Download Heart surgery

Heart Surgery
Methods of entry
 Fracture the sternum, clamp rib cage open
o Potential issues
 Can promote degenerative changes in the plane gliding joints of the spine and
rib spine articulations
 Can irritate musculature (primarily intercostals, paraspinals)
 May be alignment problems with sternal repair – biomechanical stresses

Via the diaphragm (to address issues in the lower aspects of the heart)
o No fractures, cut abdominal wall instead to go through diaphragm
 More direct respiratory complications post-operatively
Complications/ongoing issues (re: both procedures)
 If infection occurs, healing can be delayed
 Cardiovascular function at the time of surgery may predict rate of healing
 Stability of heart function following surgery
Musculoskeletal Complications
 Decreased rib cage expansion (immediately post-op, primarily due to pain) can lead to decreased
mechanics of respiration, impaired perfusion, and an increased susceptibility to infection
 Scar tissue
o Decreases range of motion
o Irritated muscles
o Causes pain
 Osteoarthritic changes
 Thoracic outlet syndrome and/or intercostal neuralgia
 Frozen shoulder
 Bursitis
 Neck tension headaches
o Cervical osteoarthritic changes
o Lumbar osteoarthritic changes
o Chronic pain syndromes
 Hyperkyphosis
Coronary Artery Bypass Grafting:

uses pieces of the patient's own veins or arteries from elsewhere in the body (long saphenous vein or
internal mammary artery in the chest) to create a detour that re-routes the flow of blood around a
blocked area of a coronary artery.
Minimally Invasive Bypass Surgery:
 a newer, less invasive procedure used in selected traditional coronary bypass candidates with only one
or two blocked arteries. In this procedure, a heart-lung machine is not necessary, the breastbone
(sternum) does not have to be cracked, the incision is smaller, the cost of the procedure is less than that
of a traditional bypass and it is likely the patient will recover more quickly because of less trauma and
pain.
Angioplasty:

blocked artery
catheter inserted and inflated
a procedure in which a balloon-tipped catheter
is inserted into a damaged artery, where the
balloon is inflated. The balloon compresses the
plaque, pushing it against the artery wall, to
allow for freer blood flow.
post treatment
Stenting:


a procedure in which a small wire mesh tube, called a stent, is placed into a damaged artery via a
catheter to support and stretch the artery walls and provide for unrestricted blood flow. (normally
done in conjunction with the angioplasty procedure
note: approximately 11 percent of angioplasty procedures will re-occlude whereas only about 5
percent will re-occlude if a stent is used.
Directional Atherectomy:
 a procedure in which a bladed catheter is used to cut away plaque in the arteries. The plaque is then
removed when the catheter is withdrawn from the artery.
mitral valve repair technique: leaflet plastic / annulus repair / ring
implantation
Step 1: Assessment of the mitral valve. A
prolapse of the posterior leaflet is found (too
much tissue) as well as ruptured chordae,
causing the incompetence of the valve.
Step 3: A 'sliding leaflet' plastic is
Step 2: A quadrangular resection is
performed - by re-adapting the posterior
Step 4: Reconst
performed (cutting away the excess valve
leaflet into the shortened valve annulus. The slide shows the
tissue). The posterior leaflet is cut from the
posterior mitral valve leaflet is
valve ring to be
valve annulus. The annulus is shortened.
reconstructed.
Step 5: Sutures are put into the mitral valve Step 6: The reconstructed valve is tested by Step 7: The testing of the valve shows a
Step 8: Final vi
annulus and the mitral valve ring.
flushing water into the heart.
good result with no residual incompetence. showing a good
mitral valve repair technique: annulus repair / ring implantation
Step 1: Assessment of the mitral
valve. A annular dilatation (the
natural mitral valve ring is
enlarged) is causing the
incompetence of the valve.
Step 2: After sizing the size of the
Step 3: To reconstruct the mitral valve
mitral valve ring (to reduce the size
Step 4: Result: The valve is repaired b
(by reducing the enlarged valve
of the mitral valve annulus) sutures
the enlarged annulus and resulting in a
annulus) a mitral valve ring is
are put into the valve annulus and the
leaflets.
implanted into the valve annulus.
ring
The Heart and Its Electrical System
Normally, an area of specialized heart tissue called the SA node (located in the right atrium) fires
and sends an electrical impulse through the right and left atria, signaling these chambers to
contract and pump blood into the ventricles. The impulse then travels down to the AV node
(located between the atria and ventricles), where it is relayed through the Perkinje Fibers into the
ventricles, signaling them to contract and pump blood out to the lungs and throughout the body.
Contraction of the heart's chambers and its ability to effectively pump blood to the lungs and
throughout the body are dependent on the precise functioning of the heart's electrical system.
Unfortunately, the heart's electrical system can malfunction, heart rates become irregular and not
enough blood is pumped through the body. There are many reasons for the heart to “misfire” and
require pacemaker assistance. Two common reasons are SA node and AV node malfunctions.
The SA node is responsible for “triggering” the heart chambers to contract. In other words, it
regulates the heart rate. If the SA node does not fire frequently enough, the lowered heart rate
disallows adequate blood flow through the body. Some medications can cause slow firing of the SA
node but more frequently, it simply gives out over time (with age). A pacemaker can then be
implanted to ensure that the heart pumps adequate amounts of blood throughout the body.
If the AV node begins to malfunction, it may no longer be able to conduct every impulse that
reaches it from the atria down into the ventricles. The ventricles are no longer stimulated to
contract frequently enough to pump adequate amounts of blood throughout the body. If the AV
node stops working completely, the ventricles may no longer be stimulated to contract at all. When
the AV node malfunctions to the point that too few electrical impulses are being conducted or when
it appears there is a risk that the AV node may stop working completely, a pacemaker is implanted.
How it works
Pacemakers consist of a pager-sized housing device which contains a battery and the electronic
circuitry that runs the pacemaker, along with one or two long thin electrical wires that travel from
the pacemaker housing device to the heart. The housing device is implanted below the skin in the
shoulder area. The thin wires, which can conduct electrical impulses, are then threaded from the
housing device through a vein that runs in the chest, on to the heart. In some patients, only one of
these long, thin electrical wires, called leads, are implanted into one of the chambers of the heart.
Most patients who receive pacemakers will have two leads implanted, one going to the right atrium
of the heart and one going to the right ventricle of the heart.
The pacemaker and leads can be programmed in various and often complex ways to analyze the
heartbeat and then to decide if the pacemaker should electrically stimulate the heart to contract.
Pacemakers can serve as sensors, detecting if electrical impulses generated by the SA node have
occurred and if they have been conducted by the AV node down into the ventricle. These same
electrical leads can also be used to transmit an electrical impulse. If the implanted leads do not
detect that electrical impulses have been fired from either the SA node or AV node, the pacemaker
itself will send an electrical impulse to the appropriate area. In this manner, the pacemaker can
supervise the heart and ensure that it continues to contract at a heart rate adequate to pump
sufficient blood throughout the body.
Implantation Procedure
Implantation of a pacemaker takes about an hour. Although it is regarded as a relatively safe
procedure, complications do occasionally occur, including bleeding at the site of pacemaker
insertion, infection at the insertion site, damage to the blood vessels or lung in the chest, and
perforation of one of the chambers of the heart. Death during pacemaker implantation is extremely
uncommon.
After the procedure, patients are usually observed in the hospital for a day or so to make sure no
bleeding or infection occurs at the site of pacemaker implantation. Patients will usually be monitored
overnight in an intensive care or intermediate care unit where their heart beat can be continuously
monitored. Patients who have a pacemaker inserted may be treated for several days with antibiotics
to decrease the chances of infection developing.
Follow up
Pacemakers need to be periodically checked to ensure that they are functioning correctly; over time
the pacemaker's battery will wear down and there is a small chance that one of the electrical leads
can "fracture" or malfunction.
Special Considerations for Patients with Pacemakers
There are certain special considerations about which persons with pacemakers shoud be aware.

Electromagnetic noise or interference (such as that generated by certain heavy industrial
equipment) may interfere with pacemaker function or may even change the way a
pacemaker has been programmed to operate.

Cellular phones can interfere with pacemaker functioning. Digital phones are more likely to
cause problems than analog phones. Keeping the cellular phone at least 6 inches away from
the pacemaker may decrease the chances of problems. Issues regarding cellular phones
should be discussed with the patient's heart doctor.

Pacemakers are made of metal – be aware of Hydrotherapy considerations!
Experimental Treatments
Transmyocardial Revascularization (TMR):


a procedure in which a laser beam makes small holes in the heart to aid in increasing blood flow. TMR
is used in some patients who are considered otherwise inoperable and is considered an experimental
procedure.
small holes (up to 45 channels), approximately one millimeter wide and one centimeter apart are
‘drilled’ into the heart. Gentle pressure is then applied to the external surface of the myocardium to
arrest bleeding and ‘heal over’ the sites. The internal surface may remain open, allowing fresh blood to
circulate and nourish the myocardium. The primary goal of this procedure is, however, to facilitate
new microvessel growth within the myocardium as these ‘channels’ heal to improve nourishment and
decrease angina symptoms.