Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Procedures are performed by specifically trained cardiologist. Since there is no surgery performed, the leading doctors are not cardiovascular surgeons, but cardiologists.
Also pacemaker implantation is a commonly performed invasive cardiology procedure at Electrophysiology Pacemaker Laboratory of our Center.
Electrophysiological cardiac work-ups are;
Vessels that supply heart’s muscle tissue are called “coronary vessels”. Atherosclerosis is formation of plagues (produced by fatty accumulation and calcification) in the blood vessel wall. These plagues may result in obstruction or stenosis of the vessels. Stenosis or obstruction of coronary arteries might cause chest pain and heart attack (myocardial infarction) in the patient.
The basic principle to prevent stenosis of coronary arteries is to improve risk factors.
Measures are the essential for treatment, e.g. regular checks of diabetes mellitus, loss of weight, treatment of hypertension, improvement of high cholesterol and triglyceride values, cessation of smoking, and regular exercises.
Despite preventive measures taken, if complaints are present suggesting stenosis of coronary arteries, or if any abnormalities are detected by pre-tests (e.g. effort test, thallium test, etc.), cardiac catheterization and coronary angiography are performed to identify location and size of this stenosis. In case the stenosis is critical, the treatment options can be balloon angioplasty-stent or bypass operation. Both of these treatment options are performed safely in our day.
Cardiac catheterization is a diagnostic method that has been used for people since 1930s, and has been widely utilized since 1953. At the present time femoral artery is often used while arm vessels are rarely used. Cardiac catheterization and coronary angiography are diagnostic methods not treatment. It is based on imaging of cardiac cavities and coronary arteries with injection of contrast material and also measuring the pressure of the cardiac cavities and associated vessels.
The patient is delivered a tranquilizer and transferred to catheter laboratory after signing informed consent form. Femoral or arm section is anaesthetized to place a cannula in the vessel. The thin catheter made of plastic-like material is guided through cardiac cavities first to record the pressure then contrast material is injected for taking pictures. Then coronary arteries are displayed and recorded. This procedure takes approximately 15 -30 minutes.
Mitral valve is located between the left atrium and the left ventricle. It has two leaflets. Mitral stenosis occurs when two leaflets of the valve thicken and attach to each other, and is characterized by narrowed valve as a result of thickened and shrunk muscles and fibers holding the mitral valve. Mitral stenosis is a heart valve disease developed associated with acute rheumatic fever suffered in the childhood.
Mitral stenosis prevents oxygenated blood coming from the lungs from passing from the left atrium to the left ventricle. Therefore, the left atrium is the first to enlarge then the blood begins accumulating in the lungs. Intrapulmonic pressure is increased by accumulated blood in the lungs, and the patients will have complaints of shortness of breath, cough, heart-throb, and in the advanced stages hemoptysis (pulmonary edema or pulmonary congestion) may occur.
Treatment of mitral stenosis varies depending on the severity of stenosis. Pharmacotherapy should be enough for mild stenosis. Diuretics will be helpful to prevent accumulation in the lungs and beta blockers will be useful for heart-throb. With progressed stenosis, percutaneous mitral balloon valvuloplasty (PMBV) or open heart surgery (surgical repair or replacement of mitral valve) is performed.
Mitral balloon valvuloplasty is used to enlarge narrowed mitral valve by a balloon. When performed on appropriate patients, mitral balloon valvuloplasty has many advantages over open heart surgery.
The most important advantage is that the patient does not receive general anesthesia, and the rib cage is not opened. Thus, the patient is conscious during the procedure and does not require intensive care after the procedure.
In addition, patients are able to recover in short time and mostly discharged the following day.
Another important advantage is that a large number of patients, who has received a mitral balloon valvuloplasty, does not need to use anticoagulant drugs if no arrhythmia occurs while the patients, who have undergone an open heart surgery and implanted an artificial (prosthesis) valve, need to use anticoagulant drugs (coumadin-warfarin) for a lifetime.
Mitral balloon valvuloplasty procedure is performed by interventional cardiologists at angiography laboratory.
Mitral balloon valvuloplasty procedure has been performed for years at our hospital. We are the leading hospital with a serious of 1200 cases in the world and in the country. We perform mitral balloon valvuloplasty safely.
Based on more than 30-years’ experience in each field of cardiology and cardiological interventions, Group Florence Nightingale Hospitals, Heart Center team easily and effectively tackle cardiac problems from different levels of severity.
A Cardiac Pacemaker is an electronic device implanted in the body to correct heart’s rhythm and transmission system disorders.
It is vital to correct transmission system disorders, especially bradycardia. A device called pacemaker is implanted in the body to correct bradycardia and for better performance of daily activities. A pacemaker is an electronic device with two parts.
Pulse Generator: the part producing stimulus
Lead or Electrode: The part transmitting
Pulse generator consists of a battery and electronic circuit. Battery is usually lithium. Electronic circuit is a miniature computer with various programs installed in. The programs can be changed when required by a magnet. The power from the battery is converted to small electronic pulses and transmitted to the heart by lead. The electronic circuit controls the timing and intensity of electric stimuli transmitted to the heart.
Lead (electrode) provides the transmission between the heart and the pulse generator. It is usually an insulated wire from polyurethane.
There are two types of a cardiac pacemaker.
It consists of a pacemaker box and special lead. The lead is placed inside the heart through a vascular access (from neck, arm or groin). The other end of the wire is connected to the pacemaker box. Such pacemakers implanted temporarily are easy to remove when the patient recovers.
There are two methods of implantation:
This procedure is performed in a special catheter lab with a radioscopy device and under full sterilization, administering local anesthesia. During the procedure, the surgeon and assisting staff will wear a sterile dress, bonnet, and mask as in the operating theatre. The front side of the chest is cleaned with a special solution and covered with a sterile blanket. The pacemaker is usually implanted in the left chest (may be in the right side) below the clavicula.
The site is incised in 8-10 cm. Depending on the type of the pacemaker implanted 1-2-3 leads are guided through the vessels exposed by incision to be placed in the required cavity of the heart. Measurements we call threshold measuring are performed to see the state of the lead to detect and produce a stimulus. The leads are then attached to tissues and vessel at the site of incision. The other end of the lead is connected to the pulse generator which is placed in the pocket specially prepared under the skin, and the skin is sutured.
Depending on the condition of the heart, the heart chamber to be stimulated must be determined before.
The procedure usually takes 1-2 hours for implantation of a permanent pacemaker. In implantation of three-chamber pacemakers, it may take time to find the coronary sinus and implant the lead, resulting in prolonged time for the procedure around 3-4 hours.
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Group Florence Nightingale Hospitals Ltd UK 2020, all rights reserved.