Heart & Cardiology Procedures
Cardiac Catheterization and Coronary Angiography
This common procedure is performed in order to measure pressures inside the heart and take pictures of the coronary arteries – usually in order to look for blockages or atherosclerotic plaques that can cause chest pains and shortness of breath as well as a variety of other symptoms, and when severe can even cause a myocardial infarction (heart attack). Catheters are placed via a sheath (narrow tube) in the artery of the groin or arm, advanced into the heart, and pictures are taken with injectable contrast dye and X-ray.
Angioplasty and Stenting
Many blockages that are found by angiography can be safely opened by angioplasty. A wire is passed through the blockage, and a small balloon is advanced over the wire so that it can be inflated inside the artery, opening the blockage. However, there is an unacceptably high rate of the artery closing down again if this is the only thing done, so intracoronary stents were developed. These are small expandable metal tubes that hold the artery open. They may be bare metal or they may be coated with a medication that prevents the growth of scar tissue within the stent. Either way, they must be combined with medications to prevent clotting of the stent.
Carotid Angiography and Intervention
Blockages or plaques in the carotid arteries in the neck can cause neurologic symptoms like transient ischemic attacks (TIA or "ministrokes") or strokes. The risk of this is decreased by medication, but in many cases the blockage is already severe enough to make it necessary to open the artery. Traditionally, this has been done via a surgical procedure called carotid endarterectomy, but in recent years it has also become possible to open the artery via minimally invasive stenting, especially in patients who are poor candidates for surgery. Click here for more information.
Aortic Endovascular Aneurysm Repair
As part of the process of vascular disease, the wall of the aorta (the large blood vessel that carries blood away from the heart to the rest of the body) can become weak and dilate, and an aneurysm can form, either in the thoracic aorta in the chest or in the abdominal aorta in the belly. When these get large enough to threaten to rupture, a procedure is necessary to repair them, either a surgical procedure or a minimally invasive procedure in which the aorta is reconstructed from within using a device called a stent graft. We have been involved from the very beginning of this developing field. AAA web brochure Click here for more information.
Blockages can occur in almost any artery of the body – our physicians are expert in the care of diseases of the renal (kidney) arteries, mesenteric (gut) arteries, subclavian (arm) arteries, and the arteries of the leg. Follow this link in order to expand on this subject.
Stress Testing and Noninvasive Cardiac Risk Stratification
A stress test may be necessary to diagnose heart disease or to estimate the patient’s risk of a future cardiac event, and in many cases some kind of imaging is necessary to fully evaluate the patient. As an office-based procedure, we perform stress testing both with nuclear imaging, in which a mildly radioactive tracer is injected in order to measure blood flow, and with stress echocardiography, in which the heart is watched with ultrasound during exertion.
Our physicians have decades of experience with this common procedure, in which the heart is examined using ultrasound to measure heart function, diagnose disease of the heart valves, and clarify the cause of possibly cardiac symptoms. It is most commonly performed via an ultrasound probe on the chest (transthoracic echocardiography) but in some cases must be performed via a probe inside the throat to look at the heart from behind (transesophageal echocardiography).
Pacemakers and Defibrillators
Our physicians are expert in the placement of these implantable devices. A pacemaker is placed under the skin (usually at the shoulder) with wires extending through the veins into the heart. Electrical signals from the pacemaker can be used to increase heart rate when the electrical system of the heart fails or is diseased. In addition to being able to act as a pacemaker, an implantable defibrillator senses dangerous, life threatening heart rhythms (ventricular tachycardia and ventricular fibrillation) and shocks the heart back into normal rhythm, which can be life-saving. This may be recommended either after a life-threatening event which the patient has been lucky enough to survive, or more commonly as a preventative measure in patients who are at high risk for future events of ‘sudden cardiac death.’
A significant number of patients with symptoms of heart failure such as shortness of breath, fatigue, and fluid retention also have poor heart function and disease of the electrical system of the heart. The electrical component can be significantly improved, in most cases resulting in improved symptoms and improved heart function, by placing a pacing wire through the veins over to the left side of the heart through the coronary veins. The heart is then paced from both sides, with greater efficiency.
Laser Lead Extraction
Unfortunately, just like any other manmade device, pacemaker and defibrillator wires can break or get infected, and wire that have been implanted for several years can be difficult to remove because of scar tissue that forms around them. Our physicians are extremely experienced in handling this difficult problem of extracting leads using a variety of tools, most frequently laser-powered or mechanical sheaths to break up the scar tissue and remove the leads.
Electrophysiologic Study and Radiofrequency Ablation
Electrical or rhythm disorders of the heart can range from the annoying but benign to the life-threatening, and over the last ten to fifteen years, exciting advances have been made in the medical and interventional treatment of these arrhythmias. Small catheters can be placed inside the heart via sheaths in the groin, and the abnormal circuits that cause the arrhythmia mapped out prior to delivering either heat energy (radiofrequency) or freezing energy (cryoablation) to create small scars that break the abnormal circuits. Our physicians have been in the forefront of research and development of these procedures, and we routinely treat all of the arrhythmias that can be ablated, including supraventricular tachcyardias (SVT), ventricular tachycardia (VT), and atrial fibrillation.