Heart shunting – what is it

Author Ольга Кияница

2018-09-24

The presence of diseases of the coronary vessels may suggest the performance of such an operation as heart bypass. With its help, the normal blood supply to the myocardium is restored, which reduces the risk of developing a heart attack. There are various indications and contraindications for this surgery.

Heart shunting (AL) is an operation that helps restore blood flow through blocked coronary arteries. Surgical intervention is also known as “bypass surgery” or! Coronary arterial heart bypass !.

Cardiac bypass actually does not relieve blockages in the arteries — instead, an alternative path (also known as a “workaround”) is created during the operation, through which blood flows around the blocking area.

Surgical intervention to establish a shunt can only be performed by a highly qualified heart surgeon. Assistants, nurses and anesthesiologists are also in the operating team. Additionally, a perfusiologist may be involved in the work, who is responsible for the artificial circulation.

Video: Shunting in the heart | Circulatory System and Disease | NCLEX-RN | Khan Academy

Indications for heart bypass surgery

The coronary arteries can be narrowed or blocked by the accumulation of a fat-like substance on the walls of blood vessels, which eventually forms a plaque. This pathological process is known as atherosclerosis. The doctor may recommend heart bypass surgery if there are several areas of atherosclerosis. Also, cardiac bypass surgery may be recommended in the following cases:

  • The presence of pain in the chest, which is not removed by medication.
  • Unstable angina.
  • Earlier, a heart attack has been postponed.
  • Coronary artery disease is determined, but there are contraindications for coronary angioplasty or stenting.

In some cases, due to the development of vascular thrombosis, heart bypass can also be performed, especially when a blockage (partial or complete) of the coronary artery occurs.

The risks of heart bypass

As with any surgery, there are certain risks associated with heart-bypass surgery. Some of these complications may include:

  • Bleeding
  • Infectious disease
  • Abnormal heart rhythms (arrhythmias)
  • Lung and kidney problems
  • Short term memory problems - mostly temporary

These are usually short-term problems. In addition, the attending physician, as a rule, explains the possible risks before the patient agrees to undergo surgery. If necessary, the patient can ask questions and discuss any problems with the medical team.

Preparing for heart bypass surgery

Approximately two weeks before the surgery you will need:

  • Check with your doctor about taking prescribed medications - some may need to be postponed for a while.
  • It is desirable to prepare your home for the return after surgery. You can find someone to help you get out of the hospital, and then you could at first take part in the recovery period and in solving various household issues: shopping, cooking, cleaning, etc.
  • Some important tests can be performed - including an ECG, chest x-ray, blood tests, a nose smear, and a doppler sonography of the carotid arteries (which is an ultrasound examination of the blood vessels in the neck that supply the brain).

On the day before the operation, the following necessary manipulations are performed:

  • Colon cleansing - with a laxative or enema.
  • A small package of essential items is packaged, such as toiletries and glasses - they will be transferred to the intensive care unit, where patients are brought in after surgery.
  • Food and drink consumption is limited - from about midnight to the planned operation.

On the day of surgery:

  • It is important to remember that you should not eat or drink anything from midnight until surgery.
  • If necessary, the nurse will remove any hair from the chest, arms, legs, groin - to reduce the risk of infection.
  • Take a shower with antibacterial soap.
  • Hospital clothing is worn and, if necessary, any makeup, nail polish, jewelry, and dentures are removed.

Heart shunting surgery

The cardiac bypass surgery is performed under general anesthesia, which means administering drugs before the operation and complete relaxation of the patient, up to his immersion into sleep. As soon as a person falls asleep:

  1. The breathing tube travels through the larynx to the lungs.
  2. A urinary tube catheter is inserted into the bladder, so there will be no need to worry about the toilet; in addition, an amount of urine will be assessed.

Heart Surgery Actions:

  1. Creates access to the heart - cuts through the chest.
  2. Takes a vessel (vein or artery) cut from a leg, chest, or arm to create a bypass for blood flow to the heart.
  3. Stops the heart for a short time to install an autograft - at this time, the heart-lung machine can be connected to maintain hemodynamics in the body during surgery.
  4. Starts the heart and turns off the heart-lung machine, allowing blood to be pumped through the heart.
  5. For the fastening of the sternum metal seams are used, after which the skin on the breast is sutured.

Depending on the technique of the operation, the heart may not stop, but then stabilizing devices are superimposed on the area where the bypass surgery is performed.

The operation usually takes 3-4 hours.

Video: Left to Right Heart Shunts- animated quick review

Postoperative period

After a cardiac bypass surgery, the patient usually spends one or two days in the intensive care unit, where the equipment is under control of the heart, blood pressure, body temperature and respiration.

On the first day after the operation, it is permissible to sit out of bed or in a chair and perform several steps, but it is important not to hurry with recovery. It will be necessary to perform regular restorative movements in order to recover well and quickly. When the condition allows to leave the intensive care unit, the patient will be transferred to the cardiology chamber, where he will stay for several days.

Video: How Coronary artery bypass surgery works – Manipal Hospital


Source 1. Budts W, Gewillig M, Van de Werf F. Left-to-right shunting in common congenital heart defects: which patients are eligible for percutaneous interventions? Acta Cardiol. 2003 Jun;58(3):199-205. 2. David Carroll, Dr Henry Knipe et al. Cardiovascular shunts https://radiopaedia.org/articles/cardiovascular-shunts 3. Prabhakar Rajiah, Jeffrey P. Kanne. Cardiac MRI: Part 1, Cardiovascular Shunts. Integrative Imaging Self-Assessment Modules LIFELONG LEARNING FOR RADIOLOGY. October 2011, Volume 197, Number 4 https://www.ajronline.org/doi/full/10.2214/AJR.10.7257

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