Aortic


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Coronary artery bypass graft surgery (CABG)

Provided by Escorts Heart Institute
Brought to you by Healthbase

Coronary artery bypass graft surgery (CABG) involves sewing one end an artery or vein above a blocked coronary artery and the other end below the blockage, thereby allowing blood an alternative means to get to the heart. The arteries or veins used for the bypass (which are known as “grafts”) are usually obtained from the leg or the chest wall. Bypass surgery may not be possible if the coronary artery is heavily calcified or if the disease is very widespread. CABG can be done with or without connecting the patient to heart-lung machine, depending on the kind of blockages and surgeon’s decision.

Several new surgical approaches are being developed, which can potentially reduce the discomfort and complications associated with traditional bypass surgery. These are collectively referred to as being “minimally invasive.” In general, these approaches focus on performing bypass surgery though a very small chest incision and performing bypass surgery while the heart is still beating (ie, without the need for a heart/lung bypass machine).

OPCAB (Off Pump Coronary Artery Bypass)
The bypass surgery done without connecting the patient to of heart-lung machine or pump is called OPCAB.

MIDCAB (Minimally Invasive Direct Coronary Artery Bypass)
is bypass surgery done through a small cut (incision) in the lower part of the sternum (chest bone) only, rather than full cut across it. This type of surgery, which is possible in selected cases only, is associated with a small scar, lesser pain and faster recovery. Alternatively, this surgery can also be done through a small cut on the left side of the chest.

The location and degree of coronary artery blockages are determined before surgery by using a procedure called heart catheterization, or coronary angiogram. This procedure provides an outline, like a road map, of the arteries of the heart.

Factors favoring bypass surgery
Bypass surgery is often recommended over angioplasty when the left main coronary artery is narrowed by more than 50 percent, when angioplasty does not relieve angina, when many arteries are narrowed, or when the heart’s left ventricular pumping function is substantially impaired. Bypass surgery is also preferred over angioplasty in diabetic patients who have two or three vessels involved.

Benefits
Bypass surgery can very effectively relieve angina and can even prolong life in people with severe coronary heart disease, such as those with three-vessel involvement associated with impaired left ventricular pumping function. However, the success of bypass surgery on symptoms and on survival depends upon several factors, including the pattern and extent of arterial narrowing, the general progression of coronary heart disease over time, and the blood vessels used for bypass. In general, bypass surgery is more likely than angioplasty to provide complete revascularisation.

About 95 percent of people who have narrowing of several arteries have improvement or complete relief of their angina immediately after surgery. About 85 to 90 percent of people remain angina-free at one to three years after surgery, and about 75 percent of people remain angina-free or free of major coronary events at five years after surgery. By 10 years, about one-half of all grafted vessels become narrowed or occluded, and by 15 years, about 85 percent of grafted vessels become narrowed or occluded. These late events usually require a second surgery

Recovery from bypass surgery
It usually takes a while to recover from even routine bypass surgery. However, about 70 to 80 percent of people who have this surgery are eventually able to return to work; this is about the same as the percentage of people who are treated medically and are able to return to work. Factors that appear to have a role in a person’s ability to return to work are the presence or absence of angina after surgery, employment status before surgery and income, the function of the heart’s left ventricle, and age.


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The contents or materials provided in this website are for general information only and are not intended as medical advice

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Catheter Ablation (RFA)

Provided by Escorts Heart Institute
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Catheter ablation has revolutionized the management of patients with certain heart rhythm disorders. Having evolved from arrhythmia surgery, catheter ablation was initially performed using high voltage direct current (DC); however, over the last decade, radio frequency current has supplanted DC as the energy source of choice and has made catheter ablation a first-line therapy for many rhythm disorders. It is an alternative to life-long drug therapy or surgery.

The procedure is done in a special room, called an electrophysiology (EP) lab, by doctors trained in the study and treatment of heart rhythms. Long, flexible wires, called catheters, are inserted into the veins of the leg, arm, and neck (and possibly into arteries in the leg) and positioned in the heart. Through these catheters, the doctor can record electrical signals that come from different parts of the heart. This is similar to an ECG, which records electrical activity from the body’s surface.

With, a special catheter, the area of the abnormality is located inside the heart. The catheter is placed at this area and, by delivering either electrical current or heat from radio frequency waves; the defective heart tissue is destroyed. This eliminates the source of the abnormal heart rhythm or extra pathways.

A catheter ablation can take several hours and does involve some risks. However, the doctor recommending this procedure believes these risks are small compared to the potential benefit for you. Your doctor will discuss this with you and answer any questions you have.


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©2006 Healthbase Online Inc. All rights reserved.  |  About us
The contents or materials provided in this website are for general information only and are not intended as medical advice

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Aortic Aneurysms & Dissections

Provided by Escorts Heart Institute
Brought to you by Healthbase

An aneurysm is an abnormal swelling in a weakened blood vessel while dissection is said to have occurred when blood enters through a lengthwise tear between layers of the wall of aorta or an artery (a blood vessel carrying blood from the heart to the body). These layers then separate and swell, making a thin walled balloon-like formation that causes severe pain. This condition can be a birth defect, a complication of disease like atherosclerosis or injury. High blood pressure also contributes to this disease.The patient may experience pain in chest, abdomen, or back, and may affect the hips and legs, coughing up blood, shortness of breath, nausea, vomiting, blood in stools, fainting, difficulty in swallowing, or just headache.

The diagnosis can usually be arrived at following review of history, chest x-ray, electrocardiogram (ECG), CT scan (computerized x-rays), Angiogram (x-rays after a dye has been injected into an artery), Echocardiogram, and blood tests.

How is it done?
The preferred treatment is immediate surgery. The doctor will replace the weakened part of the artery with a graft made of artificial material, and is carried out with the help of heart lung machine on many occasions. Depending on the location of the aneurysm/dissection, aortic valve may have to be replaced in some situations. The coronary arteries may also have to be implanted on the new graft for continued blood supply to heart. After surgery, blood pressure and other vital signs will be monitored in the recovery room set up.

After Care
It is important to strictly follow certain guidelines as listed:

  • Stop smoking.

  • Maintain your ideal weight.

  • Eat a healthy diet that includes:

    • Low salt food.

    • Avoiding foods high in fat and cholesterol.

    • Increasing fiber in your diet.

    • Adequate precautions against constipation.

  • Exercise daily; walking is recommended.

  • Get enough rest and learn to use relaxation techniques to help reduce stress.

  • Keep blood pressure under control.


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©2006 Healthbase Online Inc. All rights reserved.  |  About us
The contents or materials provided in this website are for general information only and are not intended as medical advice.