Department List


Department of Cardiac Surgery


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Coronary artery bypass surgery

Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure consisting of either diverting the left internal thoracic artery (left internal mammary artery or "LIMA") to the left anterior descending (LAD) branch of the left main coronary artery; or a harvested great saphenous vein of the leg, attaching the proximal end to the aorta or one of its major branches, and the distal end to immediately beyond a partially obstructed coronary artery (the "target vessel") - usually a 50% to 99% obstruction. The purpose is to restore normal blood flow to that partially obstructed coronary artery. It is performed to relieve angina unsatisfactorily controlled by maximum tolerated anti-ischemic medication, prevent or relieve left ventricular dysfunction, and/or reduce the risk of death.

Off-pump coronary artery bypass 

Off-pump coronary artery bypass or "beating heart" surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease.  During most bypass surgeries, the heart is stopped and a heart-lung machine takes over the work of the heart and lungs. When a cardiac surgeon chooses to perform the CABG procedure off-pump, also known as OPCAB (Off-pump Coronary Artery Bypass), the heart is still beating while the graft attachments are made to bypass a blockage. In addition to off-pump surgery being associated with the clinical benefits of a reduced risk of stroke or memory problems, patients also typically have a faster recovery and shorter hospital stay, fewer blood transfusions, and fewer unwanted inflammatory/immune response issues.

LIMA-RIMA "Y"

This technique  is done on beating heart (off-pump) and uses only arteries as grafts and not veins (total arterial bypass grafts).  It uses only the two mammary arteries of the chest to construct a "Y" shaped graft and hence, no cuts are required to be made on the patient's legs or arms. Being totally arterial graft, this technique gives the best long term results amongst all the techniques of coronary bypass surgery.

MIDCAB ( Minimally Invasive Direct Coronary Artery Bypass )

Recent advances in surgical technique and equipment allow the surgeon to perform coronary artery bypass surgery in a less traumatic way. Unlike conventional surgery, which has a 10"-12" incision and places the patient on the heart-lung machine, new minimally invasive approach avoids placing the patient on a heart-lung machine, and can be performed through a 5-7 cm incision placed between the ribs

 Benefits Include:

·         No splitting of the breastbone

·         Reduction in pain

·         Lower risk of infection

·         Lower risk of bleeding

·         Reduced ICU and hospital stay

·         Improved postoperative pulmonary function

·         Accelerated recovery/return to activity

·         Improved quality of life

·         Greatly improved cosmetic result

 

Valvular Heart Disease

Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary.

The mitral and tricuspid valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart). The pulmonary valve controls the flow of blood from the heart to the lungs, and the aortic valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body. The mitral and aortic valves are the ones most frequently affected by valvular heart disease.

Normally functioning valves ensure that blood flows with proper force in the proper direction at the proper time. In valvular heart disease, the valves become too narrow and hardened (stenotic) to open fully, or are unable to close completely (incompetent).

A stenotic valve forces blood to back up in the adjacent heart chamber, while an incompetent valve allows blood to leak back into the chamber it previously exited. To compensate for poor pumping action, the heart muscle enlarges and thickens, thereby losing elasticity and efficiency. In addition, in some cases, blood pooling in the chambers of the heart has a greater tendency to clot, increasing the risk of stroke or pulmonary embolism.

The severity of valvular heart disease varies. In mild cases there may be no symptoms, while in advanced cases, valvular heart disease may lead to congestive heart failure and other complications.

Causes
There are many different types of valve disease; some types can be present at birth (congenital), while others may be acquired later in life.

·         Heart valve tissue may degenerate with age.

·         Rheumatic fever may cause valvular heart disease.

·         Bacterial endocarditis, an infection of the inner lining of the heart muscle and heart valves (endocardium), is a cause of valvular heart disease.

·         High blood pressure and atherosclerosis may damage the aortic valve.

·         heart attack may damage the muscles that control the heart valves.

·         Other disorders such as carcinoid tumors, rheumatoid arthritis, systemic lupus erythematosus, or syphilis may damage one or more heart valves.

·         Methysergide, a medication used to treat migraine headaches, and some diet drugs may promote valvular heart disease.

·         Radiation therapy (used to treat cancer) may be associated with valvular heart disease.

 

During heart valve surgery, one or more valves are repaired or replaced. Repair means that the valve is mended to help it work better. Replacement means your diseased valve is removed and a new valve is inserted in its place. During valve repair, a ring may be sewn around the opening of the valve to tighten it. Other parts of the valve may be cut, shortened, separated, or made stronger to help the valve open and close right. If a valve can't be repaired, it may be replaced with a prosthetic valve. Two kinds of prosthetic heart valves are available- mechanical and biological.

Mechanical valves are created from man-made materials. Lifetime therapy with an anticoagulant (sometimes called a "blood thinner") is needed when these types of valves are used. This medication prevents blood clots from forming on or around the valve.

Biological (tissue) valves are taken from pig, cow, or human donors. These valves don't last as long as mechanical valves. But when tissue valves are used, long-term use of an anticoagulant often isn't needed.  

The type of replacement valve selected depends on the patient’s age, condition, and the specific valve affected.

Congenital Heart Disaeses

Congenital heart defects are problems with the heart's structure that are present at birth. These defects can involve:

·         The interior walls of the heart

·         The valves inside the heart

·         The arteries and veins that carry blood to the heart or out to the body

Congenital heart defects change the normal flow of blood through the heart.

There are many types of congenital heart defects. They range from simple defects with no symptoms to complex defects with severe, life-threatening symptoms.

Congenital heart defects change the normal flow of blood through the heart. This is because some part of the heart didn't develop properly before birth.

There are many types of congenital heart defects. Some are simple, such as a hole in the septum that allows blood from the left and right sides of the heart to mix, or a narrowed valve that blocks blood flow to the lungs or other parts of the body.

Other defects are more complex. These include combinations of simple defects, problems with where the blood vessels leading to and from the heart are located, and more serious problems with how the heart develops.

A child may need open-heart surgery. Sometimes, one surgery can repair the defect completely. If that's not possible, the child may need more surgeries over months or years to fix the problem.

Common Types of Heart Defects

 

Open-heart surgery may be done to:

·         Close holes in the heart with stitches or with a patch

·         Repair or replace heart valves

·         Widen arteries or openings to heart valves

·         Repair complex defects, such as problems with where the blood vessels near the heart are located or how they developed 

Rarely, babies are born with multiple defects that are too complex to repair.

Aortic Aneurysm and Aortic Dissection

The aorta is the large artery that leaves the heart and provides oxygen-rich blood throughout the body.

Many diseases and conditions can cause the aorta to dilate (widen) or can cause aortic dissection (tear) increasing your risk for future life-threatening events. These conditions that can lead to aortic aneurysm and aortic dissection include:

·         atherosclerosis (hardening of the arteries)

·         hypertension (high blood pressure)

·         genetic conditions (such as Marfan Syndrome)

·         connective tissue disorders (such as Ehler-Danlos disorder, polychondritis, scleroderma, osteogenesis imperfecta, polycystic kidney disease, and Turners Syndrome)

·         injury

Surgery is needed to treat aortic disease for various reasons. A primary cause for surgery is when an artery wall in the aorta weakens and the wall abnormally expands or bulges as blood is pumped through it. This bulging is called an aortic aneurysm, and can lead to aortic dissection. An aneurysm can develop anywhere along the aorta:

·         Aneurysms that occur in the section of the aorta that runs through the abdomen (abdominal aorta) are called abdominal aortic aneurysms.

·         Aortic aneurysms that occur in the chest area are called thoracic aortic aneurysms and can involve the aortic root, ascending aorta, aortic arch or descending aorta.

·         Aneurysms that involve the aorta as it flows through both the abdomen and chest are called thoracoabdominal aortic aneurysms.

 

Bentall procedure 

 

A Bentall procedure is a cardiac surgery operation involving composite graft replacement of the aortic valve, aortic root and ascending aorta, with re-implantation of the coronary arteries into the graft. This operation is used to treat combined aortic valve and ascending aorta disease, including lesions associated with Marfan syndrome.

Doctor With This Department
DoctorName: Dr. Saifi Arsiwala
Education:MS, MCH
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Doctor With This Department
DoctorName: Dr. Prashant Sharma
Education:MBBS
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Doctor With This Department
DoctorName: Dr. Pramod Kumar Nagar
Education:MS,Mch
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Consultation Time
Monday To Saturday
8.00AM To 8.00PM
Sunday
10.00AM To 2.00PM
Location
Kota Heart Institute & Multi Speciality Hospital
10A Talwandi, KOTA-324005(Raj.)
Contact no.: 0744-3015000, 5001
Enquiry no.: +91-93518-38005
                 
+91-98292-28175
Fax no.: 0744-2407002 / 3015003 / 2405010
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