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Heart Non-Surgical Procedures
Angioplasty
Angioplasty is the dilation or widening of arteries narrowed by
plaque accumulation. In a coronary artery angioplasty, a special
catheter incorporating a balloon is threaded to the heart via a
major peripheral artery. Using special imaging technology in the
cardiac cath lab, the physician places the balloon at the site
of blockage within the artery and inflates the balloon. This inflation
disrupts the plaque and reopens the artery increasing blood flow
and oxygen nourishment to this region of the heart muscle. A variety
of other devices are available for use alone or in combination
with angioplasty to open up the blockage. These include “cutting” balloons,
laser, and the rotoblator or atherectomy
technique (also known as the Rotorooter procedure). Coronary Artery Stenting
Stent technology was developed to prevent the possibility of the
tendency for plaque to redevelop at a previous angioplasty site
and reblockage of the artery to occur. This created the need for
multiple repeat angioplasties for some patients. A stent is usually
a stainless steel mesh wire tube that is placed at the blockage
site after angioplasty has been successfully accomplished. The
wire mesh eventually becomes incorporated into the arterial walls
as the natural cell regeneration process of healing occurs at the
angioplasty site. Stents are available in various diameters and
lengths. Multiple stents
may be placed during one procedure if multiple blockages are present.
Drug-Eluting Stents
Recently approved by the Food and Drug Administration, drug-eluting
stents are an option for treatment of your heart disease. These
stents have a drug delivery system incorporated into the wire mesh
structure of the stent. The purpose of the drug is to prevent cell
regrowth from blocking the artery again at the angioplasty site.
This will reduce the likelihood of requiring a repeat angioplasty
at the very same site as a previous procedure. However, the decision
to utilize a drug-eluting stent rather than the bare metal stent
will be based on the location of the lesion within the coronary
anatomy, the diameter of the vessel, and how aggressively the patient
is developing heart disease. Each patient situation will be assessed
on an individual basis. Brachytherapy
This technique uses a special catheter or wire that is placed
at the site of a previous
artery blockage and controlled radiation is released in an attempt
to prevent another restenosis or renarrowing from occurring once
again. It has been found to be particularly effective in vein bypass
grafts that have become narrowed by plaque development.
Balloon Valvuloplasty
Performed in the cardiac catheterization laboratory, balloon valvuloplasty
is a procedure used to address valvular disease. As in coronary
artery angioplasty, a balloon catheter is placed within the valve
and inflated to widen the valvular area. The catheter is then removed,
and the stenosis (narrowing) of the valve has been alleviated with
improvement
of blood flow across the valve. This technique is used most often
for narrowing of the tricuspid, pulmonic, and mitral valves and
rarely for aortic stenosis. Pacemakers
Placement of a pacemaker is indicated when there is a need to
regulate the heartbeat. When the electrical conduction system of
the heart is impaired, a pacemaker may be
necessary. The procedure is considered minor surgery and is done
utilizing sedation and a local anesthetic. Pacemakers consist of a pulse generator and its leads or wires.
Think of the pulse generator as providing electronic surveillance
of the heart’s electrical activity. The battery unit is incorporated
within the pulse generator and the leads are attached to one or
more of the heart’s chambers. During the placement procedure,
a small incision is made underneath the collarbone and leads are
introduced by way of a vein in this region to the heart. A pocket
underlying the chest wall will be created for the location of the
pulse generator. The leads transmit the heart’s electrical
impulses back to the pulse generator which is programmed to monitor
this activity and provide additional electrical stimulation if
the heart rate falls below a certain desirable rate. This is the
most commonly implanted type of pacemaker and is known as a demand
pacemaker. A maintenance schedule for monitoring your pacemaker will be developed
in order to interrogate the pacemaker. This is an evaluation of
the pacemaker’s programmed messages according to your individual
situation as well as an assessment of the pulse generator’s
battery life. Batteries generally last from six to ten years and
lose their energy at a slow rate allowing ample opportunity to
identify a convenient time for replacement. It is also possible to assess pacemaker function utilizing the
telephone. The electronic impulses from the pulse generator can
be transmitted over the telephone and a recording of this activity
assessed. Immediately after pacemaker placement, you may have some discomfort
in the location of the incision that may require analgesics. You
will be advised regarding appropriate care of the incision to prevent
the possibility of infection. Keep in mind that the following can adversely affect the safe
programmed function of your pacemaker: - MRI or magnetic resonance imaging equipment
- Welding machines
- Certain dental equipment
- Radiation-producing machines such as those used in cancer treatment
- Power-generating equipment
- Heavy equipment or motors that include powerful magnets Patients are often concerned that cell phones may interfere with
their pacemaker. Because the cell phones used in the USA generally
produce less than 3 watts of energy, they usually do not affect
pacer function, but the general rule is to keep your cell phone
6 inches away from your pacemaker and use it on the opposite side
of the body from the pacer location. Automatic Implantable Cardioverter Defibrillator (AICD or ICD)
Commonly referred to as an ICD, automatic implantable cardioverter
defibrillator devices can be permanently implanted in much the
same fashion as a pacemaker. However, these
devices address a different type of malfunction within the heart’s
electrical system. They can be utilized to treat abnormally fast
and irregular heart rhythms that have life-threatening potential. The ICD monitors the heart’s electrical activity, and when
it detects a dangerous heart rate or rhythm, the device is programmed
to provide a sudden electrical shock to convert the heart rhythm
back to a more normal state. This electrical shock is equivalent
to that delivered via the external chest using pads and electrodes
when patients experience life-threatening arrhythmias or sudden
cardiac death. Smaller than a cigarette pack, ICDs are implanted either in the
upper chest or the abdominal region. The procedure is done under
minor sedation and a local anesthetic. The ICD consists of a pulse
generator and its wires or leads. A pocket will be created surgically
for the pulse generator while a vein in the upper chest will be
used to place the lead or leads in the chambers of the heart. Sometimes, the ICD implanted will combine the capabilities of
a pacemaker unit and can
detect heart rates that are too slow and are programmed to respond
accordingly. Patients who have had ICDs implanted report differing
levels of awareness and sensation with the
electrical shock provided by the ICD. Some note it as a minor fluttering
sensation while others experience it as a major blow to the chest. The usual function of an ICD may be compromised when exposed to
major electrical or
magnetic fields. Be sure to seek specific counsel as to what machines
or devices to avoid. You will be given instructions about follow-up
care and what to do when the device is activated by an arrhythmia.
The battery life of the pulse generator will also be monitored
and replacement planned when indicated. Biventricular Pacemaker Placement (Cardiac Resynchronization Therapy)
This pacemaker is a relatively new treatment option for moderate
to severe congestive heart failure. For patients on maximum medical
therapy who find their heart failure symptoms still remain self-limiting,
biventricular pacemakers send impulses to both lower chambers of
the heart (the ventricles) to provide synchronized pumping action.
By increasing the efficiency and effectiveness of the heart as
a pump, many patients receiving the biventricular pacer experience
a lessening of symptoms with an increase in energy and decreased
difficulties with shortness of breath. This device is technically
challenging to place and not all patients show a benefit from its
use. Usual pacemaker precautions and ongoing follow-up will be
specified. Dietary measures and drug therapy for congestive heart
failure will remain components of your treatment plan. Catheter Ablation
This procedure is helpful in the treatment of persistent cardiac
arrhythmias and is performed by a specially trained cardiologist
in the electrophysiology lab. When an abnormality of the heart’s
electrical system occurs producing an abnormal heartbeat, the purpose
of the ablation procedure is to disrupt the electrical conduction
pathway creating the arrhythmia. This is accomplished by introducing
electrode catheters via peripheral vessels and applying radiofrequency
waves to the abnormal pathway. This stops the abnormal conduction
in this particular region of the heart. To assess the procedure
success, attempts will be made to reproduce the abnormal heartbeat
under the controlled conditions of the electrophysiology lab. If
the electrical challenge does not reproduce the arrhythmia, the
radiofrequency waves have successfully eliminated this area of
electrical conduction. Developments in treatment options for vascular disease now include
what is referred to as minimally invasive endovascular approaches.
These procedures are accomplished through small peripheral incisions
rather than the traditional open surgical approaches. Balloon Angioplasty
Balloon angioplasty with stent placement is now sometimes an option
for alleviation of blockages in arteries and veins. A balloon catheter
is directed to the area of obstruction and inflated to disrupt
accumulated plaque and reestablish adequate blood flow. Placement
of a stent, or wire-meshed tube, acts as a scaffold to prevent
reoccurrence of the blockage at the angioplasty site. Because only
a small incision is required to accomplish this technique, patients
generally recover more quickly with decreased postprocedural discomfort. Balloon angioplasty and stent placement for treatment of carotid
artery disease remains in an investigational phase. Not yet approved
by the Food and Drug Administration, this technique may be used
to disrupt plaque formation or atherosclerosis within the carotid
arteries thus ensuring adequate blood flow to the brain. Studies
of its effectiveness versus the open surgical approach of carotid
endarterectomy are ongoing. Endovascular Stent Grafting of Abdominal Aortic Aneurysm
Endovascular stent grafting is a relatively recent technology
development that provides another option for treatment of an abdominal
aortic aneurysm. This condition, sometimes referred to as “triple
A,” is a bulging or ballooning of the wall of the abdominal
aorta. The aorta is the body’s largest blood vessel and carries
the oxygenated blood away from the heart to the body. Stent grafting
offers a repair option for patients whose general health condition
may place them at significant risk with the traditional open surgical
procedure. Endovascular stent grafting is accomplished from two small incisions
made at the top of each groin. A special catheter under x-ray guidance
is used to place a stent graft at the site of the aneurysm. Blood
flow now occurs through the stent graft, or fabric tube, thus reducing
the pressure of blood flow at the aneurysm site. This procedure
is performed with mild sedation and local anesthesia. In comparison,
to the open surgical repair, patients who undergo endovascular
stent grafting can expect a much shorter hospital stay, less discomfort,
and a shorter recovery time. However, endovascular stent grafting is not suited for repair
of all abdominal aortic aneurysms. Vessel size, the location and
nature of the aneurysm, and the patient’s other health conditions
will be considered in deciding which approach is best for each
individual. Because this is a recent technology, long-term results
are not known and studies of patients who have undergone the procedure
are continuing. | 
