Often used along with angiography and other procedures, cardiac catheterization has become a prime tool for visualizing the heart and blood vessels and diagnosing and treating heart disease.
PTCA - Percutaneous Transluminal Coronary Angioplasty, or PTA (Percutaneous Peripheral Angioplasty) more commonly refered to as a "balloon" procedure is one of the most commonly known interventional cardiac procedures. This procedure has been used to open coronary arteries for over 20 years. Cardiologists have seen many changes in techniques for accomplishing the procedure over the past years but the basic procedure has not changed. A catheter with a balloon on the end is inflated at the blockage inside the artery to "push" the plaque against the artery walls and allow the blood to flow normally.
A stent is a small stainless steel tube that is permanently placed inside an artery to keep it open. Stents can be placed inside many different arteries. Stents can be used to open the coronary arteries, arteries in the leg, kidney, neck (carotid), or other peripheral arteries. Stents are mounted on the top of a balloon catheter and then pushed through the blockage. The balloon is then inflated and the stent expanded pressing against the artery wall. The balloon is then deflated and removed leaving the vessel lumen held open by the stent. Some stents are self-expanding and are deployed without the aid of a balloon catheter.
Atherectomy - In this procedure, the plaque is actually "removed" from the inside of the blocked artery. There are three different types of atherectomies. Extraction - The catheter is placed at the beginning of the blockage. The catheter tip rotates, cuts, and vacuums the blockage out of the body. The procedure may be repeated several times before the blockage is sufficiently reduced. This procedure is commonly referred to as a TEC Atherectomy.
Directional - The catheter shaves the plaque from the inside of the artery. The catheter is then removed and the plaque removed from inside the catheter tip (cutting device). Directional atherectomy is used to removed plaque that is only on one side of the artery rather then all the way around the inside of the artery. This procedure is commonly referred to as a DVI Atherectomy.
Rotational Ablation - A small drill (burr) turns quickly to cut through plaque that is very hard. The hard plaque is cut into very fine particles that are eliminated by the body. This procedure is commonly referred to as a Rotoblator Atherectomy. Permanent
Pacemaker - Pacemaker procedures are done for many different reasons. The basic indication for pacemaker implantation is that there is some defect in the electrical conduction system in the heart. The patient may be experiencing a slow heart rate, an erratic heart rate, an irregular beating of the atrium and ventricle, or several other abnormalities. Many different types of pacemaker are used to treat the various conditions. The procedure is usually performed from the left or right subclavian vein approach. Wire(s) are placed in the right atrium and/or right ventricle via the subclavian vein and then an analyzer is connected to the leads to confirm proper positioning and conduction. After lead placement a small generator is connected to the wire(s) and permanently placed just under the skin in the subclavian area. Special post-operative precautions must be taken to ensure that lead placement is maintained.
Pacemaker Lead Extraction - Occasionally pacemaker leads must be removed. Most of the time new leads are inserted without removal of the malfunctioning lead. Most often, the pacemaker leads malfunction due to a fracture (break) of the lead which results in failure to adequately conduct electrical impulses. Pacemaker leads may need to be removed because of sepsis or because the patient has already had additional leads implanted and there is just not enough area in the vessel to accommodate additional leads. Special extraction equipment is used to tunnel over the old lead and then remove (pull) the damaged leads through the tunneling device. This procedure is done under general anesthesia.
Cardioversion - Synchronized cardioversion is an electrical shock applied to the chest to momentarily stop the heart so that normal sinus rhythm may take over. Conditions that warrant cardioversion are atrial fibrillation, atrial flutter, PSVT, and stable ventricular tachycardia. Sedation is given just prior to delivering the external electrical shock to produce an amnesic effect post procedure. Cardioversions are done in a controlled environment by appropriately trained nursing staff and a physician. Cardioversions are frequently done in the CCU, ER, or outpatient areas as long as facilities are appropriately equipped to monitor the patient.
Venacava Filter Placement (IVC filter) - Venacava filters are placed in the inferior vena cava for only one reason; to prevent thrombus from traveling through the venous system back to the heart and lungs. IVC filters are delivered into the inferior vena cava via the femoral or jugular vein. The procedure may be done in the X-Ray Department or the Cath Lab under fluoroscopy. Once the filter is deployed in the inferior vena cava it can never be removed. Patient must continue on anticoagulation therapy post procedure.
Valvuloplasty is a procedure that is performed with a large balloon to stretch open a valve. The valve is stretched open by the balloon for only a few seconds at a time and then pressure readings and angiogram are taken to determine the status of the value function. Not all patients with valvular stenosis are candidates for valvuloplasty. Most patients with valvular stenosis are taken to the operating room for replacement of the stenotic value. Valvuloplasty is most commonly used on the aortic or mitral values but can be done on any valve in the heart.
