Cardiac Care:

 interventional cardiology procedures

Saint John’s offers the latest in diagnostic and interventional cardiology including:

•    Cardiac Catheterization
•    Endomyocardial Biopsy
•    Coronary Angiography
•    Balloon Angioplasty
•    Stent Implantation
•    Rotoblator Angioplasty
•    Angioplasty and Stent Implantation for Chronic Total Occlusions
•    Intracoronary Thrombectomy
•    Intravascular Ultrasound (IVUS)
•    Coronary Flow Wire (Radi Wire)
•    Patent Foramen Ovale (PFO) Closure
•    Atrial Septal Defect (ASD) Closure
•    Peripheral Vascular Disease – Diagnostic and Interventional

Cardiac Catheterization

This is a technique in which a small, thin tube (catheter) is placed inside an artery and/or vein and then guided into the heart chambers by fluoroscopic guidance.  

Endomyocardial Biopsy

This is a procedure to obtain a small piece of heart muscle tissue for analysis under a microscope.  A catheter is placed into a vein in the neck and advanced into the heart, where pieces of tissue are grasped by the end of the catheter for examination.  

Endomyocardial biopsy is done to determine if the patient has certain rare disorders of the heart muscle that are treated differently than usual heart failure treatments.  Disorders can include myocarditis, sarcoidosis, hemochromatosis, amyloidosis as well as rejection of a heart transplant.

Coronary Angiography

This procedure is used to determine whether and to what degree a woman’s coronary arteries have narrowed and the exact location of the problem. During angiography, a contrast dye is injected into the catheter and the dye fills the coronary arteries. The dye allows the cardiologist to see, on a viewing screen, whether the coronary arteries are blocked and how the heart is beating.  

Balloon Angioplasty

A specially designed catheter with a small balloon tip is guided into the blocked artery and then inflated.  This procedure opens up blocked heart arteries and increases blood flow to the heart.  The risk of the expanded artery closing again is reduced if a stent is also implanted during the angioplasty.

Stent Implantation

A stent is a small stainless steel mesh tube which, when permanently inserted into damaged arteries already opened by angioplasty, holds the artery open and allows the continued flow of blood to the heart. Drug-eluting stents are bound with time-released drugs that discourage the growth of unwanted cells which would clog the stent and prevent the flow of blood. With the use of drug-eluting stents, return patient visits are dramatically reduced.

Rotoblator Angioplasty

This technique is an effective adjunct to balloon angioplasty for the treatment of arteries where the plaque has become extremely calcified, preventing the balloon tip from fully inflating. A catheter with a special tip that spins around at a high speed is guided into the coronary artery and, as the tip spins, it removes the plaque on the artery walls. These microscopic plaque particles are then washed safely away in the bloodstream.

Angioplasty and Stent Implantation for Chronic Total Occlusions

In some instances, a coronary artery may experience complete blockage, known as a total occlusion. Total occlusions that exist for more than three months are called chronic total occlusions and are difficult to treat with balloon angioplasty or stenting because the guide wire used to direct the catheter is unable to penetrate the occlusion. To overcome this, cardiologists use a special remote-actuated catheter that enables them to separate and fracture the plaque throughout the total occlusion without risk of perforating the artery wall. Once a micro- channel is created through or around the occlusion, the procedure can be completed using angioplasty or stenting.

Intracoronary Thrombectomy

Thrombectomies are occasionally needed to remove blood clots in an artery or bypass graft. A small catheter is threaded into a coronary artery and the clot is broken up and suctioned back into the catheter. When indicated, a thrombectomy improves both the safety and outcome of angioplasty and/or stent procedures.

Intravascular Ultrasound (IVUS)

IVUS is an adjunct to coronary angiography and angioplasties. A sound wave transducer is mounted at the end of a catheter that is inserted into a coronary artery. These catheters can measure the velocity of blood flow within a coronary artery to determine if a blockage is severe enough to deprive the heart muscle of the blood flow it needs.  These devices can also demonstrate not only how severe the narrowing of the blockage is, but also show the composition of the underlying plaque. This information helps determine which of type of angioplasty procedures would be best to treat the blockage; immediately assess the results of the angioplasty procedures to help physicians know if more work needs to be done before the catheters are removed.

Coronary Doppler Wire

The coronary flow wire is a guidewire-mounted pressure sensor for measuring intravascular pressure. This measurement called the Fractional Flow Reserve (FFR) provides physicians with a more accurate assessment of the severity of coronary stenosis (narrowing), allowing them to make more informed and accurate treatment decisions.

Patent Foramen Ovale (PFO) Closure

A Patent Foramen Ovale is a small flap valve defect between the right and left atrium. When the valve is opened, an embolus (a mass such as an air bubble or blood clot) may cross the defect, possibly resulting in a stroke or temporary lack of oxygen to the brain. To close this defect, cardiologists use a special umbrella-like closure device that is collapsed and placed into a special catheter. The catheter is then advanced through a leg vein into the heart, where the implant is re-expanded so that part of it sits on each side of the defect, covering the hole like a sandwich and closing it. Once in place, new tissue grows into the implant, making it part of the heart.

Atrial Septal Defect (ASD) Closure

Women with atrial septal defects suffer a congenital condition in which a hole between the upper chambers of the heart fails to close at birth. This defect can allow a blood clot from the body to cross from the right side to the left side of the heart, where it can cause a stroke. While treatment used to require surgery in the largest defects, cardiologists now treat most of the defects by using an umbrella-like closure device attached to a special catheter that has been inserted into a leg vein and advanced into the heart and through the hole. The device, which is fully collapsible for insertion, expands to effectively block the passageway between the atria and close the hole. Over time, heart tissue grows over the implant, becoming part of the heart.

Peripheral Vascular Disease Assessment and Treatment

Patient with significant blockages in arteries outside the heart (carotid, renal, subclavian, lower extremity, as well as mesenteric) can now be diagnosed and treated with a variety of technologies including angioplasty, stents, rotablator atherectomy and cryoplasty.