If someone has stitches on their chest, and spent about four days in a
clinic specialising in heart surgery, what kind of surgery are they
likely to have undergone? The person was in his 70s, apparently had
little recuperation period thereafter, and took a (possibly specially
fitted) plane for a long journey.

---

Request for Question Clarification by crabcakes-ga on 01 Jan 2004 06:52 PST

Hi jwag, Exactly where on the chest were the stitches? In the center?
On one side? How long is the scar?
Thank you, crabcakes-ga

Hi jwag,

Cardiac procedures vary depending on the condition of the patient,
skill and preferences of the cardiologist, and hospital policy. Two
patients having similar surgeries may have different scar sizes and
recuperation times. Having said that, it would be difficult to say
with total certainty what surgery this person had, but it very much
sounds like coronary artery bypass surgery. (CABG).

You say this person spent 4 days in a heart clinic: The post-surgical
stay for bypass surgery would be about 4 days, especially if the
patient recuperated quickly, and had no other complications or health
problems. Seeing scars (stitches) in the leg (Or at times on the
forearm) would fit the final piece of this puzzle. Bypass surgery may
utilize the saphenous vein from the leg or a radial artery from the
forearm, to bypass the diseased artery.

From The Cooper Heart Institute:
?In general, patients may go home within a week of their heart
surgery. Patients who do extremely well after surgery may go home
three or four days after surgery?
http://www.cooperhealth.org/heart/greystone/procedures/cabs06.htm

?After the procedure, you will probably spend five to seven days in the hospital
http://www.sjm.com/procedures/procedure.aspx?name=Coronary+Artery+Bypass+Graft+(CABG)+Surgery&section=ExpectAfter


A CABG patient will often have a lack of appetite for several weeks,
and may even be disgusted by the sight and smell of food, may have a
lump at the top of the incision scar, may have mood swings, be
constipated, and have mood swings. The patient would also  need to
elevate their legs often after surgery, and would most probably wear
elastic hose. CABG patients who have had a saphenous vein removed are
advised not to cross their legs.

Patients may usually drive again after three weeks. Since the sternum
has been opened for surgery, lifting heavy objects, or performing any
act that puts stress on the arms is to be avoided, until the sternum
has properly healed.
http://circ.ahajournals.org/cgi/reprint/107/3/e21.pdf
It may be possible that this person had heart valve replacement. The
sternum is also cracked for this procedure, and will produce a scar
similar to the a CABG scar.


From CooperHealth:
?In general, patients go home within a week of their heart surgery.
Patients who do extremely well after surgery may go home three or four
days after surgery. However, your individual situation will determine
how long you stay in the hospital. People who have conditions such as
diabetes, lung disease, kidney disease, or those who have previously
had heart surgery tend to take longer to recuperate.?
http://www.cooperhealth.org/heart/greystone/procedures/vsur06.htm

http://www.cooperhealth.org/heart/greystone/procedures/vsur02.htm


Conversely, a heart transplant would require a much long post-surgical
stay, usually around two weeks.
http://www.cooperhealth.org/heart/greystone/adults/index.htm
http://www.acs.ohio-state.edu/units/osuhosp/patedu/Materials/PDFDocs/surgery/heart-trans/heart-trans-surgery.pdf


With a pacemaker insertion, the typical  incision scar would be small,
and just below the collarbone. Other procedures may leave a scar
directly over the heart or in the abdomen. This is often same-day
surgery, and the patient goes home on the day of surgery. Some
patients may stay hospitalized for a day or two.
You can see the small horizontal scar of a pacemaker implant here:
http://www.cooperhealth.org/heart/greystone/adults/paceover.htm

http://www.healthatoz.com/healthatoz/Atoz/dc/tp/tppacemaker.html

I am rather surprised that this patient flew so soon after a surgical
procedure. Generally air travel is restricted in post-surgical
patients for several weeks, for fear of embolism (blood clot
formation). The plane *must* have been a medical transport plane, or
one that had been medically outfitted, and staffed with qualified
medical personnel as traveling companions!
http://www.zyworld.com/MFedin/RR/Feb7.htm#POST-SURGERY%20CAUTIONS


Pictures:

Medline has a simple video that shows the placement of the incision.
Click on ?Procedures? to skip directly to this portion.
http://www.nlm.nih.gov/medlineplus/tutorials/coronaryarterybypassgraft/ct039102.html

From the National University if Singapore, pictures of a closed heart
surgery scar, and an open heart surgery scar:
http://www.med.nus.edu.sg/paed/patient_education/chd_guide/faq/surgery.htm

A picture of a man with a heart surgery scar(Note: this is a rather
large picture. If you have dial-up internet service, you may prefer
the smaller picture below)
http://www.marvinphillips.org/travels/australia/aus2002_05.jpg

Very small picture of the same:
http://www.marvinphillips.org/travels/australia/aus2002_05_tn.jpg
Pacemaker 
http://www.pacemakerclub.com/implanted_pacer.jpg


Health Yahoo: 
http://health.yahoo.com/health/centers/heart/93.html



Hope this helps you jwag! If any part of my answer is unclear, or if I
have repeated information you already have, please request an Answer
Clarification before rating. This will enable me further assist you if
possible!

Regards,
crabcakes-ga

Search Stategy:
Personal knowledge
CABG
Cardiac bypass surgery
Cardiac surgery

Very good answer, many thanks.

I must admit, all the time this was question was locked, I was sending
crabcakes telepathic messages: BYPASS BYPASS BYPASS

With only 4 days in the hospital, the patients age, the scar, it is
highly unlikely it is anything else.

i know several people that have had a bypass done.  One friend of mine
was told by his Doctor that it is one of the only surgeries performed
--where the patient wakes up "feeling better."  Hence, the short
hospital stay.  They literally ARE better.  Virtually every other
possiblity would require a longer hospital stay in a person of that
age.

IMHO, excellent work crabcakes...

~~Cynthia

Hi Jwag-ga. Having read all the answers and comments, It surely is
"cabbage". Having been through it myself, with the 12 inch scar down
the middle of the chest, the lump at the clacicle and the long scar on
the leg where they took the vein, its CABG alright. Mine was a triple,
but interestingly enough, I had it done without any blood
transfusions. I asked the surgeon to be " extra careful". All the
advice given is spot on, and in my case, the hospital had a nearby set
of internal stairs that all patients had to negotiate three times at a
good pace, before being discharged. A sort of a fitness test. Other
patients in at the same time, who were smokers, failed it and were
still there when I left. So if your smart, stay off the smokes. I
smoked for fifteen years and quit twenty years before the heart
problem, but the smoking was part of the cause.As Yul said, whatever
you do, dont smoke!.