dr pankaj goel: September 2012

Wednesday 26 September 2012

Open Heart Surgery vs Closed Heart Surgery

It is quite common to refer all heart surgeries as open heart surgeries. However, as a matter of fact, Bypass surgery(the most commonly performed heart surgery) is not an open heart surgery.
The heart is a muscular pump which is pumping 5-6 l of blood per minute. To be able to operate on the structures inside it, it has to be stopped. We all know that if the heart stops, all organs of the body would be depleted of oxygen and the person would not survive. For this reason the patient is put on temporary artificial heart lung machine(called cardiopulmonary bypass). The function of the heart is taken over by the machine as the blood from the heart is diverted into the machine. The heart can now be stopped. It is now empty and can be cut open to perform the surgical procedure. This is open heart surgery.
Bypass surgery on the other hand is performed on arteries of the heart. These arteries can be seen on the outside of the heart. There is no need to cut open the heart. Technically speaking, bypass surgery is not open heart surgery. Previously heart kung machine was used to perform bypass surgery, but now bypass surgery can be done on the beating heart.

Sunday 16 September 2012

Mechanical or Bioprosthetic valve?

If you have a heart valve problem requiring valve replacement, the next big question is with what type of valve you should get it replaced.
Currently two types of artificial valves are being used commonly.
1. Mechanical valves- These are valves made up of special metals.They are readily available, easy to implant and have excellent long term durability. The downside is that a blood thinning medicine has to be taken lifelong to prevent clotting of the valve. To ensure that the blood is adequately thin, a blood test is required almost once a month.
Currently this valve is preferred in patients less than 60 years of age. However, women in child bearing age wanting to have a family should refrain from having this valve as pregnancy with anticoagulation is risky both for mother and the child. for such patients and those patients in whom anticoagulation cannot be given the next variety of valve is preferred.
2. Bio-prosthetic valve- These valves are made up of cow or pig tissue. The main advantage is that blood thinning medicine can be stopped after 3 months. The downside is that the valve has a life of 10-15 years. After which the valve may fail and require a re-operation. This valve is preferred in patients more than 60 years of age and in patients where anticoagulation cannot be used.