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Wednesday, 20 September 2017
Heart Failure Surgery

The heart is a work horse that beats at seventy two beats per minute putting out five litres of blood per minute. The normal heart ejects out over 60% of the blood that it receives. When this percentage comes down to less than 35% then we call it severe ventricular dysfunction. There are numerous causes for heart failure and our understanding of this condition is getting better. The therapies are changing all the time starting from resynchronising therapy to surgery to remodel the heart.

 

Every time we have a heart attack we lose some portion of our heart muscle. This part of the muscle is dead and thinned out so instead of squeezing blood it the weakened wall balloons out like an aneurysm and precious blood is collected there. Surgery has been the treatment of choice for remodeling the heart and excluding the dead area to optimize heart function.

The operation is called “ Surgical volume restoration” as the name suggests we reduce the volume of the ventricular cavity by excluding the aneurysmal segment. The operation increases the functional capacity of these patients who otherwise would have frequent admissions in the ICU for heart failure.

 

The other operation available at some center in India and abroad is Implantation of Ventricular assist devices. These are available in many sizes now and are in short mechanical devices which work with the help of a motor that runs on batteries. They have certain life after which we would need to do a heart transplant.

 

There are many devices available namely

  • Left ventricular assist devices
  • right ventricular assist devices
  • Total artificial heart – Cardiowest.


They are indicated in patients in whom all medical management and surgical management is exhausted and they are listed on the transplant registry during this time if they develop severe heart failure they buy themselves an assist device.

The right side of the heart is often an ignored part as it pumps impure blood from the heart to the lungs to get purified and return to the heart at the rate of five liters a minute. The right heart commonly fails secondary to left heart failure but in some cases such as Pulmonary Embolism( clot in the arteries of the lungs) it can fail primarily.

 

Pulmonary embolism is classified into acute and chronic. Acute is a sudden event wherein clot from the veins in the body can get dislodged and go to the lungs. This is very often fatal, morality depends on the size and location of the clot. If he patient reaches the hospital then the different options of treatment are

 

1. Medical management: Thrombolysis or breaking down the clot with medicines under physician supervision.
2. Surgical management: This is used when thrombolysis is contraindicated or if he clot is very large to dissolve easily with medications.

 

Chronic pulmonary embolism is slow continuous process wherein small clots from commonly the leg veins are accumulated in the lungs and can over a period of time cover a large area of the lung vessels preventing good exchange of oxygen making the patient crave for oxygen. The treatment of choice here is surgery namely Pulmonary endarterecomy.

 

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