Cardiovascular surgery is a medical specialty surgical class, using hand and the instrument is intended to solve or improve cardiac pathologies that are not treatable with drugs or with minor procedures such as catheters, stents, etc. In most cases the real goal is to reduce the extent of symptoms and improve quality of life of patients, since it is atypical complete resolution of the problem.

VASCULAR BYPASS

Definition

It is a surgical technique that involves creating a diversion or referral to establish a vascular bypass a blocked artery or injured segments using other veins or arteries or synthetic materials to create a bridge to the obstacle and to restore normal circulation in the tissue or organ damage.

Types of vascular shunts

Central derivations: in the heart and specifically in its own vascular supply system, ie the coronary arteries.

Peripheral leads: any peripheral vascular structure like the arteries of the extremities or head, and vessels of specific organs like the kidney.

Central bypass or coronary bypass

In coronary bypass is taken from another body vein or artery, one end is attached to the aorta to ensure blood supply and the other coronary sector is beyond the obstruction.

Peripheral vascular bypass

Shunts or bridges are made in vascular structures of the neck, limbs or organs. They may be using prosthetic or vein segments taken from the patient.

HEART VALVE SURGERY

Heart valve surgery is used to repair or replace diseased heart valves.Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must flow through a heart valve.These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.There are four valves in your heart:

Aortic valve Mitral valve Tricuspid valve Pulmonary valve

Repairing valve

Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.

Valve repair -- The surgeon trims, shapes, or rebuilds one or more of the leaflets of the valve. The leaflets are flaps that open and close the valve.

Changing valve

If your valve is too damaged, you will need a new valve. This is called valve replacement surgery. Your surgeon will remove your valve and put a new one in place. The main types of new valves are:

Mechanical -- made of man-made materials, such as metal (stainless steel or titanium) or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.

Biological -- made of human or animal tissue. These valves last 12 - 15 years, but you may not need to take blood thinners for life.

In some cases, surgeons can use your own pulmonary valve to replace the damaged aortic valve. The pulmonary valve is then replaced with an artificial valve (this is called the Ross Procedure). This procedure is ideal for people who do not want to take blood thinners for the rest of their life.

CARDIAC PACEMAKERS

It is a small battery-operated device that senses when the heart is beating irregularly or very slow. It sends a signal to the heart, which makes beat to the rhythm.

Description:

Newer pacemakers weigh just one ounce. A pacemaker usually has two parts:

The generator contains the battery and the information to control the heartbeat.

The leads are wires that connect the heart to the generator and carry electrical messages that organ.

A pacemaker is implanted under the skin. This procedure usually takes about an hour. A You will be given a sedative to help you relax; You will be awake during the procedure. A small incision (cut), usually in the left side of the chest below the collarbone. The pacemaker generator is then placed under the skin this location.

Using X-ray images live to see the area, doctor puts the leads through the incision, into a vein and then into the heart. The leads are connected to the generator. The skin is closed with sutures. Most patients go for home within a day after the procedure.

Only in medical emergencies, using two types of pacemakers, transcutaneous and ransvenous. These pacemakers are not permanent.

Why is the procedure?

Pacemakers may be used for people who have heart problems that cause their heart to beat too slowly. A slow heartbeat is called bradycardia. Two common problems that cause a slow heartbeat are sinus node disease and atrioventricular block.

When your heart beats too slowly, it is possible for the body and brain do not receive enough oxygen. Symptoms may include dizziness, tiredness, fainting spells and shortness of breath.

Some pacemakers can be used to stop a heart rate that is too fast (tachycardia) or irregular.

You can use other types of pacemaker in severe heart failure. These are called biventricular pacemakers and even the beating of both sides of the heart.

All biventricular pacemakers can also now work as implantable cardioverter defibrillator (ICD), which restores a normal heartbeat.

Risks:

Possible complications of pacemaker surgery include:

abnormal heart rhythms. Bleeding. puncture of the lung (this is rare). Infection. Drilling of the heart that can lead to bleeding around this (this is rare).

A pacemaker can usually sense if the heartbeat is above a certain rate. When it exceeds this rate, the pacemaker will stop sending signals to the heart. Can also sense when the heartbeat is too slow. It will automatically turn on and begin to regulate the frequency of the heartbeat again.

Before the procedure:

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

The day before surgery:

Take a shower and wash thoroughly. You may be asked to wash your entire body from the neck down with a

special soap.

On the day of surgery:

You may be asked not to drink or eat anything after midnight the night before the procedure. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.

Take your drugs your doctor told you to take a small sip of water.

The doctor or nurse will tell you when to arrive at the hospital.

After the procedure:

You'll probably be able to go home after a day and can return quickly to normal activity level.

Talk to your doctor about how you can use the arm on the side of the body where the pacemaker was placed. You may be advised not to lift anything heavier than 10 to 15 pounds (4.5 to 7 kg) and avoid pushing, pulling, or twisting long arm for 2 to 3 weeks. You may also be asked not to lift the arm above shoulder for 6 weeks.

TRANSPLANT OF HEART

It is a surgery to extirpate a disabled or sick heart and to replace it by the healthy heart of a donor.

Description

To find a donor of heart can be difficult. The heart must be donated for someone who is clinical dead, but that it(he,she) remains with vital support. The donor of heart must be as compatible as possible with his(her,your) type of fabric to reduce the probability that his(her,your) body it is going to reject.

To you the deep dream is induced with General anesthesia And a cut is done across the breastbone.

His (Her,Your) blood circulates across a system of extracorporeal traffic, while the surgeon is employed at his(her,your) heart. This machine does the work of the heart while this one there is arrested(held up) and supplies him(her) to the body blood and oxygen.

The sick heart is extracted and the donated heart is sutured in his(her,your) site(place). Then, there is disconnected the machine of extracorporeal traffic and the blood flows across the transplanted heart.

Pipes can insert for drenar air, liquid and blood out of the thorax for several days, in order to allow that the lung should return to expand completely.

In any cases, the surgeon will not extirpate the old heart, but he(she) will place the new heart on this one (transplant heterotópico).

Why the procedure is realized

It is possible to do a transplant of heart to treat:

Serious angina that already could not treat with medicines or other surgeries. Cardiac insufficiency Seriously when the medicines, other treatments and the

surgery already do not serve. Cardiac serious anomalies that were present on having been born and they cannot

be repaired by surgery.

Abnormal and potentially mortal throbs or paces that do not answer to other treatments.

The surgery of transplant of heart maybe is not in use in patients that:

Be Undernourished. Be bigger from 55 to 60 years. They have had cerebro-vascular serious accident or Dementia. They have had cancer. They have taken infection as a HIV. Have infections, since(as,like) Hepatitis, That are active. Have Insulindependent diabetes And other organs that are not working correctly. Have Hepatopatía, Nefropatía, neuropathy or neumopatía. Do not have any support of the family and do not follow(continue) his(her,your)

treatment. Have other diseases that affect the blood glasses of the neck and the leg. Have Pulmonary hypertension ( Engrosamiento of the blood glasses in the lung). Smoke or consume alcohol or drugs or that have other habits of the way of life

that could damage the new heart.

The doctor also can dissuade the transplant of heart if there is worry of which the patient could not expire with many visits of control in the hospital and the medical doctor's office, the examinations and the necessary medicines to support the new healthy heart.

Risks

The risks of any anesthesia are:

Reactions to the medicines

Respiratory problems

The risks of any surgery are:

Bled Infection

The risks of the transplant include:

Clots of blood (Venous deep thrombosis). I damage to the kidneys, the liver or other organs of the body immediately after

the medicines antirrechazo.

Development of cancer immediately after the medicaments used to anticipate(prepare) the rejection.

Heart attack or cerebro-vascular accident. Problems of the cardiac pace. High levels of cholesterol, diabetes and slimming of the bones for the use of the

medicines antirrechazo. Increase of the risk of infections due to the medicines antirrechazo. Rejection of the heart. Coronary Arteriopatía Seriously. Infections of wounds.

Before the procedure

As soon as the doctor sends it to a center of transplants, you will be evaluated by the equipment(team) that realizes the procedure. They will need to check that you fill the requirements for the transplant. You will have several visits in the course of several weeks or enclosedly months and it will be necessary that they extract blood and X-ray photographies take him. Also it is possible to do the following thing:

Examinations of blood or of skin(leather) to check the presence of infections. Examinations of the kidney and the liver. Examinations to evaluate the heart, as Electrocardiography, Ecocardiografía,

Cateterismo cardiac. Examinations to look for cancer. Determination of the blood group and histotipado To help to check that

his(her,your) body is not going to reject the donated heart.

You also will want to observe one or more centers of transplants to see which is the best for you:

Ask them how many transplants carry out every year and which are his(her,your) rates of survival. Compare these numbers(figures) with those of other centers.

Ask what groups of support they have available and how many help they offer with the management of travel allowances and housing.

Ask with regard to the cost of the medicines that you will have to take later.

If the equipment(team) of transplants believes that you are a good candidate, they will put it in a national waiting-list for a heart:

His(Her,Your) place in the list is based on several factors. The key factors include the type and gravity of his(her,your) cardiopathy, as the probability of which the transplant is going to be successful.

The quantity of time that you spend(pass) in a waiting-list as a rule is not a factor that determines the readiness with which they will obtain a heart, except in case of the children.

The majority of the patients, but not they all, who wait for transplants of the heart are very sick and need to be hospitalized. Many(many people) will need some type of device that helps him(her) to his(her,your) heart to pump sufficient blood to the body; with many frequency, it is a question of one Device of ventricular assistance ( Artificial device similar to a heart).

After the procedure

You must wait for a hospitalization from 7 to 21 days after a transplant of the heart. The first ones 24 at 48 hours probably will be in the unit of intensive care (UCI). During the first days after a transplant, you will need a careful control to check that it(he,she) does not contract an infection and that his(her,your) heart is working well.

The period of recovery is of approximately 6 months. Often, the equipment(team) that realizes the transplant will request him(her) that it(he,she) remains closely together to the hospital during the first 3 months. You will need to do regular checkups to him(you,them) with examinations of blood, X-ray photographies and ecocardiografías for many years.

To attack the rejection is a constant process. The system inmunitario of the body considers to the organ transplanted as an infection and attacks it. For this reason, the patients with transplant must take medicines to disable Response inmunitaria Of the body. To take the medicines and to follow(continue) the instructions carefully is very important to anticipate(prepare) the rejection.

Often, biopsies of the myocardium do to themselves every month during the first ones 6 to 12 months after the transplant and with minor frequency after this time. This helps the doctor to determine if his(her,your) body is rejecting the new heart, even before it(he,she) has symptoms.

You must take medicaments to anticipate(prepare) the rejection to the transplant for the rest of his(her,your) life. In addition, it(he,she) will need to deal how to take these medicines and to know his(her,your) side effects.

You can return to his(her,your) activities normal so soon as one sits sufficiently well and after speaking with his(her,your) doctor. Nevertheless, avoid the physical vigorous activity.

To check that it(he,she) does not develop coronary disease after a transplant, they will do him cateterismo cardiac every year.

Forecast (Prediction)

The transplant of heart prolongs the life of a patient who otherwise would die. Near 80 % of the persons whom transplants of heart are practised they continue alive(vivacious) two years after the operation. At the age of 5, 70 % of the persons still(yet) will be alive(vivacious) after this transplant.

The principal problem, since it happens with other transplants, is the rejection. If the rejection can be controlled, the survival can increase to more than 10 years.