CHD- Surgical Intervention

Coronary Heart Disease- Surgical Intervention 

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 Coronary Heart Disease- Surgical Intervention

Surgical interventions and CHD

In some people with CHD the extent of fatty deposit builds up on the insides of blood vessels, or the failure of medicines to properly manage the disease may mean that surgery should be considered as an option in order to either remove blockages within arteries or simply bypass the blockage.

 

There are three main types of surgery that a patient with CHD may be eligible for. I will summarise each procedure here:

  1. Coronary angioplasty. This technique has a number of names. These are per-cutaneous coronary intervention (PCI), per-cutaneous trans-luminal coronary angioplasty (PTCA), or sometimes referred to as balloon angioplasty. This angioplasty is sometimes offered to patients who have angina as part of a planned surgery procedure. Doctors will carry out an examination called coronary angiogram to see if the operation is appropriate for the patient. However, in some cases the surgery may be carried out in an urgent setting for patients whose symptoms have become too unstable to manage using medicines. Patients that have experienced a heart attack may undergo an emergency coronary angioplasty operation.

 

With respect to the procedure, coronary angioplasty involves inserting a small balloon into the narrowed artery. This can allow for the fatty tissue build up that caused the narrowing to be dislodged, resulting in the widening of the blood vessel. In order to keep the blood vessels, open a metal wire tube called a stent is then placed in the blood vessel. There are also stents that are able to release medicines into the blood in a controlled way in order to reduce the risk of the blood vessels becoming narrow again. These are referred to as drug-eluting stents.

 

 

                 

  1. Coronary artery bypass graft (CABG) surgery.

Coronary artery bypass graft surgery, also referred to as bypass surgery, heart bypass, and coronary artery bypass surgery is carried out in patients with either significantly narrowed or blocked arteries. The extent of the blockage is assessed by doctors performing a coronary angiogram, and this should allow them to decide to proceed with this kind of operation.

A type of bypass operation where the heart continues to pump blood around the body during surgery, so in this case a heart-lung machine is not used, is called an Off-pump coronary artery bypass (OPCAB).

Given that this type of surgery, i.e. “bypass”, the area of blockage or significant narrowing is bypassed by inserting or “grafting” a blood vessel between the major artery leaving the heart which is called the aorta and a section of the coronary artery ahead of where the blockage is. The insertion of this blood vessel therefore bypasses the blockage and the heart muscle can then receive uninterrupted blood as a source of food and energy.

Sometimes the surgeon may use one of the patient’s arteries that feed part of the chest muscles to connect with a region of the coronary artery that is upstream or beyond the blockage. This has the same effect of allowing proper blood flow to the heart muscle.

 

 

  1. Heart transplants.

Heart transplants are clearly invasive surgical processes and are only undertaken if there is severe and irreparable damage to the heart and medicines are no longer effective. Another scenario that may require a heart transplant where the heart fails and therefore is unable to pump blood around the body.

The challenge for doctors is that a heart from a healthy donor needs to be available at the right time.