Cardiac Surgery and Neurosurgery

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Chapter 11 : Cardiac Surgery and Neurosurgery

Cardiac Surgery arrow_upward

  • Cardiovascular Surgery is a surgery on the heart and/or great vessels performed by the cardiac surgeons.
  • The most common type of the heart surgery for adults includes:
    • Major Heart Surgeries include:
    • Coronary Artery Bypass Grafting (CABG).
    • Heart Transplant Surgery.
    • Minimal Invasive Surgeries include:
    • Angioplasty.
    • Minimal Invasive Heart Valve Surgery.

    Coronary Artery Bypass Grafting (CABG) arrow_upward

  • CABG is a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to improve normal blood flow to the heart.
  • Coronary heart disease (CHD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.
  • 1: Internal mammary artery graft (artery relocated from chest wall)

    2: Vein graft (Vein removed from the leg) is stitched to the aorta and coronary artery

    3: Coronary arteries

    4: Artery graft is stitched to the coronary artery

    5: Blockage in coronary artery


  • The goals of the procedure are:
    • To relieve symptoms of Coronary Artery Disease.
    • Enable the patient to resume a normal lifestyle.
    • To reduce the risk of heart attack or other heart problems.


  • During bypass surgery a long length of an artery may be detached from the chest wall or one of the arms and/or a leg vein may be removed.
  • One end is sewn onto the large artery arising from the heart while its other end is attached to the coronary artery below the blocked area.
  • Using the newly attached conduit, blood can again flows freely to the heart muscle beyond the blockage.

  • Heart Transplant Surgery arrow_upward

  • Heart Transplant is a procedure in which a surgeon removes a diseased heart and replaces it with a donor heart.
  • Heart transplants are done as a life-saving measure for end-stage heart failure when medical treatment and less drastic surgery have been failed.

  • Surgery

  • The surgery involves:
    • A major incision down the front of the chest.
    • Main coronary arteries are connected to a heart lung bypass machine to put oxygen into your blood and pump it. On the other end it is connected to ventilator.
    • Most heart transplants are done with the method called orthotropic surgery, where:
    • Most of the heart is removed but the back half of both upper chambers called atria are left in place.
    • Then the front half of the donor heart is sewn to the back half of the old heart.
    • The donor's aorta and pulmonary arteries are connected to the patient.
    • Incisions are closed.

    Angioplasty arrow_upward

  • Angioplasty is a procedure that widens a narrow or obstructed blood vessel using a balloon catheter.
  • Angioplasty can restore a blood flow to the heart if the coronary arteries have become narrowed or blocked because of CHD.

  • Objective

  • Angioplasty is a common medical procedure.
  • It may be used to:
    • Improve symptoms of CHD (Coronary Heart Disease), such as shortness of breath.
    • Reduce heart muscle damages caused by heart attack.
    • Reduce the risk of death in some patients.


  • Angioplasty includes:
    • The patient is administered with general anesthesia.
    • The physician makes a small incision in the area.
    • Under the guidance of X-ray monitor, the catheter is inserted through the incision until it reaches the blocked artery.
    • Contrast dye is injected into the body through the catheter.
    • Once, the narrowed arteries are identified, a guide wire followed by a balloon catheter is introduced gently through the cut skin.
    • As balloon catheter is placed in the blocked artery, it is inflated for a few seconds.
    • Inflation of the balloon may be practiced repeatedly by referring the X-ray monitor.
    • After the completion of angioplasty, the physician may conduct imaging tests to check for the blood flow.
    • If blood circulation to the heart is improved, the physician removes the catheter, balloon catheter and guide wire.
    • Proper dressing of the incision is done to avoid any infection.

    Minimal Invasive Heart Valve Surgery arrow_upward

  • Minimal Invasive Heart Valve Surgery is a procedure used to repair or replace diseased heart valves using small incisions.
  • Repair means that the valve is mended to help it to work better.
  • Replacement means the diseased valve is removed and a new valve is inserted in its place.
  • Both valve repair and replacement surgeries are performed by making a three to four inch incision in the sternum or on the side of the chest.

  • Neurosurgery arrow_upward

  • Neurosurgery is a specialty which deals with the treatment of diseases of the nervous system.
  • Treatment of Neurosurgery involves:
    • Traumatic Brain Injury.
    • Brain Tumors.

    Traumatic Brain Injury arrow_upward

  • Traumatic brain injury is a serious condition in which the brain is damaged by a sudden injury.
  • Traumatic brain injury (TBI) is a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical and psychosocial functions.

  • Symptoms of TBI

  • Common symptoms related to TBI:
    • Blurred or double vision.
    • Dizziness.
    • Headache.
    • Impaired balance and coordination.
    • Lightheadedness.
    • Nausea with or without vomiting.
    • Sleep disorders
  • Serious symptoms that might indicate a life-threatening condition includes:
    • Change in level of consciousness or alertness.
    • Change in mental status or sudden behavior change.
    • Garbled or slurred speech or inability to speak.
    • Loss of muscle coordination.
    • Paralysis.
    • Seizures.
    • Severe headache.
    • Sudden change in vision, loss of vision, or eye pain.


  • Because traumatic brain injuries can be life threatening, the treatment of traumatic brain injuries aims to stabilize the injury and prevent further damage.
  • Decompressive Craniectomy is a neurosurgical procedure which performed on victims of traumatic brain injury and stroke.

  • Decompressive Craniectomy arrow_upward

  • Decompressive Craniectomy is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed.
  • Decompressive Craniectomy is usually done to treat intracranial hypertension due to traumatic brain injury.
  • Craniectomy is also used to:
    • Remove tumors at the rear of the brain.
    • Relieve brain swelling.


  • Surgery involves the following steps:
    • Craniectomy is done in the operating room under general anesthesia.
    • An incision is made in the scalp above the location of the condition to be treated.
    • Since the scalp is well supplied with blood, the surgeon will have to seal many small arteries.
    • The surgeon makes a circle of holes in the skull after which a soft metal guide is pushed under the bone from one hole to the next.
    • A fine wire saw is then moved along the guide channel under the bone between adjacent holes.
    • The surgeon saws through the bone until the bone flap can be removed to expose the brain.
    • After the surgery, the piece of skull is replaced and secured with pieces of fine, soft wire.
    • Finally, the surgeon sutures the membrane, muscle, and skin of the scalp.

    Brain Tumors arrow_upward

  • A brain Tumor is an abnormal growth of the cells within the brain which can be cancerous or non-cancerous (benign).
  • The brain cells transforms and grows abnormally consuming the nutrients and blood.

  • Symptoms of Brain Tumor

  • The symptoms of brain tumors depend on the tumor size, type, and location.
  • Most common symptoms of brain tumors include:
    • Headaches.
    • Nausea or vomiting.
    • Changes in speech, vision, or hearing.
    • Balance and walking problems.
    • Changes in mood, personality, or ability to concentrate.
    • Problems with memory.
    • Jerking or twitching of muscles.
    • Numbness or tingling in the arms or legs.


  • The treatment of brain cancer involves:
  • ┬áSurgery:
    • Radiation Therapy.
    • Chemotherapy.
    • Craniotomy.
  • Surgery is often necessary for primary brain tumors.
  • Radiation therapy is used when surgery is not possible.
  • Chemotherapy may be used along with the surgery or radiation treatment.
  • A Craniotomy is a type of brain surgery which is the most commonly performed for brain tumor removal.

  • Craniotomy arrow_upward

  • A Craniotomy is the surgical removal of a section of bone (bone flap) from the skull for the purpose of operating on the underlying tissues, usually the brain.
  • During this procedure, a section of skull called a bone flap is removed to access the brain underneath and is replaced after the procedure.

  • Surgery

  • Craniotomy includes following steps:
    • Surgery normally starts after a general anesthesia.
    • The first step is the shaving of the scalp.
    • During the surgery, the neurosurgeon makes an incision on the scalp and removes a piece of bone from the skull with the help of a special type of tool called the saw.
    • Neurosurgeon also removes the tumor parts from the skull and covers the opening with that bone which he had removed initially before the surgery.
    • Finally, the incision is closed.

    Thank You from Kimavi arrow_upward

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