Cardiothoracic Surgery

There are four major heart valves that control blood flow through the heart. If the valves become narrow (stenosis) so that blood flow through them becomes difficult, or leaky so that some blood flows in the wrong direction, they may need to be repaired or replaced. Valves may be damaged by diseases such as rheumatic fever or bacterial infection, degenerate with age or may not be formed properly at birth.

Heart valve surgery involves making a cut through the front of the chest and breastbone (sternotomy) to expose the heart. The heart is then stopped and its function taken over by a heart-lung machine. Part of the heart is then opened and the valve repaired or possibly replaced using a human donor valve, a valve from a pig or cow or an artificial valve. The heart is then restarted, the heart-lung machine disconnected and the breastbone closed with wires. The operation usually takes between three and five hours.

When the arteries that supply the heart with blood (coronary arteries) become blocked with fatty substances, surgery may be required to restore blood flow to the heart muscle.

Coronary Artery Bypass Surgery uses pieces of arteries from the arm or chest or from veins in the leg to create a detour around the blocked coronary artery.

The procedure involves making a cut through the front of the chest and breastbone (sternotomy) to expose the heart. The heart is then stopped and its function taken over by a heart-lung machine. Once the new blood vessels are in place, the heart is restarted, the heart-lung machine disconnected and the breastbone closed with wires. The operation usually takes between three and five hours.

An aneurysm is a weak, bulging area that can develop on the wall of a blood vessel particularly in the aorta, the large artery that carries blood from the heart for delivery to the rest of the body.

Once an aneurysm has been identified, surgery may be performed to avoid the danger of the aneurysm bursting.

Aortic aneurysm surgery involves either:

Open chest surgery in which the part of the aorta with the aneurysm is removed and replaced with an artificial graft or

Insertion of a stent graft (an artificial tube) at the site of the aneurysm so that blood can flow through the tube and bypass the aneurysm. This is a less invasive procedure and involves small cuts or incisions in the upper thigh.

Between the vertebrae in your spine are flat, round discs that act as shock absorbers for the spinal bones. Sometimes some of the gel-like substance in the center of the disc (nucleus) bulges out through the tough outer ring (annulus) and into the spinal canal. This is known as a herniated or ruptured disc and the pressure it puts on the spinal nerves often causes symptoms such as pain, numbness and tingling.

Initial treatment for a herniated disc may involve low level activity, nonsteroidal anti-inflammatory medication and physiotherapy. If these approaches fail to reduce or remove the pain, surgical treatment may be considered.

Discectomy

This surgery is performed to remove part or all of a herniated intervertebral disc.

Open discectomy – involves making an incision (cut) over the vertebra and stripping back the muscles to expose the herniated disc. The entire disc, or parts of it are removed, thus relieving pressure on the spinal nerves.

Microdiscectomy – this is a ‘minimally invasive’ surgical technique, meaning it requires smaller incisions and no muscle stripping is required. Tiny, specialised instruments are used to remove the disc or disc fragments.

Laminectomy or Laminotomy

These procedures involve making an incision down the centre of the back and removing some or all of the bony arch (lamina) of a vertebra.

In a laminectomy, all or most of the lamina is surgically removed while a laminotomy involves partial removal of the lamina.

By making more room in the spinal canal, these procedures reduce pressure on the spinal nerves. They also give the surgeon better access to the disc and other parts of the spine if further procedures e.g. discectomy, spinal fusion, are required.

Spinal fusion

In this procedure, individual vertebrae are fused together so that no movement can occur between the vertebrae and hence pain is reduced. Spinal fusion may be required for disc herniation in the cervical region of the spine as well as for some cases of vertebral fracture and to prevent pain-inducing movements.