Surgery: Archives

Heart Attack June 14, 2021

Technological Advancements Of Stents

Heart disease often involves a problem with the valve, coronary arteries, or muscles all of which causes the heart to not function normally. The common heart disease among patients is CAD which arises from a build-up of plaque on the inner surface of the arteries. In the worst cases, it blocks the artery. Stents are instered to open the blocked artery and restor the blood by increasing the lumen area of the artery which got compromised due to plaque formation,it becomes even more important in the emergency like situation when patients suffer from the Heart Attack as due to thrombus a blood flow is totally stopped or compromised leading to the death of cardiac muscles due to lack of oxygen this need a immediate action to remove the thrombus or clot with help of medicines or angioplasty.

The idea of cardiovascular stents revolutionized the treatment of coronary-related diseases. Since then, stents have been used in coronary and peripheral procedures for decades. Let’s take a look at newer kinds of stents, their evolution and understand why better stents are needed.

What is the function of stents?

The main purpose is to open the blocked coronary arteries which occurred due to plaque formation. A stent is a tiny mesh tube inserted into a blocked passageway to keep it open, it restores the flow of blood. It is usually needed when plaque blocks blood vessels. Commonly used heart stents are made up of materials like stainless steel,cobalt chromium or platinium. It can be coated with medication to facilitae optimal healing.

Evolution of early stents

The first used stents were successful at reducing the risk of restenosis following angioplasty by about half, from 20% to 10% in the 12 months following the procedure. The first generation of stents was called bare-metal stents (BMS) as they were mostly fabricated from metal. These permanent frameworks are made from chrome steel and cobalt-chromium alloys for balloon-expandable and Nickel-titanium for self-expanding stents. This revolution was considered the turning point in the field of angioplasty however it had its disadvantages of increased risk of restenosis.

Stent developers started to coat bare-metal stents with polymers containing drugs that were aimed at inhabiting extra tissue growth at the site of the stent to reduce the rate of restenosis. These stents are called drug-eluting stents (DES). DES has been constantly developed by using several drugs.

DES has bought its advantage to overcome the limitation of BMS. Despite the influence in the clinical practice in vascular intervention, the major subject of the debate was incomplete endothelialization and hypersensitivity reactions to the polymer coating. The first-generation DES had all these drawbacks which had them failed. Due there coating material not being biodegradable or biocompatible their long-term efficiency was questioned. The potential risk associated with DES were late thrombosis and delayed healing.

The formation of a grume within the artery at the location of the stent is stent thrombosis. It is different from restenosis. Restenosis is the regrowth of tissue, it is a problem but it grows gradually so when it occurs there is time to treat it. In contrast, stent thrombosis tends to occur suddenly without warning, it commonly leads to the complete occlusion of the artery that then tends to produce a myocardial infarction (Heart attack) or sudden death.

In the youth of stenting, the matter of early thrombosis was recognized and successfully addressed by administering powerful antiplatelet or blood thiner for a couple of months after stenting. But within few years of the widespread use of DES the problem of late thrombosis was discovered. Late thrombosis may be a sudden thrombosis within the site of the stent that happens a year or two after the procedure. It is as catastrophic as early stent thrombosis. Hence the cardiologists started prescribing antiplatelet therapy for up to a year or for longer period of time. The strong use of anti-platelet drugs carried the risk. The problem of late stent thrombosis led stent developers to a challenge to develop a new type of stent that reduces this problem or eliminates it.

Researchers now believe that the polymer coating on DES may themselves increase inflammation and delay healing. Now several companies are identifying the problem and trying a general approach keeping this in mind.

Advanced stent technology

Better durable polymers DES appear to cause less inflammation and also allow better healing at the site of treatment. These stents are referred to as second-generation DES, the newer stent design use cobalt-chromium which has greater radial strength per thickness and is radio-opaque, and thus allows thinner struts.

Bioabsorbable polymers

DES has been available for several years, they employ a polymer coating which is absorbed within few months leaving just the bare stent. These stents offer the benefits of DES for several months then they become BMS. This reduces the risk of late thrombosis. As compared to the first generation DES the risk of late thrombosis is reduced with both second-generation DES and bioabsorbable polymers DES. But there is no indication that bioabsorbable polymer performs better than the second-generation DES. They both still require very prolonged therapy and anti-platelet tests.

Bioresorbable stents

Bioresorbable stents also called as bioresorbable scaffold, biodegradable stent, or naturally- dissolving stent they are made from a material that may dissolve or be absorbed in the body. The main purpose of the bioresorbable stents is to overcome the drawbacks of DES and BMS. Currently, A metallic drug-eluting stent remains in the body as a permanent implant which can lead to an increased risk of complications year on year. It may pose a hindrance if the future procedure needs to be performed in the same artery. But on the other hand, BRS provides a temporary scaffold to the lesion to restore the blood flow, once the blockage is treated and healed completely BRS dissolves on its own leaving the artery in its natural state with no foreign residue. Hence providing both physicians and patients the room to explore further treatment, if required in the same blood vessel.

We get to see all these extraordinary engineering in stent technology, it seems like sooner or later we might develop stents that would be able to eliminate the risk of both restenosis and thrombosis. But you need to make sure that before you agree to a stent talk to your doctor and explore options whether it will be helpful for you.

Aortic Stenosis/TAVR/TAVI June 14, 2021

Why You Should Not Delay Heart Valve Replacement Surgery

The possibility of having heart disease or a heart valve condition is overwhelming and frightening for most people. That is why having an understanding of heart diseases is important so that one can be well equipped with the right information, and hence take the right steps towards treatment.

Heart valve conditions are usually due to birth defects or age-related issues. Many heart valve conditions can be first identified with the help of a murmur, that is a whoosing sound as blood flows from one chamber to the next, or it may sound like an extra click when a valve allows backflow.

A murmur may indicate conditions such as Aortic stenosis, prolapse, regurgitation, etc. While medicines can be prescribed for a heart valve condition, they are mainly for the following reasons

To reduce unpleasant symptoms from milder forms of the disorder.
To maintain heart rhythm if a related arrhythmia is present.
To lower the patient’s risk for clotting and stroke.

Valve diseases are generally progressive by nature, and the outlook for those who do not receive adequate and timely treatment could be fatal. If you are suffering from an aortic valve disease it is highly advisable to opt for a surgical procedure for low surgical risk patients.

The heart has four chambers. The two upper chambers are called the left and right atrium and the lower chambers are called the left and right ventricle. The four valves that are at the exit of each chamber carry out the function of continuous blood flow through the heart to the lungs and the rest of the body. The four valves are the tricuspid valve, pulmonary valve, mitral valve, and aortic valve.

The aortic valve controls blood flow from the left ventricle into the aorta (the main artery in your body). When this valve opens, the oxygen-rich blood is pumped to the aorta and then to the rest of the body. It is key to the body’s blood circulation system.

Reasons you might need to undergo heart valve surgery

Types of aortic valve disease that may require treatment with aortic valve repair or replacement include the following:

Congenital heart disease: This condition may contribute to other complications that prevent the aortic valve from operating properly. For instance, a person may be born with a condition where the aortic valve does not have enough tissue flaps (cusps) or with a valve that is the wrong size or shape, or without an opening that allows blood to flow normally.

Aortic valve stenosis: When the aortic valve becomes narrow or obstructed, it becomes difficult for the heart to pump blood into the aorta. This may be caused by the thickening of the valve’s closure flaps, congenital heart disease or post-inflammatory changes associated with rheumatic heart disease. Around 75% of patients with unoperated aortic stenosis may die 3 years after the onset of symptoms.

Bicuspid aortic valve: A birth defect where only two cusps grow instead of the normal three. This is a common cause of aortic stenosis. Another cause may be that the valve opening does not grow as the heart does. This makes it harder for the heart to pump blood to the restricted opening. The defective valve becomes narrow and stiff over time because of a calcium build-up. Age-related Aortic Stenosis usually begins after age 60, but often doesn’t show symptoms until ages 70 or 80.

Aortic valve regurgitation: When the blood flows backward through the aortic valve into the left ventricle each time the ventricle relaxes rather than in the normal one-way direction from the ventricle to the aorta. This may be caused due to an abnormal valve shape present at birth (congenital heart disease) or by a bacterial infection.

Most symptomatic patients of AR will require valve replacement surgery within 2 to 3 years of developing breathlessness and symptoms of heart failure. A Swedish study has proven that these individuals have a life expectancy of 2 years lesser than the healthy population of the same age.

Valve diseases, although gradual and progressive are fatal if not treated in the right manner. Valve replacement surgery is recommended as it helps alleviate your symptoms and add quality years to your life.

Careful monitoring and doctor supervision may be all that is needed for a few people with mild aortic valve disease without symptoms. However, in most cases, aortic valve disease and dysfunction can get worse.

Such conditions eventually require surgery to reduce the risk of complications such as heart failure, heart attack, or a stroke or death by cardiac arrest. This is when a doctor will recommend heart surgery.

What are the consequences of not having a heart valve surgery?

Decreased life expectancy and quality of life

As per an estimate, as the aortic valve disease gradually worsens, the average rate of survival without undergoing surgery is a mere 50% post 2 years, while it is 20% post 5 years.

While you may feel normal and not notice any problems for years, valve disease is not a condition to be ignored. Once you begin to experience symptoms like the ones mentioned above, not only does life expectancy and quality of life decline but the severity of diseases such as aortic heart stenosis increases.

Contributes to more health complications

As the wall of the left ventricle works harder to pump blood through the narrow valve

opening into the aorta, the wall might show muscular thickening, along with the symptoms of aortic stenosis like fatigue and weakness.

The thickened wall allows less room for an adequate amount of blood circulated to the body, as it takes up more space inside the lower heart chamber. This may cause heart failure.

It is advisable to undergo valve replacement surgery as it not only adds to a better quality of life and solves the issue of aortic stenosis but also helps avoid the consequential conditions that come along with it.

Coping with Aortic Stenosis can not only be stressful physically but also mentally. Learning about your condition and the right treatment by talking to your doctor about it can help a great deal. Aortic Stenosis can be fatal and not undergoing the right treatment or prescribed surgery can lead to not just a deterioration in your condition but also create newer complicated conditions for your health. Knowing and understanding your condition as well as the benefits and success rates of the treatment gives you an upper hand and a better chance at survival.

Disclaimer: This blog is only for awareness purposes. We do not intent to promote any medications given in the blog. Please consult your physician before taking any medication.

Heart Attack June 11, 2021

Heart Stents: Why Do You Need Them And For How Long?

The news that one might be suffering from a heart condition that requires a heart stent can be stressful to process. It is important to understand the reasons why your doctor might have recommended a stent in the first place.

Arteries are blood vessels that carry out the function of circulating blood away from the heart to the rest of the body. They are shaped like tubes and the pumping contractions of the heart propel the blood through the arteries.

When a buildup of plaque i.e cholesterol, fat, and other substances collect in the bloodstream, it sticks to the walls of the arteries, and over time, this buildup narrows the arteries, limiting the amount of fresh blood that can be circulated to the body.

Over time, people with narrowed coronary arteries may begin to notice symptoms such as chest pain. This buildup of plaque in the coronary arteries is a cause of coronary heart disease. People with this condition may be at a higher risk of many serious complications such as a heart attack or a stroke if they do not receive treatment.

What is Coronary Artery Disease? Coronary Artery Disease (CAD) is the most common form of heart disease. It occurs when one or more of the coronary arteries becomes narrow, thus restricting the flow of blood to the heart muscle. Without adequate blood, supply the heart becomes starved of oxygen and vital nutrients required for the proper functioning of the heart muscle which may lead to chest pain called angina. The process is often called hardening of the arteries or atherosclerosis.

Symptoms of CAD may include

Early warning signs such as

A squeezing, suffocating, or burning feeling in your chest tends to start in the center of your chest but may move to your arm, neck, back, throat or jaw.
fatigue
pain
dizziness

Symptoms in women are comparatively non-traditional:

vague chest discomfort
fatigue
indigestion
Anxiety
sleep difficulties

If left untreated, CAD can lead to other serious problems such as heart attack, stroke, or even death.

When a coronary artery is narrowed by a buildup of fatty deposits called plaque, it can reduce blood flow, causing chest pain. If a clot forms and completely blocks the blood flow to part of the heart muscle, it can result in a heart attack.

Therefore if the artery is at risk of collapsing or becoming blocked, doctors may recommend inserting a stent to keep it open.

What is a stent?

A stent is a tiny wire mesh tube that your doctor can insert into a blocked artery passageway to keep it open. Its function is to open the blocked artery and post-treatments stents remain permanently in the body. Stents are made of either metal or plastic. Stents can also be coated with medication to help keep a blocked artery from closing.

How are stents used?

The stent is mounted on a balloon catheter. It is tracked through the artery to the narrowed segment/blockage which is then moved into the area of the blockage. The balloon is then inflated resulting in the stent expanding and locking in place, forming a scaffold that holds the artery open. The balloon is then deflated and withdrawn.

The stent stays permanently and improves blood flow to the heart muscle. Stents are used based on the features of the artery blockage such as the size of the artery and where the blockage is.

What are the advantages of using a stent?

After balloon angioplasty or other procedures that use catheters, certain patients may experience a re-narrowing of the artery. Stents help to reduce the re-narrowing.

Patients who have angioplasty and stents have less discomfort and also recover faster from these procedures as compared to patients that choose to undergo coronary artery bypass surgery (CABG)

How long will a stent last? Are stents permanent?

Commonly used metallic stents are permanent and stay in the body for lifelong.

Re-narrowing (Restenosis) of the treated coronary artery can occur in some cases and may require a re-intervention in the future. However, with the latest generation, the drug-eluting stents’ restenosis rate has reduced significantly.

Bioresorbable scaffold or stent is the latest innovation in the field of stent technology. Unlike metallic stents, they don’t stay permanently inside the patient body. Post healing, they dissolve naturally in 2-3 years thus leaving the artery in its natural state.

What happens after stent insertion?

Depending on the insertion site, there may be soreness, for which mil painkillers are usually given. Your doctor might prescribe medication to prevent clotting, and might want you to remain at the hospital overnight. This helps ensure that there are no complications. In cases of coronary events like a heart attack or a stroke, you might be asked to stay for a longer time. Depending on the severity of the cause of the stent insertion, such as a heart attack, recovery might take a while. Until then it is advised to take it easy for a couple of weeks, avoid heavy lifting, etc.

Are there any risks involved in the insertion of stents?

Like any other medical procedure, Stenting may also involve risk, but with the latest advancement in technology and the treatment procedure, it has been minimized significantly. One should discuss and understand with their Physician about the common risk factors which is involved with stenting.

Some of the common risk factors may include bleeding from the treatment site like groin from where the catheter was introduced, allergic reaction to dye or stent, re-narrowing of the artery or clot formation, etc

Insertion of a foreign body in your blood, there is a one in 50 chance of blood clots forming on the stent. Your physician may prescribe certain medications to lower the risk of blood clots.

While a stent can result in remarkable improvement of your condition, it is not a cure for heart disease. You will need to address the contributing factors like high blood pressure, cholesterol, and being overweight as well. Eating a well-balanced diet, exercising regularly, even quitting smoking can lead to a heart-healthy lifestyle.

Disclaimer: This blog is only for awareness purposes. We do not intent to promote any medications given in the blog. Please consult your physician before taking any medication.

Hip Replacement June 9, 2021

Hip Replacement: Relief Or Restrictions?

Hip replacement is a surgical procedure in which a surgeon removes the damaged and painful sections of the hip joint and replaces it with an artificial one that is usually made from metal, ceramic, and High density plastic components. This procedure is undertaken to reduce pain and improve one’s joint movement and function. The artificial joint is known as a prosthesis.

Hip replacement is usually done when other, less invasive methods have failed to provide relief to the patient. Also known as Hip Arthroplasty, hip replacement is also considered if the hip pain interferes with one’s daily activities. Damage caused due to Arthritis is one of the most common reasons for Hip Replacement Surgery. Some conditions that may require hip replacement surgery to treat it are:

Osteoarthritis: Also known as wear-and-tear arthritis, this condition damages the protective cartilage that cushions the ends of your bones which helps the joints move smoothly.

Rheumatoid Arthritis: This is an autoimmune disease in which there is inflammation in the joints, which in turn leads to bone erosion and joint deformity.

Osteonecrosis: Osteonecrosis occurs when there is no adequate blood supply to the ball portion of the hip joint, which might occur due to dislocation of the hip bone or hip fracture.

Does an artificial hip work better after a hip replacement?

Hip replacement offers the greatest benefit of pain relief. Along with that, there is an improvement in movement, strength, and coordination of the lower body. It also helps you to get back to your active life. But, despite being highly effective, an artificial hip is associated with certain limitations.

1. Durability: Though majority the of the artificial hip implants last for 15 to 20 years, one cannot guarantee smooth functioning in every case of certain situations such as infections or trauma, an artificial hip can get worn out quickly, making it necessary for a second replacement. Normally, an artificial hip can work for up to 15 – 20 years, without any major trouble.

2. Susceptibility to allergy: Though these problems are rarely seen, they can occur. The patient may display signs of metal allergy after the surgery. This is characterized by skin rash, itching sensation, and discoloration in the area where the artificial joint has been fixed.

3. Weather problems: In some patients, the natural bones surrounding the hip implant take more time to adapt to the metallic nature of the hip, leading to increased weather sensitivity in the patient. Due to this phenomenon, a patient may feel increased pain and stiffness in the artificial hip in certain seasons like monsoon or winter.

4. Caution in future dental visits: You need to take care while visiting your dentist after your hip replacement as you could catch an infection. Preferably, you should take a prophylactic antibiotic.

What type of permanent restrictions will one have after a hip replacement surgery?

Every patient’s experience with Hip Replacement Surgery is not the same. Hence, it is not possible to predict whether a particular patient will have permanent movement restrictions after hip replacement or not. Most of the patients can return to a normal daily routine without any permanent restrictions, albeit with less pain and discomfort. However, a risk always prevails regarding an implant getting worn out, in which case the patient might need a second replacement. Though there are no permanent restrictions in most cases, there are certain activities one has to avoid for a certain period. These restrictions are also known as posterior hip precautions. They are:

Cross your legs: One should not cross their legs past the midline of the body after a hip replacement surgery. To avoid crossing your legs, the surgeon may also advise sleeping on your side or keeping a pillow between the legs.
Forward bending: It is also important to ensure that you do not bend your hip beyond 90 degrees after a hip replacement. Your knee must be below your hip joint. You can utilize cushions and pillows to elevate your seat, to ensure that your knees are positioned lower than your hips.
Positioning your feet: Ensure that you keep your feet and your knees pointed straight ahead, in the front. Do not try turning them in or out. Also, avoid sitting in the same position for more than 30 – 40 minutes.
Seating arrangement: Make sure that you are using a firm chair with a straight back and armrests. Avoid chairs that are too soft, rocking chairs, recliners, and stools.
Climbing the stairs: Avoid climbing the stairs very frequently, as it will put a strain on the artificial joint.

Even after the joint has completely healed strenuous physical activities like sports must be avoided. It is important to keep in mind that the prosthetic joint has only been designed to withstand day-to-day physical activities. You can work with a physical therapist to learn various techniques and guidelines while performing various activities. If you do not follow the above-mentioned restrictions, you may run the risk of dislocating your joint, leading to second replacement surgery. Hence, you must be well-informed and take precautions with utmost care as suggested by your surgeon.

Aortic Stenosis/TAVR/TAVI June 1, 2021

Types Of Valvular Diseases And Its Symptoms

The human heart has four chambers, with the upper chambers being the left and right atrium and the lower chambers being the left and right ventricles. The heart valves are present at the end of each chamber and they maintain the one-way blood flow from the heart to the lungs and the rest of the body. The four different valves are – Pulmonary Valve, Tricuspid Valve, Aortic Valve and Mitral Valve.

The tricuspid valve is placed between the right atrium and right ventricle. Through this valve, blood flows to the right ventricle. The function of the pulmonary valve is to control the flow of blood between the right ventricle and the lungs. The mitral valve is positioned between the left atrium and left ventricle and allows the blood to flow between them. The aortic valve controls the blood flow from the left ventricle to the aorta. The aorta is the main artery of the body, from which blood flows to the other parts of the body.

What are Valvular Diseases?

Valvular diseases, commonly known as heart valve diseases, occur when one or more of the heart valves do not open or close properly, affecting the blood flow. When more than one valve is affected, it is known as Multiple Valvular Heart Disease. The different types of valvular diseases are:

Stenosis:

In this condition, the heart valves stiffen, leading to the narrowing of the valves. This in turn restricts the blood flow from the valves to the other organs. It keeps the valve from opening fully to allow smooth blood flow, due to which an inadequate amount of blood is supplied to the body. In severe cases, the valve opening may completely close, due to which the blood flow is blocked.

Tricuspid valve stenosis: In this condition, the blood is unable to flow from the right atrium to the right ventricle, causing the atrium to enlarge. This affects the blood pressure and flows in the surrounding chambers. It can also cause the right ventricle to shrink or become smaller, restricting the blood circulation to the lungs.
Pulmonary valve stenosis: If the pulmonary valve narrows, the blood flow from the right ventricle to the lungs is restricted, due to which oxygen-rich blood cannot be pumped to the rest of the body. In this condition, the right ventricle might have to compensate by pumping blood harder through the narrowed valve, increasing the pressure on the heart.
Mitral valve stenosis: In this condition, the blood flow from the left atrium to the left ventricle is reduced, causing fatigue and shortness of breath. It may also cause enlargement of the atrium and fluid build-up in the lungs.
Aortic valve stenosis: This is one of the most common heart conditions. In this condition, the blood flow from the heart to the aorta and the rest of the body is restricted. Due to this, the left ventricle has to pump harder to ensure blood flow to the aortic valve. This may also lead to the thickening of the left ventricle.

Prolapse:

Valvular prolapse is a condition in which the valve flaps slip out of place or bulge. This can lead to the valves being unable to close properly. Due to this, blood may flow backwards through the half-closed valve, disrupting the one-way blood flow.

Mitral valve prolapse: Also known as Barlow’s syndrome, click-murmur syndrome and floppy-valve syndrome, this condition prevents the valve from closing evenly. The mitral valves may also bulge upwards into the atrium when the two ventricles contracts. Due to this, a small amount of blood may flow backwards through the valve.
Tricuspid, Pulmonary and Aortic valve prolapse: These prolapses are less common as compared to Mitral valve prolapse. In the above-mentioned conditions, the leaflets/flaps of the valves do not close properly to form a tight seal.

Regurgitation:

Regurgitation happens when the valve doesn’t close properly, allowing the blood to flow backwards. This disrupts the one-way blood flow and puts a strain on the heart. This reduces the efficiency of the heart in pumping oxygen-rich blood to the rest of the body.

Tricuspid valve regurgitation: In this condition, the blood pumped from the right ventricle to the lungs may flow back to the right atrium, leading to the enlargement of the atrium.
Pulmonary valve regurgitation: In pulmonary valve regurgitation, the pulmonary valve doesn’t close properly, leading to the blood flowing backwards from the lungs to the heart. This backward blood flow may cause oxygen-rich blood to blend with oxygen-poor blood, reducing the availability of oxygen-rich blood to the rest of the body.
Mitral valve regurgitation: Mitral valve regurgitation can be a result of mitral valve prolapse. In this condition, blood leaks backwards into the left atrium through the mitral valve. In severe cases, this condition may lead to the enlargement of the atrium and lung congestion.
Aortic valve regurgitation: In this condition, blood leaks backwards from the aorta to the left ventricle, due to which the body does not get an adequate amount of blood, leading to the heart pumping harder to compensate. This may cause the thickening of the left ventricle.

Symptoms of Valvular Heart Diseases:

Some common symptoms of heart valve diseases are:

Discomfort or tightness in the chest.
Palpitations are a common symptom of heart valve diseases, which may cause the heart to enlarge, leading to irregular heartbeats (arrhythmia).
Shortness of breath – as valvular diseases disrupt the flow of oxygen-rich blood to the body, causing breathlessness.
Fatigue and weakness
Dizziness and fainting
Swelling occurs when the blood flows backwards, leading to fluid buildup and congestion, which in turn leads to swollen abdomen and feet.

Though the symptoms may slightly vary for different valvular diseases, it is important to be mindful of them and connect with your doctor even if you experience the mildest of symptoms. Though severe conditions may require surgical procedures, a few lifestyle changes will help keep these heart valve conditions at bay. Be aware and take precautions!