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The existence of cardiovascular surgery as a branch of medical theory and practice is yet another proof of how much medical science has expanded and advanced over the past century. Back in the early 20th century, surgical intervention in the work of the heart and adjacent vessels was considered unacceptable and unreasonably dangerous. For example, some congenital heart defects in the 80s of the last century were an inoperable pathology with a high mortality rate, and today cardiovascular surgeons with a high level of qualification relieve patients of these problems, giving them a chance for a full life.
A cardiovascular surgeon is a doctor who received an appropriate higher education, after which he practiced in an internship or residency, and was trained in specialized courses in the field of cardiovascular surgery. His area of expertise lies at the intersection of cardiology and surgery.
Cardiovascular surgeon, angiosurgeon, cardiac surgeon – what’s the difference
To the uninitiated in the particular division of specializations in medicine, at first glance it will seem that all these three specialists have a similar competence, and, in fact, do not differ from each other. This point of view is not entirely true.
For example, in Russia, in the official nomenclature of the names of medical professions, there is no term “cardiac surgeon” or “angiosurgeon”. Officially, the branch of medicine dedicated to performing operations on the heart and blood vessels is called cardiovascular surgery, and a doctor with such qualifications is called a cardiovascular surgeon, and it is understood that he thoroughly knows the technique of performing operations on both vessels and the heart. In European countries and in the USA, cardiovascular surgery belongs to the section of thoracic (thoracic) surgery.
At the same time, the anatomy of the heart and the vessels adjacent to it is very different from the anatomical structure of the vessels, for example, in the limbs. Therefore, for the convenience of doctors, in order to train more qualified physicians of a narrow focus, vascular surgery is often separated into a separate sub-branch of specialized medical care. Despite the fact that the methods of anesthesia and approaches to the operation are often similar or similar, vascular surgeons (or angiosurgeons) do not perform heart surgery, but are engaged in the diagnosis and surgical treatment of diseases of the veins and arteries of the lymphatic system. At the same time, cardiac surgeons specialize in performing heart surgery. Often, they also involve a vascular surgeon for such operations.
It should be understood that such a division is informal, since officially there is precisely the profession of a cardiovascular surgeon, who must be competent in both surgical treatment of vascular diseases and heart operations.
What does a cardiovascular surgeon do?
The qualification of this doctor allows him to diagnose and treat vascular and heart diseases. Often, other doctors send patients to him for examination: therapists, cardiologists, phlebologists. In some cases, the patient himself decides to turn to this particular specialist. One way or another, the doctor first conducts a study of the patient, his symptoms and sensations, finds out the subjective and objective manifestations of the disease that led the person to him for a consultation.
After diagnosing, a cardiovascular surgeon (usually as part of a commission with other doctors) can give an opinion on the need for an operation. Together with a group of specialists (anaesthesiologist, resuscitator, nurses), he can personally carry out the surgical procedure.
However, the scope of competence of the cardiovascular surgeon does not end there. His responsibility is to monitor the patient’s condition after the operation, prescribe rehabilitation measures for him (sometimes together with a cardiologist, therapist). Like most surgeries, surgeries on blood vessels and the heart require precision, they are a significant stress for the human body, so the observation of the patient after such a procedure is an objective necessity.
Also, the doctor can take part in the development of preventive measures to prevent the development of diseases of the cardiovascular system. His work, jointly with a phlebologist (a doctor specializing in the treatment of blood vessels) and a cardiologist, can be carried out within the same medical institution, or cover a larger level when it comes to scientific unions, congresses and conferences of cardiologists and surgeons.
Organs and parts of the body that the doctor treats
This surgeon specializes in diseases of the cardiovascular system. He treats diseases and performs operations:
- on the heart and adjacent vessels;
- on all types of vessels in the body (arteries and arterioles, capillaries, veins and venules, lymphatic vessels).
A network of blood vessels entangles the entire human body, respectively, a cardiovascular surgeon can operate on the torso and limbs of a person in almost any place.
Cardiovascular surgery is a vast industry, and in some cases, it is the operation that becomes the last chance for the patient to stay alive.
Through heart surgery, the following pathologies and disorders are treated:
- angina;
- severe stenosis of the coronary arteries of any origin;
- complicated myocardial infarction with arrhythmia, ruptures of the interventricular septum, the development of acute mitral valve insufficiency, cardiac tamponade (a condition when, due to the accumulation of fluid between the sheets of the pericardium, the heart cavities are compressed and adequate heart contractions become impossible);
- sudden cardiac arrest syndrome, cardiogenic shock.
All four of these manifestations are forms of coronary heart disease. Such deviations are most successfully treated surgically, while conservative therapy does not give particularly optimistic prognoses.
In addition, the doctor treats:
- pulmonary hypertension;
- heart failure 1-3 degrees;
- thromboembolism of the pulmonary artery;
- valve defects: congenital or consequences of rheumatism, endocarditis, pericarditis, other congenital or acquired defects;
- stenosis between the chambers of the heart and in the aorta;
- infective endocarditis;
- aneurysms of the aorta or left ventricular area;
- severe left ventricular failure;
- ejection of fluid or blood into the pericardial area, which may pose a risk of cardiac tamponade.
All these disorders are related to the work of the heart, they are dealt with by cardiac surgeons. As for vascular diseases, which doctors successfully cope with, among them:
- phlebeurysm;
- diabetic angiopathy;
- stenosis of the carotid arteries;
- lymphostatus;
- violation of the patency of the brachiocephalic vessels;
- thrombosis and thrombophlebitis;
- arteriovenous fistulas;
- varicocele;
- thromboangiitis obliterans;
- Raynaud’s syndrome.
What symptoms and situations require mandatory consultation with a specialist
Often, patients come to this specialist in the direction of the attending physician. Surgery makes sense when:
- treatment with conservative methods does not give results;
- the patient turned to the doctor in the later stages of the development of the disease;
- there is a congenital pathology and its mechanical correction is necessary.
Symptoms that patients usually complain about at an appointment with a cardiovascular surgeon:
- headaches not associated with fever or intoxication in infectious diseases (usually of a prolonged nature);
- the appearance of numbness in the limbs and other parts of the body, constant chilliness of the feet and hands, blue fingers, the appearance of areas of redness with pain;
- tinnitus of a permanent nature;
- a sharp deterioration in vision, a decrease in sharpness, the appearance of dots, “flies” before the eyes;
- feeling of heaviness in the legs, their swelling, protruding veins;
- spasmodic pain in the limbs when walking;
- venous “asterisks” on the legs;
- feeling of pulsation in the abdomen;
- sharp and repeated attacks of loss of consciousness, swaying when walking;
- frequent hemorrhages.
Methods of diagnosis
Determining the final diagnosis of the patient is one of the parts of the work of a specialist. It is on the basis of an accurate diagnosis that a decision will be made on the possible and necessary treatment, so any doubts and ambiguities are unacceptable.
Before the doctor develops a treatment regimen or prepares the patient for surgery, he must interview and examine him, find out all the symptoms and sensations that initially caused him to seek medical help. In addition, cardiovascular surgeons usually require patients to bring up-to-date results of all previous tests with them to the consultation, for example:
- a detailed blood test with a leukocyte formula and platelet count indicators;
- coagulograms;
- analysis to determine the level of cholesterol, lipoproteins, triglycerides;
- urinalysis.
Of course, the information obtained in such ways will help the doctor determine the method of treatment in each case, however, most often this is not enough.
To conduct a full examination, the doctor prescribes:
- angiography: an x-ray method, before it is carried out, a contrast agent is injected into the vessels using a catheter, which in the picture allows you to detect the localization of the thrombus and the degree of narrowing;
- ultrasound duplex scanning: a method for obtaining a two-dimensional image to study blood flow and the state of the vascular wall, the size and patency of blood vessels;
- coronary angiography: examination of the patency of the coronary arteries;
- cerebral angiography to study the blood supply to the brain;
- dopplerography of the carotid arteries;
- ultrasound examination of the heart;
- electrocardiography.
In some cases, the doctor suggests that the patient do an ultrasound of the thyroid gland and adrenal glands in order to exclude the possibility of hormonal disorders as a probable cause of the disorders that have appeared.
Methods of treatment
After conducting all the necessary examinations, the doctor, often together with other specialists, decides on the need for an operation, or on referring the patient to a competent doctor, if the ailment does not belong to the scope of the surgeon’s own qualifications. In some cases, this doctor may prescribe drug therapy, but more as preparatory or rehabilitation measures. As for therapeutic measures, his scope is precisely the conduct of operations.
Surgical interventions of the following types have become quite common now:
- Stenting of large vessels (angioplasty with the installation of a special expanding spring at the site of narrowing of the vessel).
- Carrying out balloon angioplasty (a method of expanding blood vessels by introducing a special balloon with a catheter into the narrowing area, after which the balloon is filled with air, thereby expanding the lumen of the vessel).
- Installation of a pacemaker (an operation in which a special device – a pacemaker – is sewn under the pectoral muscle in such a way that its electrodes are in contact with the surface of the heart. The device provides constant control over the contraction of the heart and is connected in their absence).
- Vascular bypass surgery (with the help of one’s own veins or prostheses, a bypass is created to the affected area, through which blood circulation is restored).
- Removal of an aneurysm of the aorta and heart (an operation during which a thin section of the aneurysm is dissected and removed, and the edges are sutured).
- Bentall operation (in the process, the method of aortic valve prosthetics and the transfer of the orifices of the coronary arteries are used).
- Various types of correction for congenital vascular and heart defects.
- Operation “maze” (destruction of the section of the pathways that supports arrhythmia is performed to treat atrial fibrillation).
- Pericardiocentesis for cardiac tamponade (an operation during which fluid, blood and effusion are sucked from the lining of the heart with a thin long needle).
- Operations for the treatment of infective endocarditis.
Carrying out heart transplantation is more within the competence of the transplant surgeon, although a cardiovascular surgeon is often present at such operations.
The doctor also performs operations on the valvular apparatus of the heart, installs and plasticizes valves.
Every year, the operations performed by cardiovascular surgeons become more and more complex. This happens, firstly, due to the improvement of practical experience and knowledge accumulated over the years in this area, and secondly, thanks to technical progress. In some cases, it is not even necessary to open the chest for operations, as there are special devices that allow you to operate through an incision. However, in order to be able to work in this way, the doctor needs to have a very high basic level of qualification, in addition, constantly improve it, take additional courses and training.
In addition to diagnosis and treatment, the doctor is engaged in the rehabilitation of patients after surgery: he monitors their condition, prescribes planned postoperative tests and examinations, procedures, and therapy.
The profession of a surgeon in general, and, in particular, a cardiovascular surgeon, is physically and mentally hard work. These doctors often have to perform multi-stage and complex surgical interventions, and some operations can last 10-15 hours. The doctor must be well versed not only in surgery and cardiology, but also in functional diagnostics, pathological anatomy, anesthesiology, and topographic anatomy. Mandatory skills are the ability to interpret the results of examinations – radiography, electrocardiography and others. The doctor must be stress-resistant, hardy, have high accuracy of hand motility, excellent vision, an analytical mindset, be able to make decisions quickly and balanced in critical situations. The skill of teamwork is also very important, because any operation is carried out by a whole team of doctors and nurses.
Of course, any surgical intervention is a complex and potentially dangerous process, however, the work of a cardiovascular surgeon in this category is one of the most responsible and stressful, because, despite all its advantages, heart and vascular surgery is considered a complex method of treatment with an increased risk. for the patient.