- Cardiac Catheterization:
It is often called as ‘Cardiac Cath’ and is done to determine the severity and degree of the cardiac problem. The Cardiologist will make a tiny cut in the arm or the groin area and then introduces the catheter in the blood vessel. Then the catheter is directed along the blood vessel to the heart.
The merit of this procedure is.
- The size and the position of the plaque are determined.
- The muscles and valves of the heart are analyzed.
- Blood samples can be taken for further analysis.
- The pressure on the blood vessels can be read.
- The dyes can be injected to check the blood flow.
It helps the cardiologist to decide whether the patient needs further treatment like surgical intervention or angioplasty or not.
- Angioplasty or Percutaneous Coronary Intervention:
It is used to treat the arteries that have been obstructed due to atherosclerosis of the heart. A hollow tube is introduced in the blood vessel by small incision made in the leg or the wrist and threaded to the heart. The tip of the tube or catheter has a balloon on its tip and when it attains the targeted area the plaque is moved to the walls of the artery and extended so that the blood circulation is improved. In few instances, the balloon is inflated and deflated many times during the procedure. The vessels which are blocked or narrowed are unblocked through this technique.
Interventional Cardiology is an inner branch of Cardiology which especially deals with the catheter based treatment for cardiac diseases.
It is one of the minimally invasive techniques as small cut that is less than an inch is made and the device is inserted in the arm, leg or groin area. The device is then guided to the heart or vascular area through the X-ray. With this procedure the patient will have less pain, reduced risk of infection, prevention of scar and speedy recovery time. It is done under local anesthesia as a day care procedure and suture is not required.
Using of Stents in Angioplasty:
About 70 to 80% of angioplasty involves the placing of stents and is called as ‘Stenting’. A stent is a minute cylinder like device which is overlapped on the balloon at the tip of catheter. When the balloon gets raised up the stent unlocks and emphasizes the artery walls. The balloon and the catheter are removed and the stent remains unharmed. After few weeks the tissue starts growing up over the stent.
Types of stent:
Bare metal stents is the basic type of stent used; the cylinder is untreated and drug eluting stents are those which are covered with the medications before introducing to the artery. The benefit of using this stent is it prevents from fibrosis and scar formation an also reduces the risk of Re-stenosis.
It is a new revolutionary device which is been used in recent years. The stent is made of softened body which is replaced in the place of metallic one’s but performs the same action. The benefit of using this stent is they get dissolved or absorbed by the body unlike the metal stents which remains inside the body forever. The metal stents might cause some side effects and that requires medications for long terms which lead to internal bleeding and stroke.
Percutaneous Valve Repair:
Human heart is made up of four important valves that direct the flow of blood into the chambers. The catheter with the help of clips or other instruments passes through the blood vessels to repair the damaged valve to maintain the good blood flow again.
It is a procedure were a ‘Revolving Shaver’ also called as Burr is placed at the catheter tip and the plaque deposits are cleared with it. In some cases, laser guided catheter is used to dissolve the plaque.
It is a method that is performed to cure Coronary Artery Disease (CAD). In CAD, the blood vessels which carry out the nutrients and oxygen necessary for the proper functioning of the heart are blocked and narrowed. The fatty deposits are formed at the walls of the arteries which obstruct the blood flow were the oxygen rich blood is present.
The way of treating this kind of condition is the blocked blood vessel is bypassed with another one. The vein that is taken from the leg or the chest is used as the graft or attach for the surgery. The top part of the graft is joined over the narrowed vein and the other below the damaged one, therefore the run is entirely re-routed and the blood moves by the new grafted vessel to the heart muscle. It has many benefits over the traditional ‘Open heart surgery’. The ‘Off – Pump’ technique where the heart is kept working was commenced in the year 1990. Several least invasive procedures such as Key hole surgery and Robot aided surgery is being used widely.
When CABG is needed?
If the person has the subsequent signs he/she obliges for Bypass surgery,
Pain in the chest
- Increased heart rate
- Irregular heart rhythms
- Breathing problems
There may be no symptoms at the early stage of cardiac disease but if there is a shortage of blood supply to the heart muscles due to high pressure and obstruction of the coronary artery, heart attack occurs. If the tissues injured are not re-activated with the blood supply then the tissues will die.
The CABG will not completely cure Coronary Heart Disease as it provides provisional solution. Even after the maneuver, you have to follow strict life style changes. You will be prescribed with medicines which help to decrease the cholesterol level and also blocks the clotting of blood and aids the heart to function properly.
Merits of CABG:
- One of the ideal treatments for the blockage of the blood to the cardiac muscle.
- Enhances the blood supply and oxygen to the heart.
- Respites from Angina
- The chance of Myocardial Infarction is reduced
- Person’s routine activity is retained
The cardiac or heart valve surgery is done for the cardiac or heart disease. In the Valve diseases, the four valves which is present in the heart which keeps the blood to flow in right direction will function abnormally. The main goal of the surgeon is to repair or replace the affected valves of the heart.
The cardiac valve diseases that can be treated with surgical procedure is,
- Aortic Valve Diseases:
This valve is present between the left ventricle and the aorta which impedes to function normally in this condition. It is present by birth itself or may be from other causes. The two major forms are,
- Aortic Valve Stenosis:
The aperture of the aortic valve is lessened and due to this the valves cannot undo fully and blocks out the blood from the heart into the aorta and to the rest of the system.
- Aortic Valve Regurgitation:
The blood gets flowed back to the left ventricle as the valve does not undo completely.
- Mitral Valve Diseases:
This valve is present between the left atrium and the left ventricle which does not task properly and the two major forms is,
- Mitral Valve Regurgitation:
The flaps will not close firmly and the blood leaks towards the left atrium of the heart and if left untreated the heart muscle will be damaged.
- Mitral Valve Stenosis:
The flaps of the mitral valve will become more rigid and starts to merge together. Therefore, the valve opening becomes narrowed and blood supply becomes less to the left atrium and the left ventricle.
- Pulmonary Valve stenosis:
It is anarchy of the pulmonary valve which is found in the heart and is accountable for the blood flow from the heart to the lungs.
- Pulmonary Regurgitation:
The blood starts to flow toward the back as the pulmonary valve becomes leaky.
- Pulmonary Stenosis:
The valve becomes tapered and the blood flow is abridged.
- Tricuspid Valve Disease:
The valve stops to function normally and often associated with problems of other valves.
- Tricuspid Valve Regurgitation:
The valve will not close firmly and hence the blood flows back towards the upper side of the right atrium.
- Tricuspid Valve Stenosis:
The blood supply becomes reduced to the right atrium to the right ventricle as the valve becomes pointed.
- Tricuspid Atresia:
It is a defect by birth, the thick wall of the tissues obstructs the flow of blood between the right chambers of the heart.
- Ebsteins Anomally:
The tricuspid valve is imprecise which is placed less than the normal position in the right ventricle causing blood to flow back to the right atrium.
The cardiac valve surgery is constructive in the following ways,
- The quality of life is enhanced
- The life span is increased
- The cardiac disease indication is reduced to maximum
- The functioning of the heart muscle is well protected
A pace maker is a small instrument which resembles like a half dollar piece and is place beneath the skin to direct the heart rate. The process of pacemaker implantation is called as ‘Cardiac Resynchronization Therapy’
The motive for pacemaker implantation is many, but the most common one is ‘Arrhythmias’ where the heart rhythm is abnormal. The age of the person makes the heart to function very slowly. Heart attack is also one of the reasons for deliberate heart rate. Intake of certain kind of medications and few genetic forms also cause irregular heart beat.
Importance of Pacemaker Implantation:
The pacemaker is implanted to organize the heart beat regularly. It is fixed provisionally to manage the slow heart rate because of the heart attack or surgery or high dose of drug intake. It is also fixed enduringly in case of Bradycardia or heart collapse.
How does it work?
Natural Pacemaker is the cluster of cells which act like a electric plug that generates electrical impulses which travel through the specialized muscle fibers. The impulse first reaches the right and the left atria making it to contract and squeezes the blood into the left and the right ventricle which supplies the blood to all parts of the body.
The artificial pacemaker impersonate the work of the natural one and it consist of the following parts,
It is tiny metal container which has a battery and the electrical circuit which normalizes the electrical pulses sent to the heart.
About one three flexible insulated wires are each placed inside the chambers of the heart which delivers the electric pulses to adjust the heart rate.
The pacemaker monitors the heart rate and if it is very slow the pacemaker will boost it up by sending the electrical impulse to the heart. The pacemaker has sensors which detects the body movement and stimulates it to increase the heart rate during physical activities to meet the body’s increased need for blood and oxygen.
Types of Pacemaker:
- Single chamber pacemaker:
Only one wire is placed inside the chamber of the heart.
- Dual/ Biventricular pacemaker:
Wires are placed in two of the chambers of the heart, one in the atria (Upper chamber) and other in the ventricle (Lower chamber). It directs and co-ordinates the work of both atrium and the ventricle thus making more innate pacing of the heart.
- Triple chamber pacemaker:
It has one wire placed in the right atrium and another one to excite both the right and left ventricles. It is mainly helpful for patients who have heart weak muscles.
- Permanent/Internal Pacemaker:
This type of pacesetter stays inside the body forever and is kept beneath the skin.
- Temporary/External Pacemaker:
It is used initially for the stabilization during cardiac problems and is not permanent.
- Demand Cardiac pacemaker:
This form has the sensor inbuilt in them and it senses when the heart beat is too slow and turns the signal. When the heart beat is normal the signal will turn off automatically.
How Pacemaker Implantation is performed?
It is done under local anesthesia as a daycare procedure. A small cut is made beneath the collar bone. A blood vessel is identified and the pacemaker is inserted into it which is directed towards the heart. Once the lead is fixed it is tested out to make sure whether it is positioned firmly and functioning properly. It is then attaché to the initiator which is fixed under the skin through the cut that is made earlier. The patient rest for few hours and observed for few hours and if he/she is stable they are allowed to discharge from the hospital.
Cardiac surgery in children is needed to repair the faults in the heart when the child is born with or has acquired after birth. It is done for child’s welfare and overall development physically. For a successful pediatric cardiac surgery, talented medical panel comprising doctors, nurses and other health care supporting staffs are required, who are skillful and have vast experience in this branch.
They can swiftly recognize the problems and the subsequent side effects and also how to respond swiftly if trouble arises. The pediatric surgery program helps out patients and their families with both emotional and psychological support before and after the surgery. We provide complete solution and make this task trouble free for the patient and relatives.
Some of the major Cardiac defects in Children:
It is seen that there is mixing of the pure and the impure blood or less supply to the parts of the body when there is defect/abnormality in the septum or the valves or location of the arteries. If the defect is complex and interferes with the existence of the child it requires immediate surgical intervention. The body of the child will turn blue if there is more amount of circulation of impure blood.
Atrial Septal Defect: (ASD)
It is often referred as a hole in the heart and is distinct opening present between the dividing walls of the atrium. ASD’s are common congenital defects in children and they are treated with few or no complications. In ASD, due to the opening present between the atrium or atria, some oxygenated blood from the left atrium passes through the hole into the right atrium were it gets mixed with the oxygen deficient blood and thus increases the total amount of blood that flows into the lungs.
Because of the huge flow of blood into the lungs, there is hissing sound which is also called as ‘murmur’ of the heart. A well experienced cardiologist can detect this sound and easily diagnose the defect. The hole can be located in several places on the atrial septum and varies from sizes. The symptoms and the management will depend on these criteria and ASD is more common among girls than boys and the exact reason is unknown.
Based on the size of the ASD and its location in the heart the symptoms are determined. Many children’s do not show any signs and develop normally. A child who has larger and complex ASD, show the following signs:
- Poor appetite
- Abnormal or poor growth
- Breathing problems
- Problem in lung and subsequent infection (Pneumonia)
- The lips and tongue will become blue color (Cyanosis)
The treatment is opted based on the child’s age, size, position and complexity of the defect. The small hole or defect will close unexpectedly without any treatment as the child matures.
Cardiac catheterization is a procedure were a thin, bendable tube is introduced into the blood vessel in the leg which then guides to the heart. The consultant measures the flow of blood, pressure and oxygen level in the chamber of the heart. An exclusive implant is sited into the hole in the septum and it will compress on the septum which then closes the hole enduringly. It is a time saving method with one night stay at the hospital.
During surgical intervention, the child will undergo open heart surgery. The surgeon opens the chest and the heart-lung device is attached to keep the heart working meanwhile the surgeon repairs/closes the hole. The hole is closed with the stitches by covering it with the surgical material. The tissues near the heart get healed after six months post surgery and hole will be covered completely.
When a child has ASD, it is a scary problem to their parents. But due to advanced technology and well experienced doctor’s the problem can be well managed. The child with corrected ASD can lead a healthy life with normal expectancy.
Ventricular Septal Defect: (VSD)
When a hole is found between the right and the left ventricle, it is called as ‘Ventricular Septal Defect’. Due to this some amount of blood in the left ventricle moves to the right ventricle through the opening. The oxygen affluent blood blends up with the oxygen poor blood and streams to the lungs through the pulmonary artery. It produces a distinctive sound called ‘heart murmur’ which is detected by the pediatric cardiologist.
There are different forms of VSD depending on the location in the ventricular septum. Among 40% of children born with the VSD does not need any treatment as it closes on its own if the hole is very small. But if the opening is large it requires surgical intervention.
- Breathing difficulties
- Tiredness or feeling weak
- Poor appetite
- Poor weight gain
Intra Cardiac Technique:
The ribs are cut open and connected to the cardiac-lung machine to maintain the circulatory and respiratory function. The surgeon then sutures the hole directly or covers it up with a patch. It is done under general anesthesia.
This surgical procedure is aided by catheter which is inserted into the femoral artery in the groin area. The catheter is slowly directed near the hole and corrected. The enlarged heart resumes back to its normal size soon and the pressure of the artery decreases.
When there is a mixture of four birth defects which influence the structure of the heart and the blood flow is called as ‘Tetralogy of Fallot’. About 10% of the newborn found to have this kind of disorder.
- Ventricular Septal Defect:
It is a condition where there is an opening in the septum or the wall; it disconnects the right ventricle from the left ventricle and prevents the mixing of the blood. Due to this, oxygen rich blood from the left ventricle merges with the right ventricle.
- Pulmonary Stenosis:
It is circumstances were the pulmonary artery that bonds the right ventricle becomes tapered. The main work of the pulmonary artery is to bring the oxygen poor blood from the heart to the lungs and it receives the oxygen rich blood and takes them back to the heart. When it is tapered, the heart works to pump out the blood to the lungs and only fewer amounts reaches out there.
- Right Ventricular Hypertrophy:
The muscular wall present in the right ventricle becomes thick and rigid.
- An Overriding Aorta:
The artery is present above both the ventricles which they get normally seated in the left ventricle in good working heart. Because of this, low oxygen blood is taken to the aorta and then to all parts of the body which is harmful and the pulmonary artery picks it up and pours into the lungs to collect the oxygen.
- Episodes of seizures and giddiness
- High chances of endocarditis
- Abnormal heart beat called as ‘Arrhythmia’
These defects are corrected by the following techniques,
Blalock’s Taussig Operation:
It is a soothing procedure which is performed in small babies to make high flow of blood to the lungs and tolerate the child to mature enough to bear the surgical treatment. The pulmonary artery and the subclavian artery are linked so that supply of oxygen rich blood is increased. This relieves the cyanosis to greater extent.Total Corrective Surgery:
When the child attains two years or more, this method is performed. With a patch the VSD is clogged and the pulmonary valve which is rigid is opened. The success rate is high and most of the child led a well healthy life with limited restrictions.
It is newly evolved technique were by means of tiny incisions at the chest the surgery is performed. The surgeons use very small tools and robots to do the surgery which is less invasive when compared to traditional heart surgeries. It is usually called as ‘Da Vinci’ procedure as it refers to the maker of the robot which is used for the process.
The robotic cardiac surgery is used to treat number of cardiac diseases and performs the following surgery,
- Robot aided Mitral Valve Repair which is done for mitral valve narrowing and mitral valve regurgitation.
- Robot aided Coronary Artery Bypass Graft (CABG) done to manage obstructions in the cardiac arteries and continuous pain in the chest which is not effective with medicine.
- Robot aided repair of Atrial Septal Defect done to fix the hole which is situated between the upper chambers of the heart that is left unclosed during the development of the fetus.
- Robot aided Biventricular Pacemaker Insertion done to treat the heart failure because of Atrial fibrillation (irregular cardiac rhythms of upper chamber).
- To excise tumor in the heart.
Merits of Robot Cardiac Surgery:
- Minimal pain and scaring of the site
- Tiny cuts made in the body so that the patient has less discomfort.
- Short hospital stay.
- Blood loss is low and need for transfusion of blood is reduced.
- The risk of further illness is decreased.
- The pain medicines are prescribed for shorter period.
- Recurring to the routine activities is very fast.
Cardiac transplant is a procedure were the damaged or injured heart is confiscated a replaced with a hale and healthy heart. It is the final stage for the healing of cardiac disease when the medications and other surgeries have failed to stabilize the patient’s condition.
It is one of the complicated surgeries where the success rate is found to be high because of the sophisticated technologies and skillful doctors. You should learn about the process, the method’s followed in the surgery, risks concerned and the post op care when you have opted out for cardiac transplant.
Need for Cardiac Transplant Surgery:
When the major treatment does not work to cure the cardiac illness and leads to cardiac failure, transplant is the only option available.
The failure of the heart is due to,
- Coronary Artery Disease
- Valve disease of the heart
- Congenital defect of the heart that is present at birth and cannot be fixed with the surgery.
- Failure of cardiac transplant.
- Severe angina or malfunctioning of the heart which is not able to treat with drugs and other surgical techniques.
- Life threatening irregular heart rate or rhythms which does not react to other treatments.
The cardiac transplant is not appropriate for the following patients;
- Malnourished and has immuno compromised system.
- More than 55yrs t0 60yrs.
- Had more occurrences of stroke and dementia.
- Had malignancy or tumor.
- Affected with HIV infection.
- Hepatitis infection which is active or viral
- Insulin reliant and inappropriate functioning of the vital organs.
- Patient suffering from kidney, lung, nerve and liver diseases.
- Patient family who does not support them and also their treatment.
- Patient who has disease of blood vessels found in the neck and leg.
- Patient who has thickening of blood vessels in the lungs (pulmonary hypertension).
- Patient who smokes or consumes alcohol or drugs or other lifestyle habits which injures the new heart.
The consultant will not advise for the cardiac transplant if the patient is not able to afford the hospital and doctor office visits, investments and drugs which are required to keep the new heart healthy.
The patient will receive general anesthesia and the breast bone or ribs are incised first. The blood is kept in flow by the heart-lung bypass machine while the surgeon repairs the heart. The machine help in the supply of blood and oxygen as the heart is made motionless. Then the donor’s heart is sutured in place by confiscating the diseased heart. Once the work is over the heart-lung machine is disconnected and the blood goes out through the new heart.
The surgeon will place a tube intact in the body for few days and the air, fluid and the unwanted blood is drained from the chest and the mean time lungs are allowed to re -develop. In few cases, the patients damaged heart is placed over it and is called as ‘Heterotrophic transplant’.
- Formation of deep clots (DVT)
- Use of anti rejection medicines can damage kidney, liver or other vital organs.
- Tumor ensuing from the use of anti rejection medicines
- Stroke and cardiomyopathy
- Rhythm problem associated with heart
- Increased cholesterol levels, diabetes and thinning of the bone because of rejection drugs used.
- Risks of infection becomes high
- Chronic CAD
- Infection of the wounds
- Rejection of the heart
Rejection of the donor’s heart:
Your body’s immune system will treat the new heart as a foreign object and always tries to overwhelm on it. Every patient who undertake transplant will receive immune suppressive drugs to lessen the activity of the body’s immune system. But still nearly 30% of them show signs of rejection during the initial years.
The denial of the transplant remains unsymptomatic and need only slight adjustment of the medicine. But if single dose is missed then it can create serious problem and therefore should be followed regularly. During the first few months after transplant, biopsies will be taken frequently to determine the denial of the new heart which will be high in this period. The symptoms of the denial is as follows,
- Breathing difficulties
- High temperature
- Gaining of weight due to water preservation
- Less urination
Cardiac transplant is a life saving technique for patients who suffers from the end stage cardiac disease or it will be fatal. Nearly 80% of the cardiac transplant patients survive for about 5yrs. But the main trouble in cardiac transplant is rejection or denial of the newly transplanted heart, or else if properly maintained the endurance of the patient can be increased to 10yrs.
When one or more valves are not working appropriately it is called as ‘Valvular Heart Disease’ or ‘Disease of the Heart Valves’. Valve replacement surgery provides a solution to the patients who has valves that are brittle, disfigured or in a position to repair.
Why replacement is needed?
The main aim of the valves is to overtake the nutrient enhanced blood to pass into the chambers of the heart. Once the blood reaches there, the valves closes like a ‘door’ so that nutrients do not leak over.
The valves are seen at each of the heart’s chamber, they are
- Tricuspid Valve: sited among the right atrium and the right ventricle.
- Pulmonary Valve: Sited among the right ventricle and the pulmonary artery.
- Mitral Valve: Sited among the left atrium and the left ventricle.
- Aortic Valve: Sited among the left ventricle and aorta.
If any of the mentioned valves are unhealthy or injured the patients will experience the following signs,
- Pain in the chest area
- Difficulty while breathing
- Increased heart rate
- Inflammation of feet, ankles or abdomen
- Abrupt gaining of weight due to water retention
How replacement of Valve is done?
In traditional way, open heart surgery is used were the ribs are cut and opened in the operating room and the heart is made still for some time and the surgeon either repair or replace the valve. By using the heart – lung machine the blood is pumped and circulated.
In latest addition, minimally invasive technique is adopted to restore or revamp the valves of the heart. A tiny incision is made so the patient has less pain and short hospital stay. The classic example of this method is Balloon Valvoplasty. Few cases of Valve Stenosis are cured by this method and it is done as a section of catheterization procedure relatively than the part of the open heart surgery.
Trans Catheter Aortic Valve Replacement (TAVR) is one of the latest substitutes to cure some cases of Aortic Valve Stenosis. It is done by both the surgeon and the interventional cardiologist. The sick valve is repaired by keeping a disc inside the patient to support their body valve or is removed fully and revamped with synthetic valve. These valves are made of metal or plastic or from the tissues of the animal valves or cadaver valves. The outcome of the procedure is excellent and is deemed as the life-saving and life-lengthening procedure.
Cardiac Surgery Days Tariff*-USD Coronary Angiography 575 Coronary Angiography + Intra vascular unltrasound study 625 Renal / Carotid / Peripheral Angiography 532 Coronary Angioplasty with one Medicated Stent 2 7,944 Coronary Angioplasty with one Regular Stent 2 5,778 RF Ablation 2,369 EP Routine 636 Biventricular 14,242 AICD 13,578 Combo Device Procedure 27,300 Cardiac Surgery CABG 8 8,378 Single Valve – AVR / MVR (with one standard valve) 8 10,400 Double Valve Replacement (with two standard valves) 8 13,000 CABG + AVR (with one standard valve) 8 12,884