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Invasive Procedures

The most invasive procedure is Open Heart Surgery.

If diet and exercise are not effective in treating heart disease, medication is usually prescribed. If the heart disease still persists in causing pain, an invasive procedure is usually performed. There are several types of procedures that may be used to improve blood supply to the heart.


To locate the arterial blockages, coronary arteriography (mapping of the coronary arteries) is done using a procedure called cardiac catheterization. A doctor guides a thin plastic tube (called a catheter) through an artery in the arm or leg and leads it into the coronary arteries. Then, the doctor injects a liquid dye through the catheter. The dye is visible in X-rays which record the course of the dye as it flows through the arteries. By mapping the dye's flow, the doctor identifies blocked areas. Once the mapping is done, the doctor can decide the best course of action.

One possibility is called percutaneous transluminal coronary angioplasty (PTCA), also known as angioplasty or balloon angioplasty. The doctor inserts and guides a catheter toward the blocked area of the artery. Then a second catheter with a small balloon on the tip is passed through the first catheter. Once the balloon tip reaches the blocked area, the balloon is inflated. This compresses the plaque build-up, widening the artery for blood flow. Finally, the balloon is deflated and removed.

Another possibility is a coronary artery bypass graft surgery. A surgeon takes a healthy blood vessel from another part of the body (usually the leg or inside the chest wall) and uses it to construct a detour around the blocked coronary artery. One end of the vessel is grafted (attached) right below the blockage while the other end is grafted right above the blockage. As a result, blood can flow to the heart muscle again. In a double bypass surgery, two grafts are performed. In a triple bypass, three grafts. In a quadruple, four grafts.

The most radical possibility is that a transplant of the heart or a part of the heart is needed. When a healthy person dies, their heart can still be used. The patient's diseased heart is removed and the healthy donor heart is then attached. The operation is complicated because so many blood vessels have to be detached and re-attached. While the operation is taking place, the patient is connected to a heart-lung machine that keeps their blood circulating. After the operation, there is still a risk that the patient's systems may reject the new heart. Tissue types have to be perfectly matched in order for the transplant to be successful. As a result, the number of transplants performed is quite low.

Many patients do not survive the wait for a donor heart. Medical scientists have developed an artificial heart that may be used to keep the patient alive for a short time until a donor heart becomes available. Scientists have also experimented with transplanting an animal heart into a human. In 1984, a twelve-day-old baby girl, known as Baby Fae, received the heart of a seven-month-old baboon. A team of medical scientists from Loma Linda University in California performed the operation. Although Baby Fae died twenty-one days later, the experiment provided valuable research information for the future.

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