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Procedures
Treatments » Procedures

Procedures

There are positive steps you can take that will truly make a difference in your future good health. First and foremost, listen to your doctor. The therapy or surgery recommended is vital to the success of your treatment.

  • Angiogram

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    A procedure used to observe the flow of blood within the vessels of the heart and diagnose Coronary Artery Disease and other heart conditions. A long, thin tube called a catheter is inserted into a blood vessel in the arm or groin and carefully manipulated into the heart. Once in the heart, the doctor introduces fluid called contrast material.

    Contrast material is designed to appear on X-ray images; since it is a fluid it mixes with blood and flows through the body. This allows the physician to verify that enough blood is reaching and flowing through the heart, or identify problematic areas.

    For example, a healthy artery appears in an angiogram as a dark line of uniform thickness – like a clear hose filled with opaque liquid. In unhealthy, stenotic vessels, the thickness of the artery passage tapers to a smaller diameter, restricting blood flow. In angiograms, a stenotic vessel is marked by a thinning of the dark artery line on one or both sides.

    Depending on your medical condition, several different types of angiograms can be obtained. Some common angiograms include:

    Coronary

    Femoral

    Renal

    Subclavian

  • Angioplasty / Stent

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    Angioplasty
    Angioplasty is a procedure by which the cardiologist inserts a balloon catheter over a thin wire across a blockage of an artery. The balloon is inflated to compress the plaque. This is repeated as necessary by the cardiologist. Inflating the catheter compresses and breaks apart the plaque. This allows more room for the blood to flow throughout the artery.

    Stent
    A stent is a small tube that is inserted into a weak or diseased blood vessel to keep it open and provide structural support. Made of stainless steel or nitinol (an alloy of nick and titanium), a stent is a tiny, spring-like tube formed from into a mesh that resembles a toy finger trap. This structure allows the stent to be very narrow as the surgeon places it inside the body. Once placed within a weak blood vessel, the stent is "deployed", or stretched out into its full diameter. Some stents are deployed with balloon angioplasty: a small balloon attached to a catheter is inflated inside the stent, expanding to the stent's final size. Other stents are made of "shape memory materials", such as nitinol, that self-expand with body heat to their full size. Once deployed, a stent remains inside the body permanently and, after time, is absorbed into the vessel wall as cells grow around and over it. In this sense, the stent becomes part of the body.

    Drug Eluting Stents
    A recent technical advancement promises to increase the efficacy of stenting: Drug Eluting Stents. A common problem in patients with occluded vessels is restenosis, or the re-closing of a vessel that was opened interventionally. Drug Eluting Stents address this problem by coating the stent with a drug that prevents excessive cell growth. This time-release medication protects the vessel from blocking itself and and causing further complication.

    In addition to the vessels in and around the heart, stents are commonly deployed in sclerotic vessels feeding the lower extremities. These include the Iliac Arteries, which descend from the thorax; Femoral Artery, the main vessel feeding the lower extremities; and each of the Renal Arteries, which supply blood to the kidneys. Over time these vessels can become occluded and, if left untreated, lead to serious complications including kidney failure and gangrene of the legs.

  • Atherectomy

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    A procedure to remove the rock-hard plaque that blocks arteries in the disease Atherosclerosis. A catheter is inserted into the body, usually through the femoral artery in the groin. At the tip of the catheter sits a removal tool, either a laser or, in a variant of atherectomy called Rotablation, a rotating shaver. The surgeon guides the catheter to the blockage and engages the tip. Laser-tipped catheters vaporize the plaque, whereas shaver tools gradually chip it away to be collected by a removal catheter.

  • Clot Extraction / Angiojet

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    Clot Extraction
    Also called Thrombectomy, Clot Extraction is the removal of a blood clot from the vessel it is blocking. One technique uses Balloon Angiography to dislodge the clot from the vessel wall with the inflation of a balloon-tipped catheter. The dislodged clot is collected by a second catheter to prevent it from causing a stroke. Clot Extraction may also be performed using Rotablation, in which the catheter tip is a rotating blade that slices into the clot.

    Angiojet Device
    Increasing numbers of patients are being treated with the Angiojet. The Angiojet is a very small device for use in keeping from clogging the dialysis grafts necessary to treat patients with kidney failure. The device was approved for dissolving potentially deadly blood clots in a patient's coronary arteries before the patient undergoes a balloon angioplasty (often with stenting). By removing blood clots from the coronary arteries before angioplasty/stenting, the Angiojet can greatly reduce the risk of complications such as heart attack or even death.

    The catheter is inserted into an artery (usually the femoral artery) and guided to the blood clot. Saline jets dissolve the clot by creating a vacuum within the artery. The clot is pulled apart and sucked out of the body via the catheter and into the pump set.

  • Valvuloplasty

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    In patients with severe valvular pulmonary stenosis, percutaneous balloon valvuloplasty is the current treatment of choice. In an adult, severe pulmonary valve stenosis requiring intervention is defined as a peak systolic gradient in excess of 60 mm Hg. The decision to treat moderate stenosis is based on the presence or symptoms, the age of the patient, and the degree of right ventricular hypertrophy.

  • Surgery

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    Bypass Surgery
    In cases of extreme CAD, such as when several of the coronary arteries
    are highly stenotic, minimally-invasive catheter intervention may be
    insufficient. Rather than repair highly diseased vessels, physicians may
    choose to replace them with Bypass Surgery. In this major procedure, the chest cavity is opened to expose the heart. One or more veins from the legs are removed and re-commissioned for use in the heart. One end of the vein is attached the Aorta, the largest artery in the body at the base of the heart. The other end of the vein is attached to the diseased coronary artery, just after the stenosis. This creates a path for blood flow from the Aorta to the myocardium.

    Patent Foramen Ovale (PFO) Closure
    Patent foramen ovale is an opening between the right atrium and
    left atrium, the top chambers of the heart. This opening is present in all
    infants, but usually closes after birth. If it does not grow closed, it may allow blood to flow between the top chambers of the heart. Blood flow through the PFO is most likely to occur when more pressure is temporarily exerted in the chest, such as while coughing, sneezing or straining to pass a stool. Blood that flows through the PFO has not been cleansed or filled with oxygen by the lungs. As a result, debris in the blood (e.g. clots) can lodge in the brain, causing stroke, or in other areas of the heart, causing a heart attack.

    Closing the PFO usually involves open-heart surgery with its associated risks and complications. Instead, many patients with a PFO are treated with blood thinners to prevent clots from forming. But continual use of blood thinners can cause other disorders within the body. A less-invasive procedure to close the PFO was developed in which a special device is passed through a thin, flexible tube (catheter) and navigated to the heart where it is put in place. While this is generally safer than open-heart surgery, results are mixed.

    Valve Repair
    The valves of the heart may cease to function properly, becoming too
    narrow (stenosis) or leaky (insufficiency). There are several options for repair of these problems. Balloon valvuloplasty, in which a balloon-tipped catheter is inserted into a valve and inflated, can restore a stenotic valve. Although this procedure is a safer alternative to open-heart techniques, there is about 50 percent incidence of re-stenosis, in which the valve returns to its narrow condition.

    Valvotomy is a class of open-heart procedures during which the surgeon repairs valve damage with a scalpel. Recent advances allow the surgeon to perform these procedures with smaller incisions in the chest.

    Valve Replacement
    In cases where valve repair is not possible, it may be necessary to replace the valve entirely. The replacement valve may be biological, coming from another part of the patient's body, a cow or pig, or a cadaver. However, biological valves tend to disintegrate after about 10 years. Man-made synthetic valves are available as a longer-term option; however, because they increase the risk of blood clot formation, the patient must use anticoagulant medication for life.

  • EECP Therapy

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    Enhanced External Counterpulsation (EECP) is a treatment to remedy insufficient blood flow to the heart by applying pressure to the lower extremities between heartbeats.

    During diastole, inflatable cuffs mechanically apply pressure to the legs starting at the calves upwards toward the heart, pushing blood through the legs towards the heart. During systole, the cuffs are deflated to allow blood to circulate at normal blood pressure. This encourages collateral circulation, capillary networks that compensate for stenotic arteries.