Cardiac Catheterization/Angiography

Cardiac catheterization is a diagnostic test, which provides information about the function of the heart.  The study evaluates the overall pumping function of the heart, the valves that direct blood flow through the heart, and the coronary arteries that supply the heart muscle itself with oxygen and nutrients.

Coronary angiography is part of the catheterization protocol.  A coronary angiogram (or arteriogram) is the x-ray imaging of the coronary arteries. A thin flexible tube, called a catheter, is inserted through a needle into an artery either in the upper part of the leg near the groin, an artery near the elbow, or one near the wrist.  The procedure is performed with local anesthesia and mild oral and/or intravenous sedation, which should eliminate any discomfort.  The catheter is advanced to the heart under X-ray guidance.  A contrast agent is then injected through the catheter to precisely locate any stenosis, or blockage. The images are recorded on x-ray film.

Coronary artery disease, or atherosclerosis, is the deposition of a fatty-like material within the wall of the artery. If coronary artery disease is detected, treatment options may include medical therapy, a catheter procedure (PTCA/angioplasty, stent implantation, or atherectomy), or open-heart bypass surgery.

After the procedure, patients typically remain in bed for several hours. Patients are asked to increase fluid consumption following the test. The angiographic contrast is removed from the bloodstream by the kidneys and excreted in the urine; there is no change in the color of the urine.

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Angioplasty (PTCA)/Stent Implantation

PTCA (Percutaneous Transluminal Coronary Angioplasty) and stent implantation are minimally invasive procedures performed to improve blood flow in narrowed coronary arteries. A PTCA/stent procedure is performed similarly to a cardiac catheterization, utilizing the same local anesthesia and sedation.  In PTCA, a balloon-tipped tube, or catheter, is transiently inflated within the coronary artery to open the narrowing, or stenosis. The balloon catheter is then removed.  Frequently, a stent is implanted during a PTCA procedure.  A stent is a flexible wire mesh tube that holds the newly expanded artery open. Some stents are coated with one of several medications, which decrease the likelihood of restenosis.  Restenosis is the renarrowing of the vessel as it heals and remodels after a PTCA procedure.

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Coronary Atherectomy

An alternative to PTCA, atherectomy is a procedure during which a small cutting device or drill is used to shave away plaque that builds up within the wall of coronary arteries. The procedure is a catheter intervention, similar to PTCA or stent implantation. Depending on the size of the artery, the characteristics of the stenosis, and its location, your physician may decide if this is a suitable option for your care.

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Percutaneous Aortic Balloon Valvuloplasty (PABV)
Percutaneous Mitral Balloon Valvuloplasty (PMBV)

A balloon valvuloplasty is a procedure used to open abnormally narrowed (stenotic) valves in the heart, in order to promote normal bloodflow. Valves regulate blood flow between the chambers of the heart. If the mitral valve is stenotic, blood may “back up” into the lungs, causing congestive heart failure.  If the aortic valve is stenotic, the main pumping chamber of the heart generates an abnormally high pressure.  The heart may become thickened and stiff, leading to chest pain (angina), congestive heart failure, fainting, or sudden death.

Previously, open-heart surgery was the only option to treat significantly stenotic heart valves in symptomatic patients.  Balloon valvuloplasty is a minimally invasive procedure performed in the cardiac catheterization laboratory.  A balloon is inserted into a vessel in the groin and advanced to the heart.  The balloon is transiently inflated across the narrowed valve and then withdrawn.  Once opened, the valve function is improved.

Valvuloplasty is performed utilizing local anesthesia and mild oral and intravenous sedation.  Patients are hospitalized for only one or two days after the procedure. 
Percutaneous mitral balloon valvuloplasty (PMBV) is a well-accepted procedure.  The results are comparable to surgical repair of a narrowed mitral valve. 

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Percutaneous Endovascular Mitral Valve Repair
Evalve MitraClip

A novel device, the Evalve MitraClip, is being evaluated against surgical valve repair or replacement at St. Francis Hospital. 

The mitral valve is situated between the left atrium and the main pumping chamber of the heart, the left ventricle.  As oxygen-rich blood leaves the lungs, it enters the left atrium and then passes across the mitral valve.  If the mitral valve does not close properly and leaks (mitral regurgitation or mitral insufficiency), when  the left ventricle pumps, blood passes back to the lungs.  This can lead to congestive heart failure. Mitral regurgitation can be controlled with medications, but not cured.  Previously, only open-heart surgery with valve repair or replacement was available to correct mitral regurgitation. 

Dr. Berke is the principal investigator of the EVEREST II trial at St. Francis. The MitraClip is a small device inserted through a vein in the leg.  It is positioned in the heart using X-ray and echocardiographic guidance.  The procedure typically requires only a one-night hospitalization. 

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Endomyocardial Biopsy

An endomyocardial biopsy is a procedure used to diagnose and monitor disease of the heart muscle itself. A catheter is introduced into a vein in the neck or one in the groin.  Local anesthesia is used with oral and intravenous sedation. Using forceps (tweezers), a small sample of tissue is removed from the heart.  There is no discomfort, because there are no pain fibers in the heart. A pathologist studies the sample microscopically. Possible causes of heart muscle dysfunction include infection, inflammation, infarction, storage diseases, or damage caused by chemotherapy, radiation, or toxins. Biopsies are also commonly performed after a heart transplant, to evaluate for possible rejection.

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ECG (Electrocardiogram)

An electrocardiogram (ECG) is an office test that records the electrical activity of the heart. The test measures the rate of the heartbeat and the status of the electrical conducting system of the heart.  Information may be inferred about the size and position of the heart chambers. Damage to the heart muscle may cause a change in the ECG.  The effects of some drugs or devices like pacemakers may be noted on an ECG. The test is administered by placing ten electrodes to the skin. The test is highly accurate and very useful in identifying the presence of heart disease.

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Pacemaker Follow-up

Pacemakers are implanted devices that give an impulse to the heart to beat, when the heart’s own electrical conducting system is diseased.  Pacemakers must be periodically checked in the office. A computerized detector placed over the pacemaker can give information about the remaining battery charge as well as the sensitivity and function of the pacemaker leads in the heart. ”Events”, such as arrhythmias (irregular beats) are stored by the pacemaker and can be retrieved and analyzed by the physician during pacemaker follow-up.   

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