Coronary Angiography

What is a coronary angiography?

A coronary angiography is a minimally invasive diagnostic procedure that helps your doctor determine whether you have any blockages in your coronary arteries. During the test, if you are found to have significant blockages in your coronary arteries, the doctor may proceed with balloon angioplasty or stent implant.

 

How do I prepare?

• We will provide you with instructions once your test is scheduled.
• If you cannot keep your appointment, please give us 24 hours notice.

 

Percutaneous Transluminal

Coronary Angioplasty (PTCA)

 

What is a Percutaneous Transluminal Coronary Angioplasty?

Also known as Percutaneous Coronary Interventions [PCI], Balloon Angioplasty and Coronary Artery Balloon Dilation. Special tubing with an attached deflated balloon is threaded up to the coronary arteries. The balloon is inflated to widen blocked areas where blood flow to the heart muscle has been reduced or cutoff. Often combined with implantation of a stent to help prop the artery open and decrease the chance of another blockage. Considered less invasive because the body is not cut open. Lasts from 30 minutes to several hours. May require an overnight hospital stay.

 

Why is it necessary?

Fatty deposits can build up in your blood vessels, reducing blood flow and in some cases, blocking it completely. The biggest danger from fat build up is that pieces may break off, form clots, and cause a heart attack or stroke. The PTCA can open blocked arteries and reduce these risks.

•     Greatly increases blood flow through the blocked artery.
•     Decreases chest pain (angina).
•     Increases ability for physical activity that has been limited by angina or ischemia.
•     Can also be used to open neck and brain arteries to help prevent stroke.

 

How do I prepare?

• We will provide you with instructions once your test is scheduled.

Coronary Atherectomy/Rotoblator

What the procedure does?

An atherectomy is a procedure to remove plaque from arteries. An ultra-thin wire is threaded through a special catheter into the blocked artery. Several devices may then be used: a high-speed rotating "burr" that grinds the plaque into tiny pieces; a small rotating cutter that "shaves off" pieces of the blockage; or a laser catheter that vaporizes the plaque.

 

Reason for the procedure

•     Increases blood flow through the blocked artery by removing plaque buildup.
•     May also be used in carotid arteries (major arteries of the neck leading to the brain) to remove plaque

and reduce risk for stroke.

Intra-Coronary Stents

What is coronary artery stent implant?

A coronary artery stent implantation is done to open up any significant artery blockages. Unlike an angioplasty, a coronary artery stent implant involves deploying a tiny wire mesh tube into the area of the artery that is blocked. This stent stays permanently in your arteries.

 

How do I prepare?

• We will provide you with instructions once your test is scheduled.
• If you cannot keep your appointment, please give us 24 hours notice.

 

Intravascular Ultrasound

What is it?

Intravascular ultrasound (IVUS) is a diagnostic test. This test uses sound waves to see inside blood vessels. It is useful for evaluating the coronary arteries that supply the heart.

 

How it works?

A tiny ultrasound wand is attached to the top of a thin tube. This tube is called a catheter. The catheter is inserted into an artery in your groin area and moved up to the heart. It is different from conventional Duplex ultrasound. Duplex ultrasound is done from the outside of your body by placing the transducer on the skin.

 

A computer measures how the sound waves reflect off blood vessels, and changes the sound waves into pictures. IVUS gives the health care provider a look at your coronary arteries from the inside-out.

 

After the Procedure

After the test, the catheter is completely removed. A bandage is placed on the area. You will be asked to lie flat on your back with pressure on your groin area for a few hours after the test to prevent bleeding.

 

If IVUS was done during:

• Cardiac catheterization: You will stay in the hospital for about 3 to 6 hours.
• Angioplasty: You will stay in the hospital for 12 to 24 hours.

 

The IVUS does not add to the time you must stay in the hospital.

Electrophysiology & Ablation

What is catheter ablation?

Catheter ablation has been used to treat heart rhythm disorders for more than 25 years. This procedure targets the origin of the VT by placing a long, thin wire or catheter into the heart chambers through the veins of the leg. When areas that are critical to the arrhythmia are identified, a localized delivery of radio-frequency energy is applied, which produces a small burn about 4 to 5 mm in diameter.1 The number of burns required to treat the VT varies among patients. In patients with scar tissue in the heart, ablations may be performed within the scar and around its perimeter to cauterize or ablate the abnormal electric circuit responsible for the VT.

 

Quick facts:

• Catheter ablation is used to treat abnormal heart rhythms (arrhythmias) when medicines are not tolerated or effective.
• Medicines help to control the abnormal heart tissue that causes arrhythmias. Catheter ablation destroys the tissue.
• Catheter ablation is a low-risk procedure that is successful in most people who have it.
• This procedure takes place in a special hospital room called an electro-physiology (EP) lab or a cardiac catheterization (cath) lab. It takes 2 to 4 hours.

 

What is electro-physiology?

An electro-physiology study, or EP study, is a test to see if there is a problem with your heartbeat (heart rhythm) and to find out how to fix it.

 

In this test, the doctor inserts one or more flexible tubes, called catheters, into a vein, typically in the groin or neck. Then he or she threads these catheters into the heart. At the tip of these catheters are electrodes, which are small pieces of metal that conduct electricity. The electrodes collect information about your heart's electrical activity. Your doctor can tell what kind of heart rhythm problems you have and where those problems are. Sometimes the problems can be fixed at the same time. A procedure called catheter ablation. uses the catheters to destroy (ablate) small areas of your heart that are causing the problem.

 

How do I prepare?

• We will provide you with instructions once your test is scheduled.
• If you cannot keep your appointment, please give us 24 hours notice.

Implantable Defibrillators

What is an implantable defibrillator?

An implantable cardioverter-defibrillator (ICD) is a battery-powered device that can fix an abnormal heart rate or rhythm and prevent sudden death. The ICD is placed inside the chest. It's attached to one or two wires (called leads) that go into the heart through a vein. An ICD is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it tries to slow the rhythm to get it back to normal. If the dangerous rhythm does not stop, the ICD sends an electric shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode.

 

An ICD also can fix a heart rate that is too fast or too slow. It does so without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow. Or it can slow down a fast heart rate by matching the pace and bringing the heart rate back to normal.

 

Whether you get pulses or a shock depends on the type of problem that you have and how the doctor programs the ICD for you.

 

How is an ICD placed?

Your doctor will put the ICD in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy.

 

Your doctor makes a small cut (incision) in your upper chest. He or she puts one or two leads (wires) in a vein and threads them to the heart. Then your doctor connects the leads to the ICD. Your doctor programs the ICD and then puts it in your chest and closes the incision.

 

In some cases, the doctor may be able to put the ICD in another place in the chest so that you don't have a scar on your upper chest. This would allow you to wear clothing with a lower neckline and still keep the scar covered.

 

Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery.

 

You may be able to see a little bump under the skin where the ICD is placed.

Permanent Pacemakers

What is a pacemaker?

A pacemaker is a small-battery operated device that helps your heart beat regularly. Some pacemakers are surgically implanted and permanent. Other pacemakers are external and temporary.

 

What is an Implantable Cardioverter Defibrillator (ICD)?

An implantable cardioverter defibrillator (ICD) is a small-battery operated device that provides an electric shock to your heart to stop any life-threatening arrhythmia.

 

How do I prepare?

• We will provide you with instructions once your test is scheduled.
• If you cannot keep your appointment, please give us 24 hours notice.

 

Left Atrial Appendage Closure

What is a Left Atrial Appendage Closure?

Also known as LAA closure or LAAC, is a treatment strategy to reduce the risk of left atrial appendage blood clots from entering the bloodstream and causing a stroke in patients with non-valvular atrial fibrillation (AF). LAAC is an implant-based alternative to blood thinners. Like blood thinning medications, an LAAC implant does not cure AF. A stroke can be due to factors not related to a clot traveling to the brain from the left atrium. Other causes of stroke can include high blood pressure and narrowing of the blood vessels to the brain. An LAAC implant will not prevent these other causes of stroke.

Transcatheter Aortic Valve Replacement

What is a Transcatheter Aortic Valve Replacement (TAVR)?

Transcatheter aortic valve replacement (TAVR) is a procedure for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening) who are not candidates for traditional open chest surgery or are high-risk operable candidates.

 

How do I prepare?

• We will provide you with instructions once your test is scheduled.
• If you cannot keep your appointment, please give us 24 hours notice.

 

Transesophageal Echocardiography

What is a transesophageal echocardiogram?

A Transesophageal echocardiogram (TEE) provides detailed images of your heart structure and valves. Unlike a standard echocardiogram, where the echo transducer is placed upon your chest, a TEE involves attaching the transducer onto a thin tube that then passes through your mouth and down into your esophagus. Because the esophagus is very close to the heart, a TEE allows for clear and detailed images of your heart.

 

How do I prepare?

• This is a same day hospital-based procedure. Patient will be required to stay in the hospital for roughly 2-3 hours.
• We will provide you with instructions once your test is scheduled.
• If you cannot keep your appointment, please give us 24 hours notice.

 

Percutaneous ASD / PFO Closure

What is a Percutaneous ASD/PFO Closure?

Percutaneous closure is a surgical procedure used to treat patients with patent foramen ovale (PFO) and atrial septal defect (ASD). Advancements in device technology and image guidance now permit the safe and effective catheter-based closure of numerous intracardiac defects, including PFO and ASD. [1, 2]  With these catheter-based closure procedures becoming more prevalent in adults, it is imperative that clinicians possess a sound understanding of intracardiac shunt lesions and indications for repair or closure.