December 4th, 2009 
admin My father, who is 73 years old, has been diagonised with CHF, old anteroseptal MI, with severe LV dysfunction. The LV ejection fraction is found to be only 30%. He is also a diabetic for the past 13 years.
I would like to know whether there are any surgical options like pin-hole surgery etc to improve the heart’s pumping efficiency (or) Is it sufficient to take medicines with controlled diet and activities?
Dear Asker!
Here are some treatment guidelines for Congestive Heart Failure.
How Is Congestive Heart Failure Treated?
Today there are more options available to treat heart failure than ever before. Regular medications and lifestyle coupled with careful monitoring is the first line of treatment. As the condition progresses, centers specializing in the treatment of heart failure can offer more advanced treatment options, such as surgery.
What Medications Are Used to Treat Congestive Heart Failure?
Taking your heart failure medications as prescribed is one of the most important things you can do to manage your heart failure. The more you know about your medications and how they work, the easier it will be for you to stay on track.
Common types of medications used to treat congestive heart failure include:
Angiotensin converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers (ARBs)
Beta-blockers
Digoxin
Diuretics
Blood vessel dilators
Potassium or magnesium
Aldactone Inhibitors
Calcium channel blockers
Heart pump medications
In your father’s case, we should add medications for diabetes, blood lipids lowering agents, blood thinner to prevent further MI.
What Surgical Procedures Are Used to Treat Heart Failure?
Surgery is aimed at stopping further damage to the heart and improving the heart’s function. Procedures used include:
Angioplasty, also know as percutaneous coronary intervention (PCI) or
Percutaneous transluminal coronary angioplasty (PTCA), is a procedure in which a catheter-guided balloon is used to open a narrowed coronary artery. A stent (a wire-mesh tube that expands to hold the artery open) is usually placed at the narrowed section during angioplasty.
CABG (Coronary Artery Bypass Graft) Bypass surgery: The most common surgery for heart failure is bypass surgery to route blood around a blocked coronary artery.
Left ventricular assist device(LVAD): The LVAD helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant.
Heart valve surgery: As heart failure progresses, the heart valves that normally help direct the flow of blood through the heart to the rest of the body stretch out of shape, allowing blood to "leak" backward. The valves can be repaired or replaced.
Infarct exclusion surgery (Modified Dor or Dor Procedure): When a heart attack occurs in the left ventricle (left lower pumping chamber of the heart), a scar forms. The scarred area is thin and can bulge out with each beat (an aneurysm). A heart surgeon can remove the infarcted (dead) area of heart tissue or the aneurysm.
Heart transplant: A heart transplant is considered when heart failure is so severe that it does not respond to all other therapies, but the person’s health is otherwise good.
Hope that may help you and your loved ones!
Good luck!
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There is little that laparoscopic (aka pin-hole) surgery can offer as there is little to "repair" on the surface of the heart. His problem is more of the muscle tissue giving out, with a section of it already dead (anteroseptal Myocardial Infarction), and the principle pump (left ventricle) described as "severely" dysfunctional (EF of only 30%).
I’m sorry to tell you this, but unless there are major coronary artery blockages to bypass or stent open, the only other surgical option would be a heart transplant. Commonly, medical treatment would include medications for reduction of cardiac workload while maintaining a steady blood pressure.
Good luck.
Ralph
References :
Dear Asker!
Here are some treatment guidelines for Congestive Heart Failure.
How Is Congestive Heart Failure Treated?
Today there are more options available to treat heart failure than ever before. Regular medications and lifestyle coupled with careful monitoring is the first line of treatment. As the condition progresses, centers specializing in the treatment of heart failure can offer more advanced treatment options, such as surgery.
What Medications Are Used to Treat Congestive Heart Failure?
Taking your heart failure medications as prescribed is one of the most important things you can do to manage your heart failure. The more you know about your medications and how they work, the easier it will be for you to stay on track.
Common types of medications used to treat congestive heart failure include:
Angiotensin converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers (ARBs)
Beta-blockers
Digoxin
Diuretics
Blood vessel dilators
Potassium or magnesium
Aldactone Inhibitors
Calcium channel blockers
Heart pump medications
In your father’s case, we should add medications for diabetes, blood lipids lowering agents, blood thinner to prevent further MI.
What Surgical Procedures Are Used to Treat Heart Failure?
Surgery is aimed at stopping further damage to the heart and improving the heart’s function. Procedures used include:
Angioplasty, also know as percutaneous coronary intervention (PCI) or
Percutaneous transluminal coronary angioplasty (PTCA), is a procedure in which a catheter-guided balloon is used to open a narrowed coronary artery. A stent (a wire-mesh tube that expands to hold the artery open) is usually placed at the narrowed section during angioplasty.
CABG (Coronary Artery Bypass Graft) Bypass surgery: The most common surgery for heart failure is bypass surgery to route blood around a blocked coronary artery.
Left ventricular assist device(LVAD): The LVAD helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant.
Heart valve surgery: As heart failure progresses, the heart valves that normally help direct the flow of blood through the heart to the rest of the body stretch out of shape, allowing blood to "leak" backward. The valves can be repaired or replaced.
Infarct exclusion surgery (Modified Dor or Dor Procedure): When a heart attack occurs in the left ventricle (left lower pumping chamber of the heart), a scar forms. The scarred area is thin and can bulge out with each beat (an aneurysm). A heart surgeon can remove the infarcted (dead) area of heart tissue or the aneurysm.
Heart transplant: A heart transplant is considered when heart failure is so severe that it does not respond to all other therapies, but the person’s health is otherwise good.
Hope that may help you and your loved ones!
Good luck!
References :
WebMD
As far as I know, surgical options for CHF would include revascularization (i.e. bypass surgery or angioplasty/stenting) to any viable heart tissue. If this is not an option, some patients that have been told they have a LV aneurysm or apical ballooning syndrome sometimes can undergo left ventricular remodeling surgery also known as SAVR.
If those options are not offered (possibly his heart muscle is not viable tissue) or this might have already been done, then they are most likely starting him on, or he is already on certain medicines for heart failure. He should currently be on a beta-blocker, ACE inhibitor, aspirin, and probably a diuretic. Our physicians will have patients on medical therapy for 3 months, then re-evaluate their response to medicines and if there is no improvement, then they are referred for a bi-ventricular defibrillator or AICD. These devices serve 2 purposes. They prevent and sometimes control dangerous arrythmias (as patients with reduced EFs are at increased risk for sudden cardiac death and dangerous arrythmias) and a Bi-V device specifically can help the heart beat more effectively to help improve heart function. Ask his doctor about this if it’s not been discussed yet. It’s worth looking into!
Hope this helps.
References :
RN for cardiology group
30% EF is not good. At this age instead taking risk with surgery, I would recommend you to go for Ayurveda. There are good remedies in Ayurveda without any side effect and with good result. The increase the blood supply to the heart anmd make the patient more active. Check in google for products such as Rudved/Cardoved/Suved/Rasoved etc.
References :