Heart catheter
In the case of an acute heart attack, it is desirable that a cardiac catheter examination be performed on the affected person within the first 60 to 90 minutes after the heart attack. Primary percutaneous coronary intervention (PCI) is not only helpful in making a diagnosis, the catheter is also used immediately to treat the heart attack by making the blocked coronary arteries pass through again. After local anesthesia, a very thin plastic tube is pushed through an artery in the groin or arm towards the heart via a small puncture in the groin or arm.
A stent (small tube with a grid structure, usually made of metal) can be inserted into the vessel immediately with this catheter to prevent the vessel from closing again. At the tip of the catheter there is an inflatable balloon on which the stent is folded up tightly. As soon as the catheter has been advanced to the narrowed area of the coronary vessel, the balloon is inflated, thereby widening the narrowed area.
At the same time, the metal grid of the stent unfolds. Due to the pressure of the balloon, the stent is pressed against the vessel wall and remains there as a stabilizing element on the dilated vessel wall. In order to prevent the stent from being recognized as a foreign body by the organism, which could lead to a new arterial occlusion, stents are increasingly being used that continuously release drugs and deliver them into the blood (so-called “drug eluting stent”).
As a result, the risk of the stent expanded vessel sections growing again has fallen to below ten percent. The placement of a stent is successful in 95 percent of cases, and the probability of a renewed occlusion is particularly high within the first six months. In this case, however, a stent can usually be repositioned.
Bypass surgery
During a bypass operation, a bypass is installed for a blocked coronary vessel, so to speak. This is usually done using the body’s own blood vessels (for example from the lower leg). This is connected to the aorta and connected to the coronary artery behind the narrowing.
This allows the blood to flow past the congested area and supply the tissue behind it with nutrients again. A bypass operation is normally performed with the chest open. This means that a skin incision is made and then the bony chest is opened so that the surgeon can reach the heart.
The operation is often performed on the heart-lung machine. In this case, the machine can take over the pumping function of the heart for a certain time. The heart itself can be immobilized with medication for this time.
This makes an operation much easier and increases the accuracy. Without the heart-lung machine, the bypass is first attached to the affected coronary vessel. Then the aorta of the body is partially closed with a clamp.
In this way, the bypass can be connected to the aorta without blood swelling out of the hole with every heartbeat. After the vessel has been successfully sewn on, the clamp is removed again. Depending on the surgical technique, the bypass operation takes three to eight hours. It is always performed under general anesthesia.
