Heart Conditions and Procedures

Our UCSF cardiothoracic surgeons are on the leading edge of treating cardiovascular and cardiothoracic (heart and chest) conditions using the latest innovations. When patients require surgery, the surgeons carefully evaluate each patient and collaborate with a multidisciplinary team to determine the best approach. In many cases, a minimally invasive procedure will address the issue. This means the surgeon accesses the heart through catheters inserted in small incisions in the skin. For others, traditional open-heart surgery is the best option.

We offer a comprehensive range of procedures, most of which are done onsite at Washington Hospital. Some procedures are performed at UCSF Health. Listed below are some of the most common heart conditions and a description of the procedures that may be used to surgically treat them.

Aortic Aneurysm and Dissection

An aortic aneurysm is a bulge that occurs in the wall of the major blood vessel (aorta) that carries blood from the heart to the body. Having an aortic aneurysm increases the risk of developing a tear or rupture in the inner layer of the wall of the aorta (aortic dissection). Blood rushes through the tear causing the inner and middle layers of the aorta to split or dissect.

• When an aortic aneurysm is located in the abdomen, it may be repaired by open surgery or through a minimally invasive procedure called endovascular aortic repair (EVAR).
• Aortic aneurysms located in the thoracic (chest) area may be repaired through open surgery or minimally invasively through thoracic endovascular aortic repair (TEVAR).
• Aortic root surgery removes an aneurysm in the area closest to the heart and replaces it with a graft. This can be a life-saving surgery preventing an aortic dissection.

Arrhythmias

A heart arrhythmia is an irregular heartbeat. Heart rhythm problems occur when the electrical signals that coordinate a person’s heartbeat does not work properly. The faulty signaling causes the heart to beat too fast (tachycardia), too slow (bradycardia) or irregularly. Arrhythmias may feel like a fluttering or racing heart and may be harmless. However, some may cause bothersome or life-threatening symptoms and require surgery.

• In the maze procedure, a surgeon makes a series of incisions in the upper half of the heart tissue (atria) to create a pattern of scar tissue. Because scar tissue does not conduct electricity, it interferes with stray electrical impulses that case some arrhythmias.
• Left atrial appendage closure is a procedure used to reduce the risk of stroke in patients with atrial fibrillation who are unable to take blood thinning medicines.

Coronary Artery Disease (CAD)

CAD is a common condition where the major blood vessels that supply the heart (coronary arteries) struggle to send enough blood, oxygen and nutrients to the heart muscle. Cholesterol deposits (plaques) in the heart arteries and inflammation are usually the cause of coronary artery disease. Signs and symptoms of CAD occur when the heart doesn't get enough oxygen-rich blood. Those with CAD may experience chest pain (angina), fatigue and shortness of breath. A complete blockage of blood flow can cause a heart attack.

• Coronary artery bypass graft surgery (CABG): A healthy blood vessel is taken from another part of the body to create a new path for blood in the heart so it can go around the blocked or narrowed coronary artery. CABG is an open-heart surgery usually only done in those with many narrowed heart arteries.

Congenital Heart Disease

There are many types of congenital heart disease which are defects in the heart’s structure that exist since birth. The more common defects involve holes in the inner walls of the heart, abnormal heart valves, or narrowed blood vessels. These problems can change the way blood flows through the heart and may range from mind to complex, life-threatening conditions.

• Some of the congenital heart disease procedures done at Washington Hospital include surgeries to treat atrial septal defects, patent foramen ovale, coarctation of aorta, bicuspid aortic valve replacement and atrial myxoma excision.

Valve Disease

The heart has four valves that keep blood flowing in the correct direction. With heart valve disease, one or more of the valves does not work properly. Heart valve problems include regurgitation, where the valve flaps don’t close properly causing blood to leak backward in your heart. Stenosis is the most common valve disease and occurs when the valve opening narrows, reducing blood flow through the valve. Symptoms include heart murmur and activity-induced chest pain, fatigue, shortness of breath, and fainting. Untreated, it can lead to heart failure and sudden cardiac death.

• Surgical aortic valve replacement (SAVR) is another way to replace the aortic heart valve through traditional open surgery. SAVR is usually the best option when the patient has other issues in the heart that can be addressed during open-heart surgery.
• Mitral valve repair and replacement may be done to fix or replace a leaky or stiff mitral heart valve. This may be done as open-heart surgery or a minimally invasive heart procedure, depending on the severity of the mitral valve disease.
• Tricuspid valve repair and replacement are done to improve blood flow and reduce symptoms of tricuspid heart valve disease. These surgeries may also be done as open-heart surgery or a minimally invasive catheter-based procedure.