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"Coronary by-pass surgery" refers to the operation of forming bridge vessels with vessels taken from another area of a body beyond narrowing of blood vessels in its own vessels of a heart. (coronary arteries). 

Coronary Artery Dısease
Coronary arteries are the arteries surrounding the vicinity of heart and feeding hearth muscle. There are three main coronary artery systems. Coronary arteries are fed from aorta that is artery moving out of heart.

Coronary Artery Disease (CAD) is a disease caused due to partial or complete failure of blood flow with narrowing or blockage of arteries referred as "coronary arteries" and feeding heart muscle. 

Coronary artery disease is ranked as the first causes of death in our country. In our country, about 200 thousand people a year are killed due to coronary diseases. The most important characteristic feature of this disease is that it may lead to life threatening myocardial infarction in advanced stages. 

Coronary artery disease is frequently seen after 40 years of age. It is more frequently seen 4 times in men as compared to women. Estrogen in women hormone is protective agent. Thus, incidence rate increases after menopausal period where this hormone decreases in women. It is most frequently seen between maximum 50-60 years of age in men and maximum 60-70 years of of age in women. 

Adopting preventive measures by recognizing the risk factors leading to this disease is as important as treatment of the disease, even more vital than this. The most common cause is atherosclerosis, namely vessel stiffness. Type of fat called "Cholesterol" present especially in animal foods and adhering to inner surface of vein when it is taken in excessive amounts reduces flexibility of our veins that are normally flexible and they accumulate on vein walls and narrows vein cavity. This hardening on vessel wall or blockage of vein is called "atherosclerosis". 

Risk Factors in Coronary Artery Disease
Unchangeable Risk Factors

 • Old Age (Being over 45 in men and over 55 in women and being the period postmenopausal period, namely cessation menstruation.
• Gender (More common in men) 
 • Heredity (Presence of this disease in the family) 
 • Changeable (avoidable) risk factors
 • Smoking
 • Hypertension (blood pressure higher than 140/90 mmHg)
 • Diabetes
 • Stress 
 • High level of cholesterol in blood
 • Other risk factors 
 • Overweight, obesity
 • Sedantry lifestyle
 • Gout disease
 • Excessive alcohol and coffee consumption
 • Hypercalcemia (high blood calcium levels)
 • Use of oral contraceptives for women (birth control pills)

What are the ways of protection from artery disease?
 • You must quit smoking. Smoking is the most important risk factor.
 • Alcohol and coffee consumption should be reduced.
 • High cholesterol levels should be normalized with diet or medication.
 • Regular walking and exercise should be made.
 • Excessive weight should be avoided and you should be down to the appropriate weight for your height.
 • If you have high blood pressure or diabetes, these should be taken under control with diet and medication.
 • In addition, you should abstain from stressful life.

What are the symptoms of coronary artery disease?
 • They may be no symptoms while there is no advanced stenosis in coronary vessels in early stages of the disease.
 • Chest pain (may spread to left shoulder and left arm). This pain is often associated with exercise. This is a compressive pain mostly stretching to the jaw and left arm over breastbone while especially climbing slopes or stairs or after meals. It may emerge in different ways. It vanishes after 5-10 minute resting.
 • Restricting exercise capacity, easily getting tired
 • Shortness of breath on exertion
 • Syncope (fainting)
 • Sudden death 
 • Please bear in mind that sometimes coronary artery disease may not give symptoms or the first sign of it may be myocardial infarction.

Treatment of Coronary Artery 
Medication, bypass surgery and percutaneous intervention are used in the treatment. (balloon, stent). The decision of which treatment to apply is given by specialist physicians by considering may variables such as ( number of diseased vessels, degree of stenosis in vessel, contractile force of heart muscle, patient's response to drug therapy, patient's age, etc.)  after the tests conducted. For this reason, the treatment for each patient should be created according to specific requirements of that patient.

The drugs used in coronary artery disease is intended for preventing angina pectoris attacks by expanding coronary arteries or reducing the requirement of heart for oxygen. In addition, the drugs (aspirin etc.) preventing formation of blood clots diluting blood and clog reduces risk of infarction. Sublingual vasodilator drugs taken 5 minutes before the effort likely to initiate chest pain may prevent emergence of pain or terminate an existing pain attack.

Myocardial Infarction(Heart Attack)
Tissue death (myocardium) occurs in heart muscle depending on failure of feeding of that area fed by this vein as a result of full clogging of narrowing of coronary arteries with a clot. Pain in myocardial infarction is more severe and long-lasting. This is not related to exercise. Since this dead tissue may adversely affect pumping function of heart, heart may not be pumped sufficiently and heart failure may occurs. In addition, myocardial infarction also jeopardize patient's life Timely diagnosis of coronary heart disease should be treated to avoid such stages in coronary heart disease.

Coronary Bypass Surgery
"Coronary by-pass surgery" refers to the operation of forming bridge vessels with vessels taken from another area of a body beyond narrowing of blood vessels in its own vessels of a heart. (coronary arteries). 
The most frequently used veins in coronary artery surgery:    

 • Leg veins (saphenous vein)
 • Arteries supplying anterior chest wall (Internal Mamaria Artery, IMA)
 • Brachia artery (radial artery) may occur.

Selection of them may vary according to patient to patient. Chance of remaining of arteries in long run open is higher when compared with veins. Coronary artery by-pass surgeries can be performed with different techniques. 

Patients can be discharged from hospital after a very short time (about 5 days) from open heart surgery thanks to state-of-the-art surgical techniques and technology of our time.  They can do household and desk job activities. They can return to their normal lives without any restriction. (Including driving a car and sex life). 

Long term results of coronary artery bypass surgery are also successful. Vast majority of the patients state that pain and shortness of breath complaints are fully recovered and they have boosted their performances in both their business and private lives. Surgery may be necessary within 10 years or longer in minor part of the patients. 

Coronary bypass surgery is a procedure that eliminates consequences rather than causes. The change of facing problems again is reduced by taking replaceable risk factors of the patients under control. Risk factors such as smoking, high cholesterol, high blood pressure, stressful life and uncontrolled diabetes should be eliminated and appropriate and drug therapy is of utmost importance. These measures will improve long-term results of surgery and boost its success.