Disease

Disease

Coronary Artery Disease: The treatment for this type of disease is bifurcated into two options. One is by following a therapeutic life style which involves dietary changes along with physical activities like exercising. These measures raise the HDL cholesterol level which is good for heart. The other option is surgery which involves Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG). Percutaneous Coronary Intervention (PCI): This treatment is also known as angioplasty which opens blocked or constricted coronary arteries. A tiny balloon attached to a thin pipe is threaded into an artery in the groin so that the balloon is positioned at the site of blockage where it is inflated. This compresses the plaque on the walls of the artery, relieving the blockage. This restores the blood flow through the artery also causing chest pain to cease. A small mesh tube called a stent is usually placed to keep the artery open. Coronary Artery Bypass Grafting (CABG): This is a procedure in which arteries or veins from other parts of the body are used to make a by-pass around the blocked artery improving the blood flow to the heart. This procedure can relieve chest pains and prevent the possibility of a heart attack.

Heart Valve Disease: Surgical interventions in this type of disease are highly likely even though lifestyle changes and medications can delay problems for a considerable length of time. Medications for this disease are for heart failure prevention by widening the blood vessels and getting rid of excess fluid. They also lower high BP and cholesterol, prevent arrhythmias and thin the blood and prevent clots. The treatment strategy also includes prevention of Infective endocarditis through proper dental hygiene. Heart valves are also repaired and replaced if they are dysfunctional depending upon their severity. Heart valve repair is always preferred over replacement. Valves maybe repaired by separating fused flaps, reshaping tissue so that they close tighter and adding tissue to locations of tear and holes to strengthen the base of the valve. Balloon Valvuloplasty is done for heart valves that don’t open fully (stenosis). The procedure involves insertion of a catheter in the artery and threaded to the location of the valve where the balloon is inflated, widening the opening. The tube is then taken out after deflating the balloon. The patient is awake during the procedure and it takes just an overnight stay at the hospital. Replacement of heart valves is done when there is no possibility of repair. Biological valves are made of heart tissue from pig, cow or human heart. They are specially treated so that the body does not reject them. Unlike biological valves, man-made valves last longer but with them one has to take blood thinning medicines for life so that clots are not formed. Several other surgeries are available these days that do not require major incisions. Transcatheter aortic valve implantation (TAVI) is a procedure in which catheter mounted valves are fitted in place of faulty aortic valves. Also, procedures are available in which pulmonary valve is fitted in place of aortic valve while pulmonary valve from deceased human subject replaces the pulmonary valve. This procedure is called Ross operation. Replacement valve can also be inserted in an existing valve that is dysfunctional. This procedure is called valve-in-valve procedure.

 Peripheral Vascular Disease: The various treatments for peripheral arterial disease (PAD) span across lifestyle changes, medicines, and surgical procedures. Treatment may cause the progress of the disease to stop otherwise without treatment there may be severe complications like sores and gangrene that can even require an amputation. Surgical procedures for this disease are Bypass grafting, Angioplasty and stenting (described above) and Atherectomy which is a procedure in which a cutting device mounted on a catheter is inserted to the location of plaque build up to scrape off the plaque. The bits of plaque that come off from this procedure are washed away in the blood stream. Doctors also use laser to dissolve away plaque. Cell and gene therapies are being researched for treatment but not available beyond clinical trials.

 Rheumatic heart disease: treatment for this disease involves steps to eliminate the infection with the help antibiotic drugs like penicillin. Strep throat caused by bacteria like streptococcus a bacterial infection, is often linked with heart valve damage. Steroidal and non-steroidal medications can be used. Surgery is done to repair or replace the valves that have been damaged by the infection. We have listed these surgeries above in the Heart Valve Disease section.

Ischaemic Heart disease: This heart disease is treated with the help of medications like Organic nitrates, Beta blockers, calcium channel blockers, statins and aspirin. Organic nitrates help to relax the nonspecific smooth muscles, beta blockers work by reducing cardiac stress and O2 consumption. Statins reduce the level of cholesterol level in the blood. Aspirin is very beneficial in patients suffering from acute myocardial infarction. Surgical treatments are same as that for treatment for coronary heart disease given above.

Congenital heart disease: Congenital heart disorders are treated with catheter procedures or surgery when medications cannot successfully treat the condition. The advantage of catheter procedures is that doctors don’t have to make large incisions and all that is required is only a needle puncture. Recovery is easier and faster in this procedure. For the disease Atrial Septal Defect repair, the surgeon inserts a catheter into a vein in the groin. The tube is then threaded to the septum of the heart. A device consisting of small disks or an umbrella like device is attached to the catheter. When the device reaches the septum it is pushed out of the catheter and the device is juxtaposed in such a way that it plugs the hole between the atria. It’s secured in place and the catheter is withdrawn from the body. In about 6 months normal tissue grows in over the device which does not need replacement as the child grows. For treatment of pulmonary valve stenosis, a catheter is thereded into a vein in the groin and guided to the heart’s pulmonary valve. A tiny balloon is inflated to push apart the leaves of the valve, repairing the narrowed valve. For guidance of the catheter, doctors use echocardiography (echo), transesophageal  echo (TEE), and coronary angiography. TEE is a special kind of imaging technique through which images of heart are taken from the oesophagus. It is used to examine complex heart defects. Open heart surgery is opted for when the heart defect cannot be corrected with the help of catheter procedure. Open heart surgeries in children are done for closing holes in the heart with stiches or patches, repairing or replacement of heart valves, widening of arteries or openings to valves, repair of complex defects such as problems with the location of blood vessels in close vicinity of the heart and how they are formed. In rare cases when a new born baby has multiple heart defects, doctors resort to transplant operation and replace the defective heart with the healthy heart of a deceased child.

Cerebrovascular disease: Treatment of cerebrovascular disease depends on the individual nature of the disease and its severity. Where haemorrhagic disease is present, the objectives are to stop the bleeding and prevention of its recurrence. This is achieved through surgery, catheters, and wire-mesh stents. Prompt treatment of such diseases may prevent more serious damage to the patient. Persons having a Carotid Artery disease (CAD) have an embolism that is a piece of plaque or a blood clot that can become dislodged and travel to a smaller artery causing blockage and resulting in a stroke. Doctors treat CAD with medications that thin the blood and prevent the formation of a clot. Where medications are not effective, surgery is employed that involves carotid artery stenting or carotid endarterectomy. Carotid endarterectomy involves the exposure of the carotid artery through an incision on the side of the neck, its clamping and removal of atherosclerotic material. More than 95% of persons who undergo this procedure are discharged the day after this procedure. Carotid artery stenting is a very recent procedure in which a catheter with a balloon attached is threaded in the artery to the location where the plaque is creating a blockage. The balloon is inflated to crush the plaque and there after a stent is placed to keep the artery open. The stent serves the purpose of prevention of plaque breaking off and travelling to the brain. Some of the stents placed are coated with medication that prevents formation of clots. The procedure is not very costly and most people who undergo it are relieved the day after from the hospital.