Cardiovascluar Surgery

Cardiovascluar Surgery

Cardiovascular surgery is a branch of science that deals with surgical treatment of health problems related to the heart and heart vessels. 

Major Areas of Interest of CVS

Coronary By-pass Surgery

Coronary artery bypass surgery is the most common type of heart surgery. 

Coronary arteries which are blood vessels supplying the heart can be narrowed or completely clogged because of various risk factors in time.  As a result, the heart cannot be supplied adequately and literally becomes unable to perform its duties. Blockage of the arteries that supply the heart causes diseases such as heart attack and heart failure; this condition is one of the leading causes of death. 

By coronary artery bypass surgery, a new vein is added to the blocked vessel and a new way is opened for blood flow. Thus, the heart may continue to operate properly by taking the blood it needs through this new blood vessel.

Coronary artery by- pass surgery is an open- heart surgery and in this surgery, blood vessels taken from another area of the body are used to provide blood flow to the coronary arteries which cannot receive enough blood. Vessels used in the operation are blood vessels which do not disrupt the flow of blood in the region where they have been removed from.

Heart Valve Surgery

Heart valves are structures that prevent blood from flowing back after it is sent forward.  In the case of conditions which prevent blood from going forward or cause it to flow back, the heart is put under pressure and problems occur in both the heart and organs requiring blood.

Heart valve diseases can be congenital or they may arise from rheumatic diseases experienced in childhood, senile calcification, various infections, and degeneration of the valve.

In heart valve condition, the first treatment option is repair of the valve.  However, if repair is not possible, artificial heart valves are implanted into the patients.  If medical condition of the patient doesn’t allow open surgery, the valve can be implanted by entering through groin artery, called TAVİ. 

Metal valves or bioprosthetic valves partially containing organic matter are used as artificial heart valves.  

Basically, we can divide heart valve diseases into 4 categories.

  • Aortic Valve Stenosis: Advanced age-related development of degeneration may be congenital or rheumatic fever.  
  • Aortic Valve Insufficiency: Unlike Aortic stenosis, although there is no restriction in forward flow of blood, the blood flows back after the heart beat. 
  • Mitral Valve Stenosis: It is the most common valvular disease after rheumatic fever disease. Mitral valve stenosis is the most common disorder in all valve diseases.  There is a problem in flow of blood from left ventricle to left atrium so the blood is prevented from flowing forwards.
  • Mitral Valve Insufficiency: In mitral valve insufficiency, the heart is exposed to pressure because of increased blood buildup inside the heart.  

Vascular Surgery

Vascular surgery is the branch that deals with medical and surgical diseases of all body vessels.

Aorta and other Artery (Artery) Surgeries 

  • Aortic Dissection (Aortic rupture)

A tear formed in the aorta, which is the largest blood vessel coming from the heart, is called dissection. Dissection occurs as a result of exposure of your aorta  to high pressure and rupture starts internally. 

It is an extremely urgent life-threatening condition. Approximately 30% of the patients don’t make it to hospital in time. At this point, the location of the tear in the vessel is of great importance. The patient may have to be operated immediately. Torn part of the aorta is repaired by replacing it with an artificial vessel.

  • Aortic Aneurysm

In some parts of the aorta, there may be congenital or acquired ballooning, in other words, aneurysm. 

Growth of the aneurysm increases the risk of burst.  Therefore, this part of the vessel must be removed and replaced by an artificial blood vessel. 

Initially, in the treatment of aneurysms, drug therapy can be used to reduce blood pressure , relax blood vessels  and reduce the risk of burst. 

Aneurysm may occur in all vessels in the body, however, it is most often seen in aorta. Hypertension, smoking, infections, trauma, and genetic predisposition, use of stimulant drugs such as cocain, etc. are among the major reasons that lead to aneurysm.

Aneurysms can form in an insidious manner over the years without showing any symptoms. If it causes any complaints, severe back / abdomen / chest pain resembling a stab, low blood pressure , dizziness, nausea / vomiting , shortness of breath can be observed.  

Local narrowing at the initial parts of branches of the aorta supplying the legs ( due to accumulation of fat and cholesterol ) can be observed. If these narrowings cause significant decrease in supply to the legs, bridging (bypass) surgery can be performed to increase the blood flow to the legs. 

  • Varices 

Substances required by body cells and oxygen are sent from the heart to the tissues through arteries. These substances are used by the tissues and waste materials are added to this blood and they are returned to the heart by the veins in order to be cleaned. Dilation and convolution of these veins result in a condition called “varices”.

Treatment must be performed according to the patient and disease level.

In early stage illnesses and for old patients with surgery risks, the progress of the disease can be prevented by merely using varices socks. Moreover, special fine needles can be introduced into the veins, and the vein can be closed by administration of special substances (sclerotherapy). This method can also be applied by special instruments such as radiofrequency and lasers. 

In an advanced level disease, methods such as standard surgeries, foam sclerotherapy, radio-frequency and laser ablation can be used. Surgical treatment should be selected according to the patient and stage of the disease. Surgical method in the form of removing varicose veins is a surgical method used in diseases at most advanced stage and causes no harm to the body. Deep veins will do the same job. It is sufficient to have the patient rest at the hospital for one night in each of these cases. Patient can return to normal life in 7-10 days.

Heart Tumors

They may basically arise from the heart or be caused by spread of tumors of adjacent or distant organs to the heart and be either benign or malignant. 

Malignant tumors of the heart often occur after the age of 40, and unlike benign tumors, they can be seen in both genders.  

It is appropriate to surgically remove the tumor. After the diagnosis of the disease, surgery should be performed before encountering any conditions such as embolism or gangrene. The success of surgical treatment is lower in the case of malignant tumors. Therefore, chemotherapy and radiotherapy can also be used to treat these patients.

Pediatric CVS

Congenital heart diseases are anomalies that occur during prenatal development of the unborn baby in mother’s womb and the majority of heart problems occurring in children are congenital problems. These anomalies can be classified as follows:

  • Holes in the heart
  • Anomalies that cause stenosis or regurgitation in heart valves, 
  • Anomalies in vessels going into or coming out of the heart, 
  • Congestive Heart Failure  
  • Heart Rhythm Problems

Congenital heart disease is a rare disorder and, in most cases, the cause of the disease is unknown. However, the following factors are known to be effective in congenital anomalies:

  • Certain viral diseases. For example, rubella, etc. during pregnancy,  
  • Genetic factors
  • Medicines used during pregnancy, alcohol, drugs, exposure to x-ray beam,  
  • Consanguineous marriage,
  • Diabetic mother 

Some of the children with cardiac anomaly can be adequately treated with medications.   Where drug therapy is not enough, a series of interventional therapies and surgical treatment are applied. 

In the case of pediatric cvs operations, pediatric cardiologists and surgeons decide together for a child to undergo surgery.

Pacemakers

Pacemakers are used for persistent rhythm disorders. Millions of people use pacemakers worldwide. 

The patient’s heart rate slows down because of the fact that impulse center in his heart can not create impulses at satisfactory rate or the impulse is interrupted for various reasons, and a normal heart rate should be re-established so that the patient maintains a normal life.  An artificial pacemaker is needed to bring heart rate to a normal level.

The procedure is conducted by a local anesthesia. An incision is made on subcutaneous region which is 1-2 cm below either right or left collar bone to create a small pocket wide enough to house the pacemaker. Leads, which are passed through large vessels to the heart and will ensure transmission between the heart and generator, are placed in one of or both ventricles. Then these electrodes are connected to the generator to be inserted subcutaneously. Generator is introduced into the subcutaneous pocket in the chest or abdomen. 

Permanent pacemakers are highly developed technology products, and they constantly check the operation of the heart and intervene when necessary. They eliminate the patient’s complaints, including fainting, dizziness, and shortness of breath because of slow down of the heart rate, and provide significant contribution to the quality of life.  

Diagnostic Methods Used In Cardiology

Cardiac MR

MR is a very old procedure that can display internal organs and tissues in a clear and detailed manner. However, its use in cardiology has improved in recent years.

Echocardiography (ECHO )

Echocardiography is an imaging method performed by using sound waves. It shows how the heart muscle and valves work. It also provides information about how wide is your heart. 

Exercise Testing

Exercise Testing is a test applied by a cardiologist or a corresponding technician to test effects of exercise on the heart. 

During the test, electrical activity of the patient’s heart is recorded and analyzed on a computer, while the patient is walking or running on a treadmill.  This test measures reaction of the heart to increasing need of the body for oxygen. The test is continued until targeted heart rate is reached or the moment when the patient says s/he can no longer continue. 

ECG (Electrocardiography)

The heart works by electrical impulses from sinoatrial node.  The procedure of recording these electrical currents created in the heart on paper is called Electrocardiography (ECG). 

ECG gives valuable information about particularly rhythm of the heart, vascular diseases, heart attack and thickening of heart muscle. ECG is widely used because it is simple, effortless for the patient, easy to apply everywhere and cheap.

Thallium scintigraphy

Thallium scintigraphy is based on whether radioactive substances such as thallium are taken up by heart muscle or not. The radiation dose which the patient is exposed to during the test is no more than having a normal chest x-ray. 

Coronary Angiography

Coronary Angiography is a diagnosis method, rather than a treatment as opposed to popular belief. Coronary angiography is a procedure utilizing x-rays, which allows imaging of coronary vessels of the heart by a special camera.

During the procedure, heart chambers are also reached so defects in heart valves and walls can also be demonstrated. It can be used for diagnosis of congenital heart diseases such as heart holes. 

In this procedure, a thin plastic tube is placed in arm or groin vessel. Then, a long, thinner and flexible plastic tube called a catheter is passed through this and guided through the artery. When coronary arteries are reached, an agent called an X-ray dye is injected into the arteries.  Thus, motion picture images of coronary arteries which have become visible are created at that moment. Then this angiography motion picture image is watched to reveal the problem in your coronary arteries.

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