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FURTHER PROCEDURES AFTER CORONARY ARTERY BYPASS SURGERY
Electrical Reversion
Some patients develop pulse irregularity, called atrial fibrillation or atrial flutter, after their operation. This is generally controlled by medical treatment. It usually stops of its own accord within a few days or weeks.
If it does not stop by itself, electrical reversion to normal rhythm is sometimes undertaken. This involves a simple anesthetic and electric shock treatment. The whole procedure lasts only a few minutes.
Repeat Angiography
Coronary angiography will be well known to you already, as you will have had it before your operation to assess the severity of your coronary heart disease. Occasionally repeat angiography is undertaken if there is a recurrence of chest pain or some other problem. This is unlikely to be required or undertaken for months or years after your operation. It is rarely performed early.
Coronary Angioplasty Stents, Atherectomy
If narrowing occurs in a graft, or in one of your coronary arteries and this is shown by angiography to be the cause for return of pain, balloon angioplasty may sometimes be performed.
This would usually be performed at the time of the coronary angiogram. In this procedure, a catheter with a long balloon near its tip is passed down the coronary artery or graft. The balloon is inflated under pressure at the site of narrowing in the artery or graft. This opens up the narrowing.
In some instances a stent is inserted in the previously narrowed section of the coronary artery. A stent is an expandable metal tube consisting of coils or wire mesh. It prevents the narrowed segment from collapsing by holding the segment fully open.
In some patients rather than opening up the narrowed segment by inflating a balloon, a catheter is passed into the segment, a balloon is inflated to anchor the catheter and a blade inside the tube shaves off the plaque. Shavings are trapped in the nose cone of the catheter and are subsequently withdrawn. Another method of opening up the artery is rotational atherectomy where a mini-drill is inserted at the end of the cardiac catheter. The drill tip rotates at over 150,000 times per minute, scouring out the obstructing plaque. The tiny pieces are flushed onwards in the blood stream.
These methods are still partly experimental but have now acquired a definite place in the management of some patients who subsequently have coronary artery narrowing. While angioplasty and stents may be used to reopen narrowed grafts, atherectomy is not yet being used to open the narrowed vein grafts.
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