Heart surgery
Sometimes medication can't control all the symptoms of heart disease. Surgery may be needed to open or replace the blocked arteries, repair damaged valves or simply keep the patient alive.
Common operations for heart disease include:
Coronary angioplasty
Coronary angioplasty, or percutaneous transluminal coronary angioplasty (PTCA) to give it its full technical name, is used to treat coronary heart disease.
It involves passing a long, thin, hollow tube or catheter up into the coronary arteries, under x-ray guidance, from an artery in the groin or arm (under local anaesthetic.) A device on the tube is then used to unblock the artery, and stretch the artery walls so that more blood and oxygen can flow to the heart muscle.
Angioplasty may be recommended if angina cannot be controlled with drugs, if angina is limiting a person's life, or when a person gets angina just sitting in a chair at rest.
PCTA may be performed as an emergency when someone is having a heart attack. If carried out soon enough it can open the blocked coronary artery before permanent damage is done to the heart muscle. But it can only be performed in a specialist hospital, so it's not an option for most people having a heart attack.
Types of angioplasty
Balloon angioplasty, often known simply as balloon treatment, was the first type of angioplasty. On the end of the tube or catheter is a small, sausage-shaped balloon. The balloon is inflated in the blocked artery, compressing the fatty build-up (atheroma) against the artery walls. The surgeon then deflates the balloon and removes it.
Another common type of angioplasty involves inserting a short stainless steel mesh tube, called a stent, at the same time as the balloon. As the balloon is deflated, the expanded stent is left in place to help keep the artery open.
This method helps to prevent the problem of reblockage (restenosis), which affects around a third of people following conventional balloon treatment.
Recently, doctors have begun to use stents that incorporate drugs to help prevent reblockage.
Doctors are also trying a number of newer ways to perform angioplasty. They're using devices to cut or drill out fatty deposits, vaporise them with a laser, or blast them with ultrasound.
But, as yet, these techniques haven't been proven to be better than the standard balloon or stent method. While they're being tested and developed in some centres in the UK, they're not routinely available.
Coronary bypass surgery
Coronary bypass surgery, medically known as coronary artery bypass graft or CABG (pronounced 'cabbage'), is an operation in which a blood vessel from another part of the body is grafted between the aorta (the main artery leading from the heart) and the coronary artery, or arteries, to bypass blockages and restore blood flow to the heart muscle.
A bypass can be done on each of the four coronary arteries if necessary, hence the terms single, double, triple or even quadruple graft, depending on how many arteries are bypassed. The operation can be done using conventional surgical techniques or by keyhole surgery (microsurgery).
While many people find this sort of surgery hugely improves their health, it's not without considerable risks.
CHD can frequently be controlled with drugs alone, but if the blood vessels have become severely narrowed, or if drug treatment is unable to control symptoms, surgery may be needed to open up or replace the blocked arteries.
Valve replacement
Diseased heart valves can be repaired or replaced with either mechanical valves or biological valves (made from human or animal tissue). Mechanical valves may last longer but usually require a person to take anticoagulant medicines because there is an increased risk of clots forming.
Coronary angioplasty, or percutaneous transluminal coronary angioplasty (PTCA) to give it its full technical name, is used to treat coronary heart disease.
It involves passing a long, thin, hollow tube or catheter up into the coronary arteries, under x-ray guidance, from an artery in the groin or arm (under local anaesthetic.) A device on the tube is then used to unblock the artery, and stretch the artery walls so that more blood and oxygen can flow to the heart muscle.
Angioplasty may be recommended if angina cannot be controlled with drugs, if angina is limiting a person's life, or when a person gets angina just sitting in a chair at rest.
PCTA may be performed as an emergency when someone is having a heart attack. If carried out soon enough it can open the blocked coronary artery before permanent damage is done to the heart muscle. But it can only be performed in a specialist hospital, so it's not an option for most people having a heart attack.
Types of angioplasty
Balloon angioplasty, often known simply as balloon treatment, was the first type of angioplasty. On the end of the tube or catheter is a small, sausage-shaped balloon. The balloon is inflated in the blocked artery, compressing the fatty build-up (atheroma) against the artery walls. The surgeon then deflates the balloon and removes it.
Another common type of angioplasty involves inserting a short stainless steel mesh tube, called a stent, at the same time as the balloon. As the balloon is deflated, the expanded stent is left in place to help keep the artery open.
This method helps to prevent the problem of reblockage (restenosis), which affects around a third of people following conventional balloon treatment.
Recently, doctors have begun to use stents that incorporate drugs to help prevent reblockage.
Doctors are also trying a number of newer ways to perform angioplasty. They're using devices to cut or drill out fatty deposits, vaporise them with a laser, or blast them with ultrasound.
But, as yet, these techniques haven't been proven to be better than the standard balloon or stent method. While they're being tested and developed in some centres in the UK, they're not routinely available.
Coronary bypass surgery
Coronary bypass surgery, medically known as coronary artery bypass graft or CABG (pronounced 'cabbage'), is an operation in which a blood vessel from another part of the body is grafted between the aorta (the main artery leading from the heart) and the coronary artery, or arteries, to bypass blockages and restore blood flow to the heart muscle.
A bypass can be done on each of the four coronary arteries if necessary, hence the terms single, double, triple or even quadruple graft, depending on how many arteries are bypassed. The operation can be done using conventional surgical techniques or by keyhole surgery (microsurgery).
While many people find this sort of surgery hugely improves their health, it's not without considerable risks.
CHD can frequently be controlled with drugs alone, but if the blood vessels have become severely narrowed, or if drug treatment is unable to control symptoms, surgery may be needed to open up or replace the blocked arteries.
Valve replacement
Diseased heart valves can be repaired or replaced with either mechanical valves or biological valves (made from human or animal tissue). Mechanical valves may last longer but usually require a person to take anticoagulant medicines because there is an increased risk of clots forming.
