Heart Bypass, also known as Coronary Artery Bypass Surgery, is a common procedure used to divert blood around clogged arteries in the heart. It is done to improve blood flow and oxygen to the heart. The arteries that bring blood to the heart muscle (coronary arteries) can become clogged by plaque (a buildup of fat, cholesterol and other substances). This can slow or stop blood flow through the heart's blood vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack.

Preparation is essential for coronary bypass surgery, detailed medical information in the form of a medical questionnaire, ECG, Pulmonary tests and blood work are necessary to provide to the physician for review and recomendation. In some cases an Angiogram is required. All of this information will allow the doctor to determine your eligibility for the procedure. Your doctor abroad will give you specific instructions about any dietary changes or activity restrictions you should follow before surgery. Additional diagnostic testing may be carried out by the doctor when you arrive.

The Procedure

The surgeon makes an incision down the center of the chest, along the breastbone. The rib cage is spread open to expose the heart. After the chest is opened, the heart is stopped and a heart-lung machine takes over blood circulation to the body.

Surgeons take a segment of a healthy blood vessel from another part of the body and make a detour around the blocked part of the coronary artery. A patient may undergo one, two, three or more bypass grafts, depending on how many coronary arteries are blocked.

New procedures have been that may reduce the need for large incisions or a heart-lung machine:

• Off-pump or beating-heart surgery. This procedure allows surgery to be done on the still-beating heart using special equipment to stabilize or quiet the area of the heart the surgeon is working on. This type of surgery is challenging because the heart is still moving. Because of this, it's not an option for everyone.

Minimally invasive surgery. In this procedure, a surgeon performs coronary bypass through several smaller incisions in the chest. This technique is usually used only when certain conditions exist. If multiple coronary arteries need to be worked on, it's best to use a conventional approach. Variations of minimally invasive surgery may be called port-access or keyhole surgery.

After surgery, the patient is moved to a hospital bed in the cardiac surgical intensive care unit. Heart rate and blood pressure monitoring devices continuously monitor the patient for 12 to 24 hours. Family members can visit periodically. Medications that regulate circulation and blood pressure may be given through the I.V. (intravenously). A breathing tube (endotracheal tube) will stay in place until the physicians are confident that the patient is awake and ready to breathe comfortably on his or her own.

The patient may feel groggy and disoriented, and sites of incisions may be sore. Painkillers are given as needed.

Hospital stays vary, but on average last for about one week or longer after surgery. During this time, some tests will be done to assess and monitor the patient's condition. After release from the hospital, the patient may experience side effects such as:

• Loss of appetite, constipation
• Swelling in the area from which the segment of blood vessel was removed
• Fatigue, mood swings, feelings of depression, difficulty sleeping
• Muscle pain or tightness in the shoulders and upper back

Many of these side effects usually disappear in four to six weeks, but a full recovery may take a few months or more.

Most people with sedentary office jobs can return to work in four to six weeks. Those with physically demanding jobs will have to wait longer. In some cases they may have to find other employment.

Angioplastia coronaria es un procedimiento que abre arterias obstruidas y permite que la sangre fluya a su músculo cardíaco. La angioplastia no es la cirugía. Se abre una arteria coronaria obstruida inflando un pequeño globo en la mismo. Cada año, más de un millón de personas en los Estados Unidos se realizan una angioplastía coronaria. Las arterias que llevan sangre al músculo del corazón (arterias coronarias) pueden obstruirse por la placa (una acumulación de grasa, colesterol y otras sustancias). Esto puede disminuir o detener el flujo de sangre a través de los vasos sanguíneos, dando lugar a dolor en el pecho o un ataque al corazón. El aumento de flujo de sangre al músculo del corazón puede aliviar el dolor en el pecho y reducir el riesgo de ataque al corazón.

Ud puede ser un buen candidato para una angioplastía si:

• Your blockage is small
• Your blockage can be reached by angioplasty
• The artery affected isn't the main vessel supplying blood to the left side of your heart
• You don't have heart failure

If the main artery supplying the left side of your heart is narrowed, if your heart muscle is weak or if you have small, diffusely diseased blood vessels, then coronary artery bypass surgery (CABG) may be a better option. In addition, if you have diabetes and multiple blockages, your doctor may suggest coronary artery bypass surgery. The decision of angioplasty versus bypass surgery will depend on the details of your heart disease and overall medical condition.

Preparation is essential for Angioplasty, detailed medical information in the form of a medical questionnaire, ECG, Pulmonary tests and blood work are necessary to provide to the physician for review and recomendation. In some cases an Angiogram is required. All of this information will allow the doctor to determine your eligibility for the procedure. Your doctor abroad will give you specific instructions about any dietary changes or activity restrictions you should follow before surgery. Additional diagnostic testing may be carried out by the doctor when you arrive.

The Procedure
General anesthesia isn't needed, so you're awake during the procedure. The doctor threads a thin tube through a blood vessel in the arm or groin up to the involved site in the artery. The tube has a tiny balloon on the end. When the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.

Angioplasty is usually combined with implantation of a small metal coil called a stent in the clogged artery to help prop it open and decrease the chance of it narrowing again (restenosis). The stent looks like a very tiny coil of wire mesh. Stents can be coated with medication that's slowly released to help prevent arteries from re-clogging. These coated stents are called drug-eluting stents, in contrast to noncoated versions, which are called "bare-metal" stents.

The entire procedure can take 30 minutes to several hours.

You'll remain hospitalized from 2 to 5 days while your heart is monitored and your vital signs are checked frequently. Your doctor will likely prescribe medications (anticoagulants) to prevent blood clots, relax your arteries and protect against coronary spasms.

You should be able to return to work or your normal routine the week after angioplasty.

Heart valve surgery is needed when a heart valve doesn't work right. A valve may not open all the way. Or, a valve may have problems closing. If this happens, blood doesn't move through the heart's chambers the way it should. If a valve doesn't open all the way, less blood moves through to the next chamber. If a valve doesn't close tightly, blood may leak backward. These problems may mean that the heart must work harder to pump the same amount of blood. Or, blood may back up in the lungs or body because it's not moving through the heart as it should.

Preparation is essential for Angioplasty, detailed medical information in the form of a medical questionnaire, ECG, Pulmonary tests and blood work are necessary to provide to the physician for review and recomendation. In some cases an Angiogram is required. All of this information will allow the doctor to determine your eligibility for the procedure. Your doctor abroad will give you specific instructions about any dietary changes or activity restrictions you should follow before surgery. Additional diagnostic testing may be carried out by the doctor when you arrive.

The Procedure

During traditional heart valve surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves.

Minimally invasive heart valve surgery

Minimally invasive surgery is a type of heart valve surgery performed through smaller incisions. This type of surgery reduces blood loss, trauma, and length of hospital stay. Heart valve surgery is the most common minimally invasive procedure. Your surgeon will review your diagnostic tests prior to your surgery to see if you are a candidate for minimally invasive valve surgery.

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. Whether a valve will be repaired or replaced can only be decided once surgery has begun. Your surgeon will talk with you about his or her plans for surgery and any other procedures you may need.

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:

1. 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.
2. 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.

Your doctor will talk with you about choosing the best valve for you. Factors weighed include your age, your occupation, the size of your valve, how well your heart is working, your heart's rhythm, your ability to take an anticoagulant, and how many new valves you need.

You'll remain hospitalized for about 10 days while your heart is monitored and your vital signs are checked frequently. Your doctor will likely prescribe medications (anticoagulants) to prevent blood clots, relax your arteries and protect against coronary spasms. Your doctor will advise you to walk or to do other physical activities, increasing gradually in order to regain your strength and return to a normal, active lifestyle.

Most individuals who have sedentary jobs can return to work in four to six weeks. Those who have physically demanding jobs will have to wait longer. Additionally, your doctor will not want you to drive a car for six weeks.

The foramen ovale is a small hole located in atrial septum that is used during fetal circulation to speed up the travel of blood through the heart. When in the womb,a baby does not use it's own lungs for oxygen-rich blood, it relies on the mother to provide oxygen rich blood from the placenta through the umbilical cord to the fetus. Therefore, blood can travel from the veins to the right side of the baby's heart and cross to the left side of the heart through the foramen ovale and skip the trip to the baby's lungs. Normally the foramen ovale closes at birth when increased blood pressure on the left side of the heart forces the opening to close.

• The septum is the muscular wall separating the heart into the left and right sides.
• The atrial septum is the wall separating the atria (the two upper chambers).
• The ventricular septum is the wall separating the ventricles (the two lower chambers)

If the atrial septum does not close properly, it is called a patent foramen ovale. This type of defect generally works like a flap valve, only opening during certain conditions when there is more pressure inside the chest. This increased pressure occurs when people strain while having a bowel movement, cough, or sneeze.

If the pressure is great enough, blood may travel from the right atrium to the left atrium. If there is a clot or particles in the blood traveling in the right side of the heart, it can cross the PFO, enter the left atrium, and travel out of the heart and to the brain (causing a stroke) or into a coronary artery (causing a heart attack).

The prevalence of PFO is about 25 percent in the general population. In patients who have stroke of unknown cause (cryptogenic stroke), the prevalence of PFO increases to about 40 percent. This is especially true in patients who have had a stroke at age less than 55 years).

A PFO can be associated with atrial septal aneurysm, which is characterized by excessive mobility of the atrial septum.

Most patients do not have any symptoms with PFO. About 40 percent of patients who have an ischemic stroke have no known cause (called cryptogenic stroke). PFO is present and associated with an increase in stroke in about 40 percent of cases. The most common symptoms of stroke are:

• weakness or numbness of the face, arm or leg on one side of the body
• loss of vision or dimming (like a curtain falling) in one or both eyes
• loss of speech, difficulty talking or understanding what others are saying sudden, severe headache with no known cause loss of balance, unstable walking, usually combined with another symptom

Migraine headaches are more common in patients with PFO. While it seems as though closure of PFO results in improvement of migraine symptoms, larger studies are needed to confirm this finding.

Patent Foramen Ovale can be detected by echocardiogram. In some cases, the patient is asked to cough or perform the Valsalva maneuver to increase pressure in the right atrium. This can increase the flow of blood from the right to left atrium. Transesophageal echo can provide a closer and more detailed view of the PFO.

The Procedure

In some patients a cardiologist may recommend closure of PFO. Most frequently, percutaneous rather than surgical closure is preferred. As part of the procedure, you will first undergo a cardiac catherization. During this test, catheters (hollow, flexible, tube) will be inserted into the veins in your groins and advanced to your heart. A balloon may be placed across the opening to determine the size and location of the hole in your heart. Measurements are taken of the pressure inside your heart chambers. A tiny catheter with an echo transducer is placed in the heart for imaging.

If the cardiac catheterization shows your PFO is an appropriate size and in an appropriate location for closure with this device, the cardiologist will position the device to close the hole.

Two closure devices

Currently there are no specially designed devices for PFO closure that is approved by the FDA. In patients that closure is indicated, devices that are approved for other heart defects are used.

The CardioSEAL® device is a small double umbrella arms attached to Dacron fabric. It is folded into a special catheter, similar to the catheter used during your catheterization. The special catheter is inserted into a vein in the leg and advanced into the heart and through the hole. The device is slowly pushed out of the special catheter allowing each umbrella to open up and cover each side of the hole (like a sandwich) and close it. When the device is in proper position, it is released from the special catheter. Over time, heart tissue grows over the implant, becoming part of the heart.

The AMPLATZER® ASD septal occluder device consists of two wire mesh discs filled with polyester fabric. It is folded into a special catheter, similar to the catheter used during your catheterization. The special catheter is inserted into a vein in the leg and advanced into the heart and through the hole. When the device is in proper position, the device is slowly pushed out the catheter until the discs of the device sit on each side of the hole (like a sandwich). Over time, heart tissue grows over the implant, becoming part of the heart.

In many cases, the procedure takes only about 30 minutes to two hours, and patients are often able to go leave the hospital the same day of after an overnight stay, returning home with minimal restrictions on normal physical activity.