly replaced valves. The aortic valve separates the heart’s left ventricle (the main pumping chamber) and the aorta (the major artery that carries blood to patient’s body). The mitral valve separates the left atrium from the left ventricle.

What Are The Types Of Valve Problems?

Heart valve problems make the heart work too hard. There can be abnormalities in heart valves because of birth defects, aging or due to certain diseases. Some patients are born with heart valve disease, while others develop it later in life. Heart valve diseases that develop before birth are called congenital heart valve diseases. Problems associated with heart valves include them not having enough tissue flaps, may be the wrong size or shape, or may lack an opening through which blood can flow properly.

Heart valves can have three basic kinds of problems:

• Regurgitation (valves don’t close properly or  let blood leak where it shouldn’t)
• Stenosis (valves don’t open enough, don’t let enough blood to flow)
• Atresia (occurs if a heart valve lacks an opening for blood to pass through)

What Is A Valve Replacement Surgery Like?

In most cases, heart valve replacement is an open-heart surgery. This means a surgeon opens the patient’s chest before operating. In the surgery, a new artificial valve is placed while removing the damaged one. In some cases, the valve can be replaced without opening the chest, with the operating happening via a series of small incisions instead. The procedure chosen will depend on the complexity of the patient’s case, the reason the valve needs replacement, the patient’s symptoms, and the risk of surgery.

The operation is conducted under general anesthesia and generally takes between 3 and 5 hours. For most of the procedure, the patient’s heart will be temporarily stopped, with a heart-lung machine taking over the patient’s breathing and blood circulation. Alternatively, there are some procedures that may be performed on a beating heart.

What Happens After My Valve Replacement Surgery?

• Following the surgery, patient must spend some time in the intensive care unit (ICU) and medical stuff will closely monitor their recovery. After that, patients will be moved to a hospital room.
• In a one day or two, you will be able to sit up and walk around.
• Patients can expect spending 4-7 days in the hospital.
• Those who have had heart valve repair or replacement surgery (open heart surgery) can usually fly after 10-15 days (longer if they have had pulmonary complications and if it is a more complex case).

What If An Open Heart Surgery Is Too Risky For Me?

How is it performed?

• The Minimally Invasive Valve Replacement procedure can be performed through an incision in the axilla (armpit) approximately 5-6 cm wide, creating access to the heart between the ribs while avoiding any incisions to the muscles, ribs or the sternum. Minimally Invasive Valve Replacement surgery is an innovative surgery technique which is very effective and cost-conscious. Patients who undergo the surgery will experience less pain, have a lower risk of infection, and a shorter hospitalization time relative to traditional procedures thanks to this sub-axillary incision and endoscopic surgical method.

• Unlike a conventional surgery which works through 10-12 incisions and places the patient on a heart-lung machine, the new minimally invasive approaches avoid placing the patient on the machine and involves either only 3-5 incisions placed between the ribs or several small incisions elsewhere. Since the incision is small in this surgery, there is less bleeding, decreasing the need for blood transfusion.

What Happens After My Minimally Invasive Valve Replacement?

• Patients may experience less pain and may have a better ability to cough, breathe deeply and move compared to conventional surgery. Additionally, patients are often discharged from the hospital in just 2-3 days, compared to the typical 5-10 days for conventional surgery.

• Patients will be able to look after their daily needs by themselves as they will retain full use of their arms and experience less pain than in conventional surgery. They can also travel on a plane, drive for short periods and wear seatbelts without the fear of harming their chests.

• Since these surgeries are performed through incisions in the armpit, even the patient themselves may not see post-operative scars. Additionally, the scars can disappear within only a month, and since the incisions are minimal and there are no bone cuts, infection risks are greatly diminished.

The left and right sides of the heart have different pumping functions. The right side of the heart collects deoxygenated blood from the body and pumps it to the lungs while the left side collects oxygenated blood from lungs and pumps it to the body. In order to carry this oxygen-rich blood properly, the halves of the heart should be divided from one another. This is achieved by a musculo-membranous (consisting of muscle and biological membrane tissue) wall called a cardiac septum.

A ventricular septal defect is also a congenital heart defect where there is a hole in the wall (septum) between the two lower pumping chambers of the heart. An example of this is an atrial septal defect (ASD), a congenital heart defect where there is a hole in the wall (septum) that separates the top two chambers (halves) of the heart. Although many of these defects, and especially ASDs, close themselves during early childhood, signs of heart failure, growth retardation or other systemic complications mean that the condition may still have to be treated as soon as possible.

For ASD or VSD correction, a minimally invasive cardiology or cardiovascular approach can be applied. For smaller ASDs and VSDs defects, surgery and other treatments may not be needed and can often be tentatively monitored without surgery. For more complex cases and larger defects, cardiovascular surgery is the first choice of treatment. Thanks to recent advances and the training of specialist surgeons, most cases can be treated with a minimally invasive surgery in which the sternum (chest) is not opened and instead an endoscopic approach is performed through a small incision in the armpit. This technique reduces the hospitalization and recovery time, and is more comfortable for the patient when compared to classical surgery.

Indications

Symptoms can develop in early childhood or later in life depending on the size of the defect. Patients with larger ASDs and VSDs are more likely to develop a heart failure or a heart stroke. Patients may experience shortness of breath, fatigue, a decrease in exercise capacity. Closing a large septum defect (ASD or VSD) by open-heart surgery usually is performed in childhood to prevent complications in the future.

How Can ASDs And VSDs Be Closed By Minimally Invasive Surgery?

The most common surgical approach requires the surgeon to open the breastbone in order to directly access the heart. Although this approach provides excellent access to the heart, the post-operative wound requires several months to heal completely, a long recovery period, and has a risk of serious complications including infection, breakdown, and even death.

Minimally invasive surgery can be performed to close all septal defects, allowing the procedure to be performed through small incisions and without stopping the heart, opening breastbone (sternum) or requiring a heart-lung machine to be used.

By using specialized endovascular catheters and endoscopic techniques, the surgeon gains access to the heart and the septum safely through small incisions in a relatively bloodless manner. This technique is less traumatic for the patient, meaning that recovery time is faster and there are fewer post-operative complications. In some cases, a robot is used to assist the surgeon while performing the minimally invasive septum defect closure.

How is it performed?