Each year, Lourdes Health System cardiologists perform thousands of cardiac catheterization and other interventional procedures at Our Lady of Lourdes Medical Center which has earned a national reputation for excellence in heart care.
At Lourdes, cardiologists determine the location and severity of narrowing or blockage in the coronary arteries. For diagnostic cardiac catheterizations, they use highly advanced imaging technologies to assess circulation to the heart walls that form the chambers of the heart.
Interventional cardiologists at Lourdes also treat blockages in coronary arteries in the catheterization lab. These procedures typically involve coronary stent insertions and may also require atherectomy procedures. Restoring coronary blood flow in this way helps many patients to avoid open-heart surgery. In addition, Lourdes cardiologists can now perform catheterization procedures through the wrist. This is called radial catheterization since it involves the radial artery.
The highly trained interventionalists on the Lourdes team, including vascular specialists, can also direct angioplasty and stenting to arteries in other parts of the body, including those that serve the kidneys, legs and feet. In addition, Lourdes cardiothoracic surgeons can sometimes treat abnormalities and defects in the heart using catheterization to make surgical repairs without the need for chest incisions.
Diagnostic Cardiac Catheterization
For decades, cardiac catheterization has been at the core of testing for heart disease, in particular for determining if a patient has atherosclerotic narrowing of the small arteries on the surface of the heart called coronary arteries. The “coronaries” provide the critical blood supply to the muscular walls of the heart. Coronary artery disease typically causes chest pain (angina) and weakened heart capacity. Patients with the condition are at risk for heart attack. A heart attack occurs when these arteries become so severely blocked that the heart wall no longer receives adequate blood supply and has difficulty contracting.
To detect and assess coronary artery disease, cardiologists evaluate patients in the cardiac catheterization laboratory. With the patient under sedation, the cardiologist makes a small incision on the inside of the patient’s thigh and to the femoral artery located there, in order to introduce slender, flexible tubes called catheters into the circulatory system. The cath-lab team advances a catheter up and into the coronary arteries and infuses a contrast material into these arteries, to make them easy to trace on the highly sophisticated x-ray equipment located over and around the lab’s treatment table.
Using this approach (of x-ray images enhanced with contrast dye, an imaging modality known as fluoroscopy) the team can create a “road-map”-like picture of the circulatory system on the outside of the heart that supplies blood to heart tissue. The cardiologist can determine which arteries have normal circulation and can identify any narrowed or blocked coronary arteries. The lab team can make very exacting measures of the extent and location of any compromised areas. The team may elect to treat these areas in the same cath-lab session or in a follow-up session.
Cardiac catheterization laboratories provide diagnostic catheterization on an elective basis, to evaluate possible symptoms of coronary artery disease, or an emergency basis, to evaluate a possible heart attack. In many cases, the team will proceed directly to angioplasty during the catheterization.
As a result of the findings of a diagnostic cardiac catheterization, patients may need to undergo treatment for narrowed or blocked areas in their coronary arteries. The term “angioplasty” refers to changing the shape of these arteries to re-establish their openings.
The cardiology team first performs a diagnostic cardiac catheterization, and then introduces additional catheters equipped with device tips that reopen the compromised areas of the arteries. Most often, the team uses a catheter tipped with a tiny balloon that it can inflate to push plaque to the sides of the artery. Sometimes, to traverse the narrowed areas with the balloon-catheter tip, the team will need make an opening through the blockage by cutting or burning away the plaque in a procedure called atherectomy.Angioplasty results in immediate (full or partial) restoration of blood blow in the treated coronary and thus to the heart wall to which this artery provides blood flow. Typically, the team will also place coronary stents in the treated area.
Once the cardiac-catheterization team has used angioplasty to reopen a coronary artery, it will usually complete the procedure by placing tiny, precisely designed mesh tubes called stents across the treated area. These wire-mesh cylinders are meant to increase the likelihood that the coronary artery will remain open and not re-accumulate plaque to narrow its opening again.
The specialists insert the closed tubes to the targeted area of the artery and then gently expand them. The stents remain in place to press out against the inner walls of the artery. Patients may receive a number of stents in contiguous areas, in different locations or branches of the same artery or in multiple arteries.
During a cardiac angioplasty procedure, the catheterization team may need to create an opening through coronary arterial plaque in order to remove this blockage and to provide an opening for a balloon-tipped catheter to further expand the artery’s opening. The specialists will use one of a number of types of highly engineered catheters for this purpose. In some cases, these catheters have a specially cooled laser tip to vaporize the blockage in a carefully controlled manner or a tiny rotary tip that cuts through the plaque material.
Atrial Septal Defect Repair
After we are born, our hearts are still forming. For some people, a small part of the heart does not close. This is called an atrial septal defect (ASD). If left untreated, ASD can put a person at a greater risk for a certain kind of heart failure, problems with heart rhythm or stroke. ASDs are seen in 30 to 40 percent of congenital heart disease patients age 40 and older. Symptoms for the defect are uncommon, but can include arrhythmia, fatigue, leg swelling and shortness of breath.
Previously, the only options were open-heart surgery or what doctors call “watchful waiting,” since the risk for surgery far outweighed the benefits. However, today we have an option that uses minimally invasive surgery to repair the heart. It has completely changed the outlook for people with ASD since this type of surgery has benefits that outweigh other options.
Minimally invasive surgery to repair ASD requires only mild anesthesia, involves less pain and has fewer postoperative complications than surgery and almost immediately leads to an improved quality of life.
Patients treated with this new approach are generally in the hospital for less than 24 hours. In addition, the previous surgical option involved a lengthy recovery period. With this approach, most patients can resume normal activities within one month of the procedure, but should avoid strenuous activity for at least that period.
Candidates and Risks
Candidates for this procedure, called “transcatheter closure” of an ASD must have had an echocardiogram that shows evidence of the ASD. They must also have symptoms, such as leg swelling, fatigue and shortness of breath.