Dr. Vernon Freeman
021 949 9332
Dr. Sizwe Mthiyane
Melomed Richards Bay
035 791 5406
Dr. Sunil Thakersee
021 638 3017
Dr. Patrick Ntuli
021 764 7158
Dr. Farai Russell Sigauke
021 110 5147
Dr. Riyad Moydien
021 764 7157
Dr. Mohamed Cassim Mayet
021 764 7500
Dr. Duncan Anderson
Melomed Gatesville & Tokai
021 637 0935
What is Coronary Bypass Surgery?
Coronary bypass surgery redirects blood around a section of a blocked or partially blocked artery in your heart to improve blood flow to your heart muscle. The procedure involves taking a healthy blood vessel from your leg, arm or chest and connecting it beyond the blocked arteries in your heart.
The risk of developing complications is generally low, but it depends on your health before surgery. Your risk of complications is higher if the operation is done as an emergency procedure or if you have other medical conditions, such as emphysema, kidney disease, diabetes or blocked arteries in your legs (peripheral artery disease). Coronary bypass surgery generally takes between three and six hours and requires general anaesthesia. The number of bypasses you need depends on where in your heart and how severe your blockages are.
Most coronary bypass surgeries are done through an incision in the chest while a heart-lung machine keeps blood and oxygen flowing through your body. The surgeon takes a section of healthy blood vessel, often from inside the chest wall or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is redirected around the narrowed part of the diseased artery.
After completing the graft, the surgeon will restore your heartbeat, disconnect you from the heart-lung machine and use wire to close your sternum. The wire will remain in your body after the bone heals.
Your results and long-term outcome will depend in part on taking medication to prevent blood clots, lower blood pressure, lower cholesterol, helping to control diabetes as directed and by following healthy lifestyle recommendations.
It is comforting to know that Melomed hospitals, namely Melomed Gatesville, Melomed Tokai, Melomed Bellville and Melomed Richards Bay offers a Cardiac Centre of Excellence, with state of the art cathlab, cardiac theatre, cardiac ICU and highly skilled staff.
What is Vascular Disease?
Your body contains an amazing, intricate system of arteries and veins. Arteries carry oxygen-rich blood from your heart to every part of your body; while veins return the blood back to your heart and lungs for more oxygen.
Most people know that heart disease occurs when the blood vessels in your heart become blocked with plaque and cholesterol, a condition known as atherosclerosis.
Many are unfortunately unaware that the same problem, atherosclerosis (hardening of the arteries), can occur in any artery of the body. Common types of artery disease include carotid artery disease and stroke, aneurysms and peripheral arterial disease.
Venous problems occur in the veins, often resulting in leg swelling, spider veins and varicose veins, deep vein thrombosis (blood clots) and chronic leg problems.
Common types of arterial disease:
Carotid artery disease and stroke
Carotid arteries in the neck carry oxygen to the brain. Patients who have had a transient ischemic attack (TIA), stroke, sudden loss vision in the eye or have an abnormal sound in the artery, should be referred to a vascular surgeon for diagnosis and possible treatment. Elderly patients with a family history of stroke should be referred for screening and prevention.
An aneurysm is a bulge that develops in a weakened part of an artery. Most commonly they occur in the aorta, the biggest artery of the body, running from the heart through the abdomen. Aneurysms can also occur in the pelvis or the knee. Over time they enlarge and rupture, this is often fatal. When suspected urgent referral is needed. Elderly patients benefit from screening and prevention.
Peripheral arterial disease
Atherosclerosis of the leg arteries causes hardening and narrowing of the blood vessels, leading to decreased or absent flow to the limbs. Early on, this may cause pain when walking, but as the disease progresses, it can cause painful feet, foot ulcers, infections, non-healing wounds and even gangrene. Untreated it carries a high risk of amputation. Screening and prevention are important and early treatment prevents limb loss.
Common venous problems:
Spider veins and varicose veins
Spider veins are small bluish veins just under the skin, while varicose veins are larger bulging veins. Most often they are cosmetic, but they can be a sign of a more serious venous disease. Modern treatment is minimally invasive and can prevent more serious complications such as venous leg ulceration.
Chronic venous insufficiency
This is caused by blood reflux or clotting in the main deep veins, usually in the pelvis. It can also be the result of previous undiagnosed deep vein thrombosis. It's a potentially painful condition, causing pain and swelling of the legs, with darkening of the skin and ultimately leg ulceration.
Deep vein thrombosis
Deep vein thrombosis is the result of blood clots in the deep leg veins. These clots are at risk of embolisation (travelling to the lungs) and resulting in pulmonary embolism.
What is a vascular surgeon?
A vascular surgeon is a super-specialist who specialises in screening and prevention of vascular disease and the treatment of any vascular condition with any treatment - medication, minimally invasive endovascular surgery, or open surgery.
Many vascular conditions are lifelong, and your vascular surgeon may become a lifelong care partner.
Be aware of your vascular health and consult your vascular surgeon.
What are Pacemakers?
Some years ago when the matriarch of a well-educated family needed a pacemaker implant, I began to understand how little is known about the subject in the community. The family was mobilizing from all over the country to be at the bedside for this “major operation”.
Pacemaker implants in South Africa was pioneered by the Barnard brothers since the late 1960’s. At that early stage the power for the device was supplied by an external battery the size of a PM9 (hope you know what this is).
For a muscle to contract it needs a stimulus (prickle). The stimulus starts from the right atrium (upper chamber) where the heart’s own impulse generation resides. The impulse travels to the pumping chambers (ventricles) via the conducting system that carries the impulse to the muscle.
As the impulse travels through the muscle it causes a coordinated contraction that pushes the blood as per our metabolic needs. This process happens more than a hundred thousand times per day during our lifetime. As, in the modern era people live to a higher age, we encounter ever increasing situations where the heart’s own (biological) pacing system degenerates. Here (fortunately) our modern technology steps in to save the day.
What can go wrong?
The heart loses its ability to generate an impulse (at the rate required by the body) or transfer that impulse to the muscle to tickle the heart muscle to contract.
A dysfunction may lead to the heart going too slow. Not enough oxygen is supplied to the brain causing a variety of symptoms:
The electrocardiogram (ECG) will usually reveal where the problem is:
1) Impulse generation or 2) Conduction abnormality. The Cardiologist will then discuss the procedure with the patient and family. After answering all additional questions, consent is obtained.
The procedure can be done under general anaesthesia (patient is asleep) or local anaesthesia (patient is awake). The leads (wires) are placed in the heart through the veins that run along the collar bone. The device is implanted below the skin. After closure of the wound, only a scar is left in the shoulder area.
Because access is gained to the veins with sharp instruments and leads are placed in a moving heart, potential complications may arise. Rarely the lung or other blood vessels may have been punctured accidently. The leads may have shifted as the patient comes upright and starts moving the arms. All these and other complications are checked before the patient is discharged.
Wound healing usually takes about one week. The patient is provided with a small card that has information regarding the device. The final settings of the device is done months later in an attempt to prolong battery life – which in modern pacemakers can last up to fifteen years.
The following are matters of concern:
2) Exquisite tenderness over the site
3) Suspected haematoma (swelling)
4) Shortness of breath
5) Frozen (stiff) shoulder
6) Any fluid drainage from the site.
7) Separation of the wound.
Particular warning should be given about getting too close to the following situations.
Mains-driven electric motors, especially if sparking or with faulty suppression (e.g. electrical kitchen equipment, vacuum cleaners, electric razors, electric power drills, motor cycles, lawn mowers, outboard motors, old car engines).
Pacemakers and sport
Vigorous contact sports are best avoided by patients with permanent pacemakers, to avoid injury to the unit (e.g. rugby football, soccer, boxing, judo or karate). Squash should be discouraged if possible. A full golf swing may be uncomfortable with a pacemaker, often more so if it is implanted on the left side.
Contact our Melomed Cardiologists should you require any medical advice.