Q: What are blockages in arteries?
A: Blockages in arteries are buildup of cholesterol, scar, and muscle tissue with calcium within the wall of the artery that can block the flow of blood to the vital organ, such as the heart. They build up from damage to the inner lining of the artery, and can abruptly change in severity to cause symptoms. An angiogram is useful to determine if the blockage is causing symptoms, such as chest pain (angina), or is impairing blood flow which can be seen during a stress test.
Q: Are any non-surgical treatments available for valve problems?
A: Currently, trials (research studies using patients) are underway for the replacement of aortic valves without using open heart surgery. These valves are not available in the United States for standard treatment outside of trial settings, but are likely to be available in the near future. Treatments for mitral valve leakages have also been developed for patients considered too high a risk for surgery.
Q: My doctor says I have heart failure. Do I need one of those new artificial heart devices?
A: Heart failure is classified from Class 1 (mild symptoms controlled with medication) to Class 4 (severe symptoms despite maximal medical treatment). Heart transplantation is the gold standard treatment for Class 4 heart failure, but is limited because of a shortage of donors and concomitant patient features such as significant kidney disease or history of cancer. The left ventricular assist device (LVAD) was developed initially as a "bridge" to help patients accepted for transplant survive until they received a new heart.
In February 2010 the FDA approved the LVAD called HeartMate 2 as "destination therapy," so that appropriate patients with Class 3 or 4 heart failure, who are ineligible for a transplant, might be supported indefinitely by the device. It is piggy-backed onto the left ventricle, the main pumping chamber of the heart. The blood pump sits in a pocket under the heart and pumps blood up to the aorta, the main artery exiting the heart. All is contained within the body except for the driveline, an electrical cord, which is connected to a power source. This may be a plug-in power-based unit, when the patient is stationary, as when in bed at night, or a battery pack which allows freedom of movement.
Studies show a significant improvement in quality of life with the HeartMate 2 compared to conventional medical treatment.
Answered by Allison J. McLarty, MD. Dr. McLarty is a cardiothoracic surgeon and associate professor of surgery.