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30 - 87

Title: Pacemaker Treatment


Pacemakers and Implantable Defibrillators

An arrhythmia is any disorder of your heart rate or rhythm. It means that your heart beats too quickly, too slowly or with an irregular pattern. Most arrhythmias result from problems in the electrical system of the heart. If your arrhythmia is serious, you may need one of two devices implanted under your skin: a cardiac pacemaker or an implantable cardioverter defibrillator (ICD).

A pacemaker monitors the electrical impulses in the heart. When needed, it delivers electrical pulses to make the heart beat in a more normal rhythm. A pacemaker may be helpful when the heart beats too slowly or has other abnormal rhythms. An ICD is a device that monitors heart rhythms. If it senses dangerous rhythms, it delivers shocks. Many ICDs record the heart's electrical patterns when there is an abnormal heartbeat. This can help the doctor plan future treatment.

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27 - 88

Title: Coronary Artery Bypass Grafting (CABG)


What is coronary artery bypass surgery?

This is a type of heart surgery. It's sometimes called CABG ("cabbage"). The surgery reroutes, or "bypasses," blood around clogged arteries to improve blood flow and oxygen to the heart.

Why is this surgery done?

The arteries that bring blood to the heart muscle (coronary arteries) can become clogged by plaque (a buildup of fat, cholesterol and other substances). This can slow or stop blood flow through the heart's blood vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack.

How is coronary bypass done?

Surgeons take a segment of a healthy blood vessel from another part of the body and make a detour around the blocked part of the coronary artery.

    An artery may be detached from the chest wall and the open end attached to the coronary artery below the blocked area.
    A piece of a long vein in your leg may be taken. One end is sewn onto the large artery leaving your heart—the aorta. The other end of the vein is attached or "grafted" to the coronary artery below the blocked area.
    Either way, blood can use this new path to flow freely to the heart muscle.

A patient may undergo one, two, three or more bypass grafts, depending on how many coronary arteries are blocked. Cardiopulmonary bypass with a pump oxygenator (heart-lung machine) is used for most coronary bypass graft operations. This means that besides the surgeon, cardiac anesthesiologist and surgical nurse, a competent perfusionist (blood flow specialist) is required.

During the past several years, more surgeons have started performing off-pump coronary artery bypass surgery (OPCAB). In it, the heart continues beating while the bypass graft is sewn in place. In some patients, OPCAB may reduce intraoperative bleeding (and the need for blood transfusion), renal complications and postoperative neurological deficits (problems after surgery).

What happens after bypass surgery?

After surgery, the patient is moved to a hospital bed in the cardiac surgical intensive care unit. Heart rate and blood pressure monitoring devices continuously monitor the patient for 12 to 24 hours. Family members can visit periodically. Medications that regulate circulation and blood pressure may be given through the I.V. (intravenously). A breathing tube (endotracheal tube) will stay in place until the physicians are confident that the patient is awake and ready to breathe comfortably on his or her own.

The patient may feel groggy and disoriented, and sites of incisions — both the chest and the leg, if a segment of blood vessel was taken from the leg — may be sore. Painkillers are given as needed.

Patients usually stay in the hospital at least three to five days and sometimes longer. During this time, some tests will be done to assess and monitor the patient's condition. After release from the hospital, the patient may experience side effects such as:

    Loss of appetite, constipation.
    Swelling in the area from which the segment of blood vessel was removed.
    Fatigue, mood swings, feelings of depression, difficulty sleeping.
    Muscle pain or tightness in the shoulders and upper back.

Many of these side effects usually disappear in four to six weeks, but a full recovery may take a few months or more. The patient is usually enrolled in a physician-supervised program of cardiac rehabilitation. This program teaches stress management techniques and other important lessons (e.g., about diet and exercise) and helps people rebuild their strength and confidence.

Patients are often advised to eat less fat and cholesterol walk or do other physical activity to help regain strength. Doctors also often recommend following a home routine of increasing activity — doing light housework, going out, visiting friends, climbing stairs. The goal is to return to a normal, active lifestyle.

Most people with sedentary office jobs can return to work in four to six weeks. Those with physically demanding jobs will have to wait longer. In some cases they may have to find other employment.

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27 - 89

Title: Open Heart Surgery Treatment


There are many different types of heart surgery. Heart Surgeries may be used to

  1.     Repair or replace the valves that control blood flow through the heart's chambers.
  2.     Bypass or widen blocked or narrowed arteries to the heart.
  3.     Repair aneurysms, or bulges in the aorta, which can be deadly if they burst.
  4.     Implant devices to regulate heart rhythms.
  5.     Destroy small amounts of tissue that disturb electrical flow through the heart.
  6.     Make channels in the heart muscle to allow blood from a heart chamber directly into the heart muscle.
  7.     Boost the heart's pumping power with muscles taken from the back or abdomen.
  8.     Replace the damaged heart with a heart from a donor.
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31 - 90

Title: Mitral - Valve Repair


The mitral valve is the inflow valve into the left side of the heart. It closes during systole (when the ventricle contracts or squeezes blood out into Mitral valve repair is an open heart procedure performed by cardiothoracic surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, and into the left atrium. When it opens, the mitral valve allows blood to flow from the left atrium to the heart's main pumping chamber called the left ventricle. It then closes to keep blood from leaking back into the lungs when the ventricle contracts (squeezes) to push blood out to the body. It has two flaps, or leaflets.

Occasionally, the mitral valve is abnormal from birth (congenital). More often the mitral valve becomes abnormal with age (degenerative) or as a result of rheumatic fever. In rare instances the mitral valve can be destroyed by infection or a bacterial endocarditis. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease). When it opens (left), the mitral valve allows blood to flow into the heart's main pumping chamber called the left ventricle. It then closes (right) to keep blood from leaking back into the lungs when the ventricle contracts (squeezes) to push blood out to the body. It has two flaps, or leaflets.

Often the mitral valve is so damaged that it must be replaced (refer to Mitral Valve Replacement). Occasionally, however, the valve can be repaired rather than replaced. One type of repair is a procedure called mitral commisurotomy. Mitral commisurotomy can be performed for some valves that are narrow or "stenotic" either from birth or from damage by rheumatic fever. Most often today, rheumatic mitral stenosis is treated by balloon valvuloplasty, a procedure performed in the cardiac catheterization laboratory by interventional cardiologists. Using a catheter with a balloon on the end, the balloon is expanded inside the valve "stretching" it open.

More often mitral valve repair is performed to correct a leaking or regurgitant valve. Congenital mitral regurgitation may be due to a cleft mitral valve (a valve with a separation or cleft down the middle) associated with an atrial septal defect, a type of hole in the heart between the low pressure chambers or atria. Such valves can sometimes be repaired simply by closing the cleft with sutures. Valves regurgitant due to bacterial endocarditis can occasionally be repaired, however the majority of mitral valve repairs are performed for degenerative disease. Degenerative mitral valve disease may be due to an elongation or rupture of the chordal apparatus, the "heart-strings" that support the valve normally, or due to a more generalized weakness of the valve itself such as the "floppy valve" syndrome in which all of the components of the valve are enlarged and elongated.

The aorta and the rest of the body). When the mitral valve leaks, blood flows backwards into the lungs. The ventricle must therefore pump more blood with each contraction to produce the same forward output of blood throughout the body. This resulting condition is called a volume overload. The heart can compensate for this volume overload for many months or years (provided the leakage came on slowly and progressively), but it eventually begins to fail producing symptoms of shortness of breath or fatigue.

The indications for mitral valve repair are undergoing constant re-evaluation. Recent evidence suggests that earlier surgical intervention, particularly if repair is possible, may prevent irreversible damage to the heart. The decision regarding when to proceed with surgery should be made with your doctor. This decision will require judgment regarding the risk of surgery and the benefits available from surgery. In some cases blood pressure medications, such as ACE-inhibitors can significantly relieve symptoms.

Severe mitral regurgitation in the presence of symptoms of congestive heart failure is usually an indication for surgery. Severe regurgitation diagnosed by echocardiography, even without symptoms, may be sufficient to warrant repair. Enlargement of the left atrium, particularly in the setting of the recent onset of an irregular heartbeat (atrial fibrillation, premature atrial contractions, paroxysmal atrial tachycardia, etc.) is considered by many doctors also to be an indication for surgery.

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27 - 91

Title: Valve Replacement Surgery Treatment


Heart valve surgery is used to repair or replace diseased heart valves.

There are four valves in your heart:

  •     Aortic valve
  •     Mitral valve
  •     Tricuspid valve
  •     Pulmonary valve

The valves control the direction of blood flow through your heart. The opening and closing of the heart valves produce the sound of the heartbeat.

Heart valve surgery is open-heart surgery that is done while you are under general anesthesia. A cut is made through the breast bone (sternum). Your blood is routed away from your heart to a heart-lung bypass machine. This machine keeps the blood circulating while your heart is being operated on.

Valves may be repaired or replaced. Replacement heart valves are either natural (biologic) or artificial (mechanical):

    Natural valves are from human donors (cadavers).
    Modified natural valves come from animal donors. (Porcine valves are from pigs, bovine are from cows.) These are placed in synthetic rings.
    Artificial valves are made of metal.

If you receive an artificial valve, you may need to take life-long medication to prevent blood clots. Natural valves rarely require life-long medication.

Why this Procedure is done


  •     Heart valve surgery may be recommended for the following conditions:
  •     Narrowing of the heart valve (stenosis)
  •     Leaking of the heart valve (regurgitation)

Valve problems may be caused by:

    Birth defects
    Calcium deposits (calcification)
    Infections such as rheumatic fever


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31 - 92

Title: EECP


Enhanced External Counterpulsation EECPW (ECP) is a non-surgical therapy for angina, heart disease, high blood pressure, and other conditions involving poor circulation. EECP (ECP) is a mechanical procedure in which long inflatable cuffs (like blood pressure cuffs) are wrapped around both of the patient’s legs.

EECP (ECP) has two potentially beneficial actions on the heart. EECP (ECP), effectively, “pumps” blood into the coronary arteries.) Second, by its deflating action just as the heart begins to beat, EECP (ECP) creates something like a sudden vacuum in the arteries. The EECP (ECP) pumping console then rapidly inflates and deflates the leg cuffs in time with the heartbeat.

Unlike procedures such as bypass surgery, balloon angioplasty, and stents, EECP (ECP) is entirely non-invasive (involves no surgery, drugs or needles), carries no risk, is comfortable, and is administered in an outpatient setting. In fact, EECP (ECP) can feel like a deep muscle massage to the legs and the patient is completely relaxed during the process.

EECP (ECP) is administered as an out-patient procedure, making it very convenient for the patient and the family. The EECP (ECP) pumping console then rapidly inflates and deflates the leg cuffs in time with the heartbeat.

Nearly everyone with coronary artery disease can benefit from EECP (ECP). EECP (ECP) is particularly well-suited to people who:


  •     Have already had angioplasty, stents or bypass surgery, and the heart     disease symptoms have returned or persisted
  •     Are not candidates for surgery due to other serious medical conditions
  •     Do not want to undergo surgery or angioplasty
  •     Rely heavily on medicines, or have to curtail their activities to avoid angina and other heart disease symptoms
  •     EECP (ECP) treatment may be the only way to obtain relieve from crippling angina.
  •     ECP treatment is a non-invasive outpatient treatment that may relieve or eliminate Angina.

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27 - 93

Title: Aortic Aneurysm


Aortic aneurysm is a widening (bulging) of part of the wall of the aorta, the body's largest artery.

Thoracic aneurysms most often occur in the descending thoracic aorta. Others may appear in the ascending aorta or the aortic arch. The most common cause of a thoracic aortic aneurysm is hardening of the arteries (atherosclerosis).

Other risk factors include:
    Connective tissue disorders such as Marfan syndrome
    Having high blood pressure for a long time
    Previous dissection of the aorta
    Trauma such as falls or motor vehicle accidents

Most patients have no symptoms until the aneurysm begins to leak or expand. Chest or back pain may mean sudden widening or leakage of the aneurysm.

Exams and Tests
The physical examination is often normal. Most non-leaking thoracic aortic aneurysms are detected by tests -- usually a chest x-ray or a chest CT scan -- run for other reasons. A chest x-ray and chest CT scan show if the aorta is enlarged. A chest CT scan shows the size of the aorta and the exact location of the aneurysm. An aortogram (a special set of x-ray images made when dye is injected into the aorta) can identify the aneurysm and any branches of the aorta that may be involved.

The treatment depends on the location of the aneurysm. For patients with aneurysms of the ascending aorta or aortic arch, surgery to replace the aorta is recommended if the aneurysm is larger than 5-6 centimeters. The aorta is replaced with a fabric substitute.

This is major surgery that requires a heart-lung machine. If the aortic arch is involved, a specialized technique called "circulatory arrest" may be necessary. This involves a period without blood circulation while the patient is on life support.

There are two options for patients with aneurysms of the descending thoracic aorta. If the aneurysm is larger than 6 centimeters, major surgery is done to replace the aorta with a fabric substitute. Endovascular stenting is a less invasive option. A stent is a tiny metal or plastic tube that is used to hold an artery open. Stents can be placed into the body without cutting the chest.

Instead, tiny, hollow tubes called catheters are inserted into the groin area. The stent is passed through the catheter and into the area of the aneurysm. Not all patients with descending thoracic aneurysms are candidates for stenting, however.

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32 - 94

Title: Cosmetic Surgery Treatment



Cosmetic Surgery reconstruction of Skin and underlying tissues performed to remove the structural defect or some normal eveidence of aging.The term "cosmetic surgery" however, refers to surgery that is designed to improve cosmetics alone. The most prevalent aesthetic/cosmetic procedures are…


  • ·         Liposuction
  • ·         Face Lift
  • ·         Eyelid Surgery
  • ·         Nasal Reshaping
  • ·         Breast Reconstruction
  • ·         Tummy Tuck
  • ·         Dermabrasion
  • ·         Chemical peel
  • ·         Sex Reassignment Surgery
  • ·         Thigh Lift
  • ·         Brow Lift
  • ·         Hair Transplant
  • ·         Ear Surgery
  • ·         Neck Lift
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30 - 95

Title: Liposuction


Liposuction is designed to improve the contour of specific areas of the body, often those resistant to diet and exercise efforts. Areas commonly treated with this technique include hips, thighs, buttocks, abdomen and neck. Using tiny incisions, excessive fatty tissue is suctioned from the body, enhancing contour lines. This is generally an office procedure and multiple areas can be treated at one time.

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30 - 96

Title: Face Lift


Rhytidectomy is a procedure designed to restore youthful appearance to the face and neck. As such, it will remove many wrinkles and make those remaining much less apparent. Extra skin is removed and the facial contour is transformed to that of a younger person. A face lift is generally an office procedure and is done with local or general anesthesia.

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32 - 97

Title: Eyelid Surgery


Blepharoplasty is a low risk surgical procedure designed to remove extra skin and fatty deposits ("bags") that make a person look tired. The result is a rested and rejuvenated appearance. This procedure is generally done in the office and can be done alone or in conjunction with a face lift under local or general anesthesia. 

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30 - 98

Title: Nose Surgery


Rhinoplasty is a cosmetic procedure designed to improve the nasal size, shape, and contour. The nasal skeleton is remolded and the soft tissue is adjusted to provide facial harmony and a pleasing nasal silhouette. Septal deviation and associated airway obstruction are corrected. This procedure is generally done in the office under local or general anesthesia.

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32 - 99

Title: Breast Reconstruction


Breast reconstruction is designed to create a new breast for patients who have undergone a mastectomy. This can often be accomplished by using the patient's own tissue, or alternatively an implant, to fashion a new breast. A remarkably natural looking breast can be achieved. The new breast restores symmetry to the chest and liberates the mastectomy patient from the drawbacks of a prosthesis. This is a procedure done in the hospital under general anesthesia and requires a brief hospital stay. Recuperation depends on which procedure is performed.

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30 - 100

Title: Tummy Tuck Surgery


Abdominoplasty is a procedure designed to improve and rejuvenate the abdominal contour. Excessive skin and fat are removed and muscles are tightened, helping to create a flat abdomen. This procedure frequently may be performed on an inpatient basis.

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30 - 101

Title: Dermabrasion


Microdermabrasion is used to clarify aging skin, improve dull or uneven skin color, soften roughness, and smooth mild acne and minor skin abnormalities. Microdermabrasion is also effective in reducing fine lines, "crow's fee", age spots and acne scars. Microdermabrasion is a safe, effective way to rejuvenate the skin on your face, chest and even your back. The microdermabrasion technique exfoliates and gently resurfaces the skin, promoting the formation of new smoother, clearer skin while it stimulates the production of skin cells and collagen.

Microdermabrasion is a non-surgical procedure, with minimal discomfort, virtually no side effects or recuperation period, is effective on all skin colors and types, requires no anesthetic and is excellent for skin sensitive to chemical procedures.

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