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Interventional Cardiology

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Interventional Cardiology

Introduction :

Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist, Dr. Charles Dotter.

Most interventional cardiology procedures are considered to be minimally invasive because they do not require an instrument to enter the body or large incisions -- most incisions are approximately 1 inch. These procedures usually involve the insertion of a catheter (hollow tube) into the femoral artery in the upper leg. The catheter is guided toward the heart or vascular area through the use of real-time X-ray.

Types of Interventional Cardiology

  • Cardiac Catheterization Cardiac catheterization, sometimes called cardiac cath, often is used to determine the severity and extent of cardiovascular problems. In this procedure, the cardiologist makes a small incision in the arm or groin and threads a catheter into a blood vessel. The catheter is then guided through the blood vessel to the heart.

Using cardiac catheterization, physicians can:

  • analyze the location and size of plaque deposits,
  • assess the strength of the heart muscle and valves,
  • collect blood samples,
  • take blood pressure readings,and
  • inject dyes that are visible on x-rays into arteries to see how well blood is flowing.

Information from the cardiac cath can help determine if cardiac surgery or another interventional cardiology procedure, such as angioplasty, is necessary.

  • Angioplasty/Percutaneous Coronary Intervention

    Coronary angioplasty, also called percutaneous coronary intervention (PCI), is used to open arteries that have been narrowed by atherosclerosis. In this procedure, a catheter is entered into a blood vessel through an incision (usually in the leg or wrist) and is threaded to the heart. This catheter has a collapsed balloon at its tip. When the balloon reaches the targeted area (e.g., blockage), it is inflated to push plaque to the artery walls and widen the artery to improve blood flow. In some cases, the balloon must be inflated and deflated more than one time during the procedure.

There are two types of stents. Bare-metal stents are plain, untreated metal cylinders. Drug-eluting stents(also called drug-coated stents) are coated with medication before they are placed in the artery. This medication helps prevent scarring and lowers the risk for restenosis (re-narrowing of the artery). Drug-eluting stents may present a higher risk for blood clot formation than bare-metal stents.

  • Stents

    Approximately 70% of angioplasty procedures also involve stenting, which is the insertion of a small metal cylinder called a stent into a blood vessel. In this procedure, a collapsed stent is placed over the balloon at the tip of the catheter. When the balloon inflates, the stent pops open and reinforces the artery walls. The balloon and catheter are then withdrawn and the stent remains permanently. In a few weeks, tissue from the artery lining grows over the stent.

  • Embolic Protection

    The word "embolic" comes from the word "embolus," which refers to an abnormal particle flowing with the blood. During interventional cardiology procedures, plaque fragments can become loose, travel through the bloodstream, and increase the risk for injury or stroke. Embolic protection devices, often called "filters," can be used to trap these particles.

  • Percutaneous Valve Repair

    The human heart has four valves that control the way blood flows through heart chambers. Interventional cardiologists can use catheters to guide clips or other devices through the blood vessels to a damaged valve. These devices can then be used to repair the valve to allow blood to flow properly again.

  • Balloon Valvuloplasty

    Balloon valvuloplasty, also called balloon valvotomy, is used to repair narrow or constricted heart valves that do not open properly (e.g., aortic stenosis). In this procedure, a balloon at the tip of the catheter is inflated to stretch the valve open.

Advantages :

The advantages of catheter-based treatments include avoidance of scars, minimal discomfort, shorter recovery time after the procedure and overall lower risk due to a minimally invasive approach but with the same benefits as surgical treatment.

Interventional cardiology procedures can be performed under local anesthesia in a cardiac catheterization lab or in a hybrid operating room, which combines the advanced X-ray (angiography) technology of the cardiac catheterization lab with the operating room environment into one functional unit. Most interventional cardiac procedures are done on an outpatient basis.

Risks Interventional cardiology procedures are not recommended for all heart patients and decisions about interventional treatments are made on a patient-by-patient basis. In some cases, treatment with medications or conventional heart surgery is a better option. For example, people with diabetes and other chronic conditions and patients who have a weak heart muscle, calcification of the aortic valve, diseased blood vessels, or multiple artery blockages may not be good candidates for interventional procedures.

There are risks associated with interventional cardiology procedures.

Risks of angioplasty include the following:

  • Heart attack—In rare cases, a patient may have a heart attack during angioplasty.
  • Stroke—Blood clots may form on catheters and break loose during the procedure or catheter movement through the aorta may free plaque in the heart. If these particles reach the brain, stroke can occur. Patients are given blood thinners before angioplasty to help prevent stroke.
  • Coronary artery damage—Arteries can be torn or ruptured during angioplasty. If this occurs, emergency bypass surgery is performed.
  • Kidney damage—Dyes used in angioplasty can damage the kidneys.
  • Heart rhythm problems—Angioplasty can disturb the heart so that it beats more quickly or more slowly than usual. This often resolves on its own, but patients may need medication or a temporary pacemaker to regulate the heartbeat.

Complications

Some complications of interventional cardiology procedures, particularly angioplasty, include the following:

  • Bleeding at the catheter insertion site—Patients with excessive bleeding may need a blood transfusion or surgery.
  • Blood clots—Patients with stents have an increased risk for developing blood clots. Blood-thinning medications (e.g., aspirin, clopidogrel) can reduce this risk, but they must be taken exactly as prescribed. Blood clots can form as long as a year after the stenting procedure, so patients should not stop any medication without the approval of their physician.
  • Restenosis—In some cases, the artery narrows again, sometimes just months after angioplasty. This occurs in approximately 30–40% of patients who have angioplasty without stents, in less than 20% of patients who receive bare metal stents, and in less than 10% of patients who receive drug-eluting stents.

Ruby Hall Clinic, Wanowarie Interventional Cardiology Team strives to provide patients with expert treatment and care. We believe in offering the patients with an ethical and open environment to recover. Our team of expert Cardiologists believes in carrying out an in-depth investigation of patient condition taking into account patient’s complete medical history, therefore strategizing a tailored treatment and top recovery plan for each. Our expertise in cardiac care helps us in caring for patients with heart disease by providing complete all-round cardiology care. From diagnosis, prevention, treatment, surgical care to cardiac rehabilitation and wellness services, we look after all. Coronary stenting is routine and performed by most of the interventional cardiologists. Patients with high risk and multi vessel involvement are also treated.

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Ruby Hall Clinic, in the past 50 years has set new bench marks for standards in the health care industry, the best of which have been adopted and incorporated in the new facility at Wanowarie.

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  • Wanowarie Ruby Hall
    59/6, Azad Nagar,
    Wanowarie,
    Pune
    411040 India
  • 020-664-94949
    +91-860-002-1169
  • wanowarie [at] rubyhall [dot] com