Department of Interventional Cardiology
Cardiology is the branch of science (medical science) that deals with disorders in the functions of the heart. It involves the medical diagnosis and treatment of disorders of the heart. Some of the defects include coronary heart disease, heart failure, congenital heart disease, valvular heart disease, etc.
The heart is the most primordial organ, which is the circuit for blood circulation. Blood from the heart is pumped to various parts of the body through the lungs and receives blood back into it. It plays a key role in the pumping process so that all parts of the body receive an adequate amount of blood. If any malfunction happens in this pumping process, it will affect other parts of the body too.
We at Billroth have one of the country’s first flat-panel modular cathlabs, an ECMO, and a round-the-clock functioning surgical cardiothoracic team. In addition to the above, the state-of-the-art cath lab is equipped with recent advancements such as OCT, Electro Physiology Lab, Provisions for Fractional Flow Reserve (FFR), IVUS, IVL, and Rotab.
Our services include:
Coronary Angiogram
Coronary catheterization, also known as coronary angiography or cardiac catheterization, is a medical procedure used to visualise and assess the coronary arteries that supply blood to the heart muscle. This diagnostic test is crucial in identifying blockages, narrowing, or other abnormalities in these arteries. During coronary catheterization, a thin, flexible tube (catheter) is threaded through blood vessels, usually starting from the femoral artery in the groin or the radial artery in the wrist. Guided by fluoroscopy and contrast dye, the catheter is carefully advanced to the coronary arteries. Once in position, contrast dye is injected into the coronary arteries, making them visible on X-ray images. These images, known as angiograms, help cardiologists evaluate blood flow, identify any obstructions, and determine the extent of coronary artery disease.
Coronary catheterization is not only diagnostic but can also serve therapeutic purposes.
Angioplasty and stent placement (PTCA)
Angioplasty and stent placement are commonly performed during the same procedure if a blockage is identified. Angioplasty involves inflating a small balloon to widen the narrowed artery, while a stent—a small mesh tube—is often placed to maintain the vessel’s patency.
Coronary catheterization plays a crucial role in diagnosing and treating coronary artery disease by providing detailed images of the heart’s blood vessels. It enables timely intervention, helping improve patient outcomes and manage cardiovascular health.
Balloon valvuloplasty
Balloon valvuloplasty is a minimally invasive medical procedure used to treat stenosis, a condition where heart valves become narrowed, hindering proper blood flow. During the procedure, a catheter with a deflated balloon is guided to the narrowed valve. Once in position, the balloon is inflated, stretching the valve and improving blood flow. This method is commonly employed to address aortic and pulmonary valve stenosis.
The benefits of balloon valvuloplasty include its less invasive nature compared to open-heart surgery, shorter recovery times, and reduced hospital stays. However, its effectiveness may vary, and the procedure might need to be repeated over time. While it can provide relief, its long-term success depends on the underlying cause of the valve stenosis.
The whole procedure takes place after the patient is anesthetized. Heart function, blood pressure, and other important criteria will be monitored at regular intervals. It means a complete blockage in the coronary artery. CTO has vastly improved in technology compared to the earlier treatment procedure. It involves the steering of special guided wires and cathers across the blockage.
Some of the symptoms of coronary artery CTO are nausea, cold sweat, fatigue, rapid and irregular heartbeat, dizziness or lightheadedness, angina or chest pain, and pain in the upper body and arm.
Coronary Intravenous Lithotripsy
Coronary Intravascular Lithotripsy (IVL) is a medical procedure designed to treat calcified coronary artery lesions, a condition often encountered during percutaneous coronary interventions (PCI). This innovative technique utilises lithotripsy, which traditionally has been associated with the treatment of kidney stones, to disrupt calcified plaques within coronary arteries.
During the procedure, a specialised catheter equipped with lithotripsy technology is advanced to the target lesion site. The catheter emits sonic pressure waves, creating microscopic shockwaves that fracture the calcified deposits without causing damage to the surrounding vascular tissue. This process, known as “vascular lithotripsy,” facilitates the expansion of the narrowed artery, allowing for the successful deployment of stents and restoring blood flow.
Coronary IVL offers several advantages, including the ability to modify calcified lesions without extensive vessel trauma and reducing the risk of complications associated with conventional treatment approaches. The technique has demonstrated effectiveness in improving procedural success rates, minimising vessel dissections, and optimising stent expansion in challenging cases.
Coronary Artery Atherectomy; Rotational Arthrectomy; Coronary Rotablation
Coronary artery atherectomy is a medical procedure aimed at treating coronary artery disease by removing atherosclerotic plaque from the blood vessels supplying the heart. Unlike angioplasty, which compresses the plaque against the vessel walls, atherectomy involves physically cutting or grinding the plaque, allowing for the restoration of blood flow.
There are various methods of coronary artery atherectomy, including directional, rotational, and laser atherectomy. During directional atherectomy, a catheter with a cutting device is used to shave off the plaque, while rotational atherectomy employs a high-speed rotating burr to ablate the obstruction. Laser atherectomy uses laser energy to vaporise or break down the plaque.
This procedure is typically considered when traditional treatments such as angioplasty and stenting are less effective or not feasible due to the nature of the plaque or vessel anatomy. Atherectomy can help open narrowed arteries, improve blood flow to the heart muscle, and relieve symptoms like chest pain.
Closure of ASD (Atrial Septal Defect) and PFO (Patent Foramen Ovale)
Closure of ASD (Atrial Septal Defect) and PFO (Patent Foramen Ovale) are medical procedures aimed at addressing congenital heart defects.
ASD closure involves the sealing of a hole in the atrial septum, the wall that separates the upper chambers (atria) of the heart. This hole, known as an atrial septal defect, allows blood to flow between the atria, potentially causing complications. Closure is typically performed through minimally invasive techniques or, in some cases, open-heart surgery.
The PFO closure addresses a similar opening, the patent foramen ovale, which is a small flap-like opening in the atrial septum. This passage exists in everyone before birth but should naturally close soon after. In some individuals, it persists, potentially allowing abnormal blood flow. Closure procedures for PFO can be performed through catheter-based interventions, which are less invasive than traditional surgery.
Both ASD and PFO closures aim to prevent complications associated with these defects, such as the risk of stroke, heart failure, or other cardiovascular issues. The choice of procedure depends on various factors, including the size and location of the defect as well as the patient’s overall health.
Transcatheter Aortic Valve Implantation (TAVI) and Transcatheter Aortic Valve Replacement
Transcatheter Aortic Valve Implantation (TAVI) and Transcatheter Aortic Valve Replacement (TAVR) are minimally invasive procedures designed to address aortic valve stenosis, a condition where the aortic valve narrows, restricting blood flow from the heart to the rest of the body.
Transcatheter Aortic Valve Implantation (TAVI):
TAVI involves the insertion of a replacement valve through a catheter, usually delivered via the femoral artery or other access points, without the need for open-heart surgery. This method is particularly beneficial for high-risk patients or those deemed unsuitable for traditional surgical approaches.
Procedure Steps:
- Access Point: A catheter is typically introduced through the femoral artery, although other access points such as the transapical or subclavian route may be used.
- Valve Placement: The replacement valve, often made of bioprosthetic material, is positioned within the diseased aortic valve. The new valve is usually a balloon-expandable or self-expanding device.
- Deployment: The replacement valve is expanded, pushing aside the old valve leaflets and effectively taking over the valve's function.
Advantages:
- Minimally Invasive: Avoids the need for open-heart surgery.
- Rapid Recovery: generally shorter recovery time compared to traditional surgical procedures.
- Suitable for High-Risk Patients: Ideal for individuals who may be at high risk for complications with conventional surgery.
Transcatheter Aortic Valve Replacement (TAVR):
TAVR is essentially synonymous with TAVI and is often used interchangeably. The procedure involves replacing the aortic valve with a bioprosthetic valve through a catheter-based approach, eliminating the need for extensive surgical incisions.
Indications:
- Aortic Valve Stenosis:Primarily used to treat aortic valve stenosis in elderly patients.
- High-Risk Patients: Especially beneficial for individuals at high surgical risk.
Pacemaker Implantation
Pacemakers:
Pacemakers are implantable devices that regulate heart rhythms by sending electrical impulses to the heart muscle. They are primarily used to treat bradycardia, a condition characterized by a slow heartbeat. Modern pacemakers are small, battery-operated devices implanted under the skin, typically in the chest. They consist of leads (wires) connected to the heart and a pulse generator that houses the battery and electronics. Pacemakers ensure the heart beats at a normal rate, improving blood flow and overall cardiac function.
Cardiac Resynchronization Therapy (CRT):
CRT devices are specialised pacemakers designed to address heart failure with conduction delays, particularly in patients with left bundle branch block. These devices coordinate the contractions of the heart’s ventricles, enhancing synchronisation and improving overall pumping efficiency. CRT involves the placement of additional leads in the heart to stimulate both ventricles simultaneously. By optimising the timing of contractions, CRT can alleviate symptoms and enhance the quality of life in heart failure patients.
Implantable Cardioverter Defibrillators (ICD):
ICDs are advanced devices that combine pacemaker functionality with the ability to detect and treat life-threatening arrhythmias, such as ventricular fibrillation or ventricular tachycardia. If a dangerous rhythm is detected, the ICD delivers a shock to restore the heart’s normal rhythm. Like pacemakers, ICDs are implanted under the skin and connected to the heart via leads. They are a crucial intervention for individuals at risk of sudden cardiac death due to ventricular arrhythmias.
Electrophysiology lab and ablation therapy
A Cardiac Electrophysiology (EP) Lab is a specialised facility within the field of cardiology dedicated to diagnosing and treating heart rhythm disorders, also known as arrhythmias. This advanced medical setting plays a crucial role in understanding and managing irregular electrical activities of the heart.
Components of an EP Lab:
Mapping Systems: EP labs are equipped with sophisticated mapping systems that use catheters to precisely map the electrical pathways of the heart. This enables cardiologists to identify abnormal rhythms and pinpoint the origin of arrhythmias.
Diagnostic Catheters: Various types of catheters are used for diagnostic purposes, allowing healthcare professionals to measure electrical signals within the heart chambers. This information aids in the accurate diagnosis of the specific arrhythmia.
Ablation Technology: The cornerstone of therapeutic interventions in EP labs is ablation. Ablation involves the targeted application of energy, commonly through radiofrequency or cryotherapy, to modify or eliminate abnormal electrical pathways causing arrhythmias.
Ablation Procedure:
Patient Preparation: Before the ablation procedure, patients undergo a thorough evaluation, including imaging and electrophysiological studies, to determine the most effective approach.
Catheter Insertion: Guided by imaging and mapping systems, catheters are threaded through blood vessels and positioned within the heart. These catheters have specialised tips designed for diagnostic measurements and delivering ablative energy.
Mapping and Localization: Cardiologists use the mapping system to locate the precise areas responsible for abnormal electrical signals. This step is crucial for determining the targets for ablation.
Ablation: Energy is applied to the targeted tissue, creating lesions that disrupt the abnormal electrical pathways. This can involve either heating the tissue with radiofrequency energy or freezing it with cryotherapy.
Monitoring and Confirmation: Continuous monitoring ensures the effectiveness of the ablation. Cardiologists assess the impact on the heart’s electrical activity and confirm the successful elimination or modification of the arrhythmia.
Post-Ablation Care:
Following the ablation procedure, patients are closely monitored for a period of time to ensure stability and assess the overall success of the intervention. Medications may be prescribed to manage symptoms and support the healing process.
Highlights of interventional procedures are:
Invasive Intervention Procedures
- Daycare Coronary Angiography
- Multi-vessel Radial & Ulnar Coronary Angioplasties
- Peripheral Angiography
- Carotid & Renal Stenting
- Balloon Mitral Valvotomy
- Balloon Aortic Valvotomy
- Device Closure of Septal defects
- Pacemaker Implantations
- Automatic Implantable Cardioverter
- Defibrillator (AICD)
Our cardiac department is fully equipped with advanced technologies to provide comprehensive treatment for our patients. The country’s first flat-panel modular cath lab for coronary angiography and coronary angioplasty (PTCA)
Fractional Flow Reserve
Coronary Fractional Flow Reserve (FFR) is a diagnostic technique used in cardiology to assess the severity of coronary artery stenosis or narrowing. It provides valuable information to guide treatment decisions, particularly for patients with coronary artery disease.
During a coronary angiogram, a catheter is threaded through the coronary arteries, and a pressure sensor is placed at the tip. FFR involves measuring the pressure before and after a narrowed segment of a coronary artery while inducing maximal hyperemia, typically through the administration of adenosine.
The FFR value is calculated by dividing the mean distal coronary pressure by the mean aortic pressure. An FFR value of 1.0 indicates normal blood flow, while values below 0.80 suggest significant narrowing and reduced blood flow. This quantitative assessment helps cardiologists determine the need for interventions such as angioplasty or stent placement.
One of the advantages of FFR is its ability to provide functional information about coronary lesions, complementing traditional anatomical assessments from angiograms. This functional evaluation assists in making more informed decisions, optimising patient outcomes, and avoiding unnecessary interventions.
Intravascular Ultrasound
Intravascular ultrasound (IVUS) is a medical imaging technique used to visualise the inside of blood vessels, including coronary arteries. It involves inserting a catheter with an ultrasound probe into the blood vessels to obtain detailed images. IVUS is particularly useful in assessing the condition of coronary arteries and identifying plaque buildup, helping in the diagnosis and treatment of cardiovascular diseases.
ECMO
- 24-Hour Coronary Care Unit
- 4D ECHO cardiogram
- Holter monitoring
- TMT/Computerised ECG
Cardiology Doctors
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