Surgery

Some people with angina have extensive narrowing of the heart's blood vessels. If atheromas (plaques; fatty deposits within an artery) block an individual's coronary arteries by more than 70%, the physician usually will recommend surgery to improve blood flow to the heart muscle. Surgical procedures relieve angina symptoms and also help to prevent heart attack.

The two main surgeries for angina are:

1. Angioplasty
   
   Angioplasty is an interventional procedure to widen a blood vessel. It is commonly used for individuals who have short obstructions within one or two coronary arteries. People with three-vessel disease (obstructions in three coronary arteries) also may benefit from angioplasty if they do not have high-risk features such as severe impairment of the heart's ventricle (pumping chamber).
   
   To perform angioplasty, a physician makes an incision in a major artery of the forearm or leg and then threads a catheter (fine tube) through the blood vessels until it reaches the heart. A special dye is pumped into the bloodstream via the catheter, so that the coronary arteries are visible and the entire process can be watched on a video screen.
   
   Once the catheter reaches the blocked coronary artery, the physician removes the obstruction or flattens it against the inside of the artery by different methods. These methods include:

• " Balloon angioplasty " (also known as percutaneous transluminal coronary angioplasty, or PTCA), in which a tiny balloon is attached to the end of a catheter. When the catheter reaches the blockage, the balloon is inflated, the plaque is flattened against the arterial lining, and the coronary artery is effectively widened.
  
• Stent deployment, a newer technique being used to keep the coronary arteries open. A small, expandable metal sheath is slipped over the catheter and placed at the site where the artery has just been widened, to prevent it narrowing again.
  
• Microsurgery, in which tiny surgical instruments are used to cut through plaque.
  
• Laser surgery, in which a small laser (high-intensity, focused light beam) is used to clear out the obstruction. This procedure is known as transmyocardial revascularization, or TMR.

Both angioplasty and bypass surgery are designed to achieve the same goal - that is, to increase blood flow within the heart muscle. Depending upon the severity of angina, an individual may have the opportunity to choose between the two procedures.

Angioplasty- advantages :

• Is less invasive. Angioplasty is a much less complicated operation that involves comparatively small surgical incisions. Usually it is carried out under local anesthesia.
  
  
• Requires a shorter hospital stay. The length of hospitalization for angioplasty is three to four days versus seven to ten days for bypass surgery.
  
  
• Results in a quicker recovery. Most people are back at work within a week.

Angioplasty-disadvantages:

• Does not work in about 5% of cases, and emergency bypass surgery is necessary.
  
  Must be repeated within six months in about 40% of cases. The coronary arteries become blocked again, and the individual must undergo another angioplasty or have bypass surgery.