INTERVENTIONAL CARDIOLOGY IN INDORE
Interventional Cardiology is a branch of Cardiology that specifically deals with the catheter based treatment of structural heart diseases. Most interventional Cardiology procedures are regarded to be minimally invasive as they do not call for an instrument to penetrate inside the body or make large incisions (incisions are just about 1 inch mostly). These procedures typically entail the insertion of a catheter (hollow tube) into the femoral artery in the upper leg. The catheter is manoeuvred towards the heart or vascular area through the use of real-time X-ray. Interventional Cardiology and Radiology uses the least invasive techniques hence the patient is benefitted with minimal scar and less hospital stay.
MINIMALLY INVASIVE HYBRID REVASCULARISATION
Minimally Invasive Hybrid Revascularisation is a procedure that combines minimally invasive coronary artery bypass grafting surgery (CABG) and angiography stenting procedure to restore blood flow to the heart when there is a build-up of plaque in the blood vessels. Patients with triple vessel blockage are mostly treated with a conventional Bypass surgery (by splitting the central chest bone) which is an intense procedure that needs a longer recovery time post-surgery.
This procedure allows the surgeon to work on a beating heart through a small chest incision (small thoracotomy) between the ribs with the help of high definition camera and monitor (Thoracoscope), without having to split the breastbone. This procedure helps quick recovery and major morbidity.
This Minimally Invasive Hybrid Revascularisation procedure has a unique two stage approach. Blockage of blood flow in the main vessel requires surgery while blocks in the other blood vessels supplying blood to the heart, can be treated either with surgery or angiography stent insertion. An Endoscopic Minimally Invasive CABG to the main vessel can be done followed by Angiography and stent insertion to the other vessels.
During the Endoscopic Minimally Invasive CABG, the surgeons perform the operation through a tiny incision under the left nipple (four or five centimeters wide) while the heart continues to beat. This technique lowers the risk of complications such as stroke, lung problems and kidney problems which are associated with the use of a heart-and-lung machine (in a conventional bypass procedure). The patients have reduced pain and less need for postoperative pain medication, smaller scars, a shorter stay in the hospital and a faster recovery. As a stage two approach, angiography and drug eluting stent insertion to the remaining 2 blockages in the coronary artery under specialised Intravascular ultrasound guidance will be performed.
Hybrid revascularisation has alleviated all complications and the patient can be discharged on the fourth day post the procedure without any blood transfusion. This procedure is suitable to treat most patients with triple vessel coronary artery disease. Patients tend to have less pain with negligible risk and are able to return to normal activity within two weeks.
India’s first minimally invasive Hybrid Revascularization procedure was performed at Apollo Hospitals, Chennai by Dr. MM Yusuf. The surgery was performed to treat a triple vessel coronary artery block and give a new lease of life to a 57-year-old male patient, Mr. Zahir Hussain.
CARDIAC CATHETERIZATION AND CORONARY ANGIOGRAPHY
Procedure:
Catheters are placed via a sheath (narrow tube) in the artery of the groin or arm, advanced into the heart, and pictures are taken with injectable contrast dye and X-ray.
Major Indications:
- Unstable angina or Chest pain [uncontrolled with medications or after a heart attack]
- Heart attack
- Before a bypass surgery
- Abnormal treadmill test results
- Determine the extent of coronary artery disease
- Disease of the heart valve causing symptoms (syncope, shortness of breath)
- To monitor rejection in heart transplant patients
- Syncope or loss of consciousness in patients with aortic valve disease
Apollo Hospital, Vijay Nagar, Indore, performs procedures in a day care cath setting where the patient is discharged on the same day.
ANGIOPLASTY IN INDORE
It is also known as Percutaneous Coronary Interventions [PCI], Balloon Angioplasty and Coronary Artery Balloon Dilation.
Procedure:
Special tubing with an attached deflated balloon is threaded up to the coronary arteries. The balloon is inflated to widen blocked areas where blood flow to the heart muscle has been reduced or cutoff. Often combined with implantation of a stent to help prop the artery open and decrease the chance of another blockage.
Major Indications:
- Acute ST-elevation MI (STEMI)
- Non ST-elevation acute coronary syndrome (NSTE-ACS)
- Stable angina
- Anginal equivalent (eg, dyspnea, arrhythmia, or dizziness or syncope)
- Asymptomatic or mildly symptomatic patient with objective evidence of a moderate-sized to large area of viable myocardium or moderate to severe ischemia on noninvasive testing Apollo Hospital, Vijay Nagar, Indore
PRIMARY ANGIOPLASTY IN INDORE
Procedure:
A catheter (thin, hollow tube) is placed in through a small cut in your groin or wrist. The catheter is directed through the aorta (the main artery of the body) into the blocked artery in the heart. At the tip of the catheter is a small balloon. This is inflated, clearing the blockage in the artery. Around the balloon is a small metal tube, which can expand, called a stent. After 10 to 20 seconds, the balloon is deflated and taken out. The stent stays in place and hold the artery open. This means that blood can flow down through the artery again.
Major Indications:
In few cases, opening of blocked coronary artery during acute myocardial infarction is practised, in place of thrombolysis. An angioplasty which is performed as a planned treatment is termed as Coronary Angioplasty; however, in case of emergency, when an angioplasty is performed post heart attack, it is a primary angioplasty.
