Interventional Cardiology
Many conditions that formerly required open-heart surgery can now be treated with nonsurgical interventional procedures which use techniques and technologies that typically minimize pain, risk and recovery time.
Interventional cardiology is a non-surgical option which uses a catheter – a small, flexible tube – to repair damaged or weakened vessels, narrowed arteries, or other affected parts of the heart structure.
Common conditions treated by interventional cardiology:
- Coronary artery disease: A narrowing of the arteries which supply the heart muscle with blood and oxygen.
- Heart valve disease: Occurs when the valves which control blood flow into the heart’s chambers are not working correctly.
- Peripheral vascular disease: Your heart can also be affected by clogged or hardened veins and arteries which are in other parts of your body.
PATIENT BENEFITS
Interventional cardiology procedures are generally less invasive than traditional surgery. In most cases, these procedures require only one small incision for insertion of the catheter. Most interventional cardiology patients do not require general anesthesia and some procedures can take as few as 30 minutes to perform.
In many cases, patients go home the same day or are hospitalized for only one night following interventional cardiology procedures, instead of the longer hospital stay required by other types of surgery. Recovery time often is shorter as well and symptoms, such as shortness of breath and chest pain, are usually relieved quickly and effectively.
KEY INTERVENTIONAL CARDIOLOGY PROCEDURES
CARDIAC CATHETERIZATION
Cardiac catheterization, also called coronary angiography, creates a detailed map of the coronary arteries that demonstrates blockages, irregularities and other problems. Using a catheter, dye is injected into the coronary arteries and followed on a video screen as it travels through those arteries. Dye can also be injected to show the shape and function of the heart’s chambers and valves.
TMT (TREADMILL TEST)
Echocardiography or echo, is actually colored ultrasound of the heart, a painless test that gives a moving picture of your heart. The test gives information about the size of your heart and how well your heart’s chambers and valves are working. Echo also can be done to detect heart problems in infants and children. The test also can identify areas of heart muscle that aren’t contracting normally due to poor blood flow or injury from a previous heart attack. In addition, a type of echo called Doppler ultrasound shows how well blood flows through the chambers and valves of your heart. Echo can detect possible blood clots inside the heart, fluid buildup in the pericardium (the sac around the heart), and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to your body.
In TMT, an ECG is done while you are doing exercise. In this test, the patient walks on a treadmill as per the protocol of the test. Most often, it is done in healthy individuals as a preventive check up or in a post myocardial infarction patient. It is a test used to induce provocable myocardial ischemia for diagnostic evaluation of coronary artery disease.
INTRAVASCULAR DIAGNOSTICS
Intravascular ultrasound imaging (IVUS) — a type of high-resolution imaging — is a new diagnostic technique that provides Swedish cardiologists with unique information about the structure of arterial walls and the space within an artery. IVUS can be used to identify plaque deposits that are blocking arteries as well as to assess the progression and regression of those deposits in patients being treated for coronary artery disease.
ANGIOPLASTY WITH STENT
Angioplasty with coronary stenting first opens up a narrowed artery by using a balloon catheter, then — if needed — a coronary stent (a tiny metal coil or mesh tube) can be implanted in the artery to make sure it stays open. The procedure is sometimes aided by the use of a rotoblader (a rotating burr) that “drills” through a tough blockage that is difficult to open with a balloon. Newer drug-eluting stents (stents that contain drugs to prevent the scarring that can cause an artery to reclose) are currently available, with bioabsorbable (able to be absorbed by the body) stents on the near horizon.
STEREOTAXIS-GUIDED INTERVENTION
The Stereotaxis Navigation System allows physicians to direct and control catheter-based therapeutic and diagnostic devices along complex trajectories within the heart and coronary blood vessels. Swedish was one of the first places in the world to offer the Stereotaxis technology. The system features a magnetic actuator and real-time imaging. The catheters and guidewires have small magnets embedded in the tips. The magnetic actuator orients the magnets and, in doing so, points the tip in the desired direction as a physician watches on a video screen.
BALLOON VALVULOPLASTY
This is a procedure that is designed to improve heart-valve function by using a balloon at the time of cardiac catheterization to increase the area of a narrowed valve. The catheter is positioned so the balloon tip is directly inside the narrowed valve, and then the balloon is inflated and deflated several times to widen the valve opening. The balloon is removed once the cardiologist has determined that the opening of the valve is wide enough. During this procedure, the cardiologist may perform an echocardiogram to get a better picture of the affected valve.
PFO/ASD CLOSURE
Swedish pioneered the PFO treatment, which involves using a special device — a tiny, double-umbrella apparatus — to seal a small congenital defect in the heart known as a patent foramen ovale (PFO). A PFO results from incomplete closure after birth in the atrial septum, which is a thin wall separating the upper chambers of the heart. It has been implicated as a potential cause for unexplained strokes in young adults. Repairing the defect may therefore reduce the patient’s future stroke risk.
Like PFO, an atrial septum defect (ASD) results from incomplete closure after birth in the wall between the left and right atria. About 7 percent of congenital heart defects fall into this category, and if the defect is large enough, oxygen-rich blood from the left atrium flows back into the right side of the heart and is pumped back to the lungs instead of to the rest of the body. This results in more work for the heart. Patients with large ASDs experience shortness of breath with physical exertion. Eventually, the right side of the heart may become weaker and, ultimately, fail. In many patients, ASD may be closed via catheter, using technology similar to PFO closure.
SEPTAL ABLATION FOR HYPERTROPHIC CARDIOMYOPATHY
Hypertrophic cardiomyopathy is a relatively complex type of heart disease that is marked by left ventricular stiffness, mitral valve changes and thickening of the heart muscle, with that thickening most commonly occurring at the septum (the wall dividing the heart’s chambers). Septal ablation — which is also called ethanol ablation — is performed in the cardiac catheterization laboratory. The artery that supplies blood to the septum is located during a cardiac catheterization procedure and a tiny amount of alcohol is injected through the catheter into this artery. This causes a very small heart attack of the septum, which results in thinning of the septum to a more normal size over time and improvement in the patient’s symptoms.
ENDOMYOCARDIAL BIOPSY
Endomyocardial biopsy is a procedure for monitoring heart transplant rejection by taking a tissue sample from the inside walls of the heart. A catheter is threaded through a vein in the patient’s leg or neck into the chambers of the heart, where the sample is taken by a small biting action at the end of the catheter.