Maintaining a healthy Heart, one of the wonderful organs gifted by the Creator, is not child’s play. It is indeed a sad thing that every one takes their heart for granted and does not take good care of this amazing pump until it is too late. We should realize that the heart has to work non-stop! Unless it is given proper care it would be akin to asking for trouble for the rest of our lives. Once heart problems do arise, people desperately try to save it, in most cases when it is too late! Prevention is better than cure is an apt warning!
Once heart problems do develop, it can be rectified by life changes, medicines, food habits, etc. When these measures have not worked, heart surgery may be the only option.
What is Heart Surgery?
It is nothing but surgery done on the heart to repair and correct the heart problems. Generally heart surgery refers to open heart surgery.
Who Needs Heart Surgery?
Heart Surgery is used to treat people who have severe heart diseases and conditions which could not be corrected even after life style changes, medicines and food habits, etc. The final decision to go for heart surgery is taken only after discussion with the patient and evaluating the following criterion:
The nature of the problem, the symptoms and the duration
Medical history of the affected and past records of treatment for heart problems including surgeries, procedures and medicines
Family history of heart problems
History of other health problems and conditions such as diabetes or high blood pressure
Age and general health
Doctors may also perform a variety of diagnostic tests as needed.
Medical diagnostic tests are done to find out heart problems and the general health of a patient. This helps the doctor to decide whether heart surgery is actually needed, the type of surgery and the timing of the surgery.
Electrocardiogram (EKG or ECG)
An ECG is a simple and painless test that records the electrical activity of the heart. It helps the doctor to detect and locate the source of the problem.
Some heart problems are easier to diagnose when the heart is under stress and beating rapidly than when it is at rest. During the Stress Test, the blood pressure is checked for any abnormalities and an EKG is done.
An Echo is a painless, non-invasive test. This particular test uses sound waves to create a moving picture of the heart.
A Coronary Angiogram is a procedure that uses X-ray imaging to see the inside of heart’s blood vessels.
This is an angiogram of the aorta. An aortogram may show the location and size of an aortic aneurysm and the arteries involved.
Chest X-ray provides a picture of the organs and structures inside the chest, including the heart, lungs and blood vessels.
Cardiac Computed Tomography Scan
A Cardiac Computed Tomography (CT) Scan provides computer generated x-ray images of an internal organ. A liquid dye that can be seen on an x-ray is injected into a vein in the arm. The dye outlines arteries and veins in the heart on the CT scan. The scan can show whether plaque is narrowing the coronary arteries or whether there is an aneurysm. It can also find problems with the heart function and heart valves.
Cardiac Magnetic Resonance Imaging - Cardiac MRI uses a computer to create images of the heart as it is beating. Computer makes both still and moving pictures of the heart and major blood vessels.
Types of Heart Surgery
There are different types of heart surgery to correct different types of heart problems.
Coronary Artery Bypass Grafting (CABG)
This is the most Common type of heart surgery. Each year more than 500,000 CABGs are done in India. Surgeons use healthy arteries and veins taken from other parts of the body to bypass blocked arteries. Bypass means to ‘go round’. CABG reduces the risk of heart attack and also relieves chest pain. It improves the blood flow to the heart. It is performed on people with severe Coronary Heart Diseases (CAD). As many as four artery bypasses can be done in a single instance of surgery.
Tran myocardial Laser Revascularization (TLR)
This type of heart surgery is rare. It is used to treat angina when no other treatment is found to be effective. Lasers are used to make channels in the heart muscle. It would allow oxygen rich blood to flow from heart chambers directly into the heart muscle.
Valve Repair or Replacement
When the heart pumps blood , it must flow in only one direction. The valves in the heart make this possible. Each valve has a set of flaps, called leaflets. These leaflets allow the blood-flow to pass from the heart chambers into the arteries and then close tightly. The Valve Repair or Replacement Surgery is used to repair the leaflets if they do not open-up wide enough. This happens when the leaflets become thick or stiff or fuse together. Due to this sufficient blood does not flow through the valve into the artery. If the leaflets do not close tightly, blood can leak back into the chambers. Here also surgery is used to repair the leaflets.
An arrhythmia is a situation where the heart either beats too fast, too slow or with an irregular rhythm. The heart may not be able to pump enough blood when the heart rate is not normal. Generally speaking arrhythmias are harmless, but some can be serious or life threatening. The common type of serious arrhythmia is arterial fibrillation. Lack of blood flow can cause serious damage to the internal organs. The first remedy for arrhythmia is medicine. If medicine does not prove to be effective, surgery is needed. Surgery is used to place a pacemaker or an Implantable Cardioverter defibrillator (ICD). Another type of surgery is Maze Surgery. Here Surgeons make new paths – a maze – for the heart’s electrical signal to travel through.
Aneurysm is an abnormal bulge or ‘ballooning’ in the wall of an artery or the heart muscle. Pressure occuring due to the flow of blood , can cause weak area of the artery or heart to bulge out. In the long run the bulge can grow or can burst, resulting in fatal bleeding inside the body. Repair involves surgery to replace the weak section with a patch or graft.
A Heart transplant is done to replace a damaged or weak heart with a healthy one from a deceased donor. This life saving measure is used when medical treatments and other less drastic surgery have failed.
The ‘Open’ in open heart surgery does not refer to the heart and but to the chest. The Heart may be opened too, depending on the type of surgery. This type of surgery is done to bypass blocked arteries, repair or replacement of heart valves, fix atrial fibrillation and transplant heart.
Minimally Invasive Heart Surgery
In this type of surgery, the surgeon makes a small incision (cut) in the side of the chest between the ribs instead of a large incision down the center of the chest to open the rib cage. One type of Minimally Invasive Heart Surgery that is still being developed is robotic-assisted surgery. For this technique the Surgeon uses a computer to control surgical tools on thin robotic arms. The tools are inserted through small incision in the chest. This allows Surgeon to perform complex and highly precise surgery. The surgeon is always in total control of the robotic arms. When compared to Open Heart Surgery, the benefits of this type of surgery include smaller incisions and scars, lower risk of infection, less pain and shorter hospital stay and a faster recovery.
Risks of Heart Surgery
Medical Science has indeed developed in the modern era and many mile stones have been established, which in turn developed surgeries as well. However, we can not ignore risks involved in the field of surgical operations. Heart surgery is no exception. The following risks are there in a heart surgery. It does not mean that these risks will be there in each and every case of heart surgery. They may or may not occur. However, we have to be cautious and be ready to face them:
Infection, fever, swelling and other signs of inflammation
Reaction to the medicine used to anesthetize the patient
Arrhythmias (irregular heart beats)
Memory loss and difficulty in concentrating or thinking clearly
Damages to tissues in the heart, kidneys and lungs
Death (People who are very sick before the surgery are at higher risk)
In general the risks of heart surgery are higher for people who:
are older than 70
have had previous heart surgery
have diseases or conditions such as high blood pressure, diabetes, kidney and lung or peripheral arterial diseases.