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Cardiologists and Cardiovascular Surgeons In Our Network
Diagnostic Angiography
A Diagnostic Angiography or Coronary Catheterization is a minimally invasive procedure to access the coronary circulation and chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes. As a diagnostic, it is called a Diagnostic Angiography and encompasses a visually interpreted test performed to recognize occlusion, stenosis, restenosis, thrombosis, aneurysmal enlargement of the coronary artery lumens, heart chamber size, heart muscle performance, and heart valve function. Heart and lung blood pressures can also be measured during the test.
During a coronary catheterization, blood pressures are recorded and moving X-Rays of the blood inside the arteries are recorded. To aid the X-ray image, the cardiologist guides the catheter through the large arteries of the body until the tip is just within the opening of one of the coronary arteries. The catheter is visible to the X-Ray and is used to release a blood compatible, radiocontrast agent into the blood flowing within the artery. This allows the image to show detail of the coronary capillaries and veins for a few seconds at a time. If clots are protruding into the lumen and narrowing the artery, it will be easily noticed and captured in a digital image. Though not the focus of the test, calcification within artery walls is sometimes recognizable on the fluoroscopy and without the need for contrast injections.
Percutaneous Coronary Intervention (PCI) - Angioplasty
Percutaceous Coronary Intervention, also known as Angioplasty, is a therapeutic procedure to treat the stenotic (narrowed) coronary arteries found in coronary heart disease and which appear as a consequence of cholesterol build-up and artherosclerosis. The procedure is usually performed by an interventional cardiologist with the purpose of reducing or eliminating the symptoms of coronary artery disease- including angina (chest pain), dyspnea (shortness of breath on exertion), congestive heart failure, and to abort an acute myocardial infarction.
In order to enter the body and coronary arteries, a PCI uses the same minimally invasive catherization method as the diagnostic angiography, However, it will likely include several sub-procedures: a) balloon angioplasty- which involves the inflation of a balloon within the coronary artery to crush the plaque into the walls of the artery; b) stent angioplasty- when a small mesh tube, or “stent", is introduced into the blood vessel or artery to prop it open using percutaneous methods; c) rotational or laser atherectomy-a laser attached to the tip of a thin flexible catheter emits short pulses of light that ablates plaque; and d) brachytherapy- use of a radioactive source to inhibit restenosis.
Coronary angioplasty is widely practiced and major procedural complications are uncommon. Nevertheless, the risk of complications is higher in people aged 75 and older, in patients with kidney disease or diabetes, in patients with poor pumping function and on those who have extensive heart disease and blockages.
Balloon Valvuloplasty
A Valvuloplasty is a minimally invasive therapeutic procedure used to correct uncomplicated heart valve stenosis by dilating the valve using a balloon. Using a similar procedure to angiography and PCI, a catheter with a special balloon is passed from the right femoral vein, up the inferior vena cava and the aorta into the heart valve to be repaired. A balloon is then inflated and deflated repeatedly until the valve has been opened sufficiently and the equipment is carefully removed.
It may be used to treat any of these two heart valves:
- Mitral valve - located between the left atrium and the left ventricle - Aortic valve - located between the left ventricle and the aorta
If the heart valves become damaged or diseased, they may not function properly. Conditions that may cause dysfunction of heart valves are valvular stenosis and valvular insufficiency (regurgitation). When one (or more) valve(s) becomes stenotic (stiff), the heart muscle must work harder to pump the blood through the valve. Reasons why heart valves become stenotic include infection (such as rheumatic fever or staphylococcus infections) and aging. If one or more valves become insufficient (leaky), blood will leak backwards and less blood will be pumped in the proper direction. Valvular heart disease may cause dizziness, chest pain, breathing difficulties, palpitations, edema (swelling) of the feet, ankles, or abdomen, and rapid weight gain due to fluid retention.
Intra-Aortic Balloon Pump or IABP
The Intra-Aortic Balloon Pump is a simple yet effective device to increase coronary perfusion and has become the most widely used form of mechanical circulatory support. Originally used for surgical patients, the pump can now be used along with interventional cardiology procedures and medical therapy.
Indications for its use include:
-Failure to wean from cardiopulmonary bypass
-Cardiogenic shock
-Heart failure
-Acute heart attack
-Support for intervention cardiology procedures in high-risk patients
The Pump is a polyethylene balloon mounted on a catheter, which is generally inserted into the aorta through the femoral artery in the leg. The pump is available in a wide range of sizes (2.5 cc to 50 cc) fitting patients of any age and size. The balloon is placed into the descending aorta and its function is to inflate at the start of diastole, increasing coronary perfusion, and deflate at the beginning of systole. With its aid, blood is ejected from the left ventricle, increasing the cardiac output by as much as 40 percent and decreasing the left ventricular stroke work and myocardial oxygen requirements. The balloon is inflated with helium, an inert gas that is easily absorbed into the bloodstream in case of rupture. Its inflation can be triggered according to the patient's electrocardiogram, its blood pressure, a pacemaker, or by a pre-set internal rate.
The following conditions exclude patients for treatment: aortic valve insufficiency, aortic dissection, and severe aortoiliac occlusive disease. Other conditions in which patients are not usually recommended for an IABP are prosthetic vascular grafts in the aorta, aortic aneurism, and aortofemoral grafts.
Please consider that as in any cardiology procedure, and especially one in which a mechanical element is placed inside the body, there are risks which you should consult your doctor about.
Coronary Artery Bypass Graft or Coronary By-pass
Also called an CABG, this is a procedure used to treat angina pectoris and coronary artery disease. This disease causes the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle) caused by a buildup of fatty material along their walls. This causes the inside of the arteries to become rough and narrowed, limiting the supply of oxygen-rich blood to the heart muscle. One way to treat the blocked or narrowed arteries is to bypass the blocked portion of the coronary artery with another piece of blood vessel. The vessels or grafts used for the bypass procedure may be pieces of a vein taken from the legs or another artery in the chest. One end of the graft is attached above the blockage and the other end is attached below the blockage, therefore rerouting or bypassing the blockage. In many cases, multiple blockages will mean that more than one artery may need to be bypassed.
The CABG surgery involves opening the chest and accessing the heart behind the sternum. The heart is then stopped for a limited time while a cardiopulmonary bypass machine (heart-lung machine) takes care of circulation. Once the heart is stopped, the surgeon can perform as many artery bypasses as requires in the operation. While the traditional "open heart" procedure is still performed and often preferred in many situations, newer, less invasive techniques have been developed to bypass blocked coronary arteries. "Off-pump" procedures, in which the heart does not have to be stopped, were developed in the 1990's. Other minimally-invasive procedures, such as key-hole surgery (performed through very small incisions) and robotic procedures (performed with the aid of a moving mechanical device), are also in development. CABG is sometimes preferred to PCI in patients with more than two stenotic arteries, left coronary artery disease, or diabetes.
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