Personally performed operations (as of 2019)
Acquired coronary vessel defects: 3166
Innate heart conditions* (surgery on newborns, children and adults): 2800
Heart transplants: 71
Coronary heart disease
Coronary heart disease (CHD) leads to a continuous narrowing of the coronary vessels, which supply the cardiac muscle with blood. Acute closure of the vessels is called a heart attack.
The underlying condition is called atherosclerosis. Starting with fat deposition within the vessel wall, it leads to an increased calcification and finally a constriction of the coronary vessels.
Risk factors for the occurrence of CHD are high blood pressure, high cholesterol, smoking, obesity, diabetes and a genetic disposition.
Typical symptoms of a relevant CHD is the so called Angina Pectoris, a tight feeling in the chest, radiating into the left arm, the neck or the jaw. Furthermore, back pain and pain in the stomach area can be expression of a CHD. Those kinds of pain are often due to physical stress and can be reproduced. They are called a stable Angina Pectoris. If pain occurs during rest, one speaks of a unstable Angina Pectoris. Should the pain be continuous, a heart attack is probable and one should call an ambulance immediately.
The occurrence of an Angina Pectoris is already an indicator for a relevant CHD. Additionally, it is advisable to perform a ECG. This way an acute heart attack can be excluded quickly.
Other diagnostic means are the exercise ECG or cardiac ultrasound. If those examinations cannot entirely rule out a relevant CHD, a imaging system during exercise should be executed (stress heart ultrasound, stress heart MRI).
If a relevant CHD or a heart attack is detected, a cardiac catheter examination should be performed.
During this examination, either the artery of the groin or on the wrist (left or right) is punctured. Through this entry, a thin tube (catheter) is pushed up to the coronary vessels and a contrast agent is injected. Meanwhile the process is recorded via x-ray. This procedure has to be repeated several times to make sure the vessel can be evaluated from all perspectives. One uses two catheters to evaluate both vessels on the left and the one on the right.
Should the examination show constrictions (stenoses), there are basically three methods of treatment:
- If the constrictions are located in very small vessels (who are less significant for circulation), a medicinal therapy is recommended
- For the constrictions described above, an implanted balloon dilatation is recommended
- If the a lot of vessels are affected in a diffuse manner, bypass surgery is the most common recommendation
Sometimes it can be difficult to narrow down a diagnose to one of those three instances. In that case, a team of cardiologists and cardiac surgeons have to work on an optimal solution with the patient.
Both the implantation of a stent, as well as bypass surgery remove the symptoms, yet they do not cure the illness. For that reason, when diagnosed with a CHD, a medicinal therapy is mandatory. In the best case scenario, it should stop the progress of the disease, at the very least it should slow it down significantly. Next to the specific treatment of the risk factors, there are two main medications, which should be taken indefinitely:
One is Aspirin to dilute the blood, the other one is Statin to bring down cholesterol. The intake of Statin also positively influences the inflammation in the vessels and thus leads to a stabilisation of the calcification. Although both medications can help, a change of lifestyle is important. Mediterranean diet is recommended, red meat is not. Regular exercise (particularly for endurance) is also important.
*One percent of humans are born with a heart condition, which is often dealt with right after birth. Many patients however – be it in childhood or as an adult – are in need of an additional operation. Furthermore adults, who have been successfully treated early in their lives, can develop the same conditions as any other adult later on. They may need surgery of the valves, aorta or a bypass operation, which can become quite sophisticated because of the earlier intervention.