> HEART PACEMAKER IMPLANTATION
The heart pacemaker or cardiac pacemaker is a small battery designed to return the heart to a regular beat and the proper pace. There are several types of pacemakers.
Reasons for the implantation of a heart pacemaker.
• Cardiac arrhythmia: the heart beats too fast, slow or irregularly.
• When the arrhythmia has not been resolved through the use of drugs.
Procedure for heart pacemaker implantation
The electrical impulses of the heart cause the heart chambers to contract. Arrhythmias are changes in the normal rhythm of the heart. When the heart beats too fast or slow, the circulation of the blood decreases in a dramatic manner throughout the body, thus causing dizziness, chest pain, or more difficulty breathing, etc.
The pacemaker controls the electrical impulses of the heart and when necessary sends electrical pulses to regulate the beat of the heart.
A cardiac pacemaker is composed of two elements:
• An electrical pulse generator: a small box containing a microchip and a battery.
• One isolated cable (s) from the pulses generator to the muscle of the heart. this receives information from the heart and transmits electrical signals. The wires of the pacemaker lead into the heart through large venous vessels.
A small space is created to place the generator under the skin of the chest.
Type of surgery and anaesthesia:
The implementation is a simple and safe surgery that lasts 1 hour. It is usually done under local anaesthesia.
Postoperative monitoring of heart pacemaker implantation
A check-up at least twice a year is strongly recommended to check that the pacemaker is highly functioning correctly.
> CORONARY ANGIOPLASTY
Coronary angioplasty is a surgery aimed at “unplugging” the occluded arteries and thus restoring the blood flow in thema.
Reasons for the coronary angioplasty.
Arterial diseases that make arteries harden and narrow. The obstruction is usually due to the build-up of cholesterol and its subsequent calcification.
Coronary angioplasty procedure.
Coronary angioplasty is performed by introducing a balloon with a catheter through a blood vessel, which can be accessed through the arm or the groin. Once placed in the obstructed artery, the balloon is inflated and the plaque that clogs the artery is pushed toward the walls thus, restoring the blood flow.
In many cases one or more “stents” are required. Stents are small hollow spring like tubes, whose purpose is to keep the artery open.
Type of surgery and anaesthesia :
Coronary angioplasty is a minimally invasive surgery that can last several hours, depending on the number of clogged arteries. It is usually done under local anaesthesia.
The patient does not usually remain in the hospital for more than 24 hours.
Postoperative monitoring of coronary angioplasty:
There is no permanent guarantee with this surgery. Over the years, the arteries may become clogged once again. Therefore, we recommend regular check-ups.
> HEART BY PASS SURGERY
Bypass surgery of a coronary artery, also called coronary revascularization surgery is, as its name indicates, a bypass surgery for a blocked artery. The goal is to create a new “path” which enables the blood and oxygen to flow normally.
Reasons for performing heart bypass surgery:
• Coronary arterial diseases which make arteries harden and narrow.
• Obstruction of the coronary artery
• When the coronary angioplasty has not achieved the desired results and the patient meets the appropriate criteria for this type of surgery.
Procedure for bypass surgery:
The derivation of the occluded coronary artery is carried out with an autograft: the surgeon removes either a piece of vein from the leg or a piece of artery from the chest or arm. Coronary revascularization surgery consists of joining this graft to the artery, above and below the blocked area. Blood flow is then diverted and once again flows normally.
The heart bypass may be performed without stopping the heart: the patient is connected to an extra corporeal circulation pump or to a device that stabilises and controls the rhythm of the heart. In this case it is used to slow the heart’s activity.
Type of surgery and anaesthesia in surgery of heart bypass:
This is open-heart surgery. Surgery lasts for several hours depending on the individual case and is performed under general anaesthetic. The patient usually remains in hospital for 2 or 3 days.
Postoperative monitoring of bypass surgery:
There is no permanent guarantee with this surgery. Over the years, the arteries may become clogged once more. Therefore, regular check-ups are recommended.
> MITRAL VALVE REPLACEMENT
The heart has 4 valves that open so the blood can flow through the organ. These valves can close to prevent the back flow of the blood. The replacement surgery of the mitral valve is used to replace a defective valve.
Reasons for mitral valve replacement.
In many cases, weakness of the heart tissues and heart valves are a result of an acute myocardial infarction or symptoms seen in patients suffering from coronary heart diseases.
• Mitral valve prolapse: a malfunction of the heart valve meaning that it does not close properly and allows the blood to regurgitate.
• Mitral valve stenosis: the heart valve does not open sufficiently for the blood to flow normally.
Mitral valve replacement procedure
There are several techniques used when carrying out this heart surgery:
• Small incisions are made which allow direct access to the mitral valve.
• This can be performed using laparoscopic surgery, whereby a camera is introduced, and special instruments are used. • This surgery can be performed with the help of robotic arms. During this surgery, the patient may or may not be connected to a system of extracorporeal circulation. The replacement of the mitral valve can be done with grafts: an autograft (bone grafts from the own patient), allograft (human graft), xenograft animal (graft) or with artificial valves of ceramic or titanium.
Depending on the case the mitral valve may be repaired rather than replaced.
Type of surgery and anaesthesia:
The surgery for the replacement of the mitral valve can be performed using minimally invasive surgical techniques (MIS). This surgery lasts from 2 to 4 hours and is usually carried out general anaesthesia.
Postoperative monitoring of a replacement surgery of the mitral valve.
Regular check-up is recommended.
> PERCUTANEOUS MITRAL VALVE REPAIR
The heart has 4 valves that open so that the blood can flow through the organ. These valves can also close to prevent the back flow of the blood. The repair of the coronary valve is the procedure used to repair a defective valve.
Reasons for percutaneous mitral valve repair.
In many cases, the weakness of the heart tissues and valves are a result of an acute myocardial infarction or symptoms seen in patients suffering from heart diseases. • Mitral valve prolapse: a malfunction in the heart valve meaning that it does not close properly and allow the blood to regurgitate. • Mitral valve stenosis: the heart valve does not open sufficiently for the blood to flow normally.
Procedure for mitral valve repair.
Both the percutaneous line and catheter repair procedure are non-surgical interventions. This consists of inserting a catheter into a blood vessel in the groin or the armpit to reach the mitral valve inside the heart.
There are 2 percutaneous repair techniques:
• Balloon percutaneous procedure:
This is used in case of patients with stenosis of a mitral valve. A balloon is fixed to the tip of the catheter, and once this is fitted to the mitral valve, it is blown up in order to “open” the valve or break the calcified plaque.
• The edge to edge technique:
It is used in case of mitral valve prolapse and when the surgery for the replacement of the mitral valve is not recommended. The surgeon accesses the femoral artery, and with the help of a catheter, a pair of tweezers are used in the outer part of the valve to close its borders and to prevent regurgitation.
Type of surgery and anaesthesia:
The percutaneous mitral valve repair is usually performed under general anaesthesia.
Postoperative monitoring of percutaneous valvuplasty
Regular check-ups are recommended.