Minimally Invasive Procedures
Minimally invasive procedures are performed through small incisions using specialized surgical instruments. The incision used for minimally invasive heart surgery is about 3 to 4 inches instead of the 6 to 8 inch incision required for traditional surgery. The benefits of minimally invasive surgery techniques may include:
- A smaller incision
- A smaller scar
- Decreased risk of infection
- Less bleeding
- Less trauma
- Less pain
- Decrease in the length of stay in the hospital after surgery
- Decreased recovery time
Minimally invasive treatments include:
Angioplasty
Angioplasty is a procedure in which a small balloon at the tip of the catheter is inserted near the blocked or narrowed area of the coronary artery. The technical name for balloon angioplasty is percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart. This procedure is sometimes complicated by vessel recoil and restenosis.
In cutting balloon angioplasty, the catheter has a balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then, the balloon compresses the fatty matter into the arterial wall. This type of balloon may be used to treat the build up of plaque within a previously placed stent (restenosis) or other types of blockages.
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Atrial Fibrillation Ablation
Atrial fibrillation is the most common irregular heart rhythm in the United States. Atrial fibrillation is an abnormal heart rhythm originating in the atria. Instead of the impulse traveling in an orderly fashion through the heart, many impulses begin and spread through the atria and compete for a chance to travel through the AV node. This causes a rapid and disorganized heartbeat.
Atrial fibrillation ablation is a type of treatment for cardiac arrhythmias. During ablation, a doctor inserts a catheter (thin, flexible tube) into the heart. A special machine delivers energy through the catheter to tiny areas of the heart muscle that cause the abnormal heart rhythm. This energy “disconnects” the pathway of the abnormal rhythm. The ablation procedure also can be used to disconnect the electrical pathway between the upper chambers (atria) and lower chambers (ventricles) of the heart. The type of ablation performed depends upon the type of arrhythmia.
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Cardiac Cathetierization
Cardiac catheterization is a test that uses a catheter (tube) and x-ray machine to assess the heart and its blood supply. It is generally to find out why you are having symptoms, like chest pain, that could mean heart problems. Cardiac catheterization helps doctors to identify narrowed or clogged arteries of the heart, measure blood pressure within the heart, evaluate how well the heart valves and chambers function, check heart defects and evaluate an enlarged heart.
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Cardiac Defibrillator Implantation
An implantable cardioverter defibrillator (ICD) is a device that is placed permanently inside your body. An ICD monitors your heart rhythm (the speed and pattern of your heartbeat). If this rhythm becomes too fast or too slow, the ICD sends out electrical signals that help bring the rhythm back to normal. The ICD is put inside your body during a minor surgical procedure called implantation. In most cases, implantation takes 1 to 3 hours.
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Cardiac and Vascular Artery Stenting
In most cases, balloon angioplasty is performed in combination with the stenting procedure. A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently. During a period of several weeks, the artery heals around the stent. In this way, restenosis is somewhat diminished compared with balloon angioplasty.
Drug-eluting stents contain a medication that is actively released at the stent implantation site. Drug-eluting stents have a thin surface of medication to further reduce the risk of restenosis.
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EP Ablation
Electrophysiology (EP), often used as a diagnostic tool, is also used to help correct arrhythmias through catheter ablation. Ablation is a treatment that cauterizes (burns) cells to eliminate rhythm abnormalities in patients.
During an EP study the electrophysiologist will thread special electrode catheters to the heart, normally through the groin area. Once it is determined which area of the heart is responsible for the arrhythmia, a special wire carrying radiofrequency energy is used to cauterize the site. Catheter ablation is an outpatient procedure that normally takes only a couple of hours to complete and has few complications.
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Electrophysiology Study
Electrophysiology (EP) studies are used to locate and diagnose the cause of known arrhythmias, whether they occur in the upper chambers of the heart (atria) or lower chambers of the heart (ventricles). In general, EP studies are only recommended for patients whose conditions could not be adequately diagnosed with a standard electrocardiogram (ECG). Because the EP study is invasive, it is not considered a first-line diagnostic test for arrhythmias.
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Interventional Radiology
Interventional Radiology (abbreviated IR or sometimes VIR for vascular and interventional radiology) is a subspecialty of radiology in which minimally invasive procedures are performed using image guidance. Some of these procedures are done for purely diagnostic purposes, while others are done for treatment purposes. Images are used to direct these procedures, which are usually done with needles or other tiny instruments like small tubes called catheters. The images provide road maps that allow the Interventional Radiologist to guide these instruments through the body to the areas of interest.
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Mitral Valve Repair
Percutaneous valvotomy (also called valvuloplasty) is performed in many patients to treat mitral valve and pulmonic valve stenosis (narrowing of the valve). Percutaneous valvotomy may also be performed in carefully selected patients to treat stenosis of the aortic valve.
During mitral valvotomy, a catheter is placed through the femoral vein (in the groin) and guided into the chambers of the heart. The cardiologist then creates a tiny hole in the wall between the heart’s two upper chambers. This hole provides an opening for the cardiologist to access the left atrium with a special catheter that has a balloon at the tip.
The catheter is positioned so the balloon tip is directly inside the narrowed mitral valve. The valve opening is widened by rapidly inflating and deflating the balloon. Once the cardiologist has determined that the opening has been widened sufficiently, the balloon is deflated and removed.
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Valvular Heart Disease
Valvular heart disease is the name given to any dysfunction or abnormality of one or more of the heart’s four valves. There are a number of types of valvular heart disease, including:
Valvular Stenosis – A condition in which there is a narrowing, stiffening, thickening, fusion or blockage of one or more valves of the heart. As a result, the defective valve can interfere with the smooth passage of blood through it. Depending on which valve is affected, the diagnosis may be aortic stenosis, mitral stenosis, pulmonic stenosis or tricuspid stenosis.
Valvular Regurgitation – A condition in which blood leaks back in the wrong direction because one or more of the heart’s valves is closing improperly. The nature and severity of the leakage, in turn, may keep the heart from circulating an adequate amount of blood through the defective valve. Depending on which valve is affected, the diagnosis may be aortic regurgitation, mitral regurgitation, pulmonary regurgitation or tricuspid regurgitation.
Atresia of One of the Valves – A serious condition in which one of the valves has failed to develop properly and is completely closed at birth. Depending on which valve is affected, the diagnosis may be aortic atresia, mitral atresia, pulmonary atresia or tricuspid atresia.
Mitral Valve Prolapse – A common and rarely serious condition in which the two flaps of the mitral valve (located between the left atrium and the left ventricle cannot close properly, and may result in blood leaking back into the left atrium (mitral valve regurgitation). It is due to either one (or both) of the flaps being too large, or because the muscle “hinges” of the flaps are too long.
Treatment for valvular heart disease depends on the type and severity of the diagnosis. People with minor valve problems may not require treatment. Those with more serious disorders can often be treated successfully with medications such as, ACE inhibitors, antiarrhythmics, antibiotics, anticoagulants, diuretics or inotropes.
If medications are not successful or a valve condition worsens interventional procedures and/or surgery may be necessary. These may include heart valve repair or replacement.
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