Interventional cardiology is involved in the transcatheter treatment of certain heart diseases. Interventional cardiologists are trained to perform this type of treatment in cardiac catheterization laboratories within a hospital. Most of the interventions that are performed on the cardiovascular system are considered minimally invasive due to the size of the incision that does not exceed 2 cm. These procedures involve inserting a catheter into certain blood vessels of the arms or legs to the heart or a certain segment of a blood vessel and it is monitored under x-rays.
The advantages of this type of interventions include reduced pain, significantly reduced risk of infections, avoidance of major scarring and a shorter recovery time after the intervention. In most cases the patients are awake during the intervention and anesthesia is given locally and the patients can go home a few hours after the intervention.
Interventional procedures include:
- Balloon angioplasty: it is used for unclogging a clogged artery by inserting a small balloon and inflating it wherewith it pushes the atherosclerotic plaque towards the wall of the artery, thus establishing a normal blood flow, whereupon the balloon is removed from the blood vessel.
- Carotid stenting: during this procedure, a stent is inserted into the narrowed or clogged carotid arteries, which are the arteries that feed the brain.
- Correction of a congenital heart defect: usually it is performed for correction of a congenital opening between the atria or ventricles of the heart or for angioplasty of the large blood vessels.
- Intracoronary stenting: inserting a small metallic mesh tube called a stent that will keep the coronary arteries open at the spot of their previous narrowing.
- Implantable cardioverter defibrillators (ICD): these are implanted in people with an increased risk of sudden cardiac failure. They are implanted subcutaneously through a small incision near the shoulder, they use electrical impulses for correction of life-threatening irregular rhythm.
- Implanting an electrostimulator – pacemaker: mostly in patients with unusually slow heart rhythm, heart failure, and in people at risk of sudden cardiac death. The pacemakers coordinate the pump action of the heart by sending electrical signals.
- Peripheral arterial disease: assessment of the disease of the blood vessels outside the heart. The balloon angioplasty and stenting techniques can be used in this case as well.
Procedure wherewith the cardiologist makes a small incision on the arm or the leg through which he inserts a catheter through a blood vessel to the heart. This procedure is used for:
- Determination of the location and the size of the blood vessel constrictions
- Determination of the pumping force of the heart and the function of the valves
- Taking blood from a specific segment
- Determination of blood pressure in a particular segment
- Injection of a contrast agent visible under the x-rays in the arteries for determination of their loading with blood.
The information obtained from this procedure is helpful in planning a cardiovascular surgery or in resolution of the condition with another type of intervention procedure such as angioplasty.
Angioplasty / percutaneous coronary intervention
It is used for opening the arteries that have been constricted by atherosclerosis and it is performed through a catheter inserted with an incision from an arm or a leg to the arteries that feed the heart. The catheter has a deflated balloon at the top and when it reaches the tightened or clogged part, it is inflated in order to push the atherosclerotic plaque towards the artery wall and it extends the artery to improve the blood flow.
About 70% of angioplasty procedures end with stenting – inserting a small metal cylinder called a stent in the artery. The closed stent is positioned through a closed balloon at the top of the catheter, and when the balloon inflates, the stent opens and stabilizes the arterial walls. After this, the balloon and the catheter are removed and the stent remains forever and within a few weeks the cells of the artery envelop it.
There are 2 types of stents: Bare-metal stents and drug-eluting stents that prevent scarring and reduce the risk of arterial re-closure.
It is used for expansion of narrowed valves that do not open properly, for example during aortic stenosis. In this procedure, the balloon at the top of the catheter inflates in order to stretch and fully open the valve.
IMPLANTING AN ELECTROSTIMULATOR – PACEMAKER mostly in patients with unusually slow heart rhythm, heart failure, and in people at risk of sudden cardiac death. Pacemakers coordinate the pump action of the heart by sending electrical signals.