Cardiac Catheterization
Cardiac catheterization is the most common minimally invasive procedure used to diagnose and treat cardiovascular conditions.
One of the most accurate tests in the diagnosis of coronary artery disease, cardiac catheterization is performed more than a million times each year. This minimally invasive procedure is used for diagnosing and/or treating cardiac problems.
During this procedure, a long thin tube called a catheter is inserted in an artery or vein in your groin, neck, arm or leg and threaded through your blood vessels to your heart. The physician tracks the course of the catheter by watching it on a fluoroscope, an x-ray machine that displays the catheter and blood vessels in real time on a screen.
Using a cardiac catheter, the physician has access to the beating heart, and a variety of measurements may be performed when the catheter is in place. They then can check the heart’s internal blood pressure, assess blood supply, view coronary arteries on the surface of the heart and the aorta, and check the blood oxygen level. Then the catheter is removed.
Results should be available within a matter of hours, while the patient remains in recovery. Most cardiac catheterization patients go home after about six hours.
Cardioversion
Cardioversion is a procedure to restore normal cardiac rhythm. Your doctor applies controlled electrical shock to the chest wall. Cardioversion can sometimes be accomplished with medication only.
Cardioversion converts certain types of abnormal heart rhythms to normal rhythms. Abnormal heart rhythms are called arrhythmias. Cardioversion can be accomplished as either an internal or external procedure. In an emergency situation, external cardioversion is performed with a defibrillator.
Non-emergency external cardioversion is usually scheduled on an outpatient basis. The most common type uses carefully timed mild electrical shocks to restore a normal heart beat by stopping an arrhythmia. During the procedure, the patient receives general anesthesia or a strong sedative, and does not feel any pain.
Cardioversion is successful in correcting specific arrhythmias, such as atrial fibrillation, that have not improved by medication alone. Some patients may be required to continue anti-arrhythmic drugs after the cardioversion procedure.
Balloon Angioplasty
Balloon angioplasty is a procedure to treat narrowed arteries. Your doctor inserts a balloon-tipped catheter into an artery to press plaque back against the vessel wall to widen or unblock the artery, therefore restoring blood flow.
Also called Percutaneous Transluminal Coronary Angioplasty (PTCA), balloon angioplasty is most commonly performed on the coronary arteries. In emergency situations, balloon angioplasty is sometimes used as treatment for a heart attack.
Along with medication and bypass surgery, balloon angioplasty is a standard treatment for coronary artery disease, or CAD. In CAD, hardened arteries (atherosclerosis) that are clogged with plaque deposits restrict blood flow to the heart. Balloon angioplasty attempts to push fatty plaque back against the artery wall, providing more room for blood flow through the artery. Improved blood flow reduces the risks for heart attack and sudden cardiac death.
During balloon angioplasty, the physician numbs a specific area of the patient’s body using a local anesthetic. Then, the physician inserts a long, thin tube (catheter) with a deflated balloon at the tip into the femoral artery, located in the upper thigh or groin area. The balloon-tipped catheter is guided to the heart and site of the blockage. The physician rapidly inflates the balloon, which pushes the plaque in the artery back against the wall of the artery. The catheter is then removed, but a wire mesh tube, or stent, is often permanently implanted to hold the artery open. After the balloon angioplasty, the patient is given time to recover and usually goes home after about 24 hours.
Coronary Stent
Coronary stent is a procedure to hold an artery open, usually performed immediately following a balloon angioplasty. While the balloon-tipped catheter is still in place, your doctor inserts a wire mesh tube, or stent, through the catheter.
Stenting is a catheter-based procedure in which a small, expandable wire mesh tube is inserted into a diseased artery, providing a support to hold the artery open. First performed in the mid-1980s and approved by the U.S. Food and Drug Administration in 1994, stenting currently is performed most often in conjunction with other catheter-based procedures.
While catheter-based procedures such as balloon angioplasty or atherectomy partially reduce vessel narrowing, the stent functions to ensure little or no remaining narrowing within the coronary arteries. Stent insertion in conjunction with other procedures reduces the risk of the artery re-narrowing (restenosis) and almost eliminates the risk of abrupt vessel closures during and/or within 24 hours of the procedure. Drug-coated, or drug eluting, stents have been developed to help reduce the rates of long-term re-narrowing.
Within one month, a thin layer of the artery’s inner lining cells will cover the stent. Metal detectors and most mechanical equipment will not affect a stent. To ensure successful stenting, patients are strongly encouraged to learn and practice healthy lifestyle behaviors for good heart health. Risk factors such as smoking and high cholesterol levels can threaten the success of a stenting procedure. For instance, unchecked high cholesterol levels can lead to new blockages in the coronary arteries.
Transcatheter Aortic Valve Replacement (TAVR)
The TAVR procedure treats severe aortic stenosis by using a catheter-based process to implant an artificial valve without stopping the patient’s heart. The procedure is ideal for patients who are considered of intermediate or high-risk for open heart surgery.
Aortic stenosis occurs when aortic valves do not open properly, hindering the heart from pumping blood throughout the body. During the procedure, the bio-prosthetic valve is guided by a catheter to the heart. After the valve is in the correct position, the catheter is retracted, allowing the newly implanted valve to take over the function of the native aortic valve. This valve replacement is performed in a cardiac catheterization laboratory without the use of general anesthesia.
Insertable Cardiac Monitors
An insertable cardiac monitor is a small implantable device that continuously monitors heart rhythms and records them. Smaller than a key, the Reveal LINQ™ Insertable Cardiac Monitor is inserted in the upper chest area during a catheterization procedure. By looking at your heart rhythms, your doctor can identify an irregular heartbeat or other cardiac-related problem. An insertable cardiac monitor is for long-term use.
Thrombectomy
Thrombectomy is a procedure performed in a catheterization laboratory to remove a blood clot in an artery, particularly when there is an arterial blockage that is causing severe tissue injury in a limb.
Atrial Septal Defect (ASD) Closure
An atrial septal defect (ASD) is a congenital hole between the two upper chambers of your heart. This lack of atrial septal tissue causes new oxygenated blood to mix with the deoxygenated blood. The extra blood can overwork the heart and lungs, and if the hole is large and untreated, it can weaken the right side of the heart. In some cases, ASD may cause the blood pressure in the lungs to rise and result in pulmonary hypertension and could cause deoxygenated blood to be pumped to the body.
If blood oxygen levels are very low, your physician may recommend that you have a procedure to close the ASD.
Percutaneous Endovascular Aneurysm Repair (PEVAR)
An abdominal aortic aneurysm (AAA), also called triple A, is a balloon-like swelling in the wall of the lower part of a weakened aorta, the largest blood vessel that carries blood from the heart to the body. An aneurysm is a silent killer because it typically expands slowly without showing symptoms until a rupture occurs.
An Percutaneous Endovascular Aneurysm Repair, or PEVAR, is a minimally-invasive procedure where a stent graft is inserted with a catheter via a blood vessel in the groin and is moved to the site of the aneurysm. A stent graft is a tube of fabric with metal mesh support. The graft reinforces the weak area of the aorta and the stent holds the graft open and in place.
The latest procedure being used to manage and prevent AFIB is the WATCHMAN LAA Closure Technology that consists of a delivery catheter and a device that is permanently implanted in the left atrial appendage (LAA) of the heart. This device, often referred to as the WATCHMAN, prevents LAA blood clots from entering the bloodstream and potentially causing a stroke.