• Your heart is a muscle about the size of a man's fist.
  
  
• It pumps blood to all parts of your body. To do so, your heart needs its own supply of oxygen-rich blood for energy.
  
  
• The coronary arteries supply your heart with blood.
  
  
• The left and right coronary arteries divide into even smaller arteries which feed all of the heart muscle.

• Inside the heart there is a right side and a left side. Each side has an upper chamber, the atrium, and a lower chamber, the ventricle.
  
  
• The normal heart beats regularly 60-100 times per minute
  
  
• There are 4 valves inside the heart; 2 on the right side and 2 on the left. The valves are responsible for controlling the direction of blood flow.
  

Heart Disease

Atherosclerosis/Angina

• The most common heart problems in adults are cloggedarteries or problems with a heart valve.
  
  
• Atherosclerosis is a disease which results in the buildup of cholesterol and other fats in the linings of arteries. This is called plaque.
  
  
  

• Plaque reduces the blood flow through the arteries and your heart muscle doesn't get enough blood and oxygen.
  

• Angina, a common symptom of coronary artery disease, can be experienced as numbness, pressure or pain in your chest, arms, jaw, throat, or upper back.

• Angina is a warning sign that your artery may become completely blocked.
  

• If blood supply is completely blocked to the heart muscle, that area of muscle soon "dies". This is called a heart attack or Myocardial Infarction (MI).

• The area that is damaged is no longer able to function as a healthy muscle and is not able to assist with pumping blood around the body.
  

• By doing bypass surgery, the doctors hope to stop both the pain of angina and prevent the loss of muscle from a heart attack.

Valve Disease

• The heart depends on the 4 valves to function properly.
  
  
• Infections such as rheumatic fever or bacteria in the blood may damage one or more valves. Coronary artery disease and heart attacks may damage a valve.
  
  
• Sometimes valves become "stiff"(stenotic) and sometimes they become "floppy" (incompetent, insufficient, or regurgitant).
  
  
• Whether the problem is that the valve doesn't open well or doesn't close well, either prevents the heart from pumping normally.
  
  
• As the heart tries to make up for the poorly functioning valve(s), eventually the heart begins to fail to meet the body's demand for blood.
  
  

The Surgical Procedure

• The heart is protected by the rib cage.
  
  
• Your doctor will make an incision through the breast bone (sternum) and spread it apart just far enough to be able to see and reach all sides of the heart.
  

Bypass Surgery

• The purpose of coronary artery bypass surgery is to provide blood supply to the area of heart muscle that is not being adequately fed due to a blockage.
  
  
• The internal mammary arteries are often used to bypass blockages.
  
  
  

• Another blood vessel often used as a bypass graft is the saphenous vein from the leg.
  

• This vein is removed at the beginning of surgery. One end is attached to the aorta and the other end to the coronary artery beyond the blockage.

Valve Surgery

• If rest, diet changes and medicines do not relieve the symptoms of valve disease, the valve may need to be repaired or replaced.

Three Methods of Repairing Valve Damage

• A commissurotomy is a procedure which may be done to separate valve leaflets which have become stuck together. Infection and deposits of calcium are 2 possible causes of this problem. Separating the leaflets allows the valve to open and close normally again.
  
  
• An annuloplasty may be done if the valve ring or annulus has been stretched due to enlargement of the heart's chambers. When the annulus is stretched, the valve leaflets which sit in that ring can no longer reach to close the valve completely. In this procedure, the size of the ring is returned to a more normal size by stitching it or by attaching the valve ring to an artificial ring-like device.
  
  
• A valvuloplasty involves the repair of the valve leaflets and/or chords and papillary muscles which hold the valve leaflets in place. When the chords or papillary muscles are damaged the valve is unable to close properly.

Valve Replacement

• If it is not possible to repair your damaged valve, you may need to have a valve replacement.
  
  
• Your surgeon will decide whether a tissue valve or a mechanical valve is best for you.