Cardio thoracic surgery is a medical field which involves the surgical treatment in the thorax. It includes heart, lungs, esophagus and other organs in the chest
Cardiothoracic surgery services include
Closed and open heart surgeries
When a person is diagnosed with heart disease then he is advised for a surgery which may be open or closed heart surgery that may depend on the complication.
A closed heart surgery is an invasive method in which the heart is not opened directly and no heart-lung bypass machine is required. This reduces the chances of complication and it is the first step to any further procedures that deals with the heart.
Closed heart surgeries are performed by opening the chest in front or through ribs. This surgery deals with arteries which carry blood from and to the heart rather than dealing with the chambers itself. Palliative heart surgeries are often performed on young children which is carried out in different stages. Some examples of closed heart surgeries are ligation of patent ductus arteriosus, repair of coarctation of the aorta, and the placement of pulmonary artery bands and Blalock-Taussig shunts
Every surgery is done by anesthetizing the patients and post surgical care such as regular monitoring of patients by keeping them in ICU, providing intravenous medication to combat pain if any and checking heart beat and blood pressure at regular intervals.
Open heart surgery is highly invasive as the name suggests. It involves opening of chest and heart to operate on its chambers, muscles, arteries. One of the most carried out open heart surgery is coronary artery bypass grafting. It involves grafting of a healthy artery or vein to carry blood that becomes impossible with the blocked artery. Hence the newly attached artery brings fresh blood bypassing the old blocked one.
Now a days open heart surgery has become a traditional method because of the advancement in this protocol. It involves just a small cut or incision which is unlike the traditional method of wide opening. Open heart surgery is carried out with a help of heart-lung machine.
Open heart surgeries are usually adopted for the following
- Coronary heart disease which occurs due to narrowing and hardening of blood vessels that provides blood and oxygen to the heart.
- In replacement or repair of heart valves through which blood flows from one chamber to another
- Replaced damaged heart with donated heart.
Beating heart surgery
Beating heart surgery is nothing but performing an open heart without the heart-liver machine, while the heart is pumping, thus not stopping it during the surgery. Our surgeons use tissue stabilization system to mobilize the heart when required.
This surgery is carried out when the arteries cannot provide enough blood to the heart. In such case physicians mostly recommend for coronary artery bypass graft (CABG) surgery.
The surgery is usually carried out by grafting technique. The surgeon first gets a healthy vein or artery to act as a graft. One end of it is fixed inside the heart and the other end into the coronary artery just below the block, so that the blood flow bypasses the block there by producing blood to the heart.
The surgeon uses a stabilization method to keep the heart steady. The stabilization system consists of heart positioner and tissue stabilization to hold the heart in position while it is being operated. The advantage of this type of surgery is, it reduces the risk that might occur when the heart is temporarily stopped, a condition called reperfusion that occur when the surgeon fails to restore blood to the tissues.
Valve repair and replacement
Human heart consists of four valves namely tricuspid, bicuspid, mitral and aortic. These play a key role in the flow of blood from and into the heart. The well known ‘lub’ and ‘tub’ sound of the heart is due to the closure of these heart valves. They are vital in maintaining the one way blood flow. Thus any defect in any of these valves is a serious criterion to be addressed immediately. Every repair and replacement is done through open heart surgery.
In the repairing process the physician adopts certain procedure. Some of them are listed below.
Commissurotomy is a technique to narrow the valves whose leaflets are thickened and gets struck while closing. The surgeon cuts the joints where the leaflets meet to open the valve.
Valvuloplasty is a process in which the leaflets are strengthened to close tightly. It is an added support to the valve. A ring like device is attached around the outside of valve opening.
Reshaping is done to cut a portion of leaflets and when it is sewn again, the valve functions properly.
Decalcification to remove excess amount of calcium storage in the leaflet which when removed restores its function.
Repair is a structural support to replace or shorten the cords which in turn supports the valves to close properly.
Patching is covering tears and holes in the leaflets with a tissue patching
If a valve is completely damaged in which repair is not possible, replacement is the best way for it. Replacement is also done when there is a valve disease that may be life threatening. It is often done to mitral and aortic valves.
Replacement can be either mechanical or biological.
In mechanical method, the valve is made of plastic, carbon or metal which is strong and life lasting. When blood passes through these valves it has a chance to thicken and clot in some areas which again becomes a problem. Hence patients are advised to take blood thinning medicine throughout their life
In biological method, the valve is made up of either animal tissue or human tissue from the heart that is donated. In some cases patient’s own tissue is also used. This is not strong as mechanical valves and it need replacements once in 10 years or so but in this case blood thinning medicine is not required.
Repair of complex congenital heart defects
Congenital heart disease is nothing but some defect in the heart right from birth. The defect can be in the walls, the valves or in the flow of blood to the heart. Doctors usually identify such defect either during pregnancy or immediately after birth. Some of the defects include
Poor blood circulation
Cyanosis (a bluish to skin, lips and finger nails)
There are many types of congenital heart disease. Some of the common defects include
Pulmonary stenosis is a defect in which the pulmonary valve through which the blood from right ventricle of the heart reaches lungs get hard and narrowed. In such case ventricle is pressures itself to pump more blood which results in swelling of right ventricle
Pulmonary atresia is a defect in which the pulmonary valve which allows the flow of blood from right ventricle to the lungs remains closed at birth. As a result the blood never reaches the lungs from right ventricle where it gets oxygenated. This may turn to be severe if the condition remains untreated.
Tricuspid atresia is a defect in the tricuspid valve by which the flow of blood from right atrium to right ventricle is blocked. The valve would not have been developed fully or not opened to allow the blood flow. Hence the blood to lungs is blocked which is again a major defect that leads to fatal when untreated.
Aortic stenosis is a defect in the aortic valve which allows the flow of blood from left ventricle to aorta, the largest artery which carries oxygen rich blood from heart to different parts of the body. When this valve is thickened, the blood to various parts of the body becomes insufficient; thereby less oxygenated blood to the body.
Coarctation of the aorta is a defect in which aorta is constricted which carries blood to the lower parts of the body.
There are other defects apart from this. ‘Hole in the heart’ is one of the major congenital heart problems. During birth the opening in the wall of the heart allows blood to flow from right and left chambers itself instead of pumping to other parts of the body. It causes the heart to swell and enlarge. Some of the problems of ‘hole in the heart’ are
Atrial septal defect is a hole between the atria. The blood from left atrium should flow to the left ventricle and then to aorta to the whole part of the body. But in this case due to the hole blood flows from left atrium flows into the right atrium which become fatal in later stages.
Ventricular septal defect is a hole in the ventricle. Blood from lungs is returned to the heart into the left ventricle to enter into aorta and then to rest of the body. In this case blood flows from left ventricle to right ventricle. The complications are more in such cases.
Congenital heart diseases are diagnosed through different methods.
Cardiac catheterization, to check blood pressure inside the heart and get images of the chambers of the heart.
Chest x-ray to show the size and shape of the heart and lungs and other bone condition.
Echocardiogram to show the size and pumping action of the heart along its valves.
Electrocardiogram to record the electrical activity if the heart
Hence these are some of the congenital heart disease to which we provide a comprehensive care.
Minimally Invasive Bypass Surgery
It is nothing but a bypass surgery which is performed with several small incisions instead of traditional method of wide opening the chest. This type of surgery may help patients who were neglected from older method of heart surgery due to age. It has a wide range of advantage like less blood loss, less post surgery discomforts, fast healing and lower infection rate, less trauma, little scars, etc., minimally invasive bypass surgery gives the physician a clear image of other parts of the heart than the traditional methods.
Some of the minimally invasive surgeries include
- Aortic valve surgery
- Atrial septal defect closure
- Heart valve close surgery
- Maze heart surgery
- Mitral valve surgery
- Tricuspid valve surgery
Other two major areas are heart and lung transplantation.