Heart surgery - Angioplasty, Bypass, Pacemakers

In more severe heart diseases, when medication can't control the symptoms and a heart attack is imminent, cardio-surgery is the optimal solution for prolonging the patient's life.

Coronary angioplasty

It is an indication when the heart disease can't be controlled by drugs and the patient suffers angina without doing physical exertion even just sitting at rest.
The complete name of coronary angioplasty is PTCA - Percoutaneus Transluminal Coronary Angioplasty and is used in treating coronary heart disease. The method consists of a thin and elastic catheter, introduced through the carotid artery into aorta to the coronary arteries under X-ray guidance (with local anesthetic). The catheter has a device removing the clot (thrombus) and this way unblocking the artery and stretching the walls so that more oxygenated blood could flow to the myocardium.

Types of coronary angioplasty:

• Balloon angioplasty - the surgeon introduces the catheter in the coronary artery. At its end, catheter has a small sausage-shaped balloon. After it reaches the fatty buildup (atheroma) the surgeon inflates it and the atheroma is compressed against the artery walls. The balloon is then deflated and removed. This is the oldest method and sometimes it is inefficient / the atheroma continues to grow and it can lead to another clot (restenosis).
• To prevent the restenosis of the coronary arteries after angiolplasty with balloon, a stent (stainless steel mesh tube) is introduced at the same time as the balloon. As the balloon is deflated - the expanded stent is left there in place to keep the atheroma compressed to the walls and this way the coronary artery remains always opened.
• In the near future doctors say they'll be able to perform angioplasty with devices able to cut or drill the fatty deposits, vaporize them with laser or ultrasound. These techniques, as I know, are yet under development.

Coronary Bypass Surgery (CABG, or "cabbage")

An operation in which a blood vessel from another part of the body (usually a vein) creates a bypass between aorta and the coronary artery for to assure the necessary blood flow to the heart muscle. The operation can be done on one or all four coronaries, depending on their level of narrowness or occlusion. The operation requests microsurgical equipment, this why it can be performed only in specialized centers.

Coronary bypass is not a simple operation and it implies considerable risks and the probability that the bypassed coronary artery will block again. Also, sometimes, there may be the necessity of repeated interventions in case of the bypass obstructs with thrombi.

Cardiac Pacemaker

Myocardium has an excellent property - it cans autostimulate, generating small electrical impulses which determine the heart's rhythm (pulse). Sometimes after a heart attack or a heart disease, the myocardium may fail in generating such impulses and the heart will contract irregularly (arrhythmic) or cause even more serious problem as fibrillation and heart arrest.

First experiments on using artificial cardiostimulators were almost 120 years ago. Since that, cardiologists, improved and developed devices which generate tiny electrical shocks and which one transmitted to the heart.

Pacemakers remembered me a sad story.
As I am a student in medicine, last year I remember I went with my colleagues and our professor to visit a very special and interesting patient - an 11 years old boy suffering for a several heart failure and who had more than 5 heart attacks in the last year. His diagnosis was very complex, starting from hypertension and to severe heart failure. The boy, being 11, seemed to be like one of 7, his growing and physical indicators were drastically affected by the cardyomypathy he suffered of. 2 years ago, cardio-surgeons decided to implant him a pacemaker, as his heart continued to fail and hypertrophy as a result of ventricular insufficiency

His pacemaker was implanted under the abdominal skin and on palpation, it was given to us to feel its presence and shape (a cardio stimulator with a built-in li-ion battery) Unfortunately for him, his maximum life-expectancy was less than 1 year because this was the life-time of the battery. Surgeons decided that another intervention, to change the battery would be fatal to him, so this was a very delicate situation when it comes to that one child's life depends by a battery.

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