Health & Surgery Information

The following information is provided for educational purposes only and is not intended to replace the medical advice of your doctor or health care provider.  Please contact your physician about advice for your specific medical condition or contact Cardiovascular Surgical Clinic if you would like to schedule an appointment.

 Your Coronary Arteries (blood vessels feeding your heart)

 Diagnosis of coronary artery disease (heart disease)

 What Causes Heart Attacks?

 Coronary Artery Bypass Surgery

 Carotid Artery Disease

 Heart Valve Disease

 Aneurysm Repair Surgery

 Lung Surgery 

Surgery Preparation

 Use of Antibiotics for Cardiovascular and Non-Cardiovascular Surgeries

 Pre-surgery Preparation for Abdominal Vascular Surgery

 

Hospital Stay

 Northwest Medical Center - Springdale, AR

 Northwest Medical Center - Bentonville, AR

 Washington Regional Medical Center - Fayetteville, AR

After Your Surgery

 Post Surgery Wound Care

 Follow-up Clinic Visits

 Diet and Exercise After Surgery

 

Coronary Artery Disease

Your Coronary Arteries

Coronary Arteries are blood vessels on the outer surface of your heart.  Your coronary arteries work as lifelines to your heart.  Your heart is made up of muscle and supplies blood to all parts of your body.  To do its job, the heart needs to be supplied with oxygen-rich blood at all times.  The coronary arteries form a network of blood vessels covering the surface of the heart muscle.  When the inner lining of the artery is healthy, blood passes through the artery easily, supplying oxygen and nutrients to the muscle tissue.  There are three major coronary arteries that supply blood flow to your heart tissue - the left main coronary artery, the left anterior descending coronary artery and the right coronary artery.

Diagnosis of Coronary Artery Disease

Coronary Artery Disease is diagnosed using a series of tests designed to help doctors. Cardiologists use tests such as EKGs, echocardiography, blood tests and cardiac catheterization to diagnose the extent of disease and make treatment decisions based on these results.  The cardiologist and surgeon base their decision to proceed with surgery on the extent of heart disease, the age of the patient, and other acute and chronic diseases that may complicate the patient's recovery after surgery.  

What Causes Heart Attacks?

Each coronary artery supplies blood to a specific region of heart tissue.  When the coronary artery becomes damaged by high blood cholesterol, high blood pressure or smoking the inner lining of the artery will be more likely to form a buildup of plaque.  Plaque within your coronary arteries is made up of fat, cholesterol, fibrin and calcium.  Blood flow is reduced due to the narrowing of the coronary artery causing your heart muscle to become "starved" for oxygen sometimes causing "chest pain" or angina.  If plaque is allowed to build up, a narrowing of the artery or even total blockage may occur by a clot that forms within the narrowed artery.  Once blood flow is stopped, the heart tissues is damaged due to lack of oxygen and the muscle cells die.  This is called a myocardial infarction (MI) or heart attack.

Coronary Artery Bypass Surgery (open-heart or heart bypass surgery)

Coronary artery bypass is one of the most commonly performed surgeries.  Over 800,000 coronary artery bypass surgeries are done worldwide every year.  Bypass surgery is performed when the patient is found to have a high level of blockage that limits blood flow in one or more coronary arteries.  These arteries are "bypassed" using a blood vessel from the patient's own chest, leg or arm to restore blood flow to the area of the heart affected by the blockage.  The decision to use either saphenous vein (leg), radial artery (arm) or internal mammary artery (chest) graft is made depending on the degree of blockage, location of blockage and size of the coronary artery that is to be bypassed.

Coronary artery bypass offers the best long-term results for patients with significant artery blockage because it improves heart function and reduces the risk of further damage to heart tissue by restoring the flow of oxygen and nutrients.

Prior to surgery, the cardiovascular surgeon reviews the results of your cardiac catheterization and determines the degree of blockage and which vessels will need to be bypassed.  The surgeon may decide after direct examination during the surgery to use more or fewer bypasses than planned.  

The surgery is performed by making an incision down the middle of the chest over the sternum.  A special saw is used to cut through the breast bone (sternum) allowing the surgeon to work directly on the heart.   In order to maintain a continual flow of blood throughout the body, the patient is placed on the heart-lung bypass machine to keep blood and oxygen supplied to organs and tissues during crucial periods during the surgery.  The heart is stopped to allow the surgeon to work directly with the heart.  During this time the surgeon attaches the selected graft to the area below the blockage or blockages.  New methods of bypass surgery allows the surgeon to work on the beating heart.  This type of bypass surgery is called "off pump" coronary artery bypass surgery.

If saphenous vein is used, one end of the vein is attached (sewn) to the largest artery leading away from the heart called the aorta.  The other end of vein graft is attached below the blockage.  Radial artery is also attached in the same fashion.  Only internal mammary artery grafts retain their point of origin (the subclarian artery) while the other end is sewn to the coronary artery.

 

ANEURYSMS

 

An aneurysm is a ballooning in the wall of an artery. Aneurysms can form in arteries throughout the body, but the most common location is in the abdomen in the major artery just below the kidney arteries. Very small aortic aneurysms can be checked by periodic ultrasound testing, but since rupture is the most frequent complication of an aneurysm, if it enlarges, an operation is required.

 



 

Causes

Atherosclerosis (plaque build-up that hardens within the artery) is the most common cause of abdominal aortic aneurysms. Even though men and women have equal incidences of atherosclerosis, men are ten times more likely to develop an aortic aneurysm. Other causes of aneurysm formation that might explain this sex difference in occurrence are being studied. For example, aneurysms may run in some families. Abnormal levels and activity of certain enzymes may play a role. Trauma, infection of the vascular wall, and congenital defects can also lead to aneurysm formation.

Symptoms

People who have aortic aneurysms usually have no symptoms until the aneurysm has ruptured or is about to rupture. More than half of abdominal aortic aneurysms do not produce symptoms. A person may, however, feel that the heartbeat is "too strong" - when reading in bed, the book may bounce while it is resting on the abdomen. Many people with an aortic aneurysm also have high blood pressure. A ruptured aneurysm causes sudden, severe back and/or abdominal pain and low blood pressure leading to shock. Some people die within minutes, but the average survival time is eight hours. Immediate surgical repair is essential.

Diagnosis

Aneurysms are usually diagnosed in people who are between 50 and 75 years of age. An aneurysm may first be detected during a routine physical examination, an ultrasound or abdominal x-rays performed for unrelated symptoms (such as gallbladder disease), or while the person is hospitalized for another problem. To confirm the diagnosis, a complete physical examination and special tests are necessary. The doctor will ask about low back pain or tenderness below the ribs. These symptoms are sometimes suggestive of an abdominal aneurysm. As part of the examination, the doctor will carefully feel the patient's abdomen for signs of swelling or tenderness. An x-ray examination may be needed to rule out other causes for the symptoms.


Tests that may be used to diagnose aneurysms include:

If an aneurysm is diagnosed, the doctor will conduct a thorough cardiovascular examination. Since atherosclerosis is present in one part of the body, it may exist in other parts of the body as well.

Ultrasound In this test, high-frequency sound waves are quickly and painlessly sent through the skin; the echoes form an image on a monitor (somewhat like a television), revealing the presence of an aneurysm.

Arteriography An arteriogram may be performed to distinguish the origin of the renal arteries and to locate any other arterial blockage. Blood clots and debris that have lodged in the rounded walls of the aneurysm may prevent this test from providing an accurate estimation of size.

CT scan Computerized axial tomography will give a more accurate estimation of size, will identify other problems that may be present, and assess involvement above and including the renal arteries.

Treatment

A small aneurysm will be examined on ultrasound every three to six months to evaluate any change in its size. It generally grows larger as time passes. An aneurysm whose diameter is five centimeters or more is dangerous because it can rupture at any time, usually causing death - the risk of rupture is greater than the risk of surgery to repair it. Thus, aneurysms between four and six centimeters in diameter are usually repaired surgically or endovascularly, before they rupture. Untreated, most large aneurysms rupture within one or two years. A ruptured aneurysm requires immediate emergency surgery. Without surgery, the mortality rate is 100%.

 

 

Surgery

Surgery to remove an aneurysm is one of the most common vascular procedures performed. The operation is safe and the results are excellent. The operation to repair an aneurysm is usually performed in less than two hours. General anesthesia is given, so the patient is not awake and does not feel anything. The incision in the abdomen is about seven to ten inches long. First the surgeon locates and exposes the aneurysm. The aorta is clamped above and below the aneurysm to prevent bleeding, and the aneurysm is then opened. Any clots and atheromatous material that have lodged in the aneurysm are removed.

A synthetic graft - usually a straight tube of woven Dacron - is sutured to the aorta above and below the aneurysm. When the graft is in place, the clamps will be removed. Blood will flow through the graft to the legs. Patients are usually hospitalized for five to seven.
 

Endoluminal Graft (ELG)

An endoluminal graft is made of a combination of synthetic graft and metal stents. It is inserted non-surgically through an artery in the groin area and positioned inside the vessel at the site of the problem. X-ray and ultrasound technologies projected on to a television monitor are used to create a map for the doctor to locate the aneurysm. Once the problem area is found, the stent is then expanded to keep the device in place. By lining the inside of the artery with a graft, the ELG allows for normal blood flow, effectively eliminating the diseased area. In treating aneurysms, ELG's are used to restore blood flow and prevent a possible rupture.

 

 

After Recovery

Treatment of the aneurysm is only the first step in restoring good health. It does not cure the underlying condition that caused the problem to develop. Further medical evaluation, treatment, and changes in lifestyle to reduce risk factors for heart and blood vessel disease are essential. These changes may include exercising, adopting a healthy diet, controlling blood pressure and weight, lowering cholesterol levels in the blood, and not smoking. Making these changes in lifestyle may reduce the chances of developing another aneurysm or blockages in the arteries.