FitSugar

Dara Torres Just Had Shoulder Surgery?!

FitSugar — Fri, 29 Aug 2008 03:30:00 -0700

Dara Torres left Beijing with her three silver medals in tow, and went almost straight to the operating room. This means the 41-year-old comeback ~~kid~~ mama - and hot mama at that - was swimming in pain. I couldn't tell, could you?

Torres lost her signature race, the 50-meter freestyle sprint, by .01 seconds. She has a phenomenal swim, and now that I know Torres was dealing with degenerative arthritis in her AC joint (where the collar bone, or clavicle, connects to the top of the shoulder blade), I am even more impressed. I'm impressed by her competitive drive, focus, and ability to race in pain. Obviously, she put the surgery and its six-week recovery period off so she could compete in her fifth Olympic games. She had surgery on Aug. 27 to create space in the arthritic joint so hopefully she can move her shoulder pain-free. I sure hope she has a speedy recovery, since she has a little one to chase after.

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Have You Ever Had Surgery?

FitSugar — Wed, 13 Aug 2008 04:30:00 -0700

I'll admit that I'm a huge fan of doctor shows like Grey's Anatomy and House - not that I think they're entirely accurate. I am intrigued by the diseases and entertained that the doctors can perform miraculous operations to make people healthy in just 60 minutes. Luckily, I haven't had to spend much time in hospitals, and the only surgery I've had was pretty minor. What about you . . .

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Uterus Transplants?

FitSugar — Tue, 16 Jan 2007 02:00:00 -0800

A New York hospital is taking steps to offer the first uterus transplant in the U.S. This is an amazing and radical surgery that may allow women whose wombs were removed to still bear children.

The wombs would come from women who passed away, just as most organ transplants do. The woman would get the womb transplant, get pregnant (hopefully), and then give birth. After she gave birth, the uterus would then be removed, so she wouldn't have to take antirejection drugs her whole life.

The hospitals president warned women not to get their hopes up, because uterus transplant is not expected "any time in the near future."

Scientists are still doing research and conducting tests. They want to try it out on animals first, to make sure it is an effective procedure that produces healthy offspring.

Organ transplants usually are performed to save lives, but increasingly they are being done to improve the quality of life. Hand transplants and the recent partial face transplant of a woman in France are examples.

Uterus transplants might be next. They are a reassuring idea for women who can't have babies themselves, and whose only option for having a biological baby is through a surrogate mother. It blows my mind that this could be possible. Only time will tell.

Surgery to Get Your Feet Stiletto-Slim?

FitSugar — Mon, 09 Nov 2009 03:00:48 -0800

According to Christian Louboutin, Barbie has cankles - but she's not the only one who needs a makeover to fit her stilettos. Apparently, donning perfectly crafted sky-high heels means women need perfectly re-crafted feet to match. In fact, even while most cosmetic procedures are on the decline - thanks to the recession - podiatrists report that the demand for cosmetic foot surgery is on the rise.

The fashion industry is already credited with making women feel inadequate when it comes to their figures, but I was surprised to learn that even a pair of strappy, heeled sandals can wreak havoc on female body image, causing some women to develop body dysmorphic disorder about their feet. Michelle Tzonov, a massage therapist from San Diego, always enjoyed an active lifestyle - an avid runner, hiker, dancer, and snowshoer - who decided her fully functionally, but bunion-covered, feet were in need of a makeover. Multiple surgeries to beautify her feet with intensive cosmetic surgery and a bunionectomy have since left her feet mutilated and saddled her with excruciating pain, likely to be lasting results of her botched surgeries.

To see how three inch heels affect your body, read more.

On their own heels are bad enough - even at three-inches high, they can increase the weight on the forefront of the foot by 110 percent, displacing bones and tissue, according to a recent study by the Journal of the American Podiatric Medical Association. But, surgery to get the foot stiletto-ready can cause severe complications that will eventually radiate throughout the whole body. While I'm certainly not an advocate of any kind of cosmetic surgery, just think of it this way - face work will never jeopardize your ability to walk, but feet support the whole body - mess with them and you're likely to jeopardize any kind of movement, especially the ability to strut your stuff in a pretty pair of Louboutins.

Weight-loss surgeries

admin — Thu, 04 Sep 2008 19:19:36 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Alternative Names

Bariatric surgery - gastric bypass; Roux-en-Y gastric bypass; Gastric bypass; Laparoscopic adjustable gastric banding; LAGB; Vertical banded gastroplasty

Definition

Weight-loss surgeries are procedures that can be used to cause significant weight loss if you are very obese.

Description

Weight-loss surgeries lower the body's intake of calories, which help you lose weight. Calorie reduction occurs in two ways:

After the surgery, your stomach is smaller. You feel full or satisfied faster and learn to reduce the amount that you eat at any given time. (This is called a restrictive procedure)
When you eat, the food skips over part of your stomach and small intestines so that they absorb fewer calories. Unfortunately, sometimes nutrients are lost as well. (This is called a bypass or malabsorptive procedure.)

Some surgeries use both of these techniques.

Before any weight-loss operation, your doctor will give you a complete medical examination and evaluate your overall health.

You also will have a psychological evaluation. This will determine whether you are ready to stick to a healthier lifestyle. If you are not ready to make lifestyle changes (and have not tried hard to do so already), you will not be considered eligible for the procedure. Without changing your lifestyle, the surgery will not be a success.

You will also receive nutritional counseling before and after your surgery.

GASTRIC BYPASS

Roux-en-Y gastric bypass is the most common surgery of this type.

The surgery is performed under pain-killing medicine (anesthesia). There are two basic steps:

STEP 1 -- The first step in the surgical procedure makes your stomach smaller. The surgeon divides the stomach into a small upper section and a larger bottom section using staples that are similar to stitches. The top section of the stomach (called the pouch) will hold your food.
STEP 2 -- After the stomach has been divided, the surgeon connects a section of the small intestine to the pouch. When you eat, the food will now travel from the pouch through this new connection ("Roux limb"), bypassing the lower part of the stomach. The surgeon will then reconnect the base of the Roux limb with the rest of the small intestines from the bottom of the stomach, forming a y-shape.

This "y-connection" allows food to mix with pancreatic fluid and bile, helping to absorb important vitamins and minerals. You still may have poor absorption of certain nutrients.

The risk of poor absorption is of greater concern in gastric surgeries that skip over a larger portion of the small intestines. These are performed much less often than the Roux-en-Y gastric bypass described here.

Gastric bypass can be performed as open surgery with a larger surgical cut in the abdomen.

It may also be done using a camera placed in the abdomen (laparoscopy). This less-invasive technique allows the surgeon to make smaller surgical cuts, which lowers the risk of large scars and hernias after the procedure.

First, small surgical cuts are made in your abdomen. The surgeon passes thin surgical instruments through these narrow openings. The surgeon also passes a camera (laparoscope) through one of these small openings and watches through a lens and video monitor to do the surgery.

Not everyone is a candidate for the laparoscopic approach. Your surgeon will determine the best and safest approach for you.

You may NOT be a good candidate for laparoscopy if you:

Have had past abdominal surgery, due to scar tissue
Have significant heart and lung disease
Weigh more than 350 pounds

Gastric bypass tends to work better for weight loss than purely restrictive surgeries. However, your body may not absorb vitamins and minerals properly.

LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING (Lap-Band, LAGB)

A newer procedure, called the Lap-Band, places a band around the upper part of the stomach, creating a small pouch to hold food. The band limits the amount of food you can eat, and increases the time it takes the intestines to digest the food.

Your doctor can later adjust the band to allow food to pass more slowly or quickly through your digestive system. Possible complications include nausea, vomiting, and gastroesophageal reflux.

Final weight loss with gastric banding is not as much as with gastric bypass. However, it may be enough for many patients. You should talk to your physician about which procedure is best for you.

Indications

Weight-loss surgery may be an option if you are very obese and have tried unsuccessfully to lose weight on diet and exercise programs and are unlikely to lose weight successfully with nonsurgical methods.

Gastric bypass surgery is not a "quick fix" for obesity. The surgery can take several hours and has risks and possible complications. For example, people can vomit after the surgery if they eat more than the new, small stomach can hold.

Your commitment to diet and exercise must be very strong because even after the surgery, you must stick to these lifestyle changes. Otherwise, you are likely to have complications from the surgery.

The procedure may be considered for obese individuals who have:

A Body Mass Index (BMI) of 40 or more. BMI is a calculation based on height and weight that is used to determine whether you are of normal weight or are overweight. Someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is between 18.5 and 25.
A BMI of 35 or more along with a life-threatening illness that can be made better with weight loss, such as sleep apnea, type 2 diabetes, and heart disease.

Risks

The risks of weight-loss surgery include:

Anemia from iron or vitamin B12 deficiencies
Bleeding
Breakdown of the pouch needing repair
Calcium deficiency, which can contribute to the development of early osteoporosis or other bone disorders
Death from breathing (respiratory) failure, blood clots to the lungs, or problems with the bypass procedure
Follow-up surgeries to correct complications, or to remove extra skin
Gallstones and gallbladder attacks
Gastritis and heartburn
Infections
Malnourishment
Vomiting from eating more than the stomach pouch can hold

Follow-up surgeries may be less likely if gastric bypass is done with a laparoscope.

Another common complication from weight-loss surgery is "dumping syndrome." The symptoms often include:

Bloated feeling
Diarrhea
Dizziness
Nausea and vomiting
Sweating

Expectations after surgery

The weight loss results of gastric bypass surgery are generally good. Most patients lose an average of 10 pounds per month and reach a stable weight 18 - 24 months after surgery. Often, the greatest rate of weight loss occurs in the very beginning (just after the surgery when you are still on a liquid diet).

Losing enough weight as a result of surgery can improve or even relieve many medical problems, such as:

Asthma
High blood pressure (hypertension)
Obstructive sleep apnea
Stress incontinence

After the surgery, you will need to follow up with your doctor fairly often during the first year. During those visits, your physician will be checking your physical and mental health, including any change in weight and your nutritional needs. You will likely see a dietitian during those visits as well.

The surgery is not a solution by itself. Although it can train you to eat smaller amounts of food and feel full more quickly, you still have to do much of the work. To lose weight and avoid complications from the procedure, you must exercise and eat properly -- according to important, healthy guidelines that your doctor and nutritionist will teach you.

Recovery

Most people stay in the hospital for a few days or less after gastric bypass surgery. Some may need to stay 4 - 5 days. Your doctor will approve your discharge home once you can do the following:

Eat liquid and/or pureed food without vomiting
Move without too much discomfort
No longer require pain medication given by injection

You will remain on liquid or pureed food for several weeks after the surgery. Even after that time, you will feel full very quickly, sometimes only being able to take a few bites of solid food. This is because the new stomach pouch at first only holds a tablespoonful of food.

The pouch eventually expands. However, it will hold no more than about one cup of chewed food (a normal stomach can hold up to one quart).

Upon follow-up, your doctor will determine if you need replacement of iron, calcium, vitamin B12, or other nutrients. Supplements, such as a multivitamin with minerals, can provide any nutrients that you may not be getting from your diet. This lack of nutrients can occur because you are eating less and because the food moves through your digestive system more quickly.

Once your diet begins to consist of more solid food, remember to chew each bite very slowly and thoroughly.

You will be instructed to eat small meals (usually six meals) often throughout the day, rather than large meals that your stomach cannot handle.

Your new stomach probably won’t be able to handle both solid food and fluids at the same time. You should separate fluid and food intake by at least 30 minutes and only sip what you are drinking.

You won’t be able to tolerate large amounts of fat, alcohol, or sugar. You should reduce your fat intake, especially:

Deep-fried foods
Fast-food meals
High-fat foods
High-sugar foods such as cakes, cookies, and candy

Exercise and the support of others (for example, joining a support group with people who have undergone weight-loss surgery) are extremely important to help you lose weight and maintain that weight loss after gastric bypass.

You can usually start exercising again 6 weeks after the operation. Even sooner than that, you will be able to take short walks at a comfortable pace, with the approval and guidance of your doctor. Exercise improves your metabolism, and both exercise and attending a support group can boost your self-esteem and help you stay motivated.

References

Frank A. Bariatric surgery: too many unanswered questions. Am Fam Physician. 2006;73:1403-1408.

Virji A, Murr MM. Caring for patients after bariatric surgery. Am Fam Physician. 2006;73:1403-1408.

Allen JW. Laparoscopic gastric band complications. Med Clin North Am. 2007;91:485-497.

Leslie D, Kellogg TA, Ikramuddin S. Bariatric surgery primer for the internist: keys to the surgical consultation. Med Clin North Am. 2007;91:353-381.

Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Townsend: Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders; 2008.

Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery, 2007;142:621-632.

Review Date: 2/4/2008

Reviewed By: Shimul A. Shah, MD, Assistant Professor of Surgery, University of Massachusetts Medical School, Worcester, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Source Doc: 1_007199

Heart bypass surgery

admin — Thu, 04 Sep 2008 19:02:23 -0700

Illustrations

Heart, front view

Posterior heart arteries

Anterior heart arteries

Atherosclerosis

Heart bypass surgery - series

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Heart bypass surgery is performed to route blood flow around clogged arteries supplying the heart.

Alternative Names

Bypass surgery - heart; CABG; Coronary artery bypass graft

Description

Coronary arteries are the small blood vessels that supply the heart muscle with oxygen and nutrients. Fat and cholesterol can build up inside these small arteries. The arteries can gradually become clogged. This buildup of fat and cholesterol plaque is called atherosclerosis.

When one or more of the coronary arteries becomes partially or totally blocked, the heart does not get enough blood. This is called ischemic heart disease or coronary artery disease (CAD). It can cause chest pain (angina).

Sometimes CAD does not cause pain until the blood supply to the heart becomes critically low, and the muscle begins to die. The first symptom of CAD in this case may be a potentially deadly heart attack. Symptomless CAD is especially common in diabetics.

OVERVIEW OF THE PROCEDURE

Heart bypass surgery creates a detour or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. The surgery is commonly called Coronary Artery Bypass Graft, or CABG (pronounced "cabbage").

You will receive anesthesia and be completely free from pain. Then the heart surgeon makes a surgical cut in the middle of the chest and separates the breastbone.

Through this cut, the surgeon can see the heart and aorta (the main blood vessel leading from the heart to the rest of the body). After surgery, the breastbone will be rejoined with wire and the opening will be sewn closed.

ARTERY AND VEIN GRAFTS

If the saphenous vein in the leg is to be used for the bypass, an incision is made in the leg and the vein is removed. The vein is located on the inside of the leg. It runs from the ankle to the groin.

The saphenous vein normally does only about 10% of the work of circulating blood from the leg back to the heart. Therefore, it can be taken out without harming you or or the leg.

The internal mammary artery (IMA) can also be used as the graft. This has the advantage of staying open for many more years than the vein grafts, but there are some situations in which it cannot be used.

The left IMA, or LIMA, is an artery that runs next to the sternum on the inside of the chest wall. It can be disconnected from the chest wall without affecting the blood supply to the chest. It is commonly connected to the artery on the heart that supplies most of the muscle.

Other arteries are also now being used in bypass surgery. The most common of these is the radial artery. This is one of the two arteries that supply the hand with blood. It can usually be removed from the arm without affecting the blood supply to the hand.

TRADITIONAL APPROACH

In the traditional surgery, you are connected to the heart-lung machine, or bypass pump. This machine adds oxygen to the blood and circulates blood during the surgery. This is necessary because the heart muscle must be stopped before the graft can be done.

One end of the graft is stitched to an opening below the blockage in the coronary artery. If the grafted vessel is the saphenous vein or the radial artery, its other end is stitched to an opening made in the aorta. If the grafted vessel is the mammary artery, its other end is already connected to the aorta.

The entire surgery can take 4-6 hours. After the surgery, you will be taken to the Intensive Care Unit. For a few days after the surgery, you will be connected to monitors and tubes.

OTHER TECHNIQUES

Other surgical techniques for this procedure are being used more frequently. One popular method is to avoid the use of the heart-lung machine. This is called off-pump coronary artery bypass or OPCAB. This operation allows the bypass to be created while the heart is still beating.

The advantage is that use of the heart-lung machine can lead to some loss of memory and mental clarity. With OPCAB, that risk is reduced because the heart isn't stopped, and oxygen isn't added to the blood outside the body.

Another alternative is the use of smaller incisions that avoid splitting the breastbone. This is referred to as Minimally Invasive Direct Coronary Artery Bypass or MIDCAB.

Coronary bypass surgery can now be performed with the aid of a robot. This robot allows the surgeon to perform the operation without being in the same room as the patient.

Indications

Coronary artery bypass surgery is a treatment option for ischemic heart disease (too little blood reaching the heart muscle). Coronary surgery is recommended for:

Disease of the left main coronary artery
Disease of three or more vessels (triple vessel disease)
Cases in which nonsurgical management (medication or angioplasty) hasn't worked

The earliest symptoms of ischemic heart disease include chest pain (angina) and shortness of breath. You may have no symptoms; mild, intermittent chest pain; or more pronounced and steady pain. Some people have CAD that is severe enough to make everyday activities difficult.

Symptoms that usually bring a person to a doctor are a feeling of heaviness, tightness, pain, burning, pressure, or squeezing. This is usually behind the breastbone, but sometimes it is also in the arms, neck, or jaw. Some people have heart attacks without ever having any of these symptoms first.

In cases where there are no symptoms, a doctor may suspect CAD and perform a stress test to determine if it is present. CAD is sometimes suspected if there is a family history of heart disease and a combination of other factors, including:

Cigarette smoking
Diabetes
High blood cholesterol
High blood pressure
Male gender

Because CAD varies so much from one person to another, the way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment.

Risks

When considering the risks of CABG, it is important to remember that bypass surgery has been performed for more than 30 years. It is the most frequently performed major surgery in the United States. Cardiovascular surgeons have received extensive training in bypass techniques.

As with any surgery, your health before surgery is a major consideration in determining your risks. Health conditions that should be considered before surgery are:

Age -- patients over 70 are at a slightly higher risk for complications
Gender -- women have a slightly higher risk
Having another serious medical condition (such as diabetes, peripheral vascular disease, kidney disease, or lung disease)
Previous heart surgery -- puts a person at a higher risk

Possible risks in having CABG are:

Blood clots
Death (very small risk)
Heart attack
Sternal wound infection (this complication most often occurs with obesity, diabetes, or having had previous CABG)
Stroke (the risk is greatest in those over 70)

About a third of patients have "post-pericardiotomy syndrome" a few days to 6 months after surgery. The symptoms of this syndrome are fever and chest pain. It can be treated with medication.

The surgery site in the chest or the graft site (if the graft was from the leg or arm) can be itchy, sore, numb, or bruised.

Some people report memory loss and loss of mental clarity or "fuzzy thinking" after CABG.

As with all surgeries, there is a risk for heavy bleeding. In case you need a transfusion during or after surgery, ask your doctor about banking your own blood beforehand. You may also have family or friends with a compatible blood type donate blood for your surgery. The hospital, Red Cross, or local blood bank can provide family members and friends with necessary information about blood donation for your surgery.

There are general risks from anesthesia. These include reactions to medications and problems breathing.

Expectations after surgery

In most people who have heart bypass surgery, the grafts remain open and functioning for 10 to 15 years.

CABG will improve blood flow to the heart but NOT prevent the coronary blockage from returning. Lifestyle changes are necessary:

Don't smoke
Eat a healthy diet
Get regular exercise
Treat high blood pressure and high cholesterol

Convalescence

After the operation, you will spend 5 - 7 days in the hospital. You'll spend the first 2 hours in an intensive-care unit (ICU). In the ICU, heart function is monitored continuously.

You may need the temporary assistance of a breathing tube for a few hours after surgery. Two to three tubes in the chest drain fluid from around the heart and are usually removed 1 - 3 days after surgery.

A urinary catheter in the bladder drains urine until you are able to void on your own. Intravenous lines (IV) provide fluids and medications. Nurses watch the monitors and check vital signs (pulse, temperature, breathing) constantly.

When constant monitoring is no longer needed, usually within 12 - 24 hours, you will be moved to a regular or a transitional care unit. You can gradually resume activity. You may begin a cardiac rehabilitation program within a few days. The incision in the chest does not bother most people after the first 48 - 72 hours.

After surgery, it takes 4 - 6 weeks to start feeling better. During recovery it is normal to:

Have a poor appetite -- it will take several weeks for it to return.
Have swelling in the leg if the graft was taken from the leg. Raising the leg and wearing elastic TED hose for several weeks helps reduce swelling.
Have difficulty sleeping at night -- this will improve.
Have constipation.
Have mood swings and feel depressed -- this will get better.
Have difficulty with short-term memory or feel confused -- this also improves.

The full benefits from the operation may not be determined until 3 - 6 months after surgery. You may resume sexual activities 4 weeks after surgery. All activities that do not cause fatigue are permitted. Your doctor will help you determine the schedule for resuming normal activities.

References

Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl J Med. 2008;358:331-341.

Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, et al. 2007 Focused Update of teh ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2008;117:296-329.

Review Date: 5/15/2008

Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

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Congenital heart defect corrective surgery

admin — Thu, 04 Sep 2008 19:02:27 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Surgery to correct or treat birth defects of the heart (congenital heart disease) is required if the defects threaten the child's well-being or life.

Alternative Names

Congenital heart surgery; Patent ductus arteriosus ligation; Hypoplastic left heart repair; Tetralogy of Fallot repair; Coarctation of the aorta repair; Heart surgery for children; Atrial septal defect repair; Ventricular septal defect repair; Truncus arteriosus repair; Total anomalous pulmonary artery correction; Transposition of great vessels repair; Tricuspid atresia repair; VSD repair; ASD repair; PDA ligation

Description

Heart defects come in all types, from minor to major. Defects can occur inside the heart or in the large blood vessels outside the heart. The heart defect may need immediate surgery or may be able to safely wait for months or years. In most cases, the timing of the surgery will depend on how sick the baby is.

The heart defect may be repaired in a single surgical procedure or may require a series of procedures. Surgery may involve opening the heart to repair defects or repairing defects of the blood vessels.

An incision may be made through the breastbone (sternum) and between the lungs (mediastinum) while the child is under general anesthesia. For some heart defect repairs, the incision is made on the side of the chest, between the ribs (thoracotomy), instead of through the breastbone (sternotomy).

It is sometimes necessary to use tubes to re-route the blood through a special pump (heart-lung bypass machine) that adds oxygen to the blood and keeps it warm and moving through the rest of the body while the repair is being done. This machine does the work of the heart and lungs during the operation.

Heart surgery for children requires a specialized team of health care providers:

Pediatric heart (cardiovascular) surgeons
Pediatric cardiologists and echocardiographers
Pediatric anesthesiologists
Pediatric heart-lung (cardiopulmonary) bypass pump technologists
Pediatric surgical nurses and technicians
Pediatric intensive care physicians and nurses

Heart surgery requires intensive and extensive monitoring, treatment and coordination by the entire team. Heart surgery for children may take as many as 12 hours in the operating room.

After heart surgery, the child will be moved to the intensive care unit (ICU) to be constantly and closely monitored and treated for several days. During this time the child will have the following:

A tube in the airway (endotracheal tube) and a respirator to help with breathing. The child will be kept sleeping (sedated) while on the respirator.
One or more small tubes in a vein (IV line) to give fluids and medications.
A small tube in an artery (arterial line) to measure the blood pressure.
One or two chest tubes to drain air, blood, and fluid from the chest cavity.
A tube through the nose into the stomach (nasogastric tube) to empty the stomach and give medications and feedings for several days.
A tube in the bladder to drain and measure the urine for several days.
Many electrical lines and tubes used to monitor the patient.

The child may also have pacemaker wires in the chest in case a pacemaker is needed to regulate heartbeat and rhythm.

SPECIFIC HEART DEFECT SURGERIES INCLUDE:

Patent ductus arteriosus (PDA) ligation

Before birth, there is a natural blood vessel between the aorta (the main artery to the body) and the pulmonary artery (the main artery to the lungs) called the ductus arteriosus. This opening usually closes shortly after birth. A PDA occurs when this opening fails to close.
PDA is often treated initially with a medication called indomethacin. If the ductus arteriosus fails to close on its own or with indomethacin, surgery is performed. A small incision is made on the left side of the chest. The ductus arteriosus is either ligated (tied off) or divided and cut. A minimally invasive technique is available. In this procedure, the surgeon inserts a few small tubes into the chest to close the PDA.

Coarctation of the aorta repair

Coarctation of the aorta occurs when a segment of the aorta has a very narrow spot, like that in an hourglass. To repair this defect, an incision generally is made on the left side of the chest, between the ribs.
A few different techniques can be used in this repair. One approach is to remove the narrowed segment of the aorta and stitch the remaining ends together. This can usually be done in older children due to the size of the aorta.
Another approach is called a subclavian flap. An incision is made in the narrowed portion of the aorta. A patch is made from a portion of the left subclavian artery (the artery to the arm) to enlarge the diameter of the aorta.
In the third and most common approach, the surgeon cuts the narrowed region and uses a Gor-tex patch to enlarge the area.
In the fourth approach, the surgeon places a tube between the areas before and after the narrowing in the aorta, allowing blood to bypass the narrowed segment.

Atrial septal defect (ASD) repair

The atrial septum is the wall between the left and right atria (upper chambers) of the heart. There is a natural opening prior to birth that usually closes spontaneously. When the defect fails to close, a child is left with an ASD.
ASDs can be closed in the heart catheterization lab with two small umbrella-shaped "clamshell" devices placed on both the right and left side of the septum. The two devices are attached together, closing the hole in the heart. This procedure is performed only in select centers and can only be done on certain types of ASDs.
Surgical repair is a well-accepted treatment for ASD. The septum is closed using sutures or covered with a patch made of membrane or synthetic material.

Ventricular septal defect (VSD) repair

The ventricular septum is the wall between the left and right ventricles (lower chambers) of the heart. A hole in the ventricular septum is called a VSD.
Depending on the location of the lesion, small defects usually close on their own -- 90% by age 8 -- and do not require surgery. Larger defects, small defects in some part of the ventricular septum, or those causing heart failure or endocarditis require surgical repair with a synthetic patch.
Some VSDs may be closed using cardiac catheterization.

Tetralogy of Fallot repair

Tetralogy of Fallot is a complex congenital heart defect with a range of severity that requires surgical correction, typically between 6 months and 2 years of age.
Types of repairs vary related to the specific defects. The ventricular septal defect is closed as described above. The pulmonary valve is opened and the thickened muscle (stenosis) is removed. A patch may be placed on the right ventricle and main pulmonary artery to improve circulation to the lungs.

Transposition of the great vessels repair

The aorta normally comes from the left side of the heart, and the pulmonary artery normally comes from the right side. Transposition of the great vessels occurs when these arteries come from the opposite sides of the heart from where they should.
Transposition of the great vessels requires surgical correction. If possible, this surgery is performed shortly after birth. The most common repair is an arterial switch. The aorta and pulmonary artery are divided. The pulmonary artery is connected to the right ventricle, where it belongs, and the aorta and coronary arteries are connected to the left ventricle, where it belongs.

Truncus arteriosus repair

Truncus arteriosus is a rare condition that occurs when the aorta, coronary arteries, and the pulmonary artery arise from one common trunk. This very complex defect requires a complex surgical repair.
Repair is generally done in the first few days or weeks of life. The pulmonary arteries are separated from the aortic trunk and any defects are patched. There is usually an associated VSD, which is patched. A conduit is then placed between the right ventricle and the pulmonary arteries.

Tricuspid atresia repair

Tricuspid atresia is a condition in which the tricuspid valve (the valve between the upper and lower chambers on the right side of the heart) is missing. Blood must cross an ASD, VSD, or a PDA to get to the lungs. This condition severely restricts blood flow to the lungs.
Other defects may exist with tricuspid atresia and can aid in the oxygenation of blood and flow to the lungs. A medication called prostaglandin E may be given to maintain a patent ductus arteriosus as an alternate channel to the lungs until corrective surgery can be performed.
A series of shunts and surgeries may be necessary to correct this defect. The goal of this surgery is to allow blood from the body to flow into the lungs, and blood from the lungs to be pumped to the rest of the body through the left ventricle.

Total anomalous pulmonary venous return (TAPVR) correction

TAPVR is a condition in which the pulmonary veins bring oxygenated blood from the lungs back to the right side of the heart, rather than to the left side of the heart, where it should be.
This condition requires surgical correction, the timing of which depends on how sick the baby is. The surgery may be done in the newborn period if the infant has severe symptoms. If not done immediately, it is done in the first six months of life.
TAPVR repair is an open-heart procedure. The pulmonary veins are attached to the left atrium, where they belong, and any abnormal connections are closed.
If a PDA is present, it is tied off and divided.

Hypoplastic left heart repair

This is a very severe heart defect that results from a severely underdeveloped left heart and causes death in most affected babies if not treated. Operations to treat this defect are performed at specialized centers with excellent success rates.
The best reported results are with a series of three heart operations. The first operation is done in the first week of life. This is a complicated surgery in which a single vessel is formed from the pulmonary artery and aorta to create a blood supply to the lungs and the body.
At about 4-6 months of age, the second operation is performed. A third operation is required a year later.
A heart transplant may be performed to treat this condition, but donor hearts for infants are rare and the procedure can only be performed at a small number of centers.

Indications

The type and timing of surgical repair depends on the child's condition and the type and severity of heart defects.

In general, symptoms that indicate that surgery is needed include the following:

Blue or gray skin, lips, and nail beds (cyanosis), meaning there is not enough oxygen in the blood (hypoxia)
Difficulty breathing because the lungs are "wet," congested, or fluid-filled (congestive heart failure)
Problems with heart rate or rhythm (arrhythmias)
Excessive workload on heart that interferes with breathing, feeding, or sleeping

Risks

Risks for any anesthesia include the following:

Reactions to medications
Problems breathing

Risks for any surgery include the following:

Bleeding
Infection

Additional risks of heart surgery include the following:

Blood clots (thrombi)
Air bubbles (air emboli)
Pneumonia
Heartbeat problems (arrhythmias)
Heart attack
Stroke

Expectations after surgery

The outcome of heart surgery depends on the child's condition, the type of defect, and the type of surgery. Many children recover completely and lead normal, active lives.

Convalescence

Most children need to stay in the intensive care unit (ICU) for 2 - 4 days and then stay in the hospital for 5 - 7 more days. By the time the child is transferred out of the ICU, most of the tubes and wires have been removed and the child is encouraged to resume many of his daily activities.

At the time of discharge, parents are instructed on activity, how to care for the incision, and how to give medications their child may need.

The child needs at least several more weeks at home to recover.

References

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. St. Louis, Mo; WB Saunders; 2007.

Review Date: 12/10/2007

Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; and Mark A Fogel, MD, FACC, FAAP, Associate Professor of Pediatrics and Radiology, Director of Cardiac MR, The Children's Hospital of Philadelphia.

A.D.A.M. Copyright

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Source Doc: 1_002948

Minimally invasive heart surgery

admin — Thu, 04 Sep 2008 19:18:53 -0700

Overview

Definition
Alternative Names
Description
Indications
Risks
Convalescence
References

Illustrations

Heart, front view

Posterior heart arteries

Anterior heart arteries

Coronary artery stent

Heart bypass surgery - series

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Minimally invasive heart surgery refers to several approaches for bypassing blocked arteries. The minimally invasive procedures are less difficult and risky than conventional open heart surgery such as coronary artery bypass grafting (CABG).

The minimally invasive procedures restore healthy blood flow to the heart without having to stop the heart and put the patient on a heart-lung machine during surgery.

Currently, there are three types of these procedures:

Minimally Invasive Direct Coronary Bypass (MIDCAB)
Off-Pump Coronary Artery Bypass (OPCAB)
Robotic Assisted Coronary Artery Bypass (RACAB)

Patients who have one of these procedures instead of open heart surgery have a lower risk of complications associated with the heart-lung machine, such as stroke, lung problems, kidney problems, and problems with mental clarity and memory. Other benefits are faster recovery and reduced hospital costs.

Alternative Names

Minimally invasive direct coronary artery bypass; MIDCAB; Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery

Description

MINIMALLY INVASIVE DIRECT CORONARY BYPASS (MIDCAB)

This procedure is for patients with a blockage or blockages in the arteries on the front of the heart. (The left anterior descending (LAD) artery and its branches.)

It allows the surgeon to perform bypass surgery without splitting the breastbone. A cut is still made on the patient's left chest to expose the heart. But unlike conventional open heart surgery, the cut is much smaller.

Muscles in the area are pushed apart. A small part of the front of the rib (costal cartilage) is removed. Then the surgeon temporarily closes off the artery that lies underneath and frees its lower end. An opening is made in the pericardium, the covering of the heart.

A device is attached to the heart to reduce its movement. Finally, the surgeon connects the artery below the blockage to the LAD artery or one of its branches. Once the other artery under the costal cartilage is reopened, blood flow bypasses the blockage and feeds the heart. A heart-lung machine is not required.

This procedure offers the benefits of conventional open heart surgery but with less traumatic injury. The recovery may be closer to that experienced by angioplasty patients. However, the procedure is limited to those patients who need just one or two bypasses.

OFF-PUMP CORONARY ARTERY BYPASS (OPCAB)

During this procedure, the surgeon must cut open the chest and split the breastbone. A heart-lung machine is not used, however.

An artery or vein is taken from one of the legs and used to make the bypass. Like the MIDCAB procedure, a device is used to restrict movement of parts of the heart so that the surgeon can operate on it while it is still beating. The surgeon can repair four to five vessels on the beating heart during the same procedure.

The use of OPCAB has grown significantly because of its advantages over other procedures. Compared with patients undergoing conventional heart bypass surgery, those undergoing OPCAB:

Have a shorter stay in the hospital after surgery
May be able to return to normal activities more rapidly
May have a decreased risk of stroke
Require fewer blood transfusions

MIDCAB and OPCAB surgeries both take approximately 3 - 4 hours.

ROBOTIC ASSISTED CORONARY ARTERY BYPASS (RACAB)

RACAB is the latest advance in heart surgery. Surgeons use a robot to perform the bypass. The breastbone does not need to be split open at all.

Surgeons do not have direct contact with the patient. They perform the operation while watching a video screen. As the technology becomes more advanced, the surgeon may perform coronary artery bypass from a distant site (that is, from another room or another geographical location).

Indications

Due to the limited size of the MIDCAB cut, only certain patients are eligible for the procedure:

1. Patients who have a blockage in one or two coronary arteries on the front side of the heart, but are considered too high-risk for conventional bypass surgery or balloon angioplasty.

2. Patients who are otherwise healthy but have a blockage in one or two coronary arteries located on the front side of the heart.

In general, every patient with coronary artery disease is a candidate for OPCAB. However, it may be better to use the traditional CABG technique for:

Those who have small coronary arteries and need several bypasses
Those whose heart will not tolerate being worked on during the procedure
Younger patients

Currently, the following patients with coronary artery disease are potential candidates for OPCAB:

1. Patients with poor heart function (very low ejection fraction).

2. Patients with severe lung disease (chronic obstructive pulmonary disease (COPD) and emphysema).

3. Patients with acute or chronic kidney disease.

4. Patients at high risk for stroke.

5. Patients with a calcified aorta.

Risks

Performing surgery on a beating heart (for both MIDCAB and OPCAB procedures) is technically more difficult than working on a heart that has been stopped with the help of the heart-lung machine. In addition, the stress on the heart during the procedure may lead to:

Brain injury if blood flow to the brain is reduced for too long during surgery
Irregular heartbeat
Lower blood pressure
More heart muscle damage

In some cases (usually less than 10%), it is necessary to switch to conventional CABG methods on an emergency basis.

Convalescence

MIDCAB and OPCAB patients typically spend one day in the surgical intensive care unit. Then they move to a regular surgery unit, where they receive cardiac rehabilitation.

The average hospital stay is 3 days for MIDCAB patients and 5-7 days for OPCAB patients. In contrast, a hospital stay of 6-10 days is typical for conventional CABG patients.

Patients who have had MIDCAB have lower chest wound infection rates than patients who have undergone CABG or OPCAB. A smaller incision means less exposure and handling of tissue, which reduces the chance of infection.

MIDCAB patients recover more quickly than those who undergo CABG or OPCAB. Within 2 weeks, most MIDCAB patients can return to their normal activity level, compared with 2-3 months for patients who have had conventional surgery.

OPCAB patients have a recovery similar to that of CABG patients. Most are able to return to full activity, including work, 2-3 months after the operation.

References

Aziz O, Rao C, Panesar SS, Jones C, Morris S, Darzi A, et al. Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery. BMJ. 2007;334:617.

A.D.A.M. Copyright

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Source Doc: 1_007012

Cosmetic nose surgery

admin — Thu, 04 Sep 2008 19:03:05 -0700

Overview

Definition
Alternative Names
Description
Indications
Risks
Expectations after surgery
Convalescence

Illustrations

Septoplasty - series

Nose surgery - series

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Rhinoplasty is surgery to repair or reshape the nose. See also septoplasty (nasal septum repair).

Alternative Names

Rhinoplasty

Description

Rhinoplasty is one of the most common of all plastic surgery procedures. It can be used to:

Reduce or increase the size of the nose
Change the shape of the tip or the nasal bridge
Narrow the opening of the nostrils
Change the angle between the nose and the upper lip
Correct a birth defect or injury
Help relieve some breathing problems

Rhinoplasty can be performed under local or general anesthesia, depending on the extent of the procedure and the patient's preference. It may be performed in a surgeon's office-based facility, a hospital, or an outpatient surgery center. Complex procedures may require a short inpatient stay. The procedure usually takes an hour or two, but may take longer.

With local anesthesia, the nose and the surrounding area is numbed. The patient will usually be lightly sedated, but awake during the surgery -- relaxed and insensitive to pain. General anesthesia allows the patient to sleep through the operation, and is typically used in children.

The surgery is usually done through the incision inside the nostrils.

Indications

Nose surgery is considered "elective" when it is done for purely cosmetic purposes. In these cases, the purpose is to change the shape of the nose to one that the patient finds more desirable. Age may be a consideration. Many surgeons prefer not to perform cosmetic nose surgery until the growth of the nasal bone is completed (around 14 or 15 for girls, a bit later for boys).

In other cases, nose surgery may be needed for medical purposes. For example, surgery may be needed to treat a serious breathing problem or an injury. Age may be less of a factor.

Risks

The risks for any anesthesia are:

Reactions to medications
Problems breathing

The risks for any surgery are:

Bleeding
Infection
Bruising

After surgery, small burst blood vessels may occasionally appear as tiny red spots on the skin's surface and are usually minor, but permanent. There is no visible scarring if the rhinoplasty is performed from inside the nose. There may be small scars at the base of the nose that are not usually visible when the procedure calls for the narrowing of flared nostrils.

Rarely, a second procedure may be necessary to correct a minor deformity.

Expectations after surgery

A splint (metal or plastic) will be applied externally to maintain the newly shaped bony structure when the surgery is complete. Soft plastic splints or nasal packs may also be placed within the nostrils to stabilize the septum (the dividing wall between the air passages).

Immediately following surgery, the nose and face will be swollen and painful. Headaches are common. Pain medications will control these discomforts.

Swelling and bruising around the eyes will increase and reach a peak after 2 or 3 days. Keeping the head raised (elevated) and placing cold compresses to the eyes can help reduce the swelling. Within 2 weeks, most of the swelling and bruising disappears. Some subtle swelling remains for several months, but this is generally unnoticeable to anyone but the patient.

During the first few days, minor bleeding from the nose is common. Do not blow the nose, pick the nose, or insert items into the nose for the first week while tissues heal.

The nasal packing is usually removed after 3 to 5 days and the patient will feel much more comfortable. All dressings, splints, and stitches should be removed within 1 or 2 weeks.

Convalescence

Within 2 days, most patients are up and about, and able to return to school or non-strenuous work within about a week following surgery. Full recovery takes several weeks.

Avoid strenuous activity (jogging, swimming, bending -- any activity that increases blood pressure) for 2 to 3 weeks. Avoid rubbing or bumping the nose. Avoid unprotected sun exposure, especially for the first 8 weeks. Be gentle when washing the face and hair or using cosmetics.

Glasses will have to be taped to the forehead or propped on the cheeks for 4 to 6 weeks after the splint is removed and the nose is completely healed.

The patient may feel depressed following surgery, but day by day the nose will look better. Within a week or two, cosmetics will camouflage signs of the operation. Healing is a slow and gradual process. The tip of the nose may have subtle swelling and numbness for months. The final results may not be apparent for up to a year.

The patient might experience some unexpected reactions from family and friends. They may act resentful, especially if something they view as a family or ethnic trait is altered. The patient should keep in mind the reasons for the nasal correction, and if these have been reached, then the surgery is a success.

Review Date: 1/18/2007

Reviewed By: Melvin Sidney Dassinger, III, MD, Department of Surgery, University of Tennessee, Memphis, TN. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_002983

Open heart surgery

admin — Thu, 04 Sep 2008 19:02:29 -0700

Overview

Definition
Alternative Names
Description

Illustrations

Heart valve surgery - series

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Open heart surgery is any surgery where the chest is opened and surgery is performed on the heart. The term "open" refers to the chest, not the heart itself. The heart may or may not be opened, depending on the type of surgery.

The definition of open heart surgery becomes confusing in light of new procedures being performed on the heart through smaller incisions. There are some new surgical procedures being performed that are done with the heart still beating.

Minimally invasive heart surgery (MIDCAB, OPCAB, RACAB), including robotic-assisted heart surgery, is still considered open heart surgery. However, these procedures are being used in some patients as an alternative to open heart surgery requiring the heart-lung machine.

Alternative Names

Heart surgery - open

Description

Open heart surgery includes surgery on the heart muscle, valves, arteries, or other structures.

A heart-lung machine (also called cardiopulmonary bypass) is usually used during conventional open heart surgery. It helps provide oxygen-rich blood to the brain and other vital organs. The machine also:

Provides anesthesia to keep the patient asleep during surgery
Pumps
Removes carbon dioxide from the blood
Supplies oxygen

A.D.A.M. Copyright

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Source Doc: 1_002950