CARDIOLOGY

Coronary Angiography
Coronary Angioplasty (PTCA or PCI) & Stenting
Coronary Artery Bypass Graft (CABG)
Cardiac Diagnostic Services
Pacemaker Implantation (Single or Dual Chamber)
Valvoplasty

Peripheral Vascular Treatment
PDA Devise
ASD Devise
Robotic Cardiac Surgery (daVinci Telmanipulation)
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

Off Pump Coronary Artery Bypass(OPCAB)
Totally Endoscopic Coronary Artery Bypass (T-CAB)
Enhanced External Counter Pulsation (EECP) (noninvasive)
Trans Myocardial Laser Revascularisation (TMLR)
Implantable Cardioverter and Defibrillator (ICD)

Coronary Angiography

A coronary angiogram is a special X-ray test. It’s done to find out if your coronary arteries are blocked or narrowed, where and by how much. An angiogram can help your doctor see if you need treatment such as angioplasty or stent, coronary artery bypass surgery (CABG) or medical therapy.

Coronary Angioplasty (PTCA or PCI) & Stenting

A coronary angioplasty is a procedure used to widen blocked or narrowed coronary arteries (the main blood vessels supplying the heart). The term ‘angioplasty’ means using a balloon to stretch open a narrowed or blocked artery

However, most modern angioplasty procedures also involve inserting a short wire-mesh tube, called a stent, into the artery during the procedure. The stent is left in place permanently to allow blood to flow more freely.

Coronary angioplasty is sometimes known as percutaneous transluminal coronary angioplasty (PTCA). The combination of coronary angioplasty with stenting is usually referred to as percutaneous coronary intervention (PCI).

Pacemaker Implantation (Single or Dual Chamber)

Pacemakers are sometimes recommended for people with conditions that cause the heart to beat abnormally.

Each time the heart beats, the heart muscle contracts (pulls inwards) in preparation for pumping blood around the body. The contractions are triggered by electrical pulses. These are generated by a group of specialized cells known as the sinoatrial node (SA node).

The SA node is often referred to as a natural pacemaker because it generates a series of electrical pulses at regular intervals.

The pulse is then sent to a group of cells known as the atrioventricular node (AV node). The AV node relays the pulse to the two lower chambers of the heart (the ventricles).

A pacemaker or implantable cardioverter defibrillator (ICD) is needed when something disrupts this process and causes an abnormal heartbeat.An abnormal heartbeat is called arrhythmia. Some of the most common causes of arrhythmias are described below.

Coronary Artery Bypass Graft (CABG)

A coronary artery bypass graft (CABG) is a surgical procedure used to treat coronary heart disease.

It diverts blood around narrowed or clogged parts of the major arteries to improve blood flow and oxygen supply to the heart.

A coronary artery bypass graft involves taking a blood vessel from another part of the body – usually the chest, leg or arm – and attaching it to the coronary artery above and below the narrowed area or blockage. This new blood vessel is known as a graft.

Peripheral Vascular Treatment

Peripheral arterial disease (PAD) is a common condition, in which a build-up of fatty deposits in the arteries restricts blood supply to leg muscles. It’s also known as peripheral vascular disease (PVD) Medication, and in some cases surgery, can be used to improve the blood flow in your legs.

Artial Septal and Ventricular Septal Defect (ASD/VSD)

Congenital heart disease refers to a range of possible heart defects.

The following defects are described below:

  • aortic valve stenosis
  • coarctation of the aorta
  • Ebstein’s anomaly
  • patent ductus arteriosus
  • pulmonary valve stenosis
  • septal defects – including atrial septal defects and ventricular septal defects
  • single ventricle defects – including tricuspid atresia and hypoplastic left heart syndrome
  • tetralogy of Fallot
  • total anomalous pulmonary venous connection
  • transposition of the great arteries
  • truncus arteriosus

Treatment for congenital heart disease depends on the specific defect child has. Mild heart defects don’t usually need to be treated, although it’s likely to have regular check-ups to monitor your health. More severe heart defects usually require surgery and long-term treatment.

PDA Devise

In the womb, baby’s oxygen comes from the mother. Since there is no need for blood to pass through the lungs of the fetus, the blood is diverted away from the lungs, to the rest of the body, by an artery called the ductus arteriosus.

Once a baby is born and takes his first breath, the ductus arteriosus is no longer needed and begins to close. Under normal circumstances, the ductus arteriosus is completely closed in a few weeks.

With some babies, this process of closure either does not happen at all or does not happen completely, leaving a small opening. As a result, normal blood flow is affected. This condition is called patent ductus arteriosus (PDA). “Patent,” in this context, means “open.”

ASD Devise

Atrial septal defect (ASD) is a defect between the two upper heart chambers (the atria). This defect allows mixing of oxygenated and deoxygenated blood, eventually causing right heart enlargement and high pressure in the lungs (pulmonary hypertension).

Moderate to large size ASD causing right heart dilatation and raised pressure in the lungs should be closed and closure can be performed either percutaneously using devices (through the femoral vein) or through open heart surgery.

Robotic Cardiac Surgery (daVinci Telmanipulation)

Robotically-assisted heart surgery, also called closed-chest heart surgery, is a type of minimally invasive heart surgery performed by a cardiac surgeon. The surgeon uses a specially-designed computer console to control surgical instruments on thin robotic arms.

Robotically-assisted surgery has changed the way certain heart operations are being performed. This technology allows surgeons to perform certain types of complex heart surgeries with smaller incisions and precise motion control, offering patients improved outcomes.

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is a minimally invasive approach to conventional Coronary Artery Bypass Graft (CABG) surgery. MIDCAB is beating heart surgery, which means that stopping the heart (cardioplegia) is not necessary and a heart-lung machine is not required.

Unlike conventional surgery, which requires a 10″-12″ incision to separate the sternum (sternotomy) and places the patient on the heart-lung machine, MIDCAB surgery can be performed through a 3″-5″ incision placed between the ribs, or may be done with several small incisions.

MIDCAB surgery results in a faster recovery, fewer complications, and less pain after surgery. It is indicated for use when bypassing one or two coronary arteries. For bypassing three or more arteries, a conventional CABG is indicated.

Off Pump Coronary Artery Bypass (OPCAB)

Off-pump coronary artery bypass or “beating heart” surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease. During most bypass surgeries, the heart is stopped and a heart-lung machine takes over the work of the heart and lungs. When a cardiac surgeon chooses to perform the CABG procedure off-pump, also known as OPCAB (Off-pump Coronary Artery Bypass), the heart is still beating while the graft attachments are made to bypass a blockage.

Totally Endoscopic Coronary Artery Bypass (T-CAB)

Totally endoscopic coronary artery bypass (TECAB) surgery is a breakthrough approach to performing coronary bypass surgery. Achieved through tiny fingertip-size slits, this completely closed-chest procedure spares the breastbone (sternum) and provides many benefits, from a faster recovery to less risk for complications.

Enhanced External Counter Pulsation (EECP) (noninvasive)

There are a large, increasing number of patients who have persistent anginal symptoms, who have exhausted the standard treatments for revascularization and remain severely restricted. Enhanced External Counterpulsation (EECP) may stimulate the openings or formation of collaterals (small branches of blood vessels) to create a natural bypass around narrowed or blocked arteries.

EECP is a non-invasive, outpatient therapy. During treatment:

  • Patients lie down on a padded table in a treatment room
  • Three electrodes are applied to the skin of the chest and connected to an electrocardiograph (ECG) machine. The ECG will display the heart’s rhythm during treatment. Blood pressure is also monitored.
  • A set of cuffs is wrapped around the calves, thighs and buttocks. These cuffs attach to air hoses that connect to valves that inflate and deflate the cuffs. Patients experience a sensation of a strong “hug” moving upward from calves to thighs to buttocks during inflation followed by the rapid release of pressure on deflation. Inflation and deflation are electronically synchronized with the heartbeat and blood pressure using the ECG and blood pressure monitors.

Benefits for EECP Treatment

  • Less need for anti-anginal medication
  • Decrease in symptoms of angina
  • Increased ability to do activities without onset of symptoms
  • Ability to return to enjoyable activities

Trans Myocardial Laser Revascularisation (TMLR)

Patients with coronary artery disease (CAD), the coronary arteries are clogged and diseased and can no longer deliver enough blood to the heart. The heart’s lack of oxygen-rich blood is called ischemia.

Not getting enough oxygen to the heart muscle increases the risk of heart attack and may cause a painful condition called angina.

For patients who cannot have bypass surgery, there is a procedure called transmyocardial laser revascularization, also called TMLR or TMR. TMLR cannot cure CAD, but it may reduce the pain of angina. MLR is a type of surgery that uses a laser to make tiny channels through the heart muscle and into the lower-left chamber of the heart (the left ventricle). The left ventricle is the heart’s main pumping chamber.

After TMLR, when oxygen-rich blood enters the left ventricle, some of that blood can flow through the tiny channels and carry much-needed oxygen to the starving heart muscle.

Implantable Cardioverter and Defibrillator (ICD)

Any irregularity in your heart’s natural rhythm is called an arrhythmia. Almost everyone’s heart skips beats, and these mild palpitations are usually harmless. But there are about 4 million Americans who have recurrent arrhythmias, and these people usually need treatment for their condition.

Electrical impulses from the heart muscle cause your heart to beat (contract). This electrical signal begins in the sinoatrial (SA) node, located at the top of the heart’s upper-right chamber (the right atrium). The SA node is sometimes called the heart’s “natural pacemaker.”

ICDs are for people who have had an abnormal, fast heart rate that caused them to faint or caused their heart to stop pumping properly. Sometimes medicines can be used to control these fast heart rates. When medicines do not work, doctors can implant an ICD.

An ICD is used in patients at risk for

    • Ventricular tachycardia, when the lower chambers of the heart independently beat faster than 100 beats per minute.
    • Ventricular fibrillation, when the muscle fibers of the lower chambers of the heart contract in a fast, uncoordinated manner.

An ICD is usually about the size of a pager. It is made up of two parts:

  • A pulse generator, which includes the battery and several electronic circuits.
  • Wires, called leads. Depending on the type of ICD, you may have one or two leads.

Once the ICD is implanted, the leads monitor your heart rate. If the ICD detects ventricular tachycardia or fibrillation, it sends out a controlled burst of impulses (called “overdrive” pacing). If that does not work, the ICD “shocks” the heart to restore a normal rhythm. Newer ICD devices can also work like a pacemaker if a slow heart rate (bradycardia) occurs.

When ventricular tachycardia or fibrillation occurs, the ICD records your heart rate, as well as the date and time of the event. It can also record what electrical therapy was needed to restore a normal heart rhythm.

Valvoplasty

Aortic valvuloplasty also known as balloon aortic valvotomy is the widening of a stenotic aortic valve using a balloon catheter inside the valve. The balloon is placed into the aortic valve that has become stiff from calcium buildup. The balloon is then inflated in an effort to increase the opening size of the valve and improving blood flow.

Balloon valvotomy can be considered:

  • As a “bridge” to surgery in haemodynamically unstable patients who are at high risk for aortic valve replacement.
  • Use for palliation in patients with serious comorbid conditions that prevent performance of aortic valve replacement.
  • In addition, there are two other settings in which balloon valvotomy has been considered:
  • As a “bridge” to delivery to symptomatic pregnant women.
  • In patients who require urgent noncardiac surgery. However, the ACC/AHA guidelines concluded that most asymptomatic patients with severe AS can undergo urgent noncardiac surgery at relatively low risk with careful intraoperative and postoperative management.

Recent improvements in both balloon technology and procedural technique may lead to a resurgence in the clinical application of balloon valvuloplasty. Valvuloplasty is an important part of the procedure to deploy a percutaneous aortic valve.