Operation in myocardial in some situations - the only way to save lives and restore the heart muscle.
Indications and contraindications
In myocardial heart surgery is an emergency treatment is carried out only in the case where during the acute pathology was missed or prolonged use of medications aimed at the restoration work and the condition of the heart muscle does not give a positive effect.
Contra-indications for surgical treatment:
- It struck simultaneously by more than one artery;
- hepatitis;
- diabetes;
- necrosis hit extensive soft tissue area;
- fundamental and irreversible change of heart;
- formed on the heart muscle scars;
- aneurysm;
- Pancreatic gap space.
Operation under these conditions is fraught with dangerous complications that are difficult to adjust and can be fatal.
Before the operation is carried out a thorough examination of the patient. If there is no need for intensive care, coronary angiography is the procedure that allows you to see the exact location of the narrowed section of the coronary artery.
types of operations
What kind of operation is performed at a heart attack depends on the patient's condition. When choosing a surgical technique takes into account the degree of:
- the stability of the heart muscle;
- coronary lesions;
- the spread of necrosis in the myocardium of the heart.
Operations are divided into two types:
- Percutaneous or minimally invasive;
- open.
The advantage in the surgical treatment of heart attack as percutaneous operations. Minimally invasive procedures have a minimal risk of complications. No need to open access much easier and reduces the rehabilitation period.
percutaneous intervention
By percutaneous techniques include:
- balloon dilatation;
- stenting;
- laser angioplasty.
In many cases, for the treatment of cardiovascular pathologies that led to a severe heart attack, can combine multiple minimally invasive techniques.
stenting
This type of surgery involves installing a special blood vessel stent which does not give the vessel eventually narrowed (constriction leads to circulatory problems, heart attack, and it can happen re)
A stent is a mesh, which is cracking in the blood vessel expands and fixes it in the right wall of the screen. Introduce a stent into a hollow blood vessel. Held in myocardial infarction operation under the control of X-ray and optical equipment.
Heart attack after surgery may occur again, because, in spite of the effectiveness of this technique, it does not eliminate the root cause of disease. After a time the wall constriction may occur on other blood vessel.
Transluminal balloon dilatation
This type of minimally invasive surgical intervention involves holding a small incision in the coronary artery, through which a catheter equipped with a balloon. In the place where the vessel wall is strongly tapered and prevent normal blood circulation, the balloon is inflated, as a result of expanding the walls, restored normal blood flow.
After extraction vessel cylinder wall remain in the corrected position. upper limb artery can be used for the procedure. Balloon dilatation is performed under the control of X-ray equipment.
A disadvantage of this technique is that it is likely re-narrowing of the arterial wall. To prevent this complication of balloon dilatation is performed in conjunction with the installation of the stent. First, the artery walls are expanding balloon, and then set the grid that prevents the re-narrowing of the blood channel.
Excimer laser angioplasty via
Percutaneous laser angioplasty is a modern method of surgical treatment of a heart attack. The advantage of the procedure in the artery minimal risk of damage.
To expand the walls of the vessel used ksenohloridnogo generator excimer type, which generates ultraviolet waves. Under their influence in a blood vessel breaks down the clot, preventing the full blood flow.
The alternate heating and cooling waves thrombus promotes complete washout of its particles artery. For heating and cooling of thrombus in blood stream is injected with saline through the catheter.
open intervention
Operations in myocardial infarction requiring open access to the heart muscle, there are such types:
- removal of an aneurysm;
- bypass surgery.
Tasks open surgery:
- elimination of neurosis and affected their tissues;
- activation processes, and quick regeneration of the healing;
- normalizing the circulation excluding therefrom damaged vessels;
- full restoration of the heart muscle.
While open surgery is technically more complex than transdermal, and have a risk of complications, they provide the maximum effect in the treatment of heart attacks.
vascular bypass surgery
Operation helps to eliminate defects in the heart, wearing irreversible. The duration of operation of about 4 hours. During the operation, the patient is required to connect to the heart-lung machine.
During the surgery is carried out in the affected artery Inserting special shunt, which restores blood flow. To carry out bypass surgery is required to make an incision in the abdominal sternum. Shunts used for patient biological materials - femoral Vienna, the radial artery of the arm.
excision of aneurysm
This method of surgical treatment of myocardial infarction is the most difficult. During the operation, the thorax was opened, the doctor is free access to the heart muscle. The purpose of the procedure - to restore blood flow by using the cardiac chambers, with the removal of damaged connective tissue and dissolution of blood clots.
If necessary, strengthen the walls of the heart is carried out using the technique of sewing with special connecting material. Excision of aneurysm - a complicated procedure of surgery after a heart attack, there is a risk that the patient could not bear the load during open surgery.
The device "pacemaker"
This technique of surgical treatment of myocardial infarction refers to a minimally invasive and is considered an emergency way to restore the heart, when the case is acute and there is no time to carry out examination of the patient to identify the exact location of the damaged coronary vessel.
The method consists in the fact that to portions of the myocardium, in which there is the least degree of resistance electrodes connected. The algorithm of:
- introduction of local anesthesia;
- incision made parallel to the clavicle;
- introduction of small vein in the electrodes;
- joining the electrodes to the pacemaker;
- Pacemaker implantation in adipose tissue;
- cut stitching.
Performed surgical procedure under X-ray control.
Rehabilitation and complications
After surgery for a heart attack patient for at least 10 days must be located in a hospital hospital under constant medical supervision.
Necessarily assigned to diet with the exception of fatty and fried foods, salt. The diet is needed to prevent severe postoperative consequences - clot formation, atherosclerosis, pressurization. After open surgery is performed daily treatment of joints. In order to prevent thrombus formation anticoagulation registers.
After discharge assigned daily conduct breathing exercises, a gradual increase in the intensity of physical activity, diet. After 3 months after the surgery the patient must undergo a stress test, which shows the degree of saturation of the heart muscle with oxygen and how correctly passes Rehabilitation period.
Possible complications:
- thrombus formation;
- heart failure;
- stroke;
- renal dysfunction.
After excision of the aneurysm is, the risk of arrhythmia, blood accumulation in the pericardium. The probability of all these complications inherent in predominantly open surgery.
