Under what circumstances does coronary heart disease require coronary artery bypass?

Anatomically proven that the number of toxoplasmosis gondii in the cells of the heart muscle (including the coronary arteries) and in the cells of the conducting nerves in people infected with Toxoplasma gondii is second only to the brain. They alternate between parasitic and pathogenic activities, causing heart disease.

Acute toxoplasmosis heart disease, which can present with myocarditis, pericarditis-like symptoms. It can cause myocardial infarction. Massive myocardial infarction, on the other hand, can lead to death.

Chronic toxoplasmosis heart disease, which progresses slowly. It can be roughly divided into three stages.

1) Hyperactive stage, in which there are a small number of toxoplasma gondii in a small number of cardiomyocytes and conduction nerve cells. No (or a few) number of cells have been destroyed. Under the interference of Toxoplasma gondii, it manifests itself in an hyperactive state.

Hypermyocardium is often diagnosed with unknown causes. This stage of the patient is more common in the adolescent population. The cause of hypermyocardial hypermyocardium is also accompanied by hyperactivity of glands (such as the thyroid gland), which is generally overlooked.

Adaptable host hyperactivity is insignificant or short-lived.

2) Stabilization phase (i.e., compensation phase). At this stage, there are more cells with Toxoplasma gondii, and even some cells are destroyed by Toxoplasma gondii. Long-term interference by Toxoplasma gondii causes the body to adapt, and the hyperactivity disappears.

Due to the strong compensatory function of the body, the host does not feel the feeling of disease. However, under adverse conditions, when the workload of the heart increases, some pathological reactions will occur. It is often mistaken for external conditions.

Because of the good external conditions, the heart works back to normal. This period of time lasted for a long time, many decades.

3) Decline stage (i.e., coronary heart disease, cardiovascular syndrome stage). At this stage, the number of cardiomyocytes occupied by Toxoplasma gondii is quite large, and the number of occupied intracellular worms is also large, and the number of destroyed cardiomyocytes and nerve cells is also large, and the compensatory function reaches its limit. Symptoms of myocardial ischemia may occur.

Toxoplasma gondii destroys the blood vessel wall (especially the coronary artery) and the damaged tissue cells will repair themselves, form a scar after repair, and then be destroyed and repaired, and so on, after years of damage and accumulation, the blood vessel loses its original properties, and the tube wall becomes thicker and less elastic. At an advanced stage, comprehensive cardiovascular disease develops.

Therefore, Toxoplasma gondii is the main pathogen of cardiovascular disease.

First of all, the left main lesion should definitely be bypassed.

If there is no lesion in the left main trunk, it depends on the number of blood vessels in the lesion.

Generally, it is better to put stents on 1-2 vascular lesions, and it is better to bypass more than 2 blood vessels.

If there are too many stenosis, you need to open the chest cavity to take the blood vessels on your own leg and replace the narrowed blood vessels, which is much cheaper than putting stents.

After the danger period, it is best to use Chinese medicine.

Can't do heart bypass :

1.Ventricular function is low.

Patients with subsurface left ventricular function, ejection fraction not higher than or higher, and end-diastolic pressure greater than 20 mmHg are not candidates for heart bypass surgery.

2.Chronic heart failure.

The clinical manifestations of patients with chronic heart failure mainly include dyspnea, weakness of limbs, etc., if the condition reaches the point of seriousness, it is basically impossible to do heart bypass surgery, there is a risk, and the mortality rate will be greatly increased.

3.Systemic disease.

If you have diabetes, high blood pressure and other systemic diseases, and it is serious, you cannot do heart bypass surgery, the risk is too high.

4.Elderly patients.

If the patient is over 65 years old, such a patient is not physically fit and weak, and heart bypass surgery may not play a positive role.

5.Not eligible.

Some patients with coronary heart disease have less than 75% stenosis, and although the lesions occur, their blood supply is not affected in any way, and the blood flow is still the same as usual. There is no need for a heart bypass in a patient room like this.

There are three main conditions in which a stent cannot be used for coronary heart disease:

First, coronary angiography confirms that the stenosis of the left main trunk is less than 50% and the stenosis of other blood vessels is less than 70%, combined with the patient's symptoms are not too obvious, obviously this situation can not be placed, because the degree of stenosis of the blood vessels is not reached, in this case, if the stent is placed, it will increase the risk of cardiac events of the patient, so the stent can not be placed.

Second, coronary artery small vessel disease, for example, less than millimeter of vascular stenosis is heavier, although this situation is said to be more severe, the patient has symptoms but can not put a stent, because if a small blood vessel is placed with a stent, it is more likely to be blocked, easy to lead to acute myocardial infarction, and also easy to lead to surgical complications, such as blood vessel rupture and dissection formation.

Third, through arteriography confirmed that the patient's coronary artery stenosis is very severe, take the main trunk plus three diffuse lesions, relying on stents alone can not solve the patient's problems, in addition, the number of stents may be required is very large, the risk is very high, obviously this situation can not do stents, it is recommended to do coronary artery bypass surgery.

The main indication for heart bypass surgery in patients with coronary heart disease is diffuse stenosis of the first heart vessel and the inability to implant a stent.

Second, patients who need to be implanted with more than three stents are recommended to do coronary artery bypass, and the others can be stent or conservative**. Patients with coronary heart disease, whether they are bypass or stent or conservative**, must use drugs for a long time and use drugs for life**.

Since coronary heart disease is currently not possible, once diagnosed, it is necessary to have secondary prevention, aimed at anti-atherosclerosis prevention, to prevent other blood vessels that are not blocked, further narrowing, and blockage.

Commonly used drugs include antiplatelets, lipid-modulators, receptor blockers, neuroendocrine activity inhibitors including ACE inhibitors and ARB drugs.

The specific type of surgery that needs to be done depends on the patient's condition, and whether bypass or stent surgery is needed should be considered in the patient's condition.

If angina attacks are frequent or more frequent than before, or if angina occurs without significant activity, coronary heart disease is more severe and requires bypass or surgery**.

Some patients have a more severe condition but the clinical symptoms are not obvious, and if the coronary artery stenosis is greater than 70% on coronary angiography, bypass and stent surgery is required.

Heart bypass surgery, I believe that many patients with coronary heart disease will not feel unfamiliar, this is the most effective method of coronary heart disease, is internationally recognized. There is no doubt that the results of heart bypass surgery are outstanding. However, not everyone is suitable for heart bypass, and doing so will make the situation more and more serious.

For the blood vessels of the heart, there are many coronary vascular lesions, such as two or more blood vessels; For particularly important blood vessels, such as left main lesions, bypass surgery is relatively safer. There are also patients with too high stent risk, coronary vascular calcification is very serious, completely occluded blood vessels, trying coronary intervention, stent placement can not be successful, can be solved by bypass surgery.

Patients with chronic heart failure, severe dyspnea, generalized edema. If you have a chronic systemic disease, such as diabetes and high blood pressure, when the condition is more severe. Some people have coronary angiography stenosis that is not severe.

The lesion is mild, and none of the above conditions are suitable for bypass surgery.

Patients with very severe coronary heart disease, or patients with frequent angina pectoris and recurrent restenosis after stenting**. In addition, if the patient has diabetes mellitus and diffuse lesions, the long-term effect of coronary artery bypass surgery is better than that of stents**. Another type of patient is the EF value, the so-called cardiac function has declined and cardiac insufficiency, this type of patient may have greater benefits from coronary artery bypass surgery.

In addition, for patients with left main lesions, or three lesions at the same time, considering the basic difficulty of coronary stents or the long-term benefits are not so great, coronary artery bypass surgery is also recommended in this case.

Whether coronary heart disease is bypass or not, it needs to be based on the indications of bypass, this question hopes that you will go to the hospital to ask about cardiac surgery, this question is not easy to answer.

Hello, patients with coronary heart disease need bypass surgery in the following cases: its.

1. Three-vessel lesions: there are many diseased blood vessels, and if you choose to intervene, you need to put a lot of stents, which will greatly increase the probability of restenosis and thrombosis. Moreover, the financial burden of patients is also heavier. That.

2. Accompanied by cardiac insufficiency: such patients need complete revascularization to promote the recovery of ischemic myocardium, and it is difficult to intervene. That.

3. Left main lesions: According to domestic and foreign guidelines, surgery is the first choice for left main lesions. This is because blockage or restenosis of the left main trunk can be fatal. In order to reduce the risk, it is best to choose a bridge. That.

4. Patients with diabetes: ordinary stents have a high rate of restenosis in diabetic patients, while drug stents have only been available for a short time, and there is no clear evidence that intervention** will have better efficacy than bypass. That.

5. Patients with complications after myocardial infarction due to coronary heart disease: ventricular rupture, ventricular septal perforation, mitral regurgitation, etc., must choose surgical bypass surgery**. That.

6. Patients who are allergic to antiplatelet drugs: Since stents require patients to take antiplatelet drugs, patients who are allergic to this drug should also consider bypass surgery. However, if the patient has a respiratory condition, receiving full anesthesia may be dangerous and unsuitable for conventional cardiopulmonary bypass bypass, and interventional therapy should be chosen**.

There are certain surgical indications for undergoing bypass surgery, and since 1967, when the world's first coronary artery bypass grafting was used for coronary heart disease, coronary artery bypass surgery has become the main method for coronary heart disease. Its short- and long-term effects have been confirmed by a large number of cases and long follow-ups worldwide. The main principle of bypass surgery is to improve myocardial ischemia as much as possible and reduce the risk to the patient.

The lesion is taken into account when choosing. The main conditions in which coronary artery bypass surgery should be confirmed by current studies include:

1) Left main lesion, stenosis lesion greater than 50. 2) Equivalent to the left main lesion, that is, the proximal left anterior descending artery and the proximal left circumflex artery are significantly stenotic (more than 70), bypass surgery should be selected. (3) Two or more vascular lesions with diabetes mellitus, especially proximal anterior descending artery stenosis in the two vascular lesions.

4) Diffuse lesions of three or more blood vessels, accompanied by left heart dysfunction, should be bypass surgery. (5) Acute myocardial infarction with cardiogenic shock. (6) Patients with cardiac mechanical complications requiring surgery**, such as chordae tendinae, mitral regurgitation, ventricular septal perforation, or aneurysm.

7) Stable angina pectoris** ineffective, unstable angina; angina pectoris after myocardial infarction; Myocardial infarction without Q waves. (8) Those who have failed to partially intervene or have acute complications, such as severe coronary artery injury. Anyway:

The basic indication for bypass surgery is that the symptoms of myocardial ischemia are not controlled by the internal medicine department**, generally speaking, the greater the scope of severe ischemia and the greater the degree of stenosis, the better the bypass effect. If the coronary artery lesion is diffuse, the distal coronary artery cannot be bypassed by surgery, and severe cardio-brain-lung-hepatic and renal insufficiency cannot tolerate the blow of surgical trauma, it is a contraindication to surgery.

Patients with transcoronary bypass grafting will have the same complications as other surgeries after surgery, plus some of the more common or specific risks associated with coronary artery bypass. 1. General complications: bleeding, incision infection or sepsis, deep vein thrombosis, anesthesia complications, malignant hyperthermia, scarring, acute and chronic pain of incision, psychiatric symptoms, pneumothorax, hemothorax.

2. Associated with cardiac surgery 1) Central nervous system complications, the incidence of off-corporeal bypass surgery cases is between 5% and 6%, and the incidence of neurological complications is greatly reduced without cardiopulmonary bypass surgery. 2) Mediastinal infection and sternal nonunion: incidence 1% 4%.

Obesity is an important risk factor, as are other factors such as diabetes mellitus, previous coronary artery bypass grafting, and use of unilateral bilateral internal mammary arteries. 3) Perioperative myocardial infarction: myocardial infarction due to embolism, hypoperfusion or bridge obstruction.

4) Acute renal insufficiency.

Audience arterial bypass grafting has been upgraded in China for a long time, and the technology has become more and more mature, if it really can't be done.

What is coronary artery bypass grafting? It means to make a connection of a coronary artery, and there may be a narrowing of the coronary artery and a bypass surgery.

"Coronary artery bypass grafting is the most commonly used surgical procedure for coronary heart disease in cardiac surgery, also known as coronary artery bypass grafting, which refers to the use of a section of autologous blood vessels, the proximal and distal ends of the blood vessels, respectively, and the distal coronary artery branches and ascending aorta of the stenosis segment for end-to-side anastomosis to increase the amount of blood in the myocardium. Grafting of early coronary artery bypass.

According to the World Health Organization, 1 in 3 deaths is due to cardiovascular disease, so coronary heart disease has become the number one killer of human health. As the name suggests, coronary artery bypass grafting is to take the patient's own blood vessels from one end of the aorta to bypass the narrowed blood vessels, and then reach the distal end of the blood vessels to improve blood supply, relieve angina, improve cardiac function, improve the quality of life of patients, and prolong life. Therefore, coronary artery bypass grafting is likened to a smooth bridge between the aortic arch and the ischemic myocardium filled with arterial blood, and it is vividly called bypass grafting.

In recent years, coronary artery surgery at home and abroad mainly includes two types, percutaneous coronary intervention** and traditional coronary artery bypass grafting, which are the most commonly used surgical methods. After more than 50 years of research, a number of studies have analyzed that there is no obvious gap between percutaneous coronary intervention** and coronary artery bypass grafting, and clinicians will obtain good clinical benefits as long as they strictly follow the surgical indications and select the appropriate blood revascularization to rebuild blood circulation. Therefore, coronary artery bypass grafting and percutaneous coronary intervention** will not be terminated and terminated because of a certain aspect of research, so there is no untouchable field between the two, and the two cannot replace each other.

Therefore, no one can replace anyone between intervention** and coronary artery bypass, and doctors must strictly grasp the indications in order to bring greater benefits to patients. Therefore, cardiac interventional surgeons and cardiac surgeons need to conduct an objective and detailed assessment of the patient before the operation, strictly grasp the surgical indications, and appropriately select what patients need to bypass and what patients need to be intervened. Coronary artery bypass surgery has a history of 50 years and is relatively mature, so it can have good results.