Heart Disease
Coronary Heart Disease
About angioplasty and bypass surgery
As you have learned, coronary heart disease is caused by the buildup of fatty matter in the walls of the coronary (heart) arteries. Over time, this buildup causes the inside of the coronary arteries to become rough and narrowed, limiting the supply of oxygen-rich blood to the heart muscle. This can cause chest pain (angina) or increase your risk of having a heart attack. If you develop this amount of fatty buildup in your coronary arteries, your doctor may recommend that you have either coronary angioplasty or coronary bypass surgery, to remove the fatty deposit or replace the damaged arteries.
Angioplasty
In coronary angioplasty (also called percutaneous transluminal coronary angioplasty, or PTCA), a tube called an inducer catheter, or sheath, is inserted into the femoral artery in your groin. A dye is used so that the narrowed artery can be viewed on a TV screen, or monitor. Through the sheath, a thin tube with a balloon at the tip is carefully threaded to the area of narrowing in your coronary artery. Once it is in place, the balloon is inflated for several seconds. As the balloon fills, it splits and compresses the fatty material in the artery wall. The opening of the artery is enlarged to allow blood to flow more easily through it. The balloon catheter is then removed. The procedure usually lasts about three hours.
Coronary bypass surgery
Two types of blood vessels are commonly used for the coronary artery bypass graft: the saphenous veins in the legs, or the left or right internal mammary artery (also called thoracic arteries), which lies in the chest wall. Both types of blood vessels can be used for bypasses because there are other pathways that circulate blood to and from the tissues of the chest wall and legs. The surgeon determines which graft(s) to use depending on the location and amount of blockage in the coronary arteries.
If the saphenous vein is used, it is surgically removed from the leg. The vein graft is then sewn from the aorta (the large artery leaving the heart) to the coronary artery below the site of blockage. Oxygen-rich blood flows from the aorta, through the saphenous vein graft, past the site of blockage to the coronary artery to nourish the heart muscle. If a mammary artery is used, it is kept intact at its origin because it carries oxygen-rich blood originally coursing through the aorta, and it is sewn to the coronary artery beyond the blockage site. Prior to admission to the hospital, your doctor will discuss the specific bypass procedure with you.
