Although most of the heart surgery performed in LHCH will fall into the category of either bypass grafts or valve replacements, there are other less common conditions that can also need to be treated. Some of these are described here.
Urgent or Emergency surgery
Patients who come into hospital via Accident and Emergency with a heart attack or collapse are often kept in for urgent surgery rather than being let go home.
Urgent surgery is offered on the next available slot - which may be up to two weeks after the decision to proceed to surgery. This means that there is a period of time during which you may be waiting in hospital. This allows the heart to recover from the heart attack to reduce the risks of surgery and also allows the
drugs to wear off that may complicate surgery if they were still in the system.
On rare occasions it is necessary to offer surgery immediately. This is usually done within the day of the decision being made, at weekends or at night if needed. Such operations are done immediately because the risks of leaving the problem untreated outweigh the risks of
For complications of myocardial infarction (VSD or rupture)
If there has been a major heart attack that has allowed the heart muscle to die in an area that is unprotected by any other circulation, this can cause holes in the heart and send blood the wrong way through the circulation or out of the heart and into the heart sac. This is an emergency and is life-threatening.
Such operations are very high risk and are designed to be life-saving. Even if they go very well, they are often associated with long recovery periods.
Infections on the heart (endocarditis) can be very serious and it is important to treat the infection aggressively with the correct antibiotics. The most common treatments will last a minimum of 6 weeks with drip antibiotics and require you to stay in hospital for most or all of that time.
If you require surgery for endocarditis, the exact nature, options and timing will be determined by the severity of the infection, the size of the infected growths on the heart (vegetations) and the valve or other areas of the heart that have been affected.
A blood clot in the lung circulation is called a pulmonary embolism. It is often, although not always, caused by a blood clot in the lower body (a Deep Vein Thrombosis or DVT) that travels through the veins of the body to the heart, where it carries on through the circulation until it lodges in the pulmonary arteries. Here it can cause a reduced blood supply to an area of lung, which reduces the amount of oxygen that can be picked up, causes that section of lung to die off
and in some cases where it is very large and obstructing the circulation can cause heart failure.
Symptoms of a pulmonary embolism include:
- * Sharp chest pains
- * Shortness of breath
- * Collapse
Treatments for this include
- * oxygen and supportive treatments
- * clot busting drugs given straight away
- * blood thinning tablets such as warfarin given over a prolonged period
- * surgery if the clot is massive and obstructing the main pulmonary artery
Surgery for these types of emergencies is high risk and is not required for the majority of pulmonary emboli. Where it is performed, it is usually a last-resort treatment because the heart is failing despite all other treatments.
The heart sac (or pericardium) encloses the entire heart and allows it to fill and eject smoothly. It is lined with a thin layer of lubricating fluid to ensure that the surface of the heart glides over the inner lining of the heart sac.
Certain conditions can allow the heart sac to thicken, stiffen and stick to the heart, thereby affecting its ability to contract and relax. This is called constrictive pericarditis. If it cannot relax, it cannot fill properly, so the amount of blood that it can circulate is reduced. Equally, if it cannot contract properly, the blood that is in it will not be sent into the circulation and the function is also reduced.
Symptoms of pericarditis include:
- * Shortness of breath
- * Fatigue
- * Ankle swelling
- * Fluid distension of the abdomen
Causes of pericarditis include:
- * Tuberculosis
- * Viral, bacterial or fungal infections
- * Asbestos exposure
- * Heart attacks
- * Autoimmune diseases
- * Radiation exposure
The surgery for constrictive pericarditis is called pericardectomy (or pericardiectomy or pericardial stripping). It involves removing as much of the thickened heart sac as possible. Although the heart is not deliberately entered, if the heart sac is very stuck, the heart can be damaged trying to get it off. Sometimes cardiopulmonary bypass will be used to support the heart whilst the heart sac is being removed.