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Barts and The London Heart Surgery Centre >> Our clinical services >> Coronary (or ischaemic) heart disease

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Coronary (or ischaemic) heart disease

Coronary heart disease - also known as ischaemic heart disease - is caused when the coronary arteries (which supply the heart muscle with blood and oxygen) become narrowed or blocked with a build-up of fatty material. If an artery becomes too narrow, it can prevent the heart muscle from receiving enough oxygen-containing blood.  This can cause severe chest pain and discomfort – known as angina. When part of the heart loses its blood supply, the heart muscle is at risk of dying unless the blockage is removed. If not treated early, coronary heart disease can lead to a heart attack.

At Barts and The London Heart Surgery Centre, we provide a range of treatments for patients with coronary heart disease, and the complications associated with coronary heart disease. The surgical options depend on individual circumstances and medical history and will be discussed with you by your surgeon. 

Our treatments include:

Coronary artery bypass graft (CABG)

To improve the blood flow to the heart an operation called a coronary artery bypass surgery can be carried out. This involves bypassing a blockage or narrowing in one or more coronary arteries with a vein from the leg, and in nearly all cases, an artery from the back of the chest wall.

Occasionally, an artery from the arm, called a radial artery, can be used. The original coronary arteries are not removed.

The benefit of the bypass graft is that it allows more blood to reach the part of the heart muscle which previously was not receiving enough blood due to a narrowing or blockage in the artery. After the operation patients will be relieved of angina.

Where appropriate, our surgeons will perform this operation using minimal access surgery. This means the surgeons make a small incision in your chest, rather than opening up the entire chest wall. The benefits of this are faster recovery and a reduced length of stay in hospital.

Coronary artery re-operation

For some patients (less than 10%), a coronary artery bypass graft does not last a lifetime and may require a second operation to improve the blood flow to the heart.

Carotid and coronary artery surgery

Very occasionally, an operation called a carotid endarterectomy may need to be performed at the same time or before your bypass operation, due to a narrowing of the carotid artery or arteries which take blood to the head and brain. This operation is done to relieve a partial blockage in the carotid artery and reduces the risk of a stroke/cerebral vascular accident in people who are at greater risk during a bypass operation.

To find out if you have a narrowing in your carotid artery, a doctor or nurse will examine your neck and if they think it necessary, a doppler or duplex scan will be arranged. This uses a simple ultrasound machine to take special images of the arteries in the neck.

Emergency surgery for ischemic ventricular septal defects (VSD) following a heart attack

A ventricular septal defect (VSD) is a hole which develops between the left and right ventricles in the heart. This condition occasionally complicates a heart attack. When a coronary artery becomes blocked during a heart attack, the wall between the right and left ventricle can die, resulting in a hole developing in this area.  

In these rare cases, the patient can become very sick and depending on the physical condition, will be taken for emergency surgery to correct the VSD.

Surgery for ventricular aneurysm and ventricular remodelling

A ventricular aneurysm is a balloon-like swelling in the wall of the heart’s ventricle and may develop following a heart attack. The patient may be short of breath due to the reduced contraction of the heart. Our heart surgeons have expertise in removing the swelling and remodelling the heart.

Surgery for ischaemic mitral regurgitation

Ischaemic mitral regurgitation can occur in patients with coronary heart disease and is caused by a heart attack. It is a disease which affects the functioning of the mitral valve (which allows blood to pass from the atrium to the ventricle and prevents the backward flow of blood). It is held apart because the ring is too big, it is flopping out (prolapsing) or is pulled backwards.

This causes shortness of breath.

A range of surgical options are available – including surgical repair or replacement of the mitral valve. This depends on the individual patient and the severity of the condition.