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Cardiac Surgery

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.

Doctors

Anatomy of the heart


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 Flow

Heart Function Video

  1. Oxygen-poor blood (shown in blue) flows from the body into the right atrium
  2. Blood flows through the right atrium into the right ventricle
  3. The right ventricle pumps the blood to the lungs, where the blood releases waste gases and picks up oxygen
  4. The newly oxygen-rich blood (shown in red) returns to the heart and enters the left atrium
  5. Blood flows through the left atrium into the left ventricle
  6. The left ventricle pumps the oxygen-rich blood to all parts of the body

Heart Valves


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.

Aortic valve

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.

Tricuspid Valve

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.

Mitral valve

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.

Cardiac procedures

Following is the overview of a few common cardiac procedures:
Aortic Aneurysms

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.
For affordable aortic aneurysm surgery cost, contact Healthbase.

Abdominal Aneurysms

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.

Thoracic aneurysms

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

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

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

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.

MIDCAB

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.

OPCAB

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

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.

Ross Procedure

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.

Bentall Procedure

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

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

Pulmonary thromboendarterectomy (PTE) is a thoracic surgery operation that removes organized clotted blood (thrombus) from the pulmonary arteries.

Cardiomyoplasty

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.

Dor Procedure

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

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

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

Ventricular reduction is a type of operation in cardiac surgery to reduce enlargement of the heart from cardiomyopathy or ischemic aneurysm formation.

Pericardiocentesis

Pericardiocentesis is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart).

Pericardiectomy

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.

Blalock-Taussig Shunt

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.

Fontan Procedure

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.

Norwood Procedure

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

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.

Maze Procedure

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.

Pacemaker
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.

Pacemaker Insertion

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.

Stem Cell Therapy for Heart


Stem Cell Therapy for Heart is a relatively new procedure for severe heart failure caused by Ischemic Heart Disease or Cardiomyopathy that could not be managed well by conventional medications or surgery. This is usually done on patients with Ejection Fraction (a measure of heart function test) 25% or lower. With very low EF patients often can not do normal daily routines and may need oxygen and other medications.

The procedure is safe and carries small risk. however, it all depends on patients condition before the procedure is done as well as initial cause of heart problem. Most of patient had the ejection fraction increased by 10 percent in 3 month follow up. In other word, it could go up from 15 to 25 or 30 to 40 % in three months. As this is rather a new treatment procedure we are collecting data to evaluate the long term results. However, those patients with severe heart problems could get the immediate benefits derived from the procedure.

The cells will derive from patient`s own blood. It is not an embryonic stem cell. These cells stimulate growth of new heart cells and muscle to improve the heart functions.

The investigations before the treatment are coronary angiogram and cardiac MRI with Gadolinium contrast.

The process of the treatment is the following:

The patient will have to come to the hospital one week before the actual treatment. This is for initial evaluation, additional tests and blood collection. Blood will be collected from the arm vein (250 cc) in the CCU. The blood will then send to the lab for cell selection and expansion. This process will take one week. The patient will be then admitted to the hospital one week after the blood collection for surgery. The procedure involves a small incision in thte left chest and direct injection of cell into heart muscle. The will need 2-3 nights stay in intensive care unit and 4 - 5 days in an ordinary ward. The patient will then discharged from the hospital and have a follow up visit 1 week after the surgery before the patient can travel back.

Cardiac Surgery and Medical Tourism


Today, people requiring cardiac procedures consider medical tourism as a viable option primarily because of the low cost of high quality care that can be received overseas. A triple cardiac bypass surgery tagged at over $250,000 in the US can be had for about 6% of this price at a JCI accredited hospital in India. Other benefits of seeking cardiac treatment abroad include immediate access to care. This is especially useful to those in Canada and the UK who have to wait excessively before they can get the treatment they need. High quality of care is assured by Healthbase as we work mainly with those international hospitals that have international accreditations like JCI, JCAHO, ISO, etc.
We connect you to the best hospitals and best doctors overseas. Our international hospital partners are present in India, Singapore, Thailand, South Korea, Turkey, Belgium, Hungary, Costa Rica, Panama, Brazil, Mexico and USA. Our international partner hospitals have access to state-of-the-art technologies and modern equipments and our partner cardiologists and heart surgeons have been educated or trained in the US, UK, Europe, etc.

Healthbase has helped heart patients get various cardiac treatments overseas including angioplasty, aortic aneurysm repair, multiple cardiac bypass surgery (CABG), etc. In general, any cardiac procedure where the patient is not in the hospital emergency room at the time the procedure is needed can be considered for medical tourism.

For detailed profiles of top hospitals and top doctors abroad offering cheap and affordable cardiac procedures, please
register or login to Healthbase. Registration also entitles you to FREE quote of your low cost high quality cardiac surgery overseas. Cardiac procedures are offered internationally in major cities including New Delhi, Mumbai (Bombay), Bangalore, Bangkok, Tijuana, San Jose, Panama City and many more. To avail of the huge savings and receive discount on cardiac surgery packages and deals, login to Healthbase now.

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CORONARY ARTERY BYPASS GRAFT

 

STENTING and ANGIOPLASTY

 

ARTIFICIAL PACEMAKER and AICD

 

ANEURYSM

 

PEDIATRIC CARDIOLOGY

 

OTHER HEART PROCEDURES

 

HEART ANATOMY

 

Healthbase, an award-winning* medical tourism facilitator in USA, is the trusted source for global medical and dental choices, connecting patients to leading healthcare facilities worldwide. We arrange a variety of medical tourism services from basic consultations to full service treatment abroad. We help you to take care of all your medical tourism details from arranging the surgery and financing options to visas, travel, lodging and tourism.

Healthbase caters to the needs of individual consumers, self-funded businesses, insurance carriers, benefit consultants, insurance agents, and third party administrators seeking affordable medical travel and dental travel options. Our state-of-the-art, easy to use, information rich web-based system makes it easy to coordinate international medical care including necessary travel and accommodation for patients and their companions, all at one place.

The cost of surgical care at our ever growing network of affiliated institutions is typically a fraction of the cost of care in the U.S. with equal or superior outcomes. Healthbase arranges first class services for patients at major internationally accredited hospitals in Thailand, India, Singapore, Malaysia, Philippines, South Korea, Turkey, Belgium, Hungary, Costa Rica, Panama, Brazil, Mexico, USA and is expanding to Canada, UK, Jordan,Taiwan, Argentina, New Zealand, Australia, El Salvador and Guatemala.

We offer over two hundred medical, dental and cosmetic procedures in various categories: Orthopedic procedures such as hip replacement, Birmingham hip resurfacing, artificial knee replacement, rotator cuff repair, knee surgery; Cardiac and Vascular procedures like heart bypass (multiple coronary artery bypass graft or CABG), aortic aneurysm repair, heart valve repair, heat valve replacement, angioplasty, RF Ablation; Spinal procedures such as spine fusion, laminectomy, disc replacement; Weight-loss procedures like gastric bypass, lap band, gastric sleeve; Eye procedures like LASIK; Cosmetic and Plastic surgery procedures such as breast augmentation, face lift, rhinoplasty (nose surgery), liposuction; Dental procedures such as orthognathic surgery, dental bridges, dental implants, dental crowns; dental veneers; and hundreds of other procedures in the departments of Urology, General surgery, Wellness and many more. The savings are up to 80% of typical US hospital prices.

Medical Tourism, also termed as Medical Travel, Health Travel, Health Tourism, Global Healthcare, Medical Vacation, Medical Value Travel, Medical Treatment Abroad, International Medical, Surgical Tourism, Surgery Abroad, Surgical Trip, Healthcare Abroad, Medical Outsourcing, offshore Medical and Overseas Medical, is the act of traveling abroad to receive medical, dental and cosmetic care. Significantly lower cost for best practice care is usually the primary motivation behind medical tourism although some medical tourists go abroad for immediate availability of procedures and to seek treatments that are not available in their home country. Patients frequently also take advantage of the opportunity to vacation and tour inexpensively in the foreign country while they are visiting for health care. Signup to know more about medical or dental tourism.

* - Awarded the "Best Website for Accessing International Medical Information for Patients/Consumers" by Consumer Health World 2007.


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