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Procedures

Cardiology & Cardiothoracic

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Angiogram and Angioplasty

The heart is supplied by three major coronary arteries and their branches. These arteries supply oxygen-rich blood to your heart. Atherosclerosis produces confined or scattered areas of plaque within a coronary artery. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Plaque can narrow or block the coronary arteries and reduce blood flow to the heart muscle. If the blockage is severe, angina, shortness of breath, and, in some cases, heart attack can occur. (Angina is chest pain or discomfort.)

Cardiac catheterization, also called coronary angiogram, is a test used to evaluate

  • The blood flow in the coronary arteries.
  • Blood flow and blood pressure in the chambers of the heart.
  • Find out how well the heart valves work.
  • And check for defects in the way the walls of the heart move.

This test can pinpoint the size and location of fat and calcium deposits (plaque) that are narrowing the coronary arteries. Results from cardiac catheterization help determine whether treatment with bypass surgery or percutaneous coronary intervention (PCI), such as angioplasty, may be effective.

Percutaneous Coronary Intervention (PCI) is similar to cardiac catheterization but it is used to open up a narrowed coronary artery.

Angioplasty physically opens the channel of diseased arterial segments thereby relieving the recurrence of chest pain, increasing quality of life and reducing other complications of the disease. Since it is performed through a little needle hole in the groin (or sometimes the arm) it is much less invasive than surgery and can be repeated more often should the patient develop disease in the same, or another, artery in the future.

The two common types of PCI are:

Angioplasty with stenting: The angioplasty is done by attaching a small balloon to the catheter. Once the catheter has been guided to the proper location in a coronary artery, the balloon is inflated. The pressure from the inflated balloon presses the plaque against the wall of the artery to improve blood flow. After the plaque is compressed using angioplasty, a small expandable wire tube called a stent is inserted into the artery to hold it open. Reclosure of the artery is less likely to occur after angioplasty followed by stenting than after angioplasty alone. This is the most common procedure performed.

Atherectomy: This may be done during cardiac catheterization to open a partially blocked coronary artery. Once the catheter reaches the narrowed portion of the artery, a cutting device such as a whirling blade (rotational atherectomy), or a laser beam is used to remove the plaque. This procedure is done in combination with balloon angioplasty or stenting.

Heart Valve Surgery

There are four valves in the heart:

  1. Aortic valve
  2. Mitral valve
  3. Tricuspid valve
  4. Pulmonary valve

These valves control the direction of blood flow through the heart. Heart valve surgery is used to repair or replace diseased heart valves. It is open-heart surgery that is done while the subject is under general anesthesia. Valves may be repaired or replaced. Replacement heart valves are either natural (biologic) or artificial (mechanical):

  • Natural valves are from human donors (cadavers).
  • Modified natural valves come from animal donors. (Porcine valves are from pigs, bovine are from cows.) These are placed in synthetic rings.
  • Artificial valves are made of metal.

Heart valve surgery may be recommended for the following conditions:

  • Narrowing of the heart valve (stenosis)
  • Leaking of the heart valve (regurgitation)

Valve problems may be caused by:

  • Birth defects
  • Calcium deposits (calcification)
  • Infections such as rheumatic fever
  • Medications

Defective valves may cause congestive heart failure and infections (infective endocarditis).

An artificial valve may require one to take lifelong medication to prevent the formation of blood clots. Natural valves rarely require lifelong medication. The success rate of heart valve surgery is high.  

CABG

Coronary Artery Bypass Grafting (CABG) is an 'open-heart' surgery to treat Coronary Heart Disease (CHD), which is a condition in which plaque builds up inside the coronary arteries. A CABG can bypass the blocked arteries so that blood can flow more easily.  A CABG uses a blood vessel (called a graft) taken from your chest, leg or arm to bypass a narrowed or blocked coronary artery.

The surgery can either be done while the heart is beating or the patient can be connected to a heart lung machine and the heart function temporarily halted. The surgery includes making a cut, about 25cm (10 inches) long, down the middle of the breastbone (sternum) and opening the ribcage to facilitate access to the heart.
New grafts may be attached while the heart is still beating, but it's more common to temporarily stop the heart.
Once the grafts are attached and the heart restarted, the sternum will be rejoined using wires and the skin on the chest will be closed with dissolvable stitches.

This surgery can also be done using keyhole (or minimally invasive) surgery. Instead of a large cut down the sternum, the operation is done through small cuts. Special instruments are passed through the cuts and the surgeon looks at a monitor to see inside your chest. Keyhole surgery isn't suitable for everybody - your surgeon will advise you if it's appropriate for you. CABG is commonly performed and generally safe.