1. All heart surgeries are major surgeries, how is the surgical plan determined?
The heart is the most important and complex organ in the human body, and there is no minor surgery for heart surgery. A comprehensive and meticulous diagnosis of heart disease is made, and a surgical plan is proposed based on the diagnosis, the patient’s general condition and individual characteristics. For difficult, rare and critical cases, an intra-hospital consultation will be conducted and professors from all relevant major departments will be invited to participate in the discussion to determine the best surgical and treatment plan. In addition, several alternative plans will be prepared, and the surgical procedure will be decided according to the actual situation during the operation to achieve the best surgical results.
2.When the surgery and anesthesia were signed, the doctor talked about many complications and dangers, are they all possible? Is the incidence high?
Whether it is the surgeon, anesthesiologist or perfusionist, the complications of surgery, anesthesia and extracorporeal circulation that you are told about have all happened before in clinical practice. However, not every patient will have these complications, and the incidence of serious complications in particular is very low. With the advancement of technology and medical development, the immediate and long-term results of our surgery have reached a high international and domestic level.
3.I don’t want to replace the valve, can I repair the valve?
Valve replacement or valve repair depends on the nature and extent of the lesion of the valve itself. In addition, the experience and skill of the operator plays an important role in determining the condition, especially when repairing the valve. Many patients with preexisting heart disease, wind heart disease, and traumatic valve injury who are considered by outside hospitals to be in need of valve replacement have undergone successful valve repair here, which not only saves money, but also avoids the disadvantage of requiring lifelong anticoagulants after valve replacement, which is especially beneficial to children in their growth and developmental years.
4.What is valve stenosis? What is valvular insufficiency?
The heart has four valves that control the direction of blood flow within the heart by opening and closing in a coordinated manner. Valve stenosis is when the valve becomes smaller and restricts the flow of water, and valve insufficiency is when the valve leaks and causes backflow. Whether the valve is stenosis or incomplete closure, or stenosis and incomplete closure coexist, both increase the burden on the heart long-term development will occur heart failure.
5.What are the types of valves? What are the disadvantages of each?
Prosthetic heart valves are divided into two types: biological valves and mechanical valves: biological valves are made of biological tissue materials, which are taken from homogeneous or heterogeneous heart valves. Biologic valves have a low thromboembolic rate and do not require lifelong anticoagulation to avoid complications such as bleeding from anticoagulant medications, but they are less durable than mechanical valves, with an average working life of about 15 years, so young patients may face the possibility of secondary valve replacement surgery. Mechanical valves are made of titanium alloy steel and advanced composite materials, which are durable and require lifelong anticoagulation therapy; daily anticoagulant medication is required, and anticoagulation indexes are tested regularly to ensure that anticoagulation therapy is in a safe range; improper anticoagulation therapy can lead to embolism or bleeding and other risks.
6.Why should coronary heart surgery be performed on the leg?
Coronary heart surgery, also known as bypass surgery, is surgery on the surface of the heart using its own blood vessels to bypass the blood supply at the distal end of the blocked coronary arteries. The most commonly used blood vessel is the saphenous vein located in the leg, so an incision is made in the leg to remove the saphenous vein for the heart bypass.
7.What is a coronary artery myocardial bridge?
Usually the coronary arteries and their branches are located in the tissue on the surface of the heart. Sometimes a small segment of some of the coronary arteries enters the myocardial fibers on the surface of the heart, and this condition is called coronary myocardial bridge. Myocardial bridges are most often seen in the anterior descending branches of the left coronary artery, but also in the right coronary artery and the gyral branches of the left coronary artery. Patients with myocardial bridges are more likely to have coronary artery spasm than those without myocardial bridges.
8.Why is the risk greater with age during surgery?
Age over 70 years old significantly increases the complications of important organs such as heart and lung, and the complication and morbidity and mortality rates increase with older age. In addition to the age factor itself, it is mainly related to age-related diseases.
9.Does lung disease have an impact on cardiac surgery?
Chronic lung disease has little effect on the surgery itself, but it does have an effect on postoperative recovery. Patients with signs and symptoms such as dyspnea, coughing and shortness of breath have 2-6 times the incidence of postoperative pulmonary complications than normal. Recent respiratory infections and increased tracheal secretions can easily lead to pulmonary atelectasis and lung infections after surgery.
10.Why is it difficult to feed infants and children with precordial disease?
The presence of sweating, shortness of breath, blue face, agitation and easy fatigue while breastfeeding indicates the presence of severe heart failure or hypoxemia. Older children who do not gain weight or are significantly underweight for their age indicate a severe heart defect. The degree of pediatric disease and cardiopulmonary impairment can be estimated based on the condition of the newborn or infant feeding.
11.Why do some heart surgeries have to be done when the child is not yet full term?
Some congenital heart malformations, such as complete transposition of the great arteries, are best treated by anatomical radical surgery when the child is not yet a month old. As the child grows, the anatomical left ventricle gradually degenerates, and then surgery is not ideal and there are many complications, some even lose the opportunity of surgery, so radical surgery cannot be performed.
12.Why can’t some complex precordial diseases be cured in one surgery and what is reduction surgery?
For some complex malformations and difficult to cure at one time, reduction surgery is a palliative surgery method to reduce symptoms, relieve the condition or exercise the heart to create conditions for the second radical surgery. However, some of the complex malformations do not have indications for radical surgery and can only be performed as reduction surgery.
13.Why can some patients undergo radical surgery for the same precordial disease, while others cannot undergo radical surgery and can only undergo reduction surgery?
The same disease has different conditions, different complexity, different comorbidities, different age and different systemic status, which determine whether the patient can undergo radical surgery. After the reduction surgery, some patients can undergo the second stage surgery after a certain period of heart exercise and recovery, while others may not have the indication for the surgery and cannot undergo the second stage surgery.
14.Why do children with precordial disease always have fever, cold, or even pneumonia?
Children with precardiac disease, such as ventricular septal defect, have more blood in the lungs, so they are prone to fever and cold, which are often recurrent and not easily cured, and even lead to pneumonia. Only after early surgery to treat the heart malformation will they get better. Delayed surgical treatment can affect the growth and development of the child.
15.Why do some children with precordial disease like to squat on the floor?
Squatting is one of the most typical manifestations of cyanotic precocious heart disease. These children usually have complex heart malformations, and tetralogy of Fallot is a typical representative, with little blood in the lungs and severe hypoxia, especially after walking for a distance, squatting is good for increasing blood in the lungs to relieve systemic hypoxia. For smaller children eating and crying can also cause increased bruising, then you can lightly press the child’s abdomen or curl up the child’s legs, which can also play a role in relieving the bruising.
16.Why do children with precocious heart disease have chicken chest?
Children with heart disease will have compensatory enlargement of the heart due to the presence of cardiac malformations, and the appearance of a chicken chest often implies that the heart is more obviously enlarged, intracardiac malformations or accompanying symptoms are more serious.
17.Adults with atrial septal defect are currently asymptomatic, can it heal on its own without surgery?
Atrial septal defects are usually asymptomatic in the early stages, but symptoms may appear in adulthood, especially in some severe rhythm disturbances that can be life-threatening. Atrial septal defects usually do not heal on their own and must be treated with surgery.
18.I am a young girl, can I make the surgical incision on my chest without affecting the aesthetics?
You don’t have to worry, we have taken all these problems into consideration. In order to take care of young girls’ love of beauty, small incisions on the right side of the chest wall can be used for minimally invasive surgery for younger patients, and we have performed nearly 200 cases with this method, the incisions are small and located in the axilla, which does not affect the aesthetics and patients respond well. For older patients, atrial septal defect can be treated by interventional blocking through a small incision in the chest wall, the incision is only 2-3 cm, and full thoracoscopic extracorporeal circulation cardiac surgery is also an ideal choice.
19.Can heart surgery be treated by open-heart surgery from the side of the body?
This depends on the nature and severity of the heart disease, the surgical procedure and difficulty, the experience of the surgeon, etc. In addition to the concealed incision, it is difficult to establish extracorporeal circulation and intracardiac operation because of the deeper heart position and poorer exposure of the operating field, and there are certain risks. Lateral open-heart surgery is more suitable for pediatric patients with simple atrial and ventricular septal defects because of their small thorax and relatively good heart exposure. In short, surgical safety and results are the first priority.
20.I am taking aspirin or Poliovel, why do I have to stop taking them before surgery?
You are taking aspirin or poliovel, which are drugs that inhibit blood clotting. If you do not stop taking them before surgery, you will have more bleeding and longer surgery time, which is not good for your recovery. More bleeding and more use of blood bank, in addition to increasing the cost, the chance of transfusion of infectious diseases is also increased.
21.I am allergic and I am allergic to seafood, does it have any effect on the surgery?
Allergy itself has no effect on surgery, but it does have an effect on perioperative management because many drugs, including antimicrobials, are used during the perioperative period. People who are allergic to fish or shrimp have a high likelihood of being allergic to one of the drugs used postoperatively in cardiac surgery, fisetin. The effects can be controlled to a minimum by taking certain preventive and control measures.
22.Do I need to bring the examination data from other hospitals to visit your hospital?
No. It is best to bring all the information about your visits, examinations and hospitalization in other hospitals to your doctor for reference, so that your condition can be judged and treatment plans can be made.
23.Do I need to repeat the laboratory tests that were done in other hospitals here?
Some laboratory tests are time-sensitive and may need to be repeated. However, the more expensive and invasive tests such as coronary angiogram that were recently done in experienced hospitals or large tertiary hospitals can meet the clinical requirements and basically do not need to be repeated. In children who are growing and developing, their conditions change rapidly. If the cardiac catheterization test used for congenital heart disease diagnosis is more than three months to six months, it may need to be repeated in order to clarify the changes in their conditions and determine the indications for surgery.
24.How is the procedure scheduled? What is the main basis?
The surgery is scheduled according to the severity of the disease. If the disease is severe and the preoperative examination is well prepared, the surgery can be performed immediately. For patients with relatively mild conditions, surgery will be scheduled in the order of admission after all examinations have been completed. Patients with upper respiratory tract infections need to be cured before surgery. Patients with severe disease and poor cardiopulmonary function need to adjust their cardiopulmonary function to the best state before surgery. For children with complex precardiac disease and particularly complex malformations, surgery should be scheduled as early as possible after the diagnosis is clear. If the patient has special circumstances, he/she can communicate with the doctor in charge to solve the problem. For each case, Director Zhang Zaigao will personally review and approve the operation and strictly control the indications for the operation to ensure the safety of patients.
25.After the infant and child who needs parental care is hospitalized, can family members accompany the bed?
After a child is hospitalized, we ask parents to keep one person in bed with them to try to reduce the children’s loneliness and fear, and we communicate with parents at any time to guide them to take better care of their children. In order to reduce the flow of people, avoid cross infection and facilitate management, the accompanying person can rest on a folding bed after lights out at 9:00 pm. Folding beds can be rented from the escort center in the hospital, or you can bring your own. We have two rooms to better meet the needs of the companions. If your family cannot stay with you, you can hire a trained nurse through the hospital escort center.
26.How long does it take to schedule surgery after hospitalization?
The time to schedule surgery is mainly based on the patient’s condition and general functional status. If the diagnosis is clear, the general condition is good, and there are no contraindications to surgery or anesthesia, surgery can be scheduled as early as the day after hospitalization, and emergency surgery can be scheduled on the same day. Patients with uncertain diagnosis, poor systemic function, heart failure and infection may need some time to clarify the diagnosis and adjust their cardiac function and systemic status.
27.How do I know my medical costs?
Charges vary depending on the type of disease, condition, surgical procedure, drugs used, consumables, monitoring measures used and length of stay and conditions of the selected ward. Our billing system is networked throughout the hospital, so you can check the approximate medical costs at any time during your stay, and the hospital will issue an itemized bill when you are discharged. What we can do is that the hospital treatment time is relatively short and the cost is relatively low for the same kind of disease, surgery and treatment.
28.Who is mainly responsible for my condition and treatment after hospitalization? Who can I contact if I have any problems?
Once each patient is admitted, the department head will assign a supervising physician to each other according to the patient’s specific situation. This supervising physician is mainly responsible for your treatment, observing and recording changes in your condition and the effects of your treatment under the guidance of your supervising physician. Any problems you have can be reported to your supervising physician, who will deal with them or report them to your supervising physician. In addition, the door of your ward is marked with the name of the doctor in charge and the nurse in charge, you can also report to other nurses or nurse manager to communicate, you will get a satisfactory answer.
29.How are the family members arranged during the patient’s admission to ICU after surgery?
When a patient is admitted to the ICU after surgery, family members need to leave the ward with their own supplies and wait at our hospital’s guest house prepared specifically for family members so that they can be contacted in time to provide patients with necessities, food and drink, etc. After the patient returns to the ward from the ICU, a separate room will be arranged.
30.Can you introduce the environment of the cardiac surgery ward?
The surgical ward is located on the fourth floor of the inpatient department, and the nurse’s station is in the center of the ward, so that patients on both sides of the ward can be closely observed. There are bathrooms and washrooms in the ward. The ward is equipped with a bedside table and a bottle warmer, and a bottle warmer and a drinking glass are placed on the table of the bedside table. Patients are required to wear hospital gowns after admission. Toiletries are put in the collection basket under the bed or on the balcony, and the washed clothes can be put on the lanai to cool and dry.
31.Briefly introduce ward management?
Every morning at 8:00 a.m., the ward director will lead the whole department to check the ward, and you can report to the doctor if there is any situation or ask questions. After the room check, the doctor in charge will make a treatment plan for you, and the nurse will do the specific operation, so you can rest and wait in the ward. After lights out at 9:00 pm, you should reduce your activities and rest quietly.
32.Are there any requirements about accompanying the stay?
In order to reduce the flow of people, avoid cross-infection, facilitate management, and at the same time reflect the concept of humane service and facilitate patients’ recovery as soon as possible, patients are allowed to stay with one person. The companion can rest on a folding bed at 9:00 pm after lights out. Folding beds can be rented from the hospital’s escort center, or you can bring your own. If family members cannot stay with the patient, they can hire trained nurses from the hospital escort center.
33.What should be paid attention to inpatients’ personal hygiene, diet, living and safety?
(1) Hygiene: After admission, nurses will assist patients with personal hygiene issues, including hair, nail, hand and foot hygiene, within 24 hours. Bathing and showering are allowed if the disease condition permits, and toiletries are prepared by individuals.
(2) Diet: The hospital is equipped with a nutritional canteen, which provides a variety of tastes and nutritionally balanced diets, including liquid, semi-liquid, diabetic meals, Muslim meals, nutritious meals, etc. Patients only need to exchange their meal tickets and make reservations one day in advance according to their tastes, and three meals a day will be delivered to the ward by the nutritional canteen staff.
(3) Safety: Patients need to abide by the rules of the ward after they are admitted to the ward to facilitate timely treatment. For the safety of patients, they cannot leave the ward without the permission of the doctor, and in case of special circumstances, they can leave the ward only with the permission of the doctor and after writing a leave note. The ward is equipped with microwave ovens for patients’ use, so patients may not use electric stoves, etc., in case they cause a short circuit in the wiring, which may lead to a fire and crisis the patient’s life.
(4) Family members: they can stay at the hospital guest house or hotel residence near the hospital, and can dine at the hospital restaurant.
34.What are the main examinations after the patient is admitted to the hospital? How long does it take to complete?
Routine tests (blood, urine, stool, biochemistry, immunology, electrocardiogram, chest X-ray, cardiac ultrasound, etc.) after hospitalization can generally be completed in 1 to 2 working days. For children who are too young or have severe cyanosis, it may take two times to collect blood. Based on the examination results, the doctor in charge may give a preliminary explanation to the patient or family about the condition, treatment plan and the cost of the treatment required. In the case of difficult diseases that require further CT or cardiac catheterization to clarify the diagnosis, the examination time will be extended accordingly. After all the results of the comprehensive study are discussed within the department, a final treatment plan will be made, and then further communication with the parents will be made. The operation can be arranged after the agreement with the parents.
35.What do we need to do before the surgery?
First of all, we will pay all the deposit for the hospitalization; the doctor in charge and the surgeon will explain the risks of the surgery to the family together, and the parents will sign on the basis of understanding. The anesthesiologist will tell the parents when they will no longer be able to eat. If the surgery is scheduled late, the pediatrician will usually give fluids to prevent dehydration fever and hypoglycemia.
36.What is the main treatment for patients who are hospitalized and ready for surgery during their stay?
From the day of hospitalization, all tests can be gradually completed, pending the scheduling of surgery. Blood sugar, blood pressure and cardiopulmonary function are adjusted before surgery. During the waiting period for surgery, pulmonary function exercises can be performed, etc. After returning to ICU after surgery, family visits are prohibited to avoid cross-infection, and living during this period needs to be done by nurses. According to the patient’s specific situation, when the condition allows, he/she can be transferred back to the ward to continue treatment. 10-15 days later, the indicators tend to be normalized and discharge is arranged.
37.How to arrange the anesthesiologist? Can I choose the anesthesiologist?
The department generally arranges the best anesthesiologist according to the patient’s specific condition, surgery and individual special conditions, combining the specialties of each anesthesiologist. For critical, complex and special patients, a department-wide discussion will be held under the auspices of the department head and experienced senior physicians, or a joint multidisciplinary discussion will be held to develop the best anesthesia treatment plan. The experienced senior physician will be present during the operation to provide guidance in case of special circumstances. We have not yet carried out anesthesia by name, so we cannot select anesthesiologists yet.
38.Is anesthesia very simple, just a shot of anesthesia and no pain in surgery?
No, it is not. Anesthesia is actually very complicated, and making the patient feel no pain during surgery is only a small part of the work of anesthesia. The anesthesiologist has to monitor the patient’s life safety, perform various treatment and rescue, avoid or reduce various complications, and provide an optimal environment for surgery. The monitoring of preoperative traumatic diagnostic tests and anesthesia and postoperative analgesia are also part of anesthesia work.
39.I only have a mild fever, why should my surgery be stopped?
Surgery and anesthesia, especially extracorporeal circulation for cardiac surgery, is a big blow to the patient’s organism, which can lead to a decrease in body resistance and induce potential diseases in the patient’s body, which is detrimental to the patient’s postoperative recovery. Fever generally indicates bacterial or viral infections in the body, and the reduced resistance caused by surgery can aggravate these infections.
40.Why should the anesthesiologist visit the patient before surgery?
Pre-anesthesia visit enables the anesthesiologist to better understand all aspects of the patient’s body, determine the anesthesia method and anticipate possible intraoperative conditions, and prepare for all aspects of the patient’s anesthesia. To communicate with the anesthesiologist about their concerns and to better cooperate with anesthesia and surgery during the operation.
41.I am especially nervous before the surgery, especially the night before the surgery, I am worried that I cannot sleep.
It is normal for anyone to be nervous about surgery. Patients should first of all relax and consult the medical staff if they have any questions, and family members can cooperate to make some comforting work. If you cannot sleep at night, you can report to the physician on duty, who will give you some medication to help you sleep. It is important to get enough rest before surgery to keep your energy up for surgery and post-operative recovery.
42.I had anesthesia last time and it didn’t seem to go well, does it have any effect on the anesthesia for this surgery?
Your question is very important. The last anesthesia has important reference significance for this anesthesia, especially for some unexpected or special cases. Knowing these cases will help the anesthesiologist to formulate the anesthesia plan and avoid the recurrence of the same unexpected cases. It is best to tell your anesthesiologist what you know for his reference.
43.Does the fact that I am “left-handed” have any effect on anesthesia or surgery?
”Left-handedness itself has no effect on anesthesia. However, it should be considered when performing direct intra-arterial manometry. In general, the left hand is used for intra-arterial manometry, and the right hand is used for “left-handed” patients, so that the left hand, which is the main functional hand, will not be affected in case of complications. In addition, if the radial artery is taken for coronary artery bypass surgery, the left radial artery is routinely taken, while the right radial artery should be taken for “left-handed” patients.
44.Why do I need anesthesia?
The role of anesthesia is to eliminate mental, psychological and physical pain and discomfort caused by surgery, to provide good surgical conditions and to ensure patient safety. The anesthesiologist is an internist in surgery, who uses some non-invasive and invasive monitoring means, mainly medication with other methods, to maintain the stability of important vital signs such as respiration and circulation during surgery, to avoid or reduce some complications caused by surgery and anesthesia itself, and to promote the patient’s recovery after surgery.
45.Why do I need a muscle injection before surgery?
The injection given before entering the operating room is a preoperative drug, the main role of which is sedation, reducing glandular secretion and having a certain analgesic effect, which helps patients enter the operating room smoothly. It prepares for general anesthesia, plays a sedative and calming role, reduces patient tension, reduces the secretion of saliva and other glands, and makes general anesthesia intubation safer and smoother.
46.Does it hurt to have anesthesia?
Like an injection, as long as you cooperate well with the doctor, the operation will be smooth and the less painful it will be, and it will not be very painful.
47.Do I have to stop the medication I have been using before the surgery, such as hypoglycemic drugs, antihypertensive drugs, and drugs to control heart rate disorders?
Do not stop the medication before the operation, and continue to take it on the morning of the operation, so as to help control blood pressure and blood sugar during the operation and reduce the risk of the operation. However, certain drugs such as aspirin, which has an effect on blood clotting, should be consulted with the surgeon and anesthesiologist.
48.I have coronary heart disease and had a heart attack a few years ago, will anesthesia be very risky?
Anesthesia is more risky than general patients, but if your physical condition is okay now, no unstable angina and acute infarction, and all the examination results are still normal, you can operate, and we will strengthen the monitoring during the operation to prevent accidents.
49.Will my smoking and drinking affect the effect of anesthesia?
You should quit smoking and drinking one week before surgery, smoking will increase the secretion of airway, drinking will increase the dosage of anesthesia drugs, such as your current physical condition is okay, all the tests are still normal, the anesthesia effect will not be greatly affected.
50.Is general anesthesia more dangerous than other anesthesia methods?
No, the anesthesia method is chosen by the anesthesiologist based on the surgical site, surgical method, general condition and patient safety, etc. It is relatively safer in monitoring and controlling the vital indicators of the patient. The patient feels more comfortable under general anesthesia, and the surgery is over after a good sleep.