Invasive/Interventional

Angioplasty and related techniques are also known as percutaneous coronary interventions (PCI). A PTCA or an angioplasty is a non-surgical procedure where a special balloon tipped catheter is inserted into the coronary artery through the groin. The procedure, which takes 1-4 hours, is used to open an area of the artery that has a narrowing due to a build-up of plaque. Once in place at the sight of the narrowing, a balloon is inflated to flatten the plaque against the artery walls to restore normal blood flow to the heart muscle. Depending on the size and location of the blockage, a stent may also be inserted to help provide support for the artery. This is referred to as coronary stenting and is typically done either to abort a heart attack or to relieve symptoms from a more chronic narrowing.

A coronary stent is a tiny, flexible wire mesh tube. It is permanently placed at the sight of a narrowing of the artery to help keep it open. Some stents are drug-eluting (coated). These stents slowly release medication over a period of time to reduce scar tissue that forms inside the artery. This helps prevent a reoccurrence of plaque buildup.

A heart catheterization - otherwise known as cardiac catheterization, coronary angiogram - is an invasive test done to determine whether there are any blockages in the coronary arteries or valvular heart disease. This test takes 1-2 hours. A small plastic catheter is inserted into the femoral artery and threaded up to the heart. A contrast agent (X-ray dye) is then injected into the coronary arteries and a moving x-ray (fluoroscopy) is then taken to show whether there is any narrowing or blockage of the arteries. If valvular heart disease is suspected, pressure readings are taken within the heart to determine how severe the problem is. This information enables your cardiologist to appropriately treat you either with invasive therapy or with medications.

Patients having a heart catheterization are asked to fast from midnight the night before their test. We want you to take your usual morning medications; however, we ask that you do not take any medication for diabetes that morning. If you take Coumadin, you will need to be off this medication for five full days prior to the procedure. If you are allergic to iodine, be sure to let your physician or nurse know as the "dye" does contain iodine. You may be asked to take additional medications to block this reaction, or medication may be given to you through the IV. Please bring a list of your current medications when you come for your catheterization. Following the procedure you will be instructed about what medicine to take and when to start taking them.

Post procedure, it is not uncommon for patients to notice a small amount of bruising at the catheterization insertion site. The catheter enters an artery where the pressure is high and there is always a small amount of blood that escapes into the tissue. If there is a large, painful area around the catheterization site that worsens or becomes more painful with time, notify your cardiologist.

A coronary atherectomy is a procedure utilized to restore normal blood flow through a blocked vessel by removing the fatty material (plaque) causing the blockage.

Transcatheter mitral valve repair (TMVR) or MitraClip is a minimally invasive technique for treatment of selected patients with symptomatic chronic moderate-severe or severe mitral regurgitation (MR). MR is a progressive disorder causing “leaking” of the mitral valve and symptoms of heart failure. The typical symptoms of heart failure are exertional breathlessness, fatigue, fluid retention and weight gain. MR can be caused by dysfunction of the valve leaflets (also known as primary or degenerative MR) or by remodeling of the left sided heart chambers (also known as functional MR). Significant MR is typically diagnosed with transthoracic echocardiogram or TTE and the mechanism of mitral valve dysfunction is confirmed by transesophageal echocardiogram or TEE. The standard of care for primary MR is surgical mitral valve repair or replacement whereas for functional MR usually medical therapy is optimized without surgical intervention. For patients ineligible for mitral valve surgery for primary MR or selected symptomatic heart failure patients with secondary MR, TMVR may be an effective treatment option for MR. 

The evaluation process for TMVR typically includes diagnostic testing (TTE, TEE, cardiac catheterization) and consultations (heart failure specialist, cardiac surgeon, and interventional cardiologist). Your physicians will work with your cardiologist and determine if there are coexisting cardiac disorders or other medical conditions that should be optimized prior to considering TMVR. 

A TMVR procedure is performed under general anesthesia in a cardiac catheterization laboratory using TEE guidance. Access to the heart is obtained through minimal invasive vascular techniques without the use of cardiopulmonary bypass or chest incision. On average, patients return home following an elective procedure in 2-3 days. After a TMVR procedure, most patients will experience improved heart failure symptoms and quality of life. Please speak to your cardiologist to consider if you would benefit from consultation with Dr. Morine for a TMVR evaluation.