Interventional Cardiology



Diagnosis


Treatment



MEDICAL CONDITIONS, DIAGNOSTIC METHODS, INTERVENTIONS

Interventional Cardiology


  • Coronary angiography/ coronary arteries angioplasty
  • Complex angioplasties:
    ► Chronic total occlusion recanalization (CTO)
    ► Left main stenosis angioplasty of coronary arteries
    ► Rotablation
    ► Intravascular Lithotripsy
    ► Intracoronary ultrasound (IVUS)
    ► FFR/ iFR
    ► OCT
  • Τranscatheter Aortic Valve Implantation (TAVI)
  • Alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy
  • Right heart catheterization
  • Myocardial biopsy

TAVI

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Coronary angiography


Coronary angiography is an invasive imaging procedure, with which a cardiologist can view the coronary arteries with the use of a special contrast and a specific X-ray machine. It allows a narrowing (stenosis) or other pathologies of the coronary arteries to be diagnosed.

This procedure is carried out percutaneously through the radial (in most cases) or the femoral artery. Α special catheter is initially advanced through these arteries in the ascending aorta and then into the ostium of the left or the right coronary artery. The contrast is then injected into the coronary arteries, which allows them to be viewed with the use of the X-ray machine.

A general anesthesia is not needed to perform this procedure; only local anesthesia is applied around the puncture site.

The complication rate during this procedure is very low.


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Percutaneous coronary intervention (PCI)


PCI is an invasive, non-surgical procedure for the treatment of coronary artery disease (mostly stenosis or occlusion). As in a coronary angiography, a specific X-ray machine is used, which allows the cardiologist to view the coronary arteries and treat their pathology.

In PCI a special catheter is advanced (mostly through the radial, rarely through the femoral artery) into the ostium of the coronary arteries. Through this catheter, the materials needed for the procedure (guidewires, balloons, stents etc.) are advanced into the coronary arteries.

The duration of the procedure varies depending on its complexity from some minutes to hours. As in the coronary angiography, general anesthesia is not needed.




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Transcatheter aortic valve intervention (TAVI)


Aortic stenosis is the most commοnly acquired heart valve disease. When severe, it can cause shortness of breath (dyspnea), chest pain (angina) or loss of consciousness (syncope).

The transcatheter aortic valve replacement/ intervention (TAVI) is an invasive procedure, which took place for the first time in 2002. In the beginning, this method was applied as an alternative to the classical surgical aortic valve replacement to patients who were at high surgical risk. In the last years, there has been a development of this method (both from a technical point of view and from the quality of the implanted prosthetic valves) so that it can also be applied to patients at intermediate or even low surgical risk.

In 80-90% of the cases, this procedure takes place through the femoral artery. Sometimes due to stenosis or other anatomical issues of the pelvis arteries, which makes the advancement of the valve impossible, alternative access sites are used, most common being the subclavian or the axillary artery or through a small incision at the apex of the left ventricle of the heart (the latter being a surgical procedure).

There is no need for general anesthesia to perform this procedure as it is performed on a beating heart.

The prosthetic valve is advanced over a guiding wire to the heart. The valve is sewn on a metallic stent-frame and when it reaches the prespecified point in the annulus of the native valve, it is released inside the native valve, which is then pushed to the side.

It is a minimally invasive procedure and in most cases its duration is between 60 and 90 minutes.





Alcohol septal ablation


Alcohol septal ablation is an invasive non-surgical method for the treatment of hypertrophic obstructive cardiomyopathy. Hypertrophic cardiomyopathy is an acquired disease which causes the thickening (hypertrophy) of the heart muscle (myocardium) of the left ventricle. In its obstructive form, the thickening of the intraventricular septum causes a narrowing in the outflow of the left ventricle obstructing the blood flow to the systemic circulation. This causes symptoms like shortness of breath as well as chest pain or loss of consciousness.

In this procedure, alcohol is injected through a catheter and a balloon into a septal branch of the left anterior descending artery (LAD). Alcohol causes destruction/ death of the myocardial cells of the interventricular septum that are supplied by the above mentioned septal branch. That leads to the formation of a scar in this area. In this way, the septum (the basal segment on the left ventricular outflow tract) becomes thinner allowing the blood to flow undisturbed in the periphery.

This procedure takes place in the cath lab with the use of a specific X-ray machine. The catheter is inserted through the radial or the femoral artery for this procedure.

The duration of the procedure is approximately 60 to 90 minutes. There is no need for general anesthesia. The most common complication is the occurrence of AV-Block and the need for implanting a permanent pacemaker.


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Heart-biopsy


Myocardial biopsy


In the myocardial biopsy microscopic particles/ samples from the myocardium are obtained, which are then sent for histological/ pathological examination. The most common indication for a myocardial biopsy is the investigation of the cause of heart failure when other obvious causes (e.g. coronary heart disease, valvular heart disease) have been ruled out.

Myocardial biopsy is an invasive procedure which takes place in the cath lab. Under local anesthesia, a tiny forceps is advanced through the femoral artery/ vein or through the internal jugular vein or sometimes through the radial artery into the right or the left ventricle and then samples (6-8) are taken from their walls, which are then sent for further examination.

The duration of this procedure is approximately 30 minutes. Complications are rare; the most common ones are hemopericardium or damage in the tricuspid or the mitral valve.




Right heart catheterisation


Right heart catheterization is an invasive diagnostic procedure, with which the blood pressure in many spots of the circulation is measured with the use of a special catheter. Additionally, in this procedure blood samples are acquired from these spots, which helps us determine/ evaluate many parameters regarding the circulation/ heart function and evaluate the severity of some congenital heart defects.

In the right heart catheterization, a special catheter is advanced through the femoral or the internal jugular vein into the right heart chambers and the pulmonary artery usually under fluoroscopic guidance.

The duration of this procedure is approximately 30 minutes. This procedure is considered to be “harmless” because the probability of complications is very low.


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