Cardiothoracic surgery

The purpose of coronary artery bypass surgery is to improve the blood supply to an area of the heart that has been deprived of adequate circulation. Two procedures are involved: an incision is made in the leg to remove a vein which is then used as a graft to create a new coronary artery. the second incision is made in the chest to enable the surgeon to reach the heart. More than one artery can be blocked and it is then necessary to insert more than one graft. Terms like double bypass, triple bypass and quadruple bypass indicate the number of grafts required. Coronary artery bypass surgery takes anything from three to six hours, depending on the number of bypasses being inserted. The above procedures are all performed in a cardiac catheterization laboratory.  

Coronary heart disease is one of the top killers in South Africa and the disease affects more than four million people a year. Owing to the stressful lifestyle that we lead in South Africa, high rates of smoking and the increase in ‘junk food’ diets coronary disease affects more people at a younger age.

It is the most common form of heart disease and is mostly caused by hardening of the arteries due to the build up of fatty deposits in the blood vessels. This can eventually deprive the heart of oxygen resulting in a heart attack or stroke. Factors leading to heart disease include high blood cholesterol, high blood pressure, a family history of heart disease, stress, smoking, being overweight and lack of exercise. 

Once a diagnostic assessment has been made, should the patient need coronary intervention our lab is able to offer interventional procedures such as coronary angioplasty and or stent procedures. These procedures are non-invasive and are performed under fluoroscopy using a series of over the wire catheters, balloons and stents . Thereafter the patient is hospitalised in the ICU overnight and is generally permitted to return to a normal routine the next day. Non invasive procedures have reduced the need for bypass surgery hugely. Specialised technologies such as vascular interventions, offered by many private hospitals including Arwyp Medical Centre, reduce the threat of limb amputation. 

Heart vocabulary

An electrocardiogram is a simple, painless test that records the heart's electrical activity. To understand this test, it helps to understand how the heart works. An ECG shows how fast the heart is beating, whether the rhythm of the heartbeat is steady or irregular and the strength and timing of electrical signals as they pass through each part of the heart. Doctors use ECGs to detect potential heart problems.

High blood pressure or hypertension

When blood flows from the heart to the blood vessels it creates pressure against the blood vessel walls. Your blood pressure reading is a measure of this pressure. High blood pressure is also called hypertension. Most high blood pressure can be kept under control by correct eating, cutting down on excessive salt intake, reducing alcohol and regular exercise. Some high blood pressure conditions are the result of other underlying diseases.


Cholesterol is a form of fat that is carried in the blood. Unhealthy cholesterol levels can raise the risk of type 2 diabetes and/or heart disease.


A restriction in blood supply, generally due to factors in the blood vessels.


The symptoms of angina are usually chest pains, discomfort in the upper body or shortness of breath. Most patients with angina complain of chest discomfort rather than actual pain: the discomfort is usually described as a pressure, heaviness, tightness, squeezing, burning, or choking sensation. Apart from chest discomfort, anginal pains may also be experienced in the upper chest, back, neck area, jaw, or shoulders.

There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e., there can be severe pain with little or no risk of a heart attack, and a heart attack can occur without pain). Major risk factors for angina include cigarette smoking, diabetes, high cholesterol, high blood pressure, sedentary lifestyle and family history of premature heart disease.

Coronary heart disease or atherosclerosis

Over time, a fatty substance called plaque can build up in your arteries, causing them to harden and narrow. This condition is called atherosclerosis. The main causes for plaque build up are smoking and diet related, but in some patients, genetics play a role. Atherosclerosis can affect any artery in the body. When atherosclerosis affects the coronary arteries, the condition is called coronary heart disease (CHD) or coronary artery disease.


The purpose of an angiogram is to assess the coronary arteries which supply blood to the heart.  Angiography is a medical imaging technique used to make an image of blood vessels and organs of the body, with particular focus on the arteries, veins and the heart chambers. This is usually done by injecting a radio-opaque contrast agent into the blood vessels and imaging using X-ray based techniques. A doctor will recommend an angiogram to a patient who is complaining of angina, the usual symptoms of which are chest pains or shortness of breath. During coronary angiography, patients are placed on their backs and are awake. The doctor will numb the area where the catheter (a small plastic tube) will enter the blood vessel through a small cut in the arm, groin (upper thigh), or neck.

The doctor then threads the catheter through the vessel up to the opening of the coronary arteries. Special x-rays are used to guide the catheter as it's moved up into the heart. The images help the doctor see where to position the tip of the catheter. Your doctor will put special dye in the catheter when it reaches the correct spot. This dye will flow through your coronary arteries and make them show up on an x ray. This x ray is called an angiogram. If the angiogram reveals blocked arteries, your doctor may use angioplasty to restore blood flow to your heart.

After your doctor completes the angiography, or the angiography and angioplasty, he or she will remove the catheter from your body. The opening left in the blood vessel will then be closed up and bandaged.


Coronary angioplasty is a procedure used to open blocked or narrowed coronary (heart) arteries. The purpose of the procedure is to improve blood flow to the heart muscle. Angioplasty can restore blood flow to the heart if the coronary arteries have become narrowed or blocked. During angioplasty, a small balloon is expanded inside the coronary artery to open the blockage. After the artery a stent is inserted mostly to keep the arteries open.

Cardiothoracic Surgeons

Dr. Pieter Scholtz

(012) 664 3824