Invasive Cardiology

The first things come to mind about Cardiology are invasive and non-invasive diagnosis and treatments of heart diseases and coronary artery disease. Invasive Cardiology deals with coronary angiography and percutaneous coronary interventions such as angioplasty, coronary stent insertion, balloon dilatation and valvuloplasty as well as cardiac procedures such as pacemaker implantation and electrophysiology studies (ablation).

INVASIVE CARDIOLOGY METHODS

Coronary Angioplasty and Stent

Coronary angioplasty implies an invasive procedure where focal stenosis of coronary arteries are eliminated with a non-surgical method (balloon dilatation). A needle is inserted into femoral artery and advanced to coronary arteries; next, “guide wire” is deploted and a non-inflated balloon is advanced over this guide wire and deployed to the localization of stenosis. Finally, the balloon (approximately 3 cm in length and 3 to 4 mm in width) is inflated and patency is achieved in stenotic lumen. In some cases, a metallic cage (Stent) that is previously mounted on this balloon is deployed into lumen and thus, recurrence of stenosis in same artery is minimized.

This method is not appropriate for all stenotic conditions of coronary arteries. Safest and most efficient therapeutic method is by-pass surgery in some patients or cardiac medications in other. The decision on best therapy will be made by physicians.

Balloon Valvuloplasty

Stenotic cardiac valves are dilated using a balloon catheter (2 to 25 cm in diameter) without requiring an open cardiac surgery. This valvuloplasty method is preferred in high-risk patients and pregnant women. Each patient may not be a candidate for this procedure. Long-term results are highly promising in carefully selected patients.

Catheter Ablation

After focus of rhythm disorder, leading to fast and irregular heart rhythm, is identified, it is “destroyed or ablated” using high radiofrequency waves. A needle is inserted into femoral artery and a thin wire is advanced to heart. Procedure lasts 1 to 4 hours and requires at least one-day stay at hospital.

Pacemaker

In conduction system disorders that lead to slow heartbeat (bradycardia), a battery placed into a subcutaneous pouch is connected to wires that are inserted into heart in order to keep heart beats above a particular pace (i.e., 60 to 70 beats per minute). Procedure does not require a full surgery and lasts 1 to 1.5 hour, and hospital stay is 1 to 2 day(s).

AICD (Automated Implantable Cardioverter-Defibrillator)

It is the most effective treatment method for cardiac rhythm disorders that may threaten life. In this non-surgical method, subclavian vein – main vein in shoulder region – is punctured and an electrode is placed into right heart, while the battery is placed beneath the left clavicle. This battery is automatically activated, when a cardiac rhythm disorder develops, and it stays in stand-by mode at other times. Patient selection is to the discretion of “cardiac electrophysiologist” who is also responsible for implanting the device.

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