How do operations with myocardial infarction: the main types and their description

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2017.06.07
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Heart Attack

An urgent or planned operation with myocardial infarction often becomes a compulsory measure, but sometimes this is the only way to save the patient's life. The surgical method is used in a number of difficult situations, when there are indications for an emergency intervention, or the use of medicines does not give the necessary results. Usually, the operation is prescribed for necrosis of the myocardium, complications in the work of the heart and under other circumstances. The decision about the surgical intervention should be made by the doctor after a timely and detailed examination of the patient.

Content

  • Types of surgical interventions
  • Percutaneous operations
  • Stenting and angioplasty
  • Interventions of an open type
  • Procedure of excision of an aneurysm
  • Potential complications

Types of surgical interventions

The answer to the question of what kind of surgery can be done with an infarction always depends on the patient's condition, the complexity of the disease and the results of the examination. Operative interventions are usually divided into two types: performed with a small puncture through the skin and open, for which an opening of the chest is required. In the first case, to perform manipulations, surgeons do not need to perform cardiac arrest - just make a miniature incision in a specific area of ​​the skin through which the catheter is inserted.

Stenting

In the second case, during an open surgery, surgeons need to open the patient's chest, and also connect special systems for artificial circulation and ventilating the lungs. Any heart surgery is done according to the prescription of a cardiologist. In most cases, the patient is first referred for coronarography, during this procedure a specialist can examine his coronary vessels and see narrowing areas in which he was stopped blood flow. In emergency situations, such a survey is not carried out because of a lack of time.

Operation with a heart attack

Percutaneous operations

Most heart operations can be performed by a percutaneous method, which has enough advantages. In addition, it is characterized by a lower risk of complications and a rapid recovery after the intervention. Surgical surgical treatment of myocardial infarction, belonging to this type, can significantly reduce the risk of sudden death of the patient from cardiac arrest, improve the quality of his life and reduce the number of attacks of angina in her availability. There are three types of percutaneous interventions, including:

  • balloon type dilatation;
  • stenting technique;
  • angioplasty of laser type.
Stenting through a vein

It is worth noting that all the methods listed above do not affect the very cause of the patient's pathological state, but only reduce the negative impact of atherosclerotic plaques affecting the vessels. Unfortunately, some time after the operation, the disease can manifest itself again. In most cases, the patient with myocardial infarction requires an operation of one of three types, each of which has its own characteristics. During dilatation, the patient is injected into the vessels of the thighs or forearms with special catheters equipped with inflatable balloons.

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Important! Percutaneous intervention is a much more gentle method compared to an open-type operation, since after such a procedure the patient is more quickly restored. In addition, it does not cause serious complications.

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Cylinders are inflated after bringing to the damaged vessels, the walls of which thus expand to normal sizes. After the patency of the deformed vessel is restored, the blood flow in this place comes back to normal. The cylinders are then removed using catheters. Usually, this procedure is prescribed for ischemia, when the patient does not require complicated surgical intervention in the heart area.

Balloon angioplasty

Stenting and angioplasty

The walls of the vessels may contract again after a while. To prevent this from happening, the most appropriate option is used, including the stenting technique. The essence of the method is the use of special cylindrical stents made of plastic or metal. Stents are inserted into vessels and expand them to acceptable sizes. Such a technique helps to reliably prevent sudden constriction and deformation of blood vessels after surgery and possible negative consequences.

Often, stenting, which is prescribed after myocardial infarction, is combined with dilatation: in this case, the stent is fixed on the balloon, which spreads it during inflation. This method is considered to be more gentle, since the process of patient recovery is much faster, and there is a noticeable improvement in the condition. But it is worth bearing in mind that after stenting the patient is prescribed a long reception of special medicines that prevent the formation of blood clots inside the stent. Also, there are stents of a new generation impregnated with antithrombotic solution.

The list of operations assigned for a heart attack also includes laser-type angioplasty, during which a thin catheter is inserted into the cardiac artery. Thanks to angioplasty, it is possible to eliminate plaques from cholesterol in the shortest possible time, interfering with the full blood flow. They are eliminated by the laser: during the operation the surgeon finds the damaged artery and acts on it with a laser beam, which allows dissolving the plaque by turning it into a gas. This is a very effective and safe procedure that practically does not cause complications, but in some cases, catheters can damage arteries and provoke bleeding.

Coronary angiography

Interventions of an open type

An operation of an open type is necessary when it is urgent to restore blood flow in especially severe cases. It is used if the patient is diagnosed with a complete blockage of the blood vessel, and the installation The stent will no longer be of use when the heart valve is deformed, and if there are other diseases. Special aortocoronary or mammarocoronary shunting is widely used in a number of such cases.

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Important! Depending on the specific situation and the purpose of the surgical intervention, the patient can sew several shunts at once, when the restoration of blood flow is required not in one but in two or three vessels.

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This operation involves sewing shunts that can replace damaged arteries and completely restore normal blood supply. Patients who are to undergo a bypass procedure must take into account possible risks and complications. As a rule, doctors warn the patient that during the operation, the sternum is dissected, and the load on the body considerably exceeds the permissible standards. Sometimes the body does not stand up, and surgical intervention ends in a fatal outcome.

Shunting

Despite the serious risks and complications, in the case of a successful operation, the patient's life expectancy is markedly increased. Shunting is a more effective method than stenting. Coronary artery bypass grafting differs from mammarocoronary by the material from which the shunts are made: in the first case a femoral vein or a ray-type artery taken from the patient's hand is used. In the second case, an artery taken from the chest is used, which is considered to be more durable. The shunting material is chosen by the surgeon, depending on the situation.

Procedure of excision of an aneurysm

An operation of this type refers to procedures of a high degree of complexity, because during the surgical procedure, doctors open the patient's chest to gain access to the heart. The pump is connected to the main vessels, and the task of surgeons is to stop the process of blood flow with the help of the heart chambers. Such an intervention is performed to remove damaged connective tissue and thrombi within the ventricles if they are present.

Aneurysm removal

At the end of the operation, the walls of the heart are sutured and strengthened if necessary. Excision is also combined with a shunt procedure of one of several types, this is done in order to prevent a possible risk of infarction. Excision is considered not only difficult, but also quite dangerous operation: even if the intervention is successful, the patient may not survive. At the same time, the list of possible complications includes excessive accumulation of blood inside the pericardium, the formation of thrombi and arrhythmia.

Potential complications

If the patient has been fitted with a valve, or the doctor needed to insert a stent into several vessels, and in a number of other operations with a heart attack, complications may occur. Often, the site of surgical intervention develops inflammation, which is triggered not by the infectious process, but by the response of the body. In addition to the traditional increase in temperature, sensation of weakness, arrhythmia, painful sensations in the chest and joints, there may be other problems.

Recovery after surgery

Before performing an operation of one of the types described above, the surgeon assesses the possible risks and complications, takes into account the patient's condition and age, and the presence of other diseases in which surgical interventions are contraindicated. In the presence of diabetes, chronic heart failure, problems with the operation of the left ventricle patients may experience complications, which in some cases can be corrected right after the operation. The video below shows in detail the procedures for stenting and angioplasty.

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