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Interventional Procedures

Catheterization Procedures

Transradial Cardiac Catheterization

Transradial cardiac catheterization is a procedure used to treat and diagnose certain heart conditions. It is also known as transradial cardiac cath or angiography.

During the procedure, a healthcare provider inserts a long thin tube (catheter) through the radial artery. The radial artery is a blood vessel in the arm. He or she then threads this tube through the blood vessels all the way to the heart with the help of special X-rays. This tube may have various tools attached to it, depending on the reason for the procedure. For example, the healthcare provider may put a special dye inside the catheter to take X-ray pictures of the arteries in your heart. The catheter might have a balloon attached to it. This catheter and balloon help open up blockages in your heart’s arteries.

Cardiac Catheterization

In cardiac catheterization (often called cardiac cath), your doctor puts a very small, flexible, hollow tube (called a catheter) into a blood vessel in the groin, arm, or neck. Then he or she threads it through the blood vessel into the aorta and into the heart. Once the catheter is in place, several tests may be done. Your doctor can place the tip of the catheter into various parts of the heart to measure the pressures within the heart chambers or take blood samples to measure oxygen levels.

Your doctor can guide the catheter into the coronary arteries and inject contrast dye to check blood flow through them. (The coronary arteries are the vessels that carry blood to the heart muscle.) This is called coronary angiography.

These are some of the other procedures that may be done during or after a cardiac cath:

Peripheral Angiogram

An x-ray of the arteries and veins to detect blockage or narrowing of the vessels in the arms and legs. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the x-ray.

Peripheral Intervention

If there are blockages or narrowing of the blood vessels in the arms and legs, treatment may be recommended. Below are treatment options:

With both angioplasty and vascular surgery, an angiogram is often performed prior to the procedure.

Abdominal Angiogram

An angiogram is an imaging test that uses X-rays to look at your blood vessels. It is done to check for conditions such as:

An abdominal angiogram looks at the blood vessels in your belly (abdomen). It may be used to check blood flow to the organs of the abdomen, such as the liver and spleen. It may also be used to guide in the placement of medicine or other materials to treat cancer or bleeding in the abdomen.

Fluoroscopy is often used during an abdominal angiogram. This is a kind of X-ray "movie" with continuous X-rays showing the provider real time images of the test procedure.

Contrast dye is used to cause the blood vessels to appear solid on the X-ray image. This lets the physician see the blood vessels more clearly. Dye is injected into specific blood vessels to look at a certain area of blood flow more closely.

For an abdominal angiogram, a catheter (small tube) is placed into a large artery in your groin and then placed into the specific artery of interest. Contrast is injected through this tube. Next, the physician takes a series of X-ray pictures. These X-ray images show the blood flow in the abdomen.

Endovascular Repair of an Abdominal Aortic Aneurysm

Endovascular repair is a type of treatment for an abdominal aortic aneurysm, or AAA. An AAA is a bulge in the wall of the large artery below your heart. The large artery is called the aorta. The bulge is caused by a weak section in the artery wall. The bulge is at risk of tearing. During the procedure, the weak section of the aorta is treated to prevent it from tearing.

Endovascular repair is a minimally invasive procedure. This means it is done with a small cut (incision). It is often done under general anesthesia, so you sleep through the procedure. During the procedure, a surgeon makes an incision through an artery in your groin. A thin, flexible tube (catheter) is threaded up through the artery and to the site of the aortic aneurysm. A stent graft is sent along the catheter to the aneurysm. The stent graft is a tube made of a thin metal mesh (the stent), covered with a thin polyester fabric (the graft). This stent graft is opened inside the aorta and fastened in place. The stent graft stays in place, and blood flows through it. It protects that part of the aorta, and prevents the aneurysm from bursting.

Carotid Angiogram

A carotid angiogram is an imaging test that uses X-rays to look at your blood vessels. It is done to check for conditions such as:

A carotid angiogram looks at the blood vessels in your neck and head. It is used to check blood flow of the neck & brain.

Fluoroscopy is often used during a carotid angiogram. This is a kind of X-ray "movie" with continuous X-rays showing the provider real time images of the test procedure.

Contrast dye is used to cause the blood vessels to appear solid on the X-ray image. This lets the physician see the blood vessels more clearly. Dye is injected into specific blood vessels to look at a certain area of blood flow more closely.

For a carotid angiogram, a catheter (small tube) is placed into a large artery in your groin and then placed into the specific artery of interest. Contrast is injected through this tube. Next, the physician takes a series of X-ray pictures. These X-ray images show the blood flow in the neck and to the brain.

Carotid Angioplasty and Stenting

Angioplasty and stenting is a type of procedure to improve the blood flow in an artery or vein. The carotid artery is a large artery running along each side of your neck.

Carotid angioplasty and stenting involves the carotid artery. During the procedure, doctors use a thin tube with a balloon at its tip to open up the artery.

The carotid arteries send oxygen-rich blood to your brain. A condition called carotid artery stenosis means that one or both of these arteries are narrowed. And, blood flow to the brain is reduced. This can lead to stroke. Carotid angioplasty and stenting can help reopen these arteries. It is a minimally invasive procedure and nonsurgical.

During the procedure, a thin flexible tube (catheter) is put into an artery in your groin. It will be gently threaded up into the problem carotid artery in your neck. The catheter has a tiny deflated balloon at the tip. When it reaches the narrowed portion of your carotid, the balloon is inflated. This opens up the narrowed area. This is known as angioplasty.

A tiny mesh tube called a stent may be put into this area. It is left in place to help keep the artery open.

Electrophysiological Studies

An electrophysiological study (EP study) is a test used to evaluate your heart's electrical system and to evaluate for abnormal heart rhythms.

Natural electrical impulses coordinate contractions of the different parts of the heart. This helps keep blood flowing the way it should. This movement of the heart creates the heartbeat, or heart rhythm.

During an EP study, your doctor inserts small, thin wire electrodes into a vein in the groin (or neck, in some cases). He or she will then thread the wire electrodes through the vein and into the heart, using a special type of X-ray “movie,” called fluoroscopy. Once in the heart, the electrodes measures the heart’s electrical signals. Electrical signals are also sent through the electrodes to stimulate the heart tissue to try to cause the abnormal heart rhythm so that it can be evaluated and its cause can be found, or to help evaluate how well a drug is working.

During the EP study, specialists in heart rhythms or an electrophysiology specialist doctors may also map the spread of the heart’s electrical impulses during each beat. This may be done to help locate the source of an abnormal heartbeat.

Catheter Ablation

This procedure guides a wire into your heart to destroy small areas of heart tissue that may be causing your abnormal heartbeat. Heat (radiofrequency) or cold energy (cryoablation) are the 2 most common ways to destroy abnormal heart tissue. It is an alternative to long- term or lifelong medication therapy. It is also an option when medicine fails to control the heart rhythm problem. The procedure usually takes 3 to 6 hours.

Pacemakers

A permanent pacemaker is a small device implanted in the chest to send electrical signals to start or regulate a slow heartbeat. It's most often placed in the chest area just under the collarbone. A pacemaker may be used if the heart's natural pacemaker (the SA node) is not working properly causing a slow heart rate or rhythm, or if the electrical pathways are blocked.

Another specialized type of pacemaker, called a biventricular pacemaker, is used for ventricles that don't contract at the same time. This can worsen heart failure. A biventricular pacemaker paces both ventricles at the same time, increasing the amount of blood pumped by the heart. This type of treatment is called cardiac resynchronization therapy (CRT).

Implantable Cardioverter Defibrillators (ICDs)

An implantable cardioverter defibrillator (ICD) looks similar to a pacemaker, though slightly larger. It works very much like a pacemaker. However, the ICD can send a low-energy shock that resets an abnormal heartbeat back to a normal. It can also send a high-energy shock if an arrhythmia becomes so severe that the heart can't pump at all.

Many devices combine a pacemaker and ICD in one unit for people who need both functions. After the shock is delivered, a "back-up" pacing mode is available if needed for a short while.

The ICD has another type of treatment for certain fast rhythms called anti-tachycardia pacing (ATP). This is a fast-pacing impulse sent to correct the rhythm. This can be used instead of shocking the heart in some cases.

Atrial Septal Defect (ASD) Transcatheter Repair

Atrial septal defect (ASD) transcatheter repair is a procedure to fix a hole in the atrial septum. The atrial septum is a wall that separates the right and left upper chambers in the heart (atria). This hole is called an atrial septal defect or ASD.

If this defect is present, blood can flow abnormally from the left atrium into the right atrium. This causes the heart to pump extra blood out to the lungs. This extra blood can damage the lung blood vessels if left untreated for a long time. Also, the right-side pumping chamber (right ventricle) can become enlarged. As a result, it has to pump harder than it should to get blood out to the lungs.

ASD transcatheter repair uses a long, flexible tube (a catheter) and a small device to close this hole. An interventional cardiologist inserts the catheter through a blood vessel in the groin. Inside the catheter is a small device folded up like an umbrella. The cardiologist moves the catheter all the way to the heart’s septum. The small device comes out of the tube and plugs up the hole in the atrial septum. Then the cardiologist removes the catheter from the body. Over time, tissue grows over the device and holds it even more firmly in place.

Patent Foramen Ovale (PFO) Transcatheter Repair

A patent foramen ovale (PFO) is a small hole between the two upper chambers of the heart, the right and the left atrium. Patent foramen transcatheter repair is a procedure to fix this hole in the heart.

Normally, the atrial septum separates the right and left atria. No blood flows between these 2 chambers. If a PFO exists, a little blood can flow between the atria. This flow of blood between the atria is not normal. This hole is normally present in the heart before birth. But in most people, it closes soon after birth.

During transcatheter repair, a healthcare provider inserts a device that can plug up the PFO. This device attaches to the end of a long, flexible tube called a catheter. The healthcare provider inserts the catheter through a blood vessel in the groin and guides it to the PFO. He or she uses the device to fix the hole and then removes the catheter from the body.

Valvuloplasty

Valvuloplasty may be done to open a stiff (stenotic) heart valve. In valvuloplasty, your doctor inserts a very small, narrow, hollow tube (catheter) into a blood vessel in the groin and advances it through the aorta into the heart. Once the catheter reaches the stiff valve, your doctor inflates a large balloon at the tip of the catheter until the flaps (leaflets) of the valve are pushed opened. Once the valve has been opened, the doctor deflates the balloon and removes the catheter.

Surgical Procedures

Riverside Medical Center offers surgical options to repair the blood vessels and flow of blood in the neck, chest, arms, abdomen and legs including treatment for peripheral vascular disease, aneurysms, aortic dissection, peripheral arterial disease and varicose veins.

Robotic-Assisted Heart Surgery

Mitral Valve Repair - • The mitral valve is a complex structure that controls blood flow through the left side of the heart. When open, the mitral valve allows blood to flow into the heart’s main pumping chamber, the left ventricle. When the left ventricle contracts to push blood through the body, the mitral valve closes to prevent blood from flowing back toward the lungs.

Surgical repair involves delicate reconstruction of native valve tissues to restore proper function. The most common approach to repair requires the surgeon to saw open the breastbone and spread the ribs to gain direct access to the heart.

If your doctor recommends surgical repair, you may be a candidate for a less invasive surgical procedure called da Vinci® Mitral Valve Repair (da Vinci MVR). This procedure uses a state-of-the-art surgical system designed to help your surgeon see vital anatomical structures more clearly and to perform a more precise operation.

Rehabilitation

Cardiopulmonary Rehabilitation - The Riverside Heart & Vascular Institute offers a comprehensive cardiopulmonary rehabilitation program to help heart patients return to an active lifestyle following a heart attack, stent placement or heart surgery. Combining both exercise and education, patients are cared for in a coordinated effort between all rehab areas to decide which service would best suit the individual needs of the patient from inpatient and in-home to outpatient and transitioning to Riverside Health Fitness Center.

Our Cardiopulmonary Rehab program is certified through AACVPR (American Association of Cardiovascular and Pulmonary Rehabilitation). We are dedicated to ensuring our patients receive the highest quality of care. Our Cardiac Rehab program is designed to assist in making lifestyle changes to enhance one's quality of life and prevent future cardiac events.

For more information about the Riverside Heart & Vascular Institute Cardiopulmonary Rehabilitation Program, please call 815-935-3271.