Percutaneous Coronary Interventions
This is a term for all of the procedures that we perform in the arteries that feed the heart with blood to treat narrowings, blockages or plaque with the use of catheter-based treatments. These interventions include Balloon Angioplasty, Cutting Balloons, Stents (including Drug Eluting Stents), Rotoblation and Brachy Therapy. With these procedures, a small wire is placed across the area of narrowing and a balloon is placed across the area of stenosis. At this point the balloon is inflated and squishes the plaque and stretches open the artery allowing a greater opening. Similar types of balloons are used to deploy a stent which is crimped on the outside of the balloon. When the balloon is inflated, the stent becomes imbedded in the wall of the artery and serves as a scaffold to help prop the artery open.
Coronary Angiography and Left Heart Catheterization are common terms for the same procedure that is also commonly referred to as the “Dye Test”. This procedure is the best test to define the exact location and severity of narrowings or blockages in the coronary arteries and is necessary before performing any coronary intervention such as Angioplasty, Stenting or Bypass Surgery. This test also provides information about left ventricular function (the strength of the heart muscles pumping action) and information about the valves on the left side of the heart. This procedure is usually performed as an outpatient and frequently may be performed at the Cardiovascular Diagnostic Center Cardiovascular Diagnostic Center, a free-standing outpatient Cath Lab adjacent to our offices
Description: After being prepped and draped in a sterile fashion and placed on the catheterization table, a small amount of numbing medicine is injected under the skin. This usually causes burning and stinging but will numb the area to prevent pain during the rest of the procedure. A needle is then inserted into the femoral artery (large artery going down each leg) and then exchanged for a wire that is used to place a small sheath, which then provides access for the catheters without further punctures. A series of catheters (small plastic tubes) are then inserted through the sheath and under x-ray guidance placed first within the heart and then at the mouth of each coronary artery where dye is injected and x-ray movie pictures are taken to obtain pictures of the coronary arteries. Several different angles will be taken of each coronary artery allowing the various branches to be seen.
The Coronary Flow Wire is another adjunctive test used with Coronary Angiography. In this test, a small wire is placed across an area of blockage and the pressures are measured as well as an estimate of the coronary flow in order to help determine the severity and physiological significance of a particular narrowing. This helps us decide whether an intervention is necessary or appropriate.
RISKS: Although this is a very safe procedure there are, of course, some risks. There is a slight chance of bleeding or infection. There is a very slight chance of damage to the artery, which could even require surgery to repair. Rarely people will have an allergic reaction to the x-ray dye or have kidney problems from the x-ray dye. The really bad things that can happen are stroke, heart attack and death. Although these are extremely bad, these outcomes are extremely rare. The chance of any major complication is less than 1 in 1,000.
These tests are similar to Coronary Angiography. In this situation, the catheters’ tips are directed to different arteries. The risks of these procedures are similar to the risks listed for Cardiac Catheterization.
In the case of Carotid and Cerebral Angiography, the catheter tip is placed in the neck arteries that lead to the brain. Dye injection is performed and x-ray movie pictures are taken to look for narrowings or blockages in these arteries.
In the case of Peripheral Angiography, the catheters are positioned to take pictures of the arteries that feed the legs with blood. Blockages or narrowings in these arteries cause claudication or cramping pains in the muscles associated with exercise.
Implantable Cardiac Defibrillators are similar to pacemakers and the surgery required to place them is much the same. These are used for treatment of episodes of rapid heartbeat and/or fibrillation; especially of the lower chambers of the heart. They prevent episodes of sudden cardiac death because of arrhythmia. They do this by either pacing or shocking the heart internally.
Bi-Ventricular Pacing is used either in combination with pacing or implantable cardiac defibrillator therapy. This involves placing a third wire on the left side of the heart at the time of pacemaker or defibrillator implantation. This is added if a significant degree of congestive heart failure and low left ventricular function is present.
Pacemakers are devices used to prevent the heart slowing excessively. If a patient has pauses or a slow heartbeat, which often leads to symptoms of fatigue, lack of energy or passing out, a pacemaker may be indicated. A small surgery is required to implant a pacemaker. In the area under the collarbone (usually left), a small incision is made approximately two inches in length. A pocket is created in the skin where the pacemaker is placed. The wires from the pacemaker are floated through the vein under the collarbone down to the heart and attached to various places on the inside of the heart wall. The other end is then attached to the pacemaker and the incision sutured closed. This usually requires a one-night hospital stay for recovery. Pacemaker batteries generally last 5 – 7 years and require a similar surgery to replace the batteries.
Percutaneous Coronary Interventions
This is a term for all of the procedures that we perform in the arteries that feed the heart with blood to treat narrowings, blockages or plaque with the use of catheter-based treatments. These interventions include Balloon Angioplasty, Cutting Balloons, Stents (including Drug Eluting Stents), Rotoblation and Brachy Therapy. With these procedures, a small wire is placed across the area of narrowing and a balloon is placed across the area of stenosis. At this point the balloon is inflated and squishes the plaque and stretches open the artery allowing a greater opening. Similar types of balloons are used to deploy a stent which is crimped on the outside of the balloon. When the balloon is inflated, the stent becomes imbedded in the wall of the artery and serves as a scaffold to help prop the artery open. Drug Eluting Stents are coated with a drug which gradually leaks out over the first few weeks. This drug acts locally to reduce the chance of scar formation in the area of the stent. Brachy Therapy is the use of radiation treatment to an area of the coronary artery which has developed scar tissue after a previous intervention. With this therapy the artery is first re-opened with another balloon or rotoblation and then brachy therapy given in the area of the scar tissue.
Tilt Table Testing is an evaluation for the tendency to pass out under certain conditions. People who are especially prone to passing out may suffer from neurocardiogenic syncope. This syndrome is an abnormal exaggeration of a normal reflex and can cause a person’s heart rate and/or blood pressure to drop suddenly. It can often be treated with medicines but may rarely require the addition of a pacemaker. During a Tilt Table Test, the person is placed on a flat table with safety support straps and then stood at approximately an 80-degree angle observed with continuous EKG monitoring for 20 – 40 minutes. Occasionally, IV medicines will be used to further stimulate this reflex. An IV heparin lock will routinely be started for the administration of medicines if necessary.
Transesophageal Echocardiogaphy is a specialized form of ultrasound where the probe is at the tip of a long, thin tube. A patient is given sedation and this tube is placed through the mouth and into the esophagus and stomach in order to make ultrasound pictures of the heart from the back side. These pictures are more detailed since there is no bone or lung tissue between the probe and the heart. This therapy is used in certain specialized situations to see details of the heart valves that might not be able to be visualized by regular echocardiography. This test is often performed after the patient has been placed under general anesthesia at the time of cardiac surgery to help the surgeon in accessing the appropriate valve treatment and to access the success of the valve treatment repairs.