Chapter 11 : Cardiac Surgery and Neurosurgery
Cardiovascular Surgery is a surgery on the heart and/or great vessels performed by the cardiac surgeons.
The most common type of the heart surgery for adults includes:
Topics covered in this snack-sized chapter:
- Major Heart Surgeries include:
- Coronary Artery Bypass Grafting (CABG).
- Heart Transplant Surgery.
- Minimal Invasive Surgeries include:
CABG is a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to improve normal blood flow to the heart.
Coronary heart disease (CHD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.
- Minimal Invasive Heart Valve Surgery.
1: Internal mammary artery graft (artery relocated from chest wall)
2: Vein graft (Vein removed from the leg) is stitched to the aorta and coronary artery
3: Coronary arteries
4: Artery graft is stitched to the coronary artery
5: Blockage in coronary artery
The goals of the procedure are:
- To relieve symptoms of Coronary Artery Disease.
- Enable the patient to resume a normal lifestyle.
- To reduce the risk of heart attack or other heart problems.
During bypass surgery a long length of an artery may be detached from the chest wall or one of the arms and/or a leg vein may be removed.
One end is sewn onto the large artery arising from the heart while its other end is attached to the coronary artery below the blocked area.
Using the newly attached conduit, blood can again flows freely to the heart muscle beyond the blockage.
Heart Transplant is a procedure in which a surgeon removes a diseased heart and replaces it with a donor heart.
Heart transplants are done as a life-saving measure for end-stage heart failure when medical treatment and less drastic surgery have been failed.
The surgery involves:
- A major incision down the front of the chest.
- Main coronary arteries are connected to a heart lung bypass machine to put oxygen into your blood and pump it. On the other end it is connected to ventilator.
- Most heart transplants are done with the method called orthotropic surgery, where:
- Most of the heart is removed but the back half of both upper chambers called atria are left in place.
- Then the front half of the donor heart is sewn to the back half of the old heart.
Angioplasty is a procedure that widens a narrow or obstructed blood vessel using a balloon catheter.
- The donor's aorta and pulmonary arteries are connected to the patient.
Angioplasty can restore a blood flow to the heart if the coronary arteries have become narrowed or blocked because of CHD.
Angioplasty is a common medical procedure.
It may be used to:
- Improve symptoms of CHD (Coronary Heart Disease), such as shortness of breath.
- Reduce heart muscle damages caused by heart attack.
- Reduce the risk of death in some patients.
- The patient is administered with general anesthesia.
- The physician makes a small incision in the area.
- Under the guidance of X-ray monitor, the catheter is inserted through the incision until it reaches the blocked artery.
- Contrast dye is injected into the body through the catheter.
- Once, the narrowed arteries are identified, a guide wire followed by a balloon catheter is introduced gently through the cut skin.
- As balloon catheter is placed in the blocked artery, it is inflated for a few seconds.
- Inflation of the balloon may be practiced repeatedly by referring the X-ray monitor.
- After the completion of angioplasty, the physician may conduct imaging tests to check for the blood flow.
- If blood circulation to the heart is improved, the physician removes the catheter, balloon catheter and guide wire.
Minimal Invasive Heart Valve Surgery is a procedure used to repair or replace diseased heart valves using small incisions.
Repair means that the valve is mended to help it to work better.
Replacement means the diseased valve is removed and a new valve is inserted in its place.
Both valve repair and replacement surgeries are performed by making a three to four inch incision in the sternum or on the side of the chest.
Neurosurgery is a specialty which deals with the treatment of diseases of the nervous system.
Treatment of Neurosurgery involves:
Traumatic brain injury is a serious condition in which the brain is damaged by a sudden injury.
Traumatic brain injury (TBI) is a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical and psychosocial functions.
- Proper dressing of the incision is done to avoid any infection.
Common symptoms related to TBI:
- Blurred or double vision.
- Impaired balance and coordination.
Serious symptoms that might indicate a life-threatening condition includes:
- Nausea with or without vomiting.
- Change in level of consciousness or alertness.
- Change in mental status or sudden behavior change.
- Garbled or slurred speech or inability to speak.
- Loss of muscle coordination.
- Sudden change in vision, loss of vision, or eye pain.
Because traumatic brain injuries can be life threatening, the treatment of traumatic brain injuries aims to stabilize the injury and prevent further damage.
Decompressive Craniectomy is a neurosurgical procedure which performed on victims of traumatic brain injury and stroke.
Decompressive Craniectomy is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed.
Decompressive Craniectomy is usually done to treat intracranial hypertension due to traumatic brain injury.
Craniectomy is also used to:
- Remove tumors at the rear of the brain.
Surgery involves the following steps:
- Craniectomy is done in the operating room under general anesthesia.
- An incision is made in the scalp above the location of the condition to be treated.
- Since the scalp is well supplied with blood, the surgeon will have to seal many small arteries.
- The surgeon makes a circle of holes in the skull after which a soft metal guide is pushed under the bone from one hole to the next.
- A fine wire saw is then moved along the guide channel under the bone between adjacent holes.
- The surgeon saws through the bone until the bone flap can be removed to expose the brain.
- After the surgery, the piece of skull is replaced and secured with pieces of fine, soft wire.
A brain Tumor is an abnormal growth of the cells within the brain which can be cancerous or non-cancerous (benign).
The brain cells transforms and grows abnormally consuming the nutrients and blood.
- Finally, the surgeon sutures the membrane, muscle, and skin of the scalp.
The symptoms of brain tumors depend on the tumor size, type, and location.
Most common symptoms of brain tumors include:
- Changes in speech, vision, or hearing.
- Balance and walking problems.
- Changes in mood, personality, or ability to concentrate.
- Jerking or twitching of muscles.
- Numbness or tingling in the arms or legs.
The treatment of brain cancer involves:
Surgery is often necessary for primary brain tumors.
Radiation therapy is used when surgery is not possible.
Chemotherapy may be used along with the surgery or radiation treatment.
A Craniotomy is a type of brain surgery which is the most commonly performed for brain tumor removal.
A Craniotomy is the surgical removal of a section of bone (bone flap) from the skull for the purpose of operating on the underlying tissues, usually the brain.
During this procedure, a section of skull called a bone flap is removed to access the brain underneath and is replaced after the procedure.
Craniotomy includes following steps:
- Surgery normally starts after a general anesthesia.
- The first step is the shaving of the scalp.
- During the surgery, the neurosurgeon makes an incision on the scalp and removes a piece of bone from the skull with the help of a special type of tool called the saw.
- Neurosurgeon also removes the tumor parts from the skull and covers the opening with that bone which he had removed initially before the surgery.
- Finally, the incision is closed.