Cardiac surgery is a surgery on the heart performed by a cardiac surgeon. It is usually done to treat complications of ischemic heart disease (e.g. CABG), correct congenital heart disease, treat valvular heart disease, or for heart transplantation.
Cardiothoracic surgery is the branch of medicine involving the surgical treatment of diseases affecting organs inside the thorax (the chest) - generally treatment of conditions of the heart (heart disease) and lungs (lung disease). Cardiac surgery and thoracic surgery are separate surgical specialties, but are frequently grouped together as cardiothoracic surgery. Cardiac surgery generally refers to surgery of the heart and great vessels, and thoracic surgery generally refers to surgery of the chest other than the heart. A cardiothoracic surgeon will perform surgery within the realm of both cardiac and thoracic surgery.
The heart is a muscular organ a little larger than your fist weighing between 7 and 15 ounces (200 to 425 grams). It is responsible for pumping blood through the blood vessels by repeated, rhythmic contractions. The average heart beats 100,000 times per day pumping about 2,000 gallons (7,571 liters) of blood. The average human heart beating at 72 BPM (beats per minute), will beat approximately 2.5 billion times during a lifetime of 66 years.
The heart is usually situated in the middle of the thorax with the largest part of the heart slightly offset to the left underneath the breastbone or sternum and is surrounded by the lungs. The sac enclosing the heart is known as the pericardium.
The heart consists of the following parts:
Aorta: It is the largest artery and carries oxygenated blood from the heart to the rest of the body.
Superior Vena Cava: Deoxygenated blood from the upper parts of the body returns to the heart through the superior vena cava.
Inferior Vena Cava: Deoxygenated blood from the lower parts of the body returns to the heart through the inferior vena cava.
Pulmonary Veins: They carry oxygenated blood from the lungs back to the heart.
Pulmonary Arteries: They carry blood from the heart to the lungs to pick up oxygen.
Right Atrium: It collects deoxygenated blood returning from the body (through the vena cavas) and then forces it into the right ventricle through the tricuspid valve.
Right Ventricle: It collects deoxygenated blood from the right atrium and then forces it into the lungs through the pulmonary valve.
Left Atrium: It collects oxygenated blood returning from the lungs and then forces it into the left ventricle through the mitral valve.
Left Ventricle: It is the largest and the strongest chamber in the heart. It pushes blood through the aortic valve and into the body.
How does the heart function?
The right side of the heart collects de-oxygenated blood from the body into the right atrium and then via the right ventricle pumps it into the lungs so that carbon dioxide can be dropped off and oxygen picked up.
The left side of the heart collects oxygenated blood from the lungs into the left atrium. From the left atrium the blood moves to the left ventricle which pumps it out to supply oxygen to the body.
Heart Function Video
Oxygen-poor blood (shown in blue) flows from the body into the right atrium
Blood flows through the right atrium into the right ventricle
The right ventricle pumps the blood to the lungs, where the blood releases waste gases and picks up oxygen
The newly oxygen-rich blood (shown in red) returns to the heart and enters the left atrium
Blood flows through the left atrium into the left ventricle
The left ventricle pumps the oxygen-rich blood to all parts of the body
The heart valves in the heart maintain the unidirectional flow of blood by opening and closing depending on the difference in pressure on each side.
The heart has two sets of pumping chambers:
1. The right-sided chambers pump blood to the lungs
2. The left side pumps blood to the rest of the body (does the harder job)
The main pumping chambers of the heart are called the ventricles. Ventricle has two valves:
1. Inflow valve
2. Outflow valve - The aortic valve is the outflow valve, allows the blood to leave the left ventricle and closes to prevent blood from leaking backwards into the ventricle from the rest of the body.
The aortic valve has three cusps. These cusps are half moon shaped hence also called aortic semilunar valve. Each cusp has a small swelling in the center called the nodule. Dilatation of the wall of the aorta behind these cusps is called aortic sinus. When the aortic valve is open, the normal size of the orifice is 3-4 sq.cm in adults. The most common congenital abnormality is a bicuspid aortic valve. The normal aortic valve has three leaflets, but a bicuspid aortic valve has only two. So it may not open or close completely.
The tricuspid valve is on the right side of the heart, between the right atrium and the right ventricle. The normal tricuspid valve usually has three leaflets and three papillary muscles. Tricuspid valves may also occur with two or four leaflets, and the number may change during life.
The mitral valve (also known as the bicuspid valve or left atrioventricular valve), is a dual flap valve in the heart that lies between the left atrium (LA) and the left ventricle (LV). In Latin, the term mitral means shaped like a miter, or bishop's cap. The mitral valve and the tricuspid valve are known collectively as the atrioventricular valves because they lie between the atria and the ventricles of the heart and control flow.
Following is the overview of a few common cardiac procedures:
An aortic aneurysm is an abnormal swelling or bulge in the wall of the aorta, the body's largest artery - the blood vessel that carries oxygen-rich blood.
The definitive treatment for an aortic aneurysm is surgical repair of the aorta. The aortic aneurysm repair surgery or aortic aneurysm surgery involves opening up the dilated portion of the aorta and replacing it with a graft (patch tube) made of a synthetic material such as Dacron or Gore-tex.
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An aneurysm can develop anywhere along the aorta, most occur in the section running through the abdomen called abdominal aneurysms.
Abdominal aortic surgery is considered for abdominal aortic aneurysms (AAA) or abdominal aneurysms larger than 5 cm.
The aneurysms occurring in the section that runs through the chest is called thoracic aneurysms. While the stretched vessel may occasionally cause discomfort, a greater concern is the risk of rupture which causes severe pain, massive internal hemorrhage and, without prompt treatment, results in a quick death.
Coronary angiography is an X-ray examination of the blood vessels or chambers of the heart. A very small tube (catheter) is inserted into a blood vessel in your groin or arm. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart, and a special fluid (called a contrast medium or dye) is injected. This fluid is visible by X-ray, and the pictures that are obtained are called angiograms. Another name for this test is coronary arteriography.
Carotid angiography is a procedure to examine the patient's carotid artery which is an artery in the neck that supplies oxygen-rich blood to the brain. It is an imaging procedure, which involves inserting a catheter into a blood vessel in the arm or leg and guiding it to the carotid arteries with the aid of a special X-ray machine. Contrast dye is injected through the catheter so that X-ray movies of your carotid arteries (the arteries that supply your brain with oxygen-rich blood) can be taken. The X-Rays help in identifying any problems. A carotid artery angiography is performed to identify any problems in the carotid artery of the heart. It may be performed to look for blockage or narrowing of the artery, or for defects in the artery wall such as an aneurysm
Angioplasty, Coronary Angioplasty or Percutaneous Coronary Intervention (PCI) is a medical procedure to open narrowed or blocked blood vessels of the heart. These blood vessels are called the coronary arteries. Angioplasty is not considered to be a type of surgery. Percutaneous coronary intervention can be performed to reduce or eliminate the symptoms of coronary artery disease, including angina (chest pain), dyspnea (shortness of breath) on exertion, and congestive heart failure. PCI is also used to abort an acute myocardial infarction, and in some specific cases it may reduce mortality.
Cardiac Bypass Surgery
Cardiac Bypass Surgery, which also goes by the names Coronary Artery Bypass Surgery, Coronary Artery Bypass Graft Surgery (CABG), Heart Bypass or simply Bypass Surgery, is a cardiac procedure performed to reroute or "bypass" blood around clogged arteries to improve blood flow and oxygen to the heart. The arteries that bring blood to the heart muscle (coronary arteries) can become clogged by plaque (a buildup of fat, cholesterol and other substances). This can slow or stop blood flow through the heart's blood vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack. Therefore, this surgery is done to improve blood flow and oxygen to the heart.
Depending on the number of coronary arteries bypassed in the procedure, the surgery may be termed single bypass, double bypass (CABG 2x), triple bypass (CABG 3x), quadruple bypass (CABG 4x) and quintuple bypass (CABG 5x). To find out CABG cost overseas, login to Healthbase.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is a minimally invasive approach to coronary artery bypass surgery (CABG). MIDCAB gains surgical access to the heart with a smaller incision than the traditional CABG. MIDCAB is also referred to as "keyhole" heart surgery because the operation is analogous to operating through a keyhole. This approach is limited to patients requiring one or two bypasses; typically bypassing arteries on the front of the heart.
Off-Pump Coronary Artery Bypass (OPCAB) is a bypass surgery performed without cardiopulmonary bypass (heart-lung machine). During this procedure, the surgeon must cut open the chest and split the breastbone. The surgeon can repair four to five vessels on the beating heart during the same procedure. Off-pump surgery is associated with less blood transfusions, may have a decreased risk of stroke, have a shorter stay in the hospital after surgery, and may be able to return to normal activities more rapidly, but it is technically more challenging than other procedures.
Valvuloplasty is used to widen a stiff or narrowed heart valve (stenotic heart valve). A catheter is guided through the heart and positioned through the diseased heart valve. Balloons on the catheter are inflated, enlarging the opening through the valve and improving blood flow through the heart and to the rest of the body. This allows the heart to pump more effectively, reduces pressures in the heart and lungs, and reduces symptoms.
Heart Valve Repair or Heart Valve Replacement (Aortic Valve, Mitral Valve or Tricupsid Valve)
During a heart valve surgery, one or more valves are repaired or replaced. The valves repaired could be aortic valve, mitral valve or tricuspid valve. Heart valve surgery is performed to treat damaged heart valves which do not function properly leading to heart valve disease. A damaged heart valve has problems either opening or closing. This causes blood to not move through the heart's chambers the way it should. Surgery fixes the problem by either repairing or replacing the affected valve. Repair means that the valve is mended to help it work better. Replacement removes the diseased valve and inserts a new valve in its place. Whether a repair or replacement will be required can be judged by your surgeon only when the surgery has begun.
The Ross procedure (or pulmonary autograft) is a type of specialized aortic valve surgery where a diseased aortic valve is replaced with the person's own pulmonary valve. A pulmonary homograft (valve taken from a cadaver) is then used to replace the patient's own pulmonary valve.
A Bentall procedure is a cardiac surgery involving composite graft replacement of the ascending aorta and aortic valve, with anastomosis of the coronary arteries into the graft.
David procedure or valve-sparing aortic root replacement is a cardiac surgery procedure involving replacement of the ascending aorta without replacement of the aortic valve.
Pulmonary thromboendarterectomy (PTE) is a thoracic surgery operation that removes organized clotted blood (thrombus) from the pulmonary arteries.
Cardiomyoplasty is a surgical procedure in which healthy muscle from another part of the body is wrapped around the heart to provide support for the failing heart. A special pacemaker is implanted to make the skeletal muscle contract.
The Dor procedure or endoventricular circular patch plasty (EVCPP) is a viable method for restoring a dilated left ventricle to its normal, elliptical geometry. The Dor procedure which uses a circular suture and a Dacron patch to correct LV aneurysms and exclude scarred parts of the septum and ventricular wall is considered the best option amongst other methods of ventricular remodeling.
Heart transplantation or cardiac transplantation, is a surgical transplant procedure used to replace a patient's heart by a working heart from a recently deceased organ donor. Heart transplant is performed on patients with end-stage heart failure or severe coronary artery disease.
Septal myectomy is a cardiac surgery treatment for hypertrophic cardiomyopathy (HCM), which is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause and leads to sudden cardiac death.
Ventricular reduction is a type of operation in cardiac surgery to reduce enlargement of the heart from cardiomyopathy or ischemic aneurysm formation.
Pericardiocentesis is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart).
Pericardiectomy is the surgical removal of part or most of the pericardium. This operation might be done to relieve constrictive pericarditis, or to remove a pericardium that is calcified and fibrous.
Pediatric Cardiac Surgery
Diagnosing and treating children's heart diseases requires specialized knowledge and a dedicated approach to care. Pediatric cardiac surgery or paediatric cardiac surgery refers to heart surgery on children.
The Blalock-Taussig shunt is a surgical procedure to give palliation to cyanotic heart defects which are common causes of blue baby syndrome. In modern surgery, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective surgery.
The Fontan procedure is a palliative surgical procedure used in children with complex congenital heart defects. It involves diverting the venous blood from the right atrium to the pulmonary arteries without passing through the morphologic right ventricle. The Fontan procedure is nowadays used where a child only has a single effective ventricle, due to either defects of the heart valves (e.g. tricuspid atresia or pulmonary atresia) or an abnormality of the pumping ability of the heart (e.g. hypoplastic left heart syndrome). The operation itself is carried out as part of a range of operations for heart defects in children where a child cannot have bi-ventricular repair.
The Norwood Procedure is a cardiac surgery performed most often to treat Hypoplastic Left Heart Syndrome, certain types of mitral atresia, or other conditions that result in single ventricle circulation.
Atrial septostomy is a surgical procedure in which a small hole is created between the upper two chambers of the heart, the atria. This procedure is primarily used to treat dextro-Transposition of the great arteries or d-TGA (often imprecisely called transposition of the great arteries), a life-threatening cyanotic congenital heart defect seen in infants.
The maze procedure is a collection of cardiac surgery procedures intended to cure atrial fibrillation (AF), a common disturbance of heart rhythm. Recently, various methods of minimally invasive maze procedures have been developed; these procedures are collectively named minimaze - "mini" versions of the original maze surgery.
A pacemaker or an artificial pacemaker is a small battery-powered implantable device that functions to electrically stimulate the heart to contract and thus to pump blood throughout the body.
A pacemaker has two parts:
1.) Generator - contains the battery and the information to control the heartbeat
2.) Leads - wires used to connect the heart to the generator and send the electrical impulses to the heart to tell it to beat
Pacemakers are usually implanted in patients in whom the heart's own "spark plug" or electrical system is no longer functioning normally. A pacemaker is implanted under the skin through the pacemaker implant surgery.
Traditional pacemakers help control the right side of the heart to control the heart beat. This is called AV synchronization.
A special type of pacemaker that works on both sides of the heart is called a biventricular pacemaker (BVP). By pacing both sides of the heart, the pacemaker can resynchronize a heart that does not beat in synchrony, which is common in heart failure patients. This is called cardiac resynchronization therapy (CRT). All of today's biventricular pacemakers can also work as an implantable cardio-defibrillator (ICD).
Three basic types of pacemakers exist to serve different purposes:
A pacemaker that controls both the atria and ventricles is called a dual-chamber pacemaker. It matches the natural pacing of the heart more closely and is useful in congestive heart failure patients. In contrast, a single-chamber pacemaker controls only one chamber of the heart - in some cases it is the upper chamber or atrium and in other cases it is the lower chamber or ventricle. The third type is a rate-responsive pacemaker which has sensors that automatically adjust to changes in the person's physical activity.
Pacemakers are battery-powered implantable devices that function to electrically stimulate the heart to contract and thus to pump blood throughout the body. Pacemakers consist of a pager-sized housing device which contains a battery and the electronic circuitry that runs the pacemaker, and one or two long thin wires that travel through a vein in the chest to the heart. Pacemakers are usually implanted in patients in whom the heart's own "spark plug" or electrical system is no longer functioning normally.
Implantable Cardioverter Defibrillator
An implantable cardioverter defibrillator or ICD is used in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation. The device is connected to leads positioned inside the heart or on its surface. These leads are used to deliver electrical shocks, sense the cardiac rhythm and sometimes pace the heart, as needed. The various leads are tunnelled to a pulse generator, which is implanted in a pouch beneath the skin of the chest or abdomen. These generators are typically a little larger than a wallet and have electronics that automatically monitor and treat heart rhythms recognized as abnormal. Newer devices are smaller and have simpler lead systems. They can be installed through blood vessels, eliminating the need for open chest surgery.
Minimally Invasive Heart Surgery
A minimally invasive heart surgery is a robot-assisted heart surgery (cardiac surgery) that allows heart surgery to be performed through tiny incisions in the patients chest unlike the traditional open surgery that requires large enough incisions to expose and provide access to the area being operated on. In minimally invasive robot-assisted heart surgery, the surgical instruments used are inserted through incisions no larger than a dime, reducing the opportunity for bacterial infection, decreasing post-operative pain, and allowing for faster recovery.
Alternative names for minimally invasive cardiac surgery are minimally invasive direct coronary artery bypass (MIDCAB), off-pump coronary artery bypass (OPCAB), beating heart surgery, robot assisted coronary artery bypass (RACAB) and keyhole heart surgery.
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