We have found in our clinical work for many years that many patients with coronary heart disease and those who have already had bypass surgery do not know much about coronary heart disease and bypass surgery. If patients do not understand the disease they are suffering from and are not familiar with the surgery and some common problems after the surgery, it will not only increase the patients’ unfamiliarity and fear of the surgery, but also create worries about a series of problems such as postoperative treatment and care, which will have a very great negative impact on the patients’ preoperative and postoperative psychology. Therefore, here is a summary of some of the questions frequently asked by patients in the clinic, hoping to help the majority of patients and their families. I. What is coronary artery disease? Coronary artery is the blood vessel that supplies blood to the heart. If the coronary artery becomes spasm, organic narrowing or blockage, it will cause myocardial ischemia or even necrosis, we call it “coronary heart disease”, also called “ischemic heart disease”. Clinically, patients can have angina pectoris, myocardial infarction, heart failure, arrhythmia and sudden death. How is coronary heart disease formed and developed? Atherosclerosis is the most important cause of coronary artery stenosis. Lipids, cholesterol and other substances are gradually deposited in the inner wall of blood vessels, forming lipid plaques, resulting in the gradual thickening of the inner layer of the vessel wall, narrowing of the lumen, hardening of the vessel wall, and reduction of blood flow through the vessel, a pathological process called “atherosclerosis”, which usually begins in childhood and continues throughout life. This pathological process is called “atherosclerosis” and usually begins in childhood and continues throughout a person’s life. This is also the reason why many patients have preoperative carotid ultrasound examinations that reveal sclerotic plaques or even stenosis in the carotid or vertebral arteries. As the plaque gradually increases and thickens, it may block the coronary artery and gradually reduce the blood supply to the heart. When the plaque blocks 70% or more of the diameter of the coronary artery, ischemia and hypoxia will occur in the heart muscle, manifesting as chest pain, chest tightness, breath-holding and discomfort in the precordial area, which is called “angina pectoris”. It can be relieved by rest or sublingual nitroglycerin, and can also occur at rest in severe cases. Many patients say that they have never had angina, but only some chest tightness or “unexplained discomfort” in the precordial region, so how can they have angina? In fact, the attack of angina is not necessarily “pain”, most people do not “pain”, only the above-mentioned “chest tightness, discomfort”, and some patients manifest as Some patients have “stomach pain”, “toothache”, “throat discomfort”, etc. Some patients even have no symptoms at all, but only find that they have an abnormal ECG or cardiac ultrasound during physical examination, and then have a coronary artery It is only after a coronary angiogram that a serious coronary heart disease is discovered. No matter how different the symptoms are, coronary angiography is the “gold standard” for diagnosing coronary artery disease, and if there is a problem with the angiography result, it is coronary artery disease. Then, the plaque may rupture and form a thrombus, causing an acute occlusion of the coronary artery, called an “acute myocardial infarction”. Patients may experience persistent chest pain or discomfort in the precordial region, radiating to the back, left forearm or throat, which cannot be relieved by rest or sublingual nitroglycerin. The coronary arteries are divided into the left coronary artery and the right coronary artery, of which the left coronary artery divides into the anterior descending branch and the gyrus branch after the shorter left main stem. What we usually call “triple lesion” refers to the narrowing of the anterior descending branch, the circumflex branch and the right coronary artery. Why is the “left trunk lesion” considered to be more severe? As you can see from the figure below, the left trunk (the location of the “left coronary artery” in the figure below) is located at the source of the left coronary artery, just like a blocked water source dries up all the downstream areas, once a severe stenosis occurs here, it will lead to ischemia in 2/3 of the heart, so it is considered more serious. What is coronary artery bypass surgery? The so-called “bypass” is to take blood vessels from other parts of the patient’s body, such as the saphenous vein, radial artery or internal mammary artery, and use them as a “bridge” to create a new channel for blood supply to the heart, cross the narrowed part of the coronary artery, and anastomose with the distal vessels, so that This allows the oxygen and nutrient-rich blood in the aorta to bypass the stenosis and reach the distal end, so that the ischemic myocardium at the distal end of the stenosis can be supplied with blood again, fundamentally solving the problem of myocardial ischemia. Coronary artery bypass grafting has an “immediate” effect on the relief of angina. Depending on the patient’s preoperative condition, many patients are able to walk up and down stairs within a few days of coronary artery bypass grafting. If they recover well, they can go out on the street after a week. One to two months after surgery, they are able to perform light work. In 3 to 4 months after surgery, the patient is basically recovered. Coronary artery bypass surgery is the most effective and reliable method for the surgical treatment of coronary artery disease, with a success rate of 98% or more. It can effectively relieve the patient’s angina, improve the patient’s mobility, improve the quality of life, and reduce the occurrence of myocardial infarction, malignant arrhythmia and sudden death, and prolong the patient’s life expectancy. Fourth, after the bypass surgery is not the angina will not be committed again? Coronary artery bypass surgery only solves the patient’s current myocardial ischemia problem, but does not completely cure coronary artery disease, nor does it prevent the further development of coronary atherosclerosis, that is, after bypass surgery, the original non-stenosed blood vessels and the bridged blood vessels may become stenosed or blocked again, thus leading to the recurrence of angina pectoris. However, the chances of such recurrence are very low. The time interval for restenosis to occur varies from person to person. It is mainly related to the combination of other underlying diseases and the extent of the coronary artery itself, with restenosis occurring within a few months after surgery in a very small number of patients and extending to several years or even decades in the majority of patients. Therefore, long-term medication is still required after coronary artery bypass surgery. Active control of susceptibility factors for coronary artery disease, such as smoking, excessive alcohol consumption, obesity, hyperlipidemia, diabetes, and hypertension, can effectively prevent further development of coronary artery disease and avoid recurrence of angina. It is generally believed that the 10-year patency rate of venous bridges is 60%, and the long-term patency rate of arterial bridges will be even higher. However, the number of arteries available for bypass in the human body is limited, and some arteries are not suitable for bypass because they are prone to spasm, have too thin lumen or have lesions. Even if a blockage of the bridge vessel occurs, there is no need to worry too much, some patients have 4 bridges, postoperative blockage of 3, only one artery bridge is open, it is not necessarily life-threatening. And with the development of medical technology, even if angina recurs, there are corresponding treatment measures to cope with it, such as putting stents inside the bridge vessels, or operating again. 5.Will the leg taking blood vessel bypass affect the function of lower limbs? The saphenous vein, the longest superficial vein in the body, extends from the ankle to the root of the thigh. It is one of the most commonly used “bridge” vascular materials for coronary artery bypass surgery because of its small curvature, sufficient length and matching caliber with coronary artery. The human body has two sets of venous return systems in the lower extremities, the deep veins and the superficial veins, and there are abundant traffic side branches between them. After removing the superficial vein, that is, the saphenous vein, the deep and superficial veins will be richer after a long enough time of recovery, which will play a compensatory role and will not have much effect on the venous blood return of the lower limbs and will not affect the motor function of the lower limbs. Sixth, why does the leg swell and numb after taking blood vessels? As mentioned in the previous question, since the saphenous vein is removed from the leg, the venous blood that originally needs to return through the saphenous vein needs to return through the deep veins to establish a new collateral circulation, and this process takes a period of time, usually several months. During this time, the lower extremity from which the vein was removed will have varying degrees of swelling. Frequent elevation of the affected limb can promote blood return to eliminate swelling. Wearing a high tension medical long elastic stocking when walking down can reduce the swelling to some extent, but do not wear it for a long time and take it off when lying down. In addition, since obtaining the saphenous vein requires cutting the skin as well as the subcutaneous tissue, the nerves and lymphatic vessels in this area will be cut and damaged, so there will also be different degrees of numbness after the surgery, which is normal and need not be worried. There are two methods of saphenous vein extraction: 1. Full incision method: Depending on the length of the saphenous vein needed, the skin is removed by full incision method in the lower leg, which usually requires 20 to 40 cm long incision. The trauma is relatively large, the swelling of the leg is more obvious after the surgery, there is a certain chance of infection, and the scar growth may cause discomfort to the patient and affect the aesthetics, and the postoperative swelling should be longer. The mobility of the lower limbs remains unaffected after surgery. Due to the simple method of extraction, it is the most commonly used method in China. 2.Minimally invasive endoscopic saphenous vein retrieval: It is to cut 2 to 3 small 1-2 cm long holes in the lower leg, and use endoscope and special instruments to separate and remove the saphenous vein completely in the subcutaneous tissue. While ensuring the quality of the vein, it greatly reduces trauma and decreases the chance of swelling, skin numbness, necrosis and infection in the patient’s lower extremity after surgery. It reduces postoperative incision pain, inconvenience of movement, faster healing, and is more aesthetically pleasing. This method is more widely used in Europe and the United States. Seven, what preparations are needed before bypass surgery? First of all, necessary preoperative examinations should be performed, including blood test, electrocardiogram, chest X-ray, cardiac ultrasound, carotid ultrasound and coronary angiography, and other special examinations if necessary. Secondly, oral anticoagulants, such as Bolivar, need to be stopped before surgery and wait for a certain period of time. Wait for these drugs to be metabolized and eliminated in the body so as not to increase the risk of bleeding, with the exception of emergency surgery. It is also necessary to reduce activity, rest in bed, avoid mental tension, emotional excitement, etc. Do not eat too much to force bowel movements, keep bowel movements smooth, and if necessary, medication can assist in bowel movements. Also, in order to prevent postoperative respiratory complications, you should quit smoking, practice deep breathing and coughing movements, and avoid catching a cold. Get a good night’s sleep and take sleeping pills if necessary. It is very important to tell your supervising physician if you have had other surgeries or taken other medications before, and if you have had other diseases such as glaucoma, peptic ulcers, severe hemorrhoids, brain embolism, etc.!