Types of heart disease and surgical therapy
Ischemic heart disease
The coronary arteries supply oxygen and nutrients to the heart muscle. Atherosclerosis, or "hardening," of these arteries can 
decrease the normal amount of blood flow and cause angina pectoris (chest pain) or a myocardial infarction (heart attack). In coronary artery bypass procedures an artery or vein, obtained from elsewhere in the body, is used to bypass the narrowed portions of these coronary arteries, thereby restoring more normal blood flow to the heart muscle.
During conventional coronary artery bypass procedures the heart is stopped while a pump-oxygenator supplies blood flow to the rest of the patient’s body. For a small minority of patients injury to one or more organ systems may result, particularly among patients with significant disease in these other organ systems. One approach to minimize this risk is to perform the operation "off pump," or on a beating heart.
The traditional method for harvesting vein from the legs to use for coronary bypass involves a long incision, which at best is cosmetically unappealing and, at worst, increase the incidence of wound healing and infectious complications. The new standard is to use an endoscope to harvest the vein through a single one-inch incision. This technique produces an excellent cosmetic result, speeds healing, and decreases the rate of infections.
When the degree of atherosclerosis is too severe for coronary artery bypass surgery to be possible, or if the patient’s overall medical condition cannot tolerate the stress of surgery, a laser can be used to drill channels into the heart muscle (transmyocardial revascularization or TMR). Studies have shown improvement in symptoms and exercise tolerance following this procedure.
Additional Resources for further information:
• Coronary artery bypass surgery information from the Society of Thoracic Surgeons
• http://www.heartsurgery-usa.com/What_s_New/Off_Pump_Heart_ByPass/body_off_pump_heart_bypass.html
• Endoscopic vein harvesting (EVH)
Valvular heart disease
There are four valves in the heart that ensure blood flows in only one direction. A variety of disorders can cause valves to become narrowed (“stenotic” or flow-limiting) and/or leaky (“regurgitant”). Clinically relevant disorders principally affect only one or two of these valves, the aortic and/or mitral valves. Defective valves may be either replaced or repaired, depending upon the circumstances. Replaced valves may be substituted with either mechanical valves, animal tissue valves (“bioprosthesis”), or human cadaver valves. There are advantages and disadvantages associated with each.
Mitral Valve Procedures
Recent technological advances have made it possible to perform heart valve procedures without fully dividing the breastbone ("sternotomy"). Mitral valve procedures are especially well suited for less invasive techniques, in which the operation is performed without arresting the heart, through a two-inch incision between the ribs. Complication rates are lower, recovery is faster, and the cosmetic result is excellent.
Additional Resources for further information:
The following links to the Society of Thoracic Surgeons website provide more information concerning valvular heart surgery:
• http://www.sts.org/sections/patientinformation/valvesurgery/aorticvalve/
• http://www.sts.org/sections/patientinformation/valvesurgery/mitralvalvereplacement/
• http://www.sts.org/sections/patientinformation/valvesurgery/mitralvalverepair/index.html
Aortic disease
The aorta is the main artery leading from the heart to the body. Disease can cause this artery to dilate, creating an “aneurysm”, which is prone to fatal rupture. In other disorders, a tear in one of the layers of the aorta (“dissection”) can lead to either rupture or obstruction of blood flow to critical organs. Marfan syndrome patients are particularly at risk for aortic problems. The treatment for most of these conditions is an operation to replace the affected portion of aorta.
Additional Resources for further information:
• http://www.sts.org/sections/patientinformation/aneurysmsurgery/aorticaneurysms/index.html
• Marfan: http://americanheart.org/presenter.jhtml?identifier=4672
Atrial fibrillation
Atrial fibrillation, also referred to as AF is a type of irregular heartbeat that includes symptoms of heart palpitations, dizziness, lack of energy, discomfort in the chest, or difficulty breathing. It can be caused by many different conditions and if not treated properly can cause blood flow to slow down making blood clots possible. These blood clots can cause strokes or move to other body parts which can be equally as dangerous.
Traditionally, Atrial fibrillation has been treated with medications and catheter ablation, but many cases are resistant to these treatments. A surgical technique is now available to convert atrial fibrillation to a normal rhythm. The so-called "Maze" procedure is quick and safe, allowing it to be done at the same time as other cardiac operations, such as coronary bypass or valve replacement."
Additional Resources for further information:
Pulmonary hypertension 
In a small group of patients with pulmonary hypertension the cause of the elevated pressure in the arteries of the lungs is the chronic deposition of blood clots – typically from the lower body – within the pulmonary arteries. This group of patients may be distinguished by an angiogram, or an X-ray study of the blood vessel. Unlike most other pulmonary hypertension patients, who may require lung transplantation, these patients may be cured by the removal of the clots in a procedure called pulmonary thrombo-endarterectomy.
Additional Resources for further information:
Additional Resources and Links
| Division Head |
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Alejandro J. Sequeira, M.D.
Head, Cardiac Surgery Program
410-601-0900 |
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| Surgeons |
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Peter W Cho, M.D.
410-601-0900 |
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| Address: |
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Division of Cardiac Surgery
Sinai Hospital of Baltimore
2435 W. Belvedere Ave, Ste 35.
Baltimore, MD 21215 |
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