On the surgical treatment of heart disease

Recently, almost all heart disease can be surgical, and get good results. However, because cardiac arrest marks the termination of human life, so heart surgery is very dangerous. Cardiac surgery the last two decades or so there has been new development in the artificial heart-lung machine running under, so that the heart stops beating, and then carry out complex heart surgery, greatly enhance the safety of surgery, so many complex heart surgery Ai was a success, there are many large and medium-sized hospitals for heart surgery in Japan more than 400 hospitals.
1. Artificial heart-lung machine (cardiopulmonary bypass machine)

Open heart surgery is not to leave the artificial heart-lung machine. When the heart is stopped, the patient must rely on the maintenance of life on the artificial heart-lung machine supply the brain and kidneys, lungs, liver and other vital organs of the fresh blood. Its not only plays the role of the heart pump, but also in cardiac arrest, the pulmonary blood can not run, it also has the role of blood oxygenation.

Artificial Heart-Lung Machine as a result of rapid development, no matter what time can replace the heart and lungs, continuous supply of fresh blood into the body, because it safe and easy to master, so to be widely available, and thus promoted the development of cardiac surgery, but despite Artificial Heart-Lung Machine assisted circulation, surgery should be possible to gain time to complete a good quick and appropriate surgery.

2. Hypothermia anesthesia

In cardiac surgery, the heart throb to stop after the artificial heart and lung in addition to assisted circulation outside the body, but also to the cooling cycle of blood, so the temperature dropped to below 30 ℃. This is from the hibernating animals have been inspired. Because at low temperature, the organ and systemic oxygen consumption decreased, thus ensuring a long time in the off-pump surgery security.

Infants and young children's heart surgery will be available to a large number of ice cooling the body, even if it does not use artificial heart-lung machine, simply use low-temperature anesthesia safety also small and medium-sized heart surgery.

3. Myocardial Protection Act

10 ~ 20 degrees Celsius below glucose and potassium, calcium mixed coolant into the coronary artery, not only make the heart to stop, but rather make it to relax, so that heart surgery can proceed smoothly. In addition to reduce myocardial damage during cardiac arrest, after the end of the operation, enabling the rapid resumption of the heart jump, and maintain a good function, like this is known as myocardial protection laws. At the same time, the use of the above-mentioned three methods to further improve the success rate of cardiac surgery.

4. Congenital heart surgery

Some heart disease in infants after birth without immediate surgery, children to survive. Such as complete transposition of the great arteries, pulmonary valve atresia completely, pulmonary vein the Director-General also satisfied abnormal huge VSD, coarctation of the aorta syndrome, tricuspid atresia, which accounts for about 20% of first heart, four weeks after birth if not surgery may be dead. Recently, for such severe congenital heart disease in infants and young children to take early diagnosis, early surgical treatment, to obtain good results, so many infants dying patients saved.

The first such severe heart infant patients with severe cardiac dysfunction and purple thread, the use of drugs and oxygen therapy can not be cured. Therefore can be radical surgery or bypass surgery. Here are three types of bypass surgery.

① increased pulmonary blood flow in surgery. Purple junction for serious heart disease, the use of the great arteries with pulmonary short-circuit operation (subclavian artery, pulmonary artery anastomosis, aortic on the gear and the right pulmonary artery anastomosis), pulmonary atresia at the time of lung incision (using catheter-type knife, do not thoracotomy, intravenous insertion in the X-ray carried out under the cut.) also falls in such.

② surgery to reduce pulmonary blood flow. VSD by giant excessive pulmonary blood flow will be available pulmonary narrow band, this method can prevent cardiac dysfunction.

③ so scared arterial blood mixed with static surgery.

In complete transposition of the great arteries, the blood from the body back into the heart through the atrial septal openings reduce cyanosis. Recently, under the X-rays without thoracotomy, heart catheter inserted through the femoral vein right atrium beam. Atrial septal wear.

Heart surgery is the most VSD, in the absence of natural healing and hope after off-pump, open there for VSD ventricular repair larger defects, the need to increase polyester patch Lun. Atrial septal defect is also required to repair, but the surgery than simple VSD.

Patent ductus arteriosus surgery can be cut off after the suture line or neutered, this surgery outside the heart, without the artificial heart-lung machine.

Law Lemin tetralogy is the most common type of congenital heart disease Zijin Gan, and sometimes can cause severe purple pliers and convulsive seizures. To school-age children in the artificial heart-lung machine to conduct Tetralogy levy radical mastectomy. However, infants and young children period in order to increase pulmonary blood, viable subclavian artery and pulmonary artery or aorta and right pulmonary artery anastomosis.

For pulmonary valve stenosis, or coarctation of the aorta, endocardial cushion defect, anomalous pulmonary venous disease, Ebstein malformation are also feasible surgery.

For congenital atrioventricular block, pulse 40-50 times per minute in less, if there is loss of consciousness and heart failure symptoms, they can put the artificial pacemaker.

Infant heart surgery is safe, but sometimes it is very difficult. Post-operative care is also very difficult. In particular, respiratory management, such as breathing disorders, then there is the risk of death.

Of newborns with congenital heart disease, such as can be equivalent to life-saving surgery, so with obstetric and pediatric physicians and nurses linked to those at risk of death in children as soon as possible to be able to carry out heart surgery hospital.

5. Acquired heart surgery

Valvular disease

As a result of repeated seizures caused by rheumatic valve disease with chronic damage. For rheumatic mitral stenosis, in the past after open heart surgery without opening the heart, only in the left atrial appendage and the left ventricle of the beating a small hole with his hands or the expansion of mitral valve open browser mouth, because the result is not really and easy to cause recurrence. The recent use of artificial heart-lung machine, open the heart, in the open under the knife and scissors mitral cross-linked Department incision. If, after the cut valve dysfunction may remove the entire valve, mechanical valve with artificial and biological valve replaced.

Mitral insufficiency, the most common is residual disease or rheumatic fever caused by mitral valve prolapse. Can be carried out under direct vision or Mitral valve replacement (with artificial mechanical valve or biological valve substitute).

Aortic stenosis and insufficiency, in the artificial heart-lung machine under artificial valve replacement. In addition to outside rheumatism also arteriosclerosis caused by aortic stenosis and insufficiency, there are uncommon due to aortic diseases syphilis and Marfan syndrome.

Mitral valve disease, such as the heart of a serious expansion, often complicated with tricuspid valve insufficiency, and more need for surgery. In order to prevent blood reflux, the tricuspid valve plasty, serious when the need for tricuspid valve replacement.

More than two valve disease, particularly mitral and aortic valve was found, usually known as Keidanren valvular disease, the current can also be safely carried out mitral valve replacement.

Coronary Heart Disease

Refers to coronary artery conditions, sometimes lead to angina coronary twins recover from illness or lead to heart attack because of coronary artery obstruction. If medical treatment fails, coronary angiography is feasible, clear the site of coronary artery stenosis, in the off-pump, and lines across the great saphenous vein bypass graft stenosis Department. This surgery to many patients with coronary artery disease has brought the gospel. In the acute phase of myocardial infarction, cardiac catheterization can be used in coronary artery blockage, such as thrombolytic enzyme urokinase PTAR therapy for chronic phase patients, can be used with balloon catheterization heart coronary obstruction expansion (FTCA therapy ), the two laws for the majority of patients, easy to accept, but good effect. However, the latter so that the risk of coronary artery ruptured, so there must be backed by surgery.

Acute myocardial infarction period, the legacy of the necrotic area convex outward to form a heart aneurysm, disease often caused by heart failure reasons, most scholars through surgery to remove lesions Department patch.

Due to cardiac rupture caused by acute myocardial infarction or ventricular septal perforation, can also lead to mitral insufficiency. Cardiac rupture often leads to sudden death, so as soon as possible complications of such surgery.

Cardiomyopathy

Of dilated cardiomyopathy can not surgery, for hypertrophic cardiomyopathy have ventricular outflow tract obstruction may be open in the off-pump left ventricular hypertrophy of cardiomyocytes will be removed, so that the expansion of outflow tract.

Arrhythmia

The so-called complete atrioventricular block is the heart rate in the 30-40 times per minute or so, often caused by cardiac syncope syndrome or heart failure, serious arrhythmias. Sick sinus syndrome, often caused by vein ease (heart rate per minute at 60 times below) or pulse frequency (heart rate of 100 times per minute and above). Regardless of complete atrioventricular block or sick sinus syndrome, as long as it is so difficult to sustain life and daily life can be placed in permanent artificial cardiac pacemaker, the current technology to improve the battery life, is now generally 7-8 only to be replaced every year, we have 90-year-old patient to carry out the surgery very safe and smooth, postoperative patients happy life.