Dr. Michael Measom, MD

Some common locations for aneurysms include:

• Abdominal aorta – the major artery from the heart that supplies blood to your abdomen, the pelvis, and legs.
• Thoracic aorta – the major artery from the heart that supplies blood through the chest.

• Open Aorta Surgical Repair – The open aorta surgical repair involves placing clamps above and below the aneurysm to stop the blood flow to that part of the artery. Whether or not the surgery will involve the use of a heart-lung machine (cardio-pulmonary bypass) depends on the location of the aneurysm. If the aortic arch is involved, the surgeon may use a specialized technique known as circulatory arrest — a period without blood circulation while the patient is on life support. The surgeon replaces the weakened wall with a fabric tube called a graft. The surgeon may also use a prosthesis device.
  
• Graft-Stent Repair – This less-evasive procedure is used to repair thoracic aneurysms and does not require a chest incision. The surgeon inserts a tube where special catheters are introduced through the arteries at the groin. The physician then deploys a stent-graft or prosthesis at the site of the aneurysm which allows the flow of blood without putting pressure on the weakened wall.
  
• Endovascular Stent-Graft Repair – This less-invasive procedure is used for abdominal aneurysms. This procedure involves using long, thin tubes called catheters inserted in the patient's groin and guided through the blood vessels using live x-ray pictures. The physician then deploys a stent-graft or prosthesis at the site of the aneurysm which allows the flow of blood without putting pressure on the weakened wall. If this repair is unsuccessful, the surgeon may elect to perform an open repair.

• Severe abdominal pain
• Fever
• Loss of appetite
• Nausea and vomiting

A ruptured appendix must be removed immediately, or it may leak into the abdominal space and cause peritonitis, a life-threatening condition. Both open and laparoscopic surgery are performed under general anesthesia, and require a hospital stay of 1-4 days. Recovery time is usually 1-3 weeks following surgery, but is shorter with laparoscopic surgery.

An orthopedic surgeon usually performs this surgery, which requires a hospital stay. Recovery time will vary, and depends upon the patient, the extent of the injury, and the judgment and expertise of the physician.

Back surgery involves removal of all or part of a vertebra or disk in order to relieve pressure and pain on the nerves in the spine. A vertebra is one of 33 small bones making up the spine. Disks are the cushioning between the vertebrae that prevent the bones from coming into contact with each other.

A herniated disk is one that has ruptured or bulged from a tear in the disk covering. If the herniated disk presses on a nerve, surgery may be required to relieve the pressure and the pain associated with it.
Surgery may include:

Back surgery is usually performed by an orthopedic surgeon, and is done under general anesthesia. It is an inpatient procedure, which means that it requires a hospital stay. The surgery will relieve pain and allow the back to heal. Recovery time is typically 1-3 months.

A kidney transplant involves placing a healthy donor kidney into the body where it can perform all the functions that a failing kidney cannot. Kidney transplants are one of the most common transplant operations in the United States. People with chronic kidney disease can receive lifesaving dialysis until a donated kidney becomes available. A donated kidney may come from a living related donor, a living unrelated donor, or a deceased donor.

The donor kidney must match as closely as possible to your tissue type to reduce the chance that your body will reject the new kidney. A healthy donated kidney can be transported in cool salt water to preserve the organ for up to 48 hours. This allows time for tests to match the donor’s and recipient’s blood type before the operation.

For the surgery, a patient is put under general anesthesia. An incision is made in the lower abdomen area. The donor kidney is placed in the lower abdomen where it is surgically connected to nearby blood vessels and the bladder.

The donor kidney should begin to function immediately and patients typically remain in the hospital for about a week. The recovery period is usually three to six weeks and requires regular check-ups with blood tests during the first year. All transplant recipients need lifelong treatment with immunosuppressant medications to prevent rejection of the transplanted kidney.

ACL meniscal repairs are typically performed using arthroscopic surgery where the physician uses a camera or arthroscope inserted in small incisions in the joint. The physician is able to insert instruments through the incisions to make repairs.

An orthopedic surgeon usually performs this type of surgery. Almost all surgeries are performed on an outpatient basis. The surgery can be performed under local, regional (specific area), or general anesthesia.

The surgery is performed on the medial (the middle part) or lateral (the side part) area of the knee. The surgery can be performed on both areas at the same time. Some procedures included in this surgery are:

• Meniscetomy – The removal of lateral or medial (or both) meniscus cartilage in the knee.
• Shaving – The partial removal or shaving of torn areas of the meniscus which also prepares the area for placement of a new ligament.

Knee replacement surgery is the placement of an artificial knee joint. The most common cause of knee pain is arthritis. It can be osteoarthritis, which normally occurs after the age of 50, rheumatoid arthritis (where too much synovial fluid is produced, overflowing the joint space), or post-traumatic arthritis following a knee injury.

Each artificial joint contains the following:

• Tibial Component – This replaces the end of the tibia (shinbone).
• Femoral Component – This replaces the end of the femur (thighbone).
• Patellar Component –This replaces the surface on the bottom of the patella (kneecap).

The knee can be attached by either cemented prosthesis, which is where the cement proxy attaches to the bone, or uncemented prosthesis, which is where there is a mesh on the surface that allows bone to grow into prosthesis.

The surgery is performed by an orthopedic surgeon using general or local anesthesia in a hospital setting. The surgeon begins by making an incision on the front of the knee to allow access to the joint. A tool is placed on the femur to keep proper alignment while the diseased bone is cut away from the end of the femur. The surgeon then prepares the top of the tibia bone by using another cutting tool. The undersurface of the kneecap is removed and the surgeon places the femoral component, the tibia component, and then the patellar component.

This procedure requires a hospital stay of several days.

Laparoscopic gallbladder removal (also known as laparoscopic cholecystectomy) is a procedure in which the gallbladder is removed using instruments inserted through small incisions in the abdomen. The procedure is performed in an operating room with the patient under general anesthesia. Most patients are released from the hospital the following day; some may even go home the same day.

Using a narrow tube-like instrument called a cannula, the surgeon enters the abdomen through small incisions made near the area of the navel. Inserted through the cannula is a tiny camera, which allows the surgeon to view the internal organs. The gallbladder is removed through the cannula, as well. If the surgeon finds one or more stones, he or she may remove them with a special scope, may choose to have them removed later through a second invasive procedure, or convert to an open procedure for the surgery.

A liver biopsy is a medical procedure to remove a small amount of tissue from the liver for examination. The biopsy helps diagnose a number of liver diseases or assess the stage (early, advanced) of liver disease. This is especially important in hepatitis C infection. The biopsy also helps detect infections, cancer, unexplained enlarged liver, or abnormal liver enzymes detected by blood tests.

The biopsy is performed in a hospital setting under local anesthesia. The physician will use a needle to remove a small piece of liver tissue, which is sent to the laboratory for evaluation. The patient usually will remain lying down for one or two additional hours, to ensure that there have been no complications. The patient is then released and sent home.

The surgeon can also explore the bile ducts during the liver biopsy for congenital abnormalities such as atresia, in which the bile may back up into the liver.

Lumpectomy is the surgical procedure in which a cancerous lump or tumor in the breast is removed. The procedure is recommended only for those patients with less than 25 percent of the breast involved.

Lumpectomies can include excisional biopsy procedures. Biopsies are obtained either by needle or tissue sampling using either a scalpel or vacuum-assisted devices while under the guidance of ultrasound, MRI or other stereotactic diagnostic imaging.

To perform the lumpectomy, the surgeon will make a small incision over or near the breast tumor and cut free the lump and at least one-half inch of healthy tissue surrounding the tumor. The surgeon will submit the tissue to the pathologist for evaluation, often while the patient is still on the operating table, and if the extra tissue does not contain any cancerous cells, the excision will be sufficient. If cells are present, the surgeon may perform another sampling or perform a partial mastectomy.

A lung biopsy is a medical procedure in which a small amount of lung tissue is removed and examined by a pathologist for any abnormalities. The procedure is used to diagnose certain lung conditions, such as pulmonary fibrosis (scarring of the lungs with fibrotic tissue), sarcoidosis (clumps of cells formed in various organs), and cancer.

There are four types of lung biopsies:

• Bronchoscope Biopsy – For this method, a lighted instrument called a bronchoscope is inserted through the mouth or nose and into the airway to remove a lung tissue sample. This method is used if an infectious disease is suspected, if the abnormal tissue is located next to the breathing tubes (bronchi), or before trying more invasive methods.

  This is an outpatient procedure done by a pulmonologist with a local anesthetic sprayed into the mouth.

• Needle Biopsy – For this method, a long needle is inserted through the chest wall to remove a sample of lung tissue. A CT scan, ultrasound or a fluoroscope is used to guide the needle to the desired area. This is the best method if the abnormality is located close to the chest wall.

  This outpatient procedure is done by a pulmonologist or a radiologist with a local anesthetic applied to the area where the needle will be inserted.

• Open Biopsy – For this method, a surgical incision is made between the ribs and a sample of lung tissue is taken. This surgical procedure is done when all other methods have not been successful or when a larger piece of tissue is needed.

  This surgical procedure is performed by a thoracic surgeon or a general surgeon under general anesthesia while the patient is in the hospital.

• Video-Assisted Thorascopic Surgery – For this method, a thorascope is passed through a small incision in the chest to remove a sample of lung tissue.

  This surgical procedure is performed by a thoracic surgeon or a general surgeon under general anesthesia while the patient is in the hospital.

• Simple or Total Mastectomy – Removal of the breast, its skin, the nipple, but no lymph nodes.
• Subcutaneous Mastectomy – Removal of entire breast but leaves nipple and areola (dark pigmented area around the nipple) in place.
• Radical Mastectomy – Removal of the entire breast, nipple/areolar region, the major and minor chest muscles, and the lymph nodes.
• Modified Radical Mastectomy – Removal of the entire breast, nipple/areolar region, and the axillary lymph nodes.

Mastectomies are performed by a surgeon while the patient is under general anesthesia. The surgeon makes an incision near the site of the tumor and removes the breast tissue, and makes another incision to remove the lymph nodes, if scheduled. Drains are inserted either in the breast or under the arm to collect any fluid during the healing process. The surgery time averages two to three hours, but can increase due to reconstruction of the breast. Most patients can leave the hospital in two to three days.

• Use forceps or a vacuum extractor. Forceps have rounded edges that fit around the fetus' head. A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. It is inserted into the vagina and uses suction to attach to the fetus's head.
• Perform an episiotomy. An episiotomy is an incision between the vaginal opening and the anus.

After delivery, the placenta will usually detach from the uterus and the woman can push out the placenta on her own. If the placenta is not delivered within 30 minutes the physician may insert a hand into the uterus, detach the placenta from the uterus and remove it.

Both regional and general anesthesia may be used. Regional anesthesia is the most frequently used for labor and delivery, and the narcotics are administered by continuous infusion into the epidural space. A physician may also use a Pudendal block, which involves injecting a local anesthetic through the vaginal wall. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section.

The normal hospital stay for a vaginal delivery is 24-48 hours.

Open bladder surgery is performed to repair the bladder, to place incisions or insertions for drainage, to remove cysts, diverticulum, or tumors, or to remove the bladder completely.

Open bladder surgeries cover many different procedures.

• Ureteroncystostomy – This procedure involves the surgical fusion of a single or duplicated ureter to the bladder. This procedure may also include a bladder flap or extensive tailoring to help prevent reflex.
• Cystotomy – This is a surgical incision into the bladder which can be used to insert radioactive material, a stent or ureteral catheter, or a drain, remove a bladder stone, or to perform cryosurgery (freezing tissue in order to destroy it).
• Excision and Cystotomy – These procedures involve removing bladder cysts, lesions, diverticulum and tumors.
• Partial Cystectomy – This procedure involves the partially removing the bladder and can include reimplanting the ureters into the bladder.
• Complete Cystectomy – This procedure involves completely removing the bladder and can include fusion to the small and/or large intestines to create a "neobladder."
• Cystoplasty or Cystouterthroplasty – This procedure involves plastic or reconstructive surgery on the urinary bladder or ureter(s).
• Cystorrhaphy – This procedure is the suturing of the bladder to repair a wound.
• Closure – These procedures are repairs done on the bladder, vagina, or vaginal fistulas.

Most procedures are done in a hospital setting under general anesthesia.

• Developmental abnormalities of the fetus
• Abnormal fetal heart rate
• Abnormal position of the fetus
• Extreme maternal illness
• Active genital herpes infection
• Maternal HIV infection
• Previous uterine surgery, including previous C-section
• Prolonged or arrested labor
• Placenta attached in abnormal location

Both regional and general anesthesia may be used. Regional anesthesia is most frequently used for labor and delivery. Regional anesthesia is when narcotics may be given by continuous infusion into the epidural space in the spine. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section. Most mothers and infants recover well.

If a patient has a heartbeat that is too fast, too slow, or frequently irregular, blood is not pumped efficiently around the body and the body's cells do not get enough oxygen and nourishment. In this situation, a physician may recommend that an artificial pacemaker be implanted in the body to ensure that the heart beats more regularly.

A pacemaker is a small, battery-operated device implanted just under the skin near the collarbone to help the heart beat regularly at an appropriate rate. Pacemakers are about the size of a matchbox and are used to treat heart arrhythmias — irregularities in your heart's natural heart rhythm. Almost everyone's heart skips a beat sometimes, and that is generally considered harmless. Some people, however, will need medication and/or a pacemaker.

A pacemaker usually has two parts: a pulse generator (which includes the battery and several electronic circuits); and a lead(s), (which is attached to the heart wall).

Pacemaker surgery is performed under local anesthesia. It is implanted just near the collarbone. If the pacemaker has only one lead, the lead is placed inside the lower right chamber. If two leads are needed, the second lead is placed in the upper right chamber. The procedure takes about one to two hours. An overnight stay is usually recommended.

Prostate removal surgery (also known as Prostatectomy) is the removal of all or part of the prostate. The prostate gland is an organ at the base of the bladder in men, surrounding the urethra. When the gland becomes enlarged, the prostate can compress the urethra, causing problems with urination.

The removal of the prostate gland can be done in different ways, depending on the size of the prostate and the cause of the enlargement. The most common prostate removal surgical procedures are:

• Transurethral Resection of the Prostate (TURP)- is the most common treatment for benign hyperplasia (prostate gland overgrowth). The procedure is performed using either a general or a spinal anesthesia. A tubelike instrument called a cystoscope is inserted into the penis through the urethra. A cutting instrument is then inserted through the cystoscope to remove the prostate gland piece by piece. Any blood vessels are cauterized during the surgery to stop the bleeding. A catheter will be placed following surgery to help the bladder drain and is usually removed within one to three days. The hospitalization time is approximately one to five days.

• Open Prostatectomy – Using general or spinal anesthesia, an incision is made in the lower abdomen between the navel and the penis. The gland is then removed through this incision. Catheters inserted following surgery will remain in place from five days to a few weeks until the bladder has healed. The hospitalization time is longer than five days. This surgical procedure is also known as suprapubic or retropublic prostactomy.

• Transurethral Incision of the Prostate (TUIP) – is a procedure that is recommended for men with only slightly enlarged prostates. In this procedure, under general or spinal anesthesia, the surgeon will use an instrument inserted into the penis through the urethra that generates an electric current or laser beam to make incisions in the prostate where the prostate meets the bladder. This relaxes the opening to the bladder, allowing for greater flow out of the bladder. A catheter is inserted in the bladder following surgery and is left in for one to three days. This procedure can be done in a hospital setting with a short stay of one to three days, or in an outpatient setting.

• Reduce or increase the size of the nose
• Change the shape
• Narrow the opening of the nostrils
• Correct a birth defect
• Relieve breathing problems
• Correct an injury.

Rhinoplasty may be performed under local or general anesthesia, depending on the extent of the procedure. Surgery is usually performed by a plastic surgeon in an office-based facility, an outpatient surgery center, or hospital. Patients are up and about within two days, and can usually return to work after a week. Complete recovery may take several weeks.

The procedure is performed by a cardiologist and a team of specialized trained individuals at a hospital catheterization laboratory. The patient remains awake for the procedure (no anesthesia) but pain medicine may be given as needed.

Coronary angioplasty is performed by inserting a hollow needle into the femoral artery (an artery located in the groin near the thigh) . With the help of x-ray images, a guide wire is pushed through the needle into the artery, where it is advanced to a point just past the narrowing of the artery to be treated. Once the guide wire is in place, a balloon-tipped catheter is threaded over the guide wire and pushed along the artery until it reaches the area to be treated. The balloon at the tip of the catheter is then inflated and deflated several times to widen the narrowed part of the artery. When the procedure is complete, the balloon is deflated and the catheter is withdrawn.

The patient is monitored for 12-14 hours after the procedure with frequent vital sign checks. Most patients are released from the hospital within a day or two of the procedure.

Alternative Names: Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation

Defibrillator implant surgery is performed to implant a device to help control a patient's heart rhythm. There are two types of devices, pacemakers and implantable cardioverter defibrillator (ICD). Both help treat arrhythmias–irregularities in your heart's natural heart rhythm. Almost everyone's heart skips a beat and most are considered harmless. Some patients, however, will need medication and/or a defibrillator implant.

• Pacemaker – This is a small battery-operated device (about the size of a matchbox). It usually has two parts: a pulse generator (which includes the battery and several electronic circuits), and leads, which are attached to the heart wall. You may have one or two leads, depending on the pacemaker.

• Implantable Cardioverter Defibrillator (ICD) – This implant is about the size of a pager (larger than a pacemaker). It too has two parts: the pulse generator (which includes the battery and several electronic circuits), and a lead wire, or wires, depending on the device implanted. The lead wire(s) are placed inside the heart or on its surface and attached to the ICD. ICD are typically used to control fast irregular heart rates.

Pacemaker surgery is performed under local anesthesia. It is implanted just near the collarbone. If the pacemaker has only one lead, the lead is placed inside the lower right chamber. If two leads are needed, the second lead is placed in the upper right chamber. The procedure takes about one to two hours.

ICD surgery is performed in a hospital under general anesthesia. The device is implanted beneath the skin near the collarbone. It can also be implanted at another location at or above the waistline. The surgeon will then test the device and this can take up to two hours. An overnight stay is recommended.

Dilatation and Curettage (D&C) is a procedure to scrape and collect tissue from inside the uterus. This procedure is used to help diagnose medical conditions using the tissue collected, to treat irregular or heavy menstrual bleeding, or to remove fetal or placental tissue following a miscarriage.

This procedure can be performed in a hospital or in a clinic setting using either local or general anesthesia.

The vaginal canal is held open by a speculum and the opening to the cervix is anesthetized. The cervix is then opened (dilated) using various rod sizes until the cervix is opened to the desired size. After the cervix is dilated, instruments can be inserted into the uterus and manipulated, depending on the nature of the procedure.

Ear tube placement, or tympanostomy, is a procedure to drain fluid that has built up behind a child's eardrums to restore the normal function of the ear. This surgery is performed by an otolaryngologist. The tubes ventilate the ears, which help prevent fluid from building up in the ear which can cause reoccurring ear infections, and help reduce hearing loss due to fluid trapped behind the eardrum.

The tubes are placed through the ear canal in an operating room under general anesthesia. A tiny hole is made in the eardrum, and fluid is suctioned. A tiny tube is then inserted into the hole, allowing air to enter the middle ear. The procedure is a short one, and the patient is allowed to go home after a brief recovery period.

The tubes usually will fall out of the ear within one to two years as the eardrum grows.

Procedures used can include:

• Esophagectomy – An esophagectomy is the partial or complete removal of the esophagus (the tube from the mouth to the stomach) and the top part of the stomach. An esophagectomy is performed using one of two methods. Transhiatal Esophagectomy is performed with surgical incisions at the upper abdomen and the neck area. The second method, Transthoracic Esophagectomy is also known as the Ivor Lewis procedure and is performed with an upper abdominal incision and an incision into the chest area.
• Esophagoenterostomy – In this procedure, a connection is made between the esophagus and the small intestine following a gastrectomy.
• Roux-en-Y Reconstruction – In this procedure a small pouch is formed and connected to the intestine.
• Gastroduodenostomy – In this procedure, a connection is made between the stomach and duodenum (the first portion of the small intestine).
• Gastrojejunostomy – In this procedure, a connection is made between the stomach and the jejunum (the portion of the small intestine that extends from the duodenum to the ileum).
• Vagotomy – In this procedure the vagus nerve is cut to reduce acid secretion in the stomach. The vagus nerve has branches that go to different parts of the stomach.
• Pancreatectomy – This procedure involves the total or partial surgical removal of the pancreas.
• Whipple Procedure – Also known as a pancreaticoduodenectomy , this procedure is the removal of the duodenum with all or part of the pancreas.

Gastroesophageal reflux surgery is used to correct gastroesophageal reflux disease (GERD). GERD is a condition in which partially digested food or liquid travels from the stomach back up into the esophagus (the tube from the mouth to the stomach). At the lower end of the esophagus, there is a small ring of muscle called the lower esophageal sphincter (LES). The LES is a one-way valve that normally closes after swallowing to prevent back-up of the stomach juices. If the LES is not functioning properly, stomach acid or partially digested material will flow back in to the esophagus often inflaming the esophagus and causing heartburn and other symptoms.

Some procedures used are:

• Upper Gastrointestinal Endoscopy – For this procedure, the physician inserts an endoscope through the mouth where it travels down to the stomach, allowing the physician to view the esophagus, stomach and duodenum (upper gastrointestinal tract). Tissue samples can be obtained, polyps can be removed and bleeding can be treated. Thermal therapy can also be administered where electrodes are placed at multiple sites and the heat is used to create lesions that help strengthen the lower esophagus sphincter (LES). This procedure is done on an outpatient basis with local anesthesia for the throat and medication to relax the patient.
• Esophagogastric Fundoplasty – This surgery reinforces the valve between the esophagus and stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus, much like the way a bun wraps around a hot dog. This allows for increased pressure within the lower esophageal sphincter (LES), allowing the LES to strengthen and lengthen. This procedure can be performed both laparoscopic (using small incisions to enter the abdomen) or open (through a large incision to the patient's abdomen). This procedure is done on an inpatient basis under general anesthesia.

Heart bypass surgery or coronary artery bypass grafting (CABG) is a surgical procedure in which a section of a coronary artery, which has been partially or completely blocked, is bypassed by transplanting a healthy section of blood vessel around the diseased area. The conduit to route blood around the obstructed area may be an artery or a vein. There is some information that arteries may have a better long-term patency rate (chance of staying open for years) than veins. The arteries and veins used for the bypass procedure are taken from the patient's own body; they may be harvested from within the chest, the arms or the legs.

This procedure is performed in a hospital under general anesthesia.

Coronary artery bypass is performed by a cardiothoracic surgeon who makes an incision in the patient's chest to expose the patient's heart. Incisions may also be made in the legs or the arms to obtain a vein or artery for the bypass. The patient is connected to a heart-lung machine that takes over the function of the heart and lungs while the surgeon works on the heart. An opening is made in the diseased artery or arteries above and below the blockage. A section of artery or vein is then sewn to the points above and below the blockage in the affected artery, effectively providing a detour around the obstruction. At the conclusion of the bypass procedure the heart-lung machine is disconnected, allowing blood to flow back through the heart, and the incision is closed.

Most bypass operations are performed by dividing the breastbone to provide access to the heart. Some bypass operations are now performed through "limited" incisions made either between the ribs or partially through the breastbone, with or without the use of the heart-lung machine.

Most patients experience some discomfort at the incision site for a few days but most preoperative angina will resolve.

For the surgery, a patient is put under general anesthesia and the patient’s blood is circulated through a heart-lung bypass machine to keep the blood oxygen-rich and circulating through the body. An incision is made through the breast bone. The diseased heart is removed and the donor heart is attached in its place. The heart-lung machine is disconnected so that blood can flow through the transplanted heart. The incision is closed.

Heart transplantation usually requires 7 to 21 days in the hospital, with the first 24 to 48 hours in an intensive care unit. The recovery period is about six months and often requires regular check-ups with blood tests and x-rays. All transplant recipients need lifelong treatment with immunosuppressant medications to prevent rejection of the transplanted heart.

Heart valve repair surgery is performed to repair malfunctioning heart valves. Examples of these can be valves that are blocked, narrowed or leaking. There are four valves in your heart. The mitral and aortic valves are the most commonly repaired, followed by the tricuspid valve.

Some procedures performed are:

• Valvuloplasty – This is plastic surgery repair of the valves and can be performed with cardiopulmonary bypass, occlusion (where the blood flow is temporarily interrupted by clamps) and dilation (stretching of the ventricle while on bypass).

• Valvotomy – This is a surgical incision into the stenosed cardiac valve to relieve obstruction. This can be performed with the patient being on occlusion (blood flow temporarily interrupted by clamps) and on a bypass. It can involve the placement of a prosthetic device that can replace the diseased area.
• Valvectomy – This is a surgical procedure in which a catheter is inserted to open a blocked or restricted valve and is performed while the patient is on bypass.

• Commissurotomy – This is a procedure where a surgical incision is made at the place where two cardiac valves form a connection.

All procedures are performed in a hospital setting by a cardiac surgeon under general anesthesia.