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 a vein from the legs to use for coronary bypass involves a long incision, which, at best, is cosmetically unappealing and, at worst, increases 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-American Heart Association 

� Off -pump cardiac surgery

� Endoscopic vein harvesting (EVH)

Valvular heart disease

There are four valves in the heart that ensure that 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:

� Aortic valve surgery
� Mitral valve replacement
� Mitral valve repair

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:

� Aortric aneurysm
� Marfan syndrome  

Atrial fibrillation

Atrial fibrillation, also referred to as AF, is a type of irregular heartbeat that can produce 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 travel to the brain and 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. With the technological advances, minimally invasive Maze procedures have become available.

Additional resources for further information:

• Surgery for atrial fibrillation

Heart failure

Heart failure is a condition caused by inadequate pumping of blood by the heart. The backup of blood in the lungs and rest of the body can produce shortness of breath, decreased exercise tolerance, edema (fluid accumulation in the tissues) and increased risk of early death. Heart failure can result from a wide variety of causes, both acute (such as massive heart attack) and chronic (longstanding valvular disease).

Treatment has traditionally been based on medications or surgical correction of underlying coronary artery or valvular disease. Newer surgical procedures have been shown to improve symptoms and survival. For patients who experience sudden decompensation of heart function, ventricular assist devices (VADs) can be lifesaving. When electrical impulse conduction is impaired, placement of pacing leads on the heart surface can dramatically improve symptoms. Hearts that have become excessively enlarged can be remodeled� to a more normal, efficient configuration.

Additional resources for further information:

• Heart failure

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 thromboendarterectomy.

Additional resources for further information:

• Surgery for pulmonary embolism

Additional resources and links

• Heart Center at Sinai   
• STS 
• AHA  
• Heart Information Network
• WebMD  

Our Team

Our unique team is composed of talented physicians, nurses and physician assistants. The physician assistants and nurse practioners here at Sinai Hospital are leaders in their field with over 15 years of full-time experience. In addition, all of our nurses are full time and are certified as AORN nurses (Association of Operation Room Nurses).

As a team, we have been recognized as a Platinum member of the EVH Leadership Circle by Guidant for our achievement in endoscopic vessel harvesting. This prestigious award is recognized for our work completing close to 2,000 EVH procedures as of late 2005. In 2006, we look forward to excelling further into the Gold status as our number grows to exceed 2,000 completed EVH procedures.