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SURGICAL PICTURES

Coronary Artery Bypass Graft Surgery

The Coronary Artery Bypass Graft (CABG) involves bypassing major blocks in the blood vessels of the heart to improve the blood to the cardiac muscle (myocardium). The conduits used for bypass grafting can be veins taken from the legs or arterial conduits which include the mammary arteries from the chest wall, the radial artery from the forearm and an artery from near the stomach.

Though venous conduits are commonly used; arterial conduits are far superior as they last much longer providing relief to patients for many more years. At AHI more than 90% of all bypass operations are done using only arterial conduits on a beating heart, without use of the heart-lung machine. The fact that all coronary cases are done on the beating heart, and arterial conduits are used in 90% cases, means less complications and longer survival for patients.

 

Asian Heart Institute is the only center in India and one of the very few centres in the world to do such operations (beating heart surgery using total arterial graft).

 

The following pictures have been taken in our operating room and show various stages of the operation

In this picture the top end of the radial artery graft has been joined to the aorta to provide blood to the affected myocardium.

This picture shows the distal ends of the arterial grafts which are connected to the coronary arteries

This picture shows the distal coronary artery which has been opened for grafting. The size of the coronary artery in the average Indian patient varies between 1 to 2 mm in diameter.

The graft has been sutured to one of the blood vessels to provide adequate blood flow and thereby prevent a heart attack and / or anginal pain. The stitching is done with surgical sutures which are thinner than the human hair.

In advanced coronary disease almost the entire inner lining of the artery is thickened and hard. The plaques have to be removed before bypass grafting, a procedure called coronary edarterectomy.

 

Coronary Endarterectomy

 

The following two pictures show the endarterectomy specimen which resembles a plaster cast of the artery and its branches.

Endarterectomy 1: Atherosclerotic (fatty) deposits in the shape of coronary arteries, removed from within an artery (endarterectomy)

This is the end result of long standing coronary artery disease with the obstruction of the artery

Ventricular Aneurysm

Following a heart attack sometimes part of the muscle gets so badly damaged that it is replaced by hard rough fibrous tissue which does not contract and leads to formation of blood clots on its inner surface. These blood clots can dislodge and travel to the brain causing serious strokes and sometimes death.

Pieces of clot removed from the heart in the previous picture.

Following removal of clots and excision of aneurysm the normal muscle of the heart is stitched together.

Mitral Valve Surgery

A view of the diseased mitral valve at operation. The patient is on cardio pulmonary bypass (heart lung machine) and valve shows areas of infection on its leaflets.

Ascending Aortic Aneurysm Surgery

Ascending Aortic Aneurysm Surgery: Disease processes affecting the ascending aorta can result in fatal complications for the patient. The 2 most common conditions affecting the aorta are:

  • Dilation of the proximal aorta due to weakness in its wall structure. This dilatation can cause massive increase in the size of the aorta and leaking of the aortic valve.
  • Dissection of the Aorta: The aorta is the first organ which takes the full force of blood ejected from the heart. Sometimes this can result in a tear in the wall of the aorta thereby causing a dissection within the layers of the aorta.

Both these conditions are life threatening and require operation to deal with the aortic pathology and also with the leaking aortic valve. Treatment of these conditions require a very major operation to remove the diseased aorta and replace it with a synthetic graft. At the same time the valve can be repaired or replaced if needed. This operation is commonly done at AHI and in the last 45 patients that have been operated, all have survived. The accompanying pictures have been taken intra - operatively.

STAGE 1: Massively dilated and ballooned out aorta

STAGE 2: Aneurysm being replaced by synthetic graft.

The patient has been put on a heart - lung machine, the aorta has been opened and Dacron tube graft is being stitched to the root of the aorta.

The upper end of the tube graft is being stitched to the aorta.

STAGE 3: Graft being sutured to the heart.

STAGE 4: Showing the completed lower end of the graft.

FINAL STAGE 5: The completed operation with the graft in place

Hope is Healing, Healing is Happiness