The maze procedure, invented by Dr. James Cox, was first performed in 1987. It was originally performed as open heart surgery, an invasive approach that required the patient’s heart to be stopped. Since then, it has evolved as less-invasive techniques have been developed. Today, a growing number of cardiac surgeons are doing maze surgery to correct atrial fibrillation. In this article, we’ll answer a few of the most common questions asked about the procedure.

What Is The Purpose Of The Operation?

This operation is done in order to treat atrial fibrillation (or, Afib). This is a condition in which a person’s heart beats erratically due to disorganized electrical impulses. Normally, the heart’s electrical system produces impulses that cause the atria and ventricles to contract in a uniform manner. With Afib, these impulses spread throughout the atria unevenly, causing them to beat rapidly out of sync. They fibrillate.

When this happens, the atria become less efficient in pumping blood into the ventricles. This can cause a number of symptoms, including shortness of breath, chest pain, and dizziness. The maze procedure was created specifically to fix this problem and relieve the associated symptoms.

How Is It Performed?

During the operation, a surgeon will create scar tissue across the surface of your atria. The purpose of the scarring is to design a pathway through which the electrical signals can be guided. Because scar tissue does not conduct electricity, the signals are forced to go around the scars. By creating a maze of scarring, the surgeon can direct the impulses through the atria and ventricles, ensuring the heart beats in a uniform manner.

With traditional maze surgery, a long incision (usually between 6 and 8 inches) is made into the patient’s chest, and the sternum and ribs are separated. A heart-lung bypass machine helps to circulate blood once the heart has been stopped. Minimally invasive techniques make this approach unnecessary (though not all patients are good candidates). Smaller incisions are made to allow the surgeon to work between the ribs.

How Is The Scar Tissue Created?

In the past, the scarring was accomplished manually by making incisions into the atria. These incisions were then sewn back together to create the scar tissue. Today, a different approach is often used. Cardiac surgeons can create lesions by using one of several energy sources. Radiofrequency energy can be applied through a catheter; microwave energy can be applied in the same manner to build the conduction block; laser, ultrasound, and a process known as cryothermy (i.e. extreme cold delivered through a probe) can also be used. Each energy source can produce the necessary scarring.

Are There Risks Involved?

While there are risks involved with the maze procedure, much depends on whether open heart surgery or a minimally invasive approach is used. The energy source can also play a role, though this is less an issue today as better technologies are being integrated.

Any type of open heart surgery poses a risk of bleeding and infection. Some patients also experience fluid retention, and a small number experience a stroke. If minimally invasive techniques are used, there is far less risk of bleeding, infection, and stroke.

Will It Cure Atrial Fibrillation?

Maze surgery can cure atrial fibrillation. The conduction block formed by the scar tissue lacks the ability to conduct electrical impulses. This is not to suggest that other heart related issues cannot surface down the road. Arrhythmias, coronary artery disease, and blood clots can potentially cause problems. However, these problems are exclusive of the maze surgery used to cure atrial fibrillation.

For many people, the symptoms caused by Afib may not be severe enough to warrant the maze procedure. Consult your doctor to determine whether this is a viable option and if you are a good candidate for the operation.

Your heart is a complex organ that pumps blood throughout your body as the result of its electrical system. A group of cells called the sinoatrial node produces electrical impulses that cause the four chambers of your heart (i.e. two atria and two ventricles) to contract. The contractions occur in a uniform manner and push blood from the chambers.

As blood leaves each chamber, it flows past a valve; there are four of them in your heart. The mitral valve (MV) separates your left atrium (upper chamber) and left ventricle (lower chamber). Illnesses, medical events, and congenital defects can cause disorders with the MV. Minimally invasive mitral valve surgery (MIMVS) can be performed to fix these disorders. This article will provide an overview of the approach and describe some of its advantages over traditional thoracotomy.

Types Of Mitral Valve Diseases

There are two main problems that can develop with the two leaflets of your mitral valve: stenosis and regurgitation. The former is far less common than the latter.

A stenotic MV is one that is narrower than normal. Because the opening is restricted, less blood can flow from the left atrium into the left ventricle. This can cause pooling and clotting within the upper chamber, and make less oxygenated blood available for circulation. This disease is usually a side effect of untreated rheumatic fever; the body’s immune system attacks the valve and causes the valve’s flaps to thicken and stiffen.

A regurgitant MV is one in which the leaflets flop back into the atrium. This is called prolapse. The condition allows blood to flow backward from the ventricle into the atrium when the lower chamber contracts. As a result, pressure rises within the upper chamber and causes it to enlarge.

Regurgitation can be caused by a previous heart attack or an infection that was left untreated. One of the side effects of this disease is atrial fibrillation; your heart’s electrical system becomes disrupted.

Different Surgical Approaches

There are several different methods used for minimally invasive mitral valve repair surgery. The approach depends on the disorder. For example, a stenotic MV can be resolved with a procedure called balloon valvuloplasty. This method uses a catheter with a balloon affixed to the tip to forcibly widen the narrowed valvular opening.

A regurgitant valve can be repaired with different methods, depending on which leaflet is diseased. A triangular resection is done if the posterior leaflet if flopping. On the other hand, if the anterior leaflet is affected, the surgeon may perform a chordal transfer. This is done to create support for the diseased flap.

Traditional thoracotomy requires a long (i.e. six to eight inches) incision into the chest after which the breastbone is separated. This process is unnecessary with minimally invasive techniques. Depending on the surgical equipment available and the surgeon’s expertise, minimally invasive mitral valve repair can normally be accomplished with a few small incisions. In some cases, surgeons can complete a procedure with little more than a few keyhole entries.

Advantages Of Minimally Invasive Techniques

Minimally invasive mitral valve surgery offers several benefits over conventional thoracotomy. First, procedures can be performed in less time with a lower likelihood of complications (i.e. stroke, endocarditis, etc.). Second, it is less traumatic on the heart muscle and thus, can better preserve its normal function. Third, the patient’s recovery time is far shorter with a minimally invasive approach than would otherwise be the case.

Another major advantage of MIMVS is that the mortality rate is lower than with traditional open heart surgery. Moreover, if the mitral valve is repaired rather than replaced, anticoagulant therapy is usually unnecessary.

All of the above benefits dovetail to provide the patient with an overall improvement in their quality of life. Less trauma during surgery, fewer complications, a shorter recovery period, and the absence of blood thinners, provide the patient with a more enjoyable postoperative lifestyle. In the end, that is the ultimate purpose of minimally invasive mitral valve repair.

Hearing impairment can now be facilitated with different kinds of hearing aids, and the degree of help that a hearing aid offers often go in accordance with one’s allotted budget for the hearing device. There are disposable hearing aids which can be availed of by a majority due to their affordability as well as with conventional hearing aids. Digital hearing aids, however, are the most costly but one may well get their money’s worth when resorting to such. The earlier hearing aids made use of standard analog technology whereas digital hearing aids have more state-of-the art, upgraded and intricate technological features.

The many features in signal processing incorporated by manufacturers into digital hearing aids have basically made these digital devices better than their analog counterparts. Computer chips installed into digital hearing aids apply math formulas to the digits and control these digits in adjusting the sounds that users of digital hearing aids experience. Digital hearing aids function by transforming sounds into a series of digits and numbers and the “smart” computer chips within the device maneuver these digits. With this computer chip technology then, a great deal of functionality can be availed of within the miniscule device of digital hearing aids.

Digital hearing devices’ digital signal processing had its origins from the military and recording industries. These intelligent devices are capable of distinguishing noise from voices and digital hearing aids can amplify the voices while deadening the surrounding noise. Conventional analog hearing devices on the other hand convert sounds into electrical impulses and these electrical impulses are the sounds that are made adjustable. With the state-of-the-art functionality of digital aids, the user can enjoy clearer voice transmission regardless of the background noise compared to analog hearing aids. With analog hearing aids, wearers usually encounter difficulties with feedback or whistling, but digital hearing devices have been designed to address this inconvenience.

Whereas users of analog devices minimize feedback by turning down their hearing aids thereby reducing its hearing capacity, digital hearing aids’ features enable them to monitor the sounds entering and exciting the hearing device. Digital hearing aids will then determine whether the noise is feedback and if it is, the digital device has been programmed to cancel them. In accordance with their functionality and technological features, digital hearing aids’ costs generally vary. A hearing impaired individual must initially consult their audiologist before resorting to digital aids to ascertain the cause and degree of the hearing impairment and to determine the size and contour of one’s ears.

Low end digital aids facilitate in hearing by providing limited feedback and noise management as well as outstanding quality of sound in ordinary instances whereas the most expensive digital hearing aids allow the wearer to eliminate feedback without an accompanying decrease in volume and hear even the faintest noise. They can also come with a directional microphone capable of being turned into the user’s front and eliminate any surrounding noise. If one has been used to analog devices, it may take some time, usually a few weeks, to get accustomed to digital hearing aids. It is also essential that they return to their audiologist so that they can make the necessary adjustments and programming into the digital hearing aids until they become perfectly suited to the user.

With the sophisticated design of digital hearing aids, the beauty of sights with sounds can be fully appreciated even by the hearing impaired.