Invasive Surgery and Treatments

Angioplasty or percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical, invasive procedure that widens narrowed arteries. This procedure entails the insertion of a catheter into the leg or arm. A catheter is a thin, plastic tube that is inserted into an artery or a vein. Catheters can serve as conduits for small balloons, drilling devices or stents. The catheter is guided via the aorta into the coronary arteries. The entire procedure is monitored by an X-ray camera called a fluoroscope. 

Once the catheter has been inserted, the physician guides a second, smaller tube into the existing catheter. This tube is a deflated balloon. When the balloon is in the narrowed portion of the artery, the physician will then inflate it. The inflated balloon compresses the plaque build-up in the artery and opens the blood vessel for easier blood flow. Balloon angioplasty opens arteries that are narrowed and not completely blocked. Instead of bypassing narrowed arteries with a vein graft, angioplasty helps eliminate the blockage within the coronary arteries. Your physician will determine whether you are a candidate for this procedure. 

Laser angioplasty is used in some patients to remove plaque in the arteries. Once a catheter is in the body a small laser is inserted into the tube. The laser is a pulsating beam of light which vaporizes the plaque. This procedure can be used alone or in conjunction with balloon angioplasty. A physician must consider the extent of the blockage, where the blockage is located, how many blockages there are, and other health risk factors when deciding whether to use laser surgery. 

Ablation Procedures are an extension of the diagnostic electophysiology study (EPS). 

Open Heart Surgery  

Coronary Artery Bypass Grafting (CAB) is an open heart surgery procedure which entails the rerouting of blood flow through healthier vessels. This procedure uses a saphenous vein from the leg, an existing artery in the chest wall or an artery from the wrist as a bypass tube. One end of the vessel is connected to the aorta where the coronary artery originates or to an open area of approximal coronary artery, below the blockage area.  

The procedure takes approximately three to six hours. The average number of arteries bypassed is four or five. Two incisions are made; one incision is made along the midline of the chest and the other is made at the site the bypass vessel will be obtained. During the operation, a heart-lung machine performs the functions of the vital organs. Blood is literally filtered through this machine and brought back into the body re-oxygenated. No blood should be flowing through the heart while the surgeon is operating. The heart is monitored closely to prevent damage. The heart needs to be kept at a very cool temperature during surgery so as to reduce the chance of infection. Chemicals are used during surgery to slow the patient's metabolism which reduces the amount of oxygen needed in the body. 

Valve replacement
Valves monitors the flow of blood between each chamber of the heart. Valves open and close to control blood flow in one direction through the chambers of the heart. When a valve is defective, it cannot restrict the blood from surging into or out of the chamber. Valves that function improperly permit leakage (regurgitation) if it refuses to close and if they become narrowed/tight (stenotic). Either of these conditions place tremendous strain on the heart muscle. 

There are several different types of open-heart valve replacement procedures. Tissue valve replacement removes a damaged valve and replaces it with a pig or cow valve. These valves have been chemically processed for transplantation from the animal to the patient. The human body has shown to respond positively to this procedure because of the similarities in tissue structure. The disadvantage, however, is that the animal valve is not as durable than human valves and is more susceptible to calcification. 

The mechanical valve is a man-made valve placed in the heart. The device is constructed of metals, plastics and/or carbon ceramics. The device is attached to the tissue by a fabric ring. There are three main types of mechanical valves. The ball-in-cage design involves a moving ball within a cage to act as the heart valve The second type of valve is called the tilting disk which is attached to the valve housing by a wire or a hook device. The third valve consists of two half disks tilting open and closed--this bi-leaflet valve is attached to the valve housing. These valves are extremely durable. However, the body has a tendency to reject the device and may also cause blood clots. These patients must take anticoagulants for the rest of their lives to guard against these complications. 

The Ross Procedure is recommended for younger patients who require valve replacement. This procedure is only performed by a limited number of physicians around the world. The Ross procedure replaces a patient's damaged aortic valve with his/her own pulmonary valve. Because the valve is created from the patients' own tissue, there is no threat of rejection. In addition, the pulmonary valve is almost always the correct size. 

Pacemakers 

The sinus node produces an electrical impulse within the heart that generates a natural "heartbeat." The pacemaker is designed to help the heart regulate and mimic a natural heartbeat. A pacemaker may be required for a slow heart beat (bradycardia), a blockage in the heart's electrical pathways or an irregular heart beat. 

There are two components to a mechanical pacemaker. There is a pulse generator that contains batteries and electronic circuitry that produce an electrical pulse or pulses to the heart muscle. This device is surgically implanted subcutaneously near the armpit. The pacemaker is connected to the heart by tiny wires called pacing leads. These pacing leads send an electrical pulse from the pacemaker to the heart. 

Present day pacemakers are the size of a pocket watch. Most pacemakers operate only when needed, they are called "demand" pacemakers. Demand pacemakers contain sensing electronics which monitor for natural heart rhythm. Stimulation pulses are only provided to the heart if a natural rhythm is not detected. Pacemakers are designed to provide up to ten years of service to a patient. However, the device is operated by batteries which will eventually run low. An indication is given to the patient with sufficient time (usually you still have six months left on the battery) to schedule a replacement procedure.