BALLOON VALVULOPLASTY

Balloon Valvuloplasty (or valvulotomy) means dilation of narrowed cardiac valve with balloon. This modality of treatment useful in certain diseases of valves of the heart in which valve stenosis occurs either due to birth defect or due to acquired inflammation. This procedure is usually done by a small injection from your groin region under local anesthesia. Mild sedation is given to you for pain relief. You remain conscious during the procedure; unlike valve replacement surgery which is an open heart surgery and requires general anesthesia.

In this procedure a long, thin tube (catheter) is inserted from your groin. Then a balloon is advanced to your heart and passed across the diseased narrowed valve. Now the balloon is inflated to open or stretch the valve. The balloon is then deflated and it is removed along with the catheter from your body. Balloon valvuloplasty relieves many symptoms of heart valve disease, but may not completely cure it.

Balloon valvuloplasty is useful for all 4 cardiac valves named Mitral, Aortic, Pulmonary and Tricuspid. It is commonly done in rheumatic heart disease involving mitral valve causing mitral stenosis (narrowing of mitral valve). Balloon aortic valvuloplasty and ballon pulmonary valvuloplasty are commonly performed in children.

If you have any heart valve problem, you should consult your cardiologist. Cardiologist will perform Echocardiography to look at the problem in the valve and then can advise whether you should get benefit of balloon valvuloplasty and whether it is an appropriate treatment for your condition.

DEVICE CLOSURE OF ASD/VSD/PDA

ASD, VSD and PDA are birth defects and usually present in children; but can be first time detected in adult also.

ASD (Atrial Septal Defect): A hole in the septum (wall) between the heart’s two upper chambers is called ASD.

VSD (Ventricular Septal Defect): A hole in the septum (wall) between the heart’s two lower chambers is called VSD.

PDA (Patent Ductus Arteriosus): Abnormal connection between two major arteries of the heart named Aorta and Pulmonary artery is called PDA.

All these defects allow blood to pass from the left side of the heart to the right side, which is abnormal and increase load on the heart.

To correct such defects, surgery was the usual method. But now thanks to medical advances, cardiologists can use catheter procedures to close such defects without major open heart surgery. This procedure is called as device closure of the defect. In this procedure, a catheter (tube) is inserted from your groin and advanced to your heart. Then it is passed across the defect. The catheter is equipped with an umbrella-like device, which is dislodged across the defect. This special device remained opened in the defect and by this way it plugs the defect. Over the time, the defect gets closed permanently.

Cardiologists often use special echocardiography called Trans-esophageal echo (TEE) and angiography before doing this procedure to close the defect.

PERIPHERAL ANGIOGRAPHY AND ANGIOPLASTY

A peripheral angiography is a test similar to coronary angiography. Unlike coronary angiography which is used to look the condition of artery supplying your heart; peripheral angiography is used to check condition of blood vessels supplying your legs and arms. This test uses special x-ray machine and it is performed in cath lab.

WHEN TO DO PERIPHERAL ANGIOGRAPHY?

Peripheral angiogram is useful test for the diagnosis of peripheral artery disease (PAD). PAD is a disease in which cholesterol and/or blood clots cause narrowing of the lumen of the artery supplying blood to your the legs or arms. Such blocks in the artery cause muscle pain or cramping in legs or arms on activity, such as walking or climbing stairs, and disappears after a few minutes of rest (intermittent claudication).

Once the disease progresses, you may feel pain even at rest. Critical narrowing of the artery can cause ulcer or gangrene formation in your leg.

PERIPHERAL ANGIOPLASTY

Treatment for peripheral artery disease includes special drugs that reduce the pain in your leg while walking or climbing stairs. If symptoms are not relieved with the medications then angioplasty or surgery is indicated. In peripheral angioplasty, a catheter (thin hollow tube) is inserted through your groin. Then in this catheter a balloon is advanced in the blocked artery.

The balloon is then inflated; this widens the artery and reduces the block. A stent (a small mesh tube) may be placed in the artery during angioplasty. A stent helps keep the artery open and prevent re-occlusion.

CATHETER-DIRECTED THROMBOLYSIS (CDT)

Sometimes your artery may be blocked due to blood clot in it. In such situation injection of a clot-dissolving drug (clot busters) into your artery through a catheter (thin hollow tube) is done to break the clot and to restore the blood flow in the blocked artery.

RENAL & CAROTID ANGIOPLASTY

RENAL ANGIOPLASTY

Renal artery stenosis is the narrowing of the arteries that supply blood to the kidneys. It can lead to uncontrolled hypertension, which should be treated initially with medications. If you have renal artery stenosis and blood pressure remains uncontrolled or complications such as pulmonary edema or worsening kidney function develop, angioplasty with stenting should be performed. Renal angioplasty restores blood flow through the renal artery and improves blood flow to your kidney. Renal angioplasty can be done by a small puncture done from your groin or sometimes from left arm. Initially the blocked artery is opened by inflating a tiny balloon in it; it is followed by permanent placement of a stent. This procedure is very similar to coronary angioplasty.

CAROTID ANGIOPLASTY

Cholesterol deposition (plaque) can narrow or block your carotid arteries which supply blood to the brain. When one or both of your carotid arteries are narrowed, it can make it hard for blood to flow to the brain. Sometimes blood clot develops in that narrowed part and may dislodge to the brain. This blood clot in the brain can block the artery in your brain and that results in stroke and paralysis. Carotid artery angioplasty and stenting may improve blood flow to your brain and lower the risk of having a stroke.

Your doctor may suggest for carotid artery stenting if:

• You have had a mild stroke or transient ischemic attacks (TIAs) in the past 6 months and your carotid artery is narrowed by 70% or more.
• You have a low risk for complications from the procedure.
• You have a high risk of complications from carotid artery surgery.

Carotid angioplasty is performed by a small puncture in your groin. The procedure is similar to coronary angioplasty. Additionally, an umbrella-shaped filter (embolic protection device) is placed beyond the block during the procedure; it helps to catch any debris that may break off from the narrowed area of artery during ballooning and stenting.

TAVR – Transcatheter Aortic Valve Replacement

WHAT IS TAVR? (Also called TAVI)

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). Transcatheter aortic valve replacement is sometimes called transcatheter aortic valve implantation (TAVI).

TAVR may be an option for people who are considered at intermediate or high risk of complications from surgical aortic valve replacement. TAVR may also be indicated in certain people who can’t undergo open-heart surgery.

WHO BENEFITS MOST FROM TAVR?

TAVR may be an option if you have aortic stenosis that causes signs and symptoms. For instance, people who are candidates for TAVR may include those who are considered at intermediate or high risk of complications from surgical aortic valve replacement. Conditions that may increase the risk of surgical aortic valve replacement include lung disease or kidney disease — which increase your risk of complications during surgical aortic valve replacement.

HOW IS TAVR OR TAVI DIFFERENT FROM THE STANDARD VALVE REPLACEMENT?

Usually valve replacement requires an open heart procedure with a “sternotomy”, in which the chest is surgically separated (open) for the procedure. The TAVR or TAVI procedures can be done through very small openings that leave all the chest bones in place. The TAVR procedure is performed using one of two different approaches, allowing the cardiologist or surgeon to choose which one provides the best and safest way to access the valve:

Entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest, or
Using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.

TAVR/TAVI – Latest Treatment of Aortic Valve/Heart Valve

EVAR & TEVAR FOR AORTIC DISSECTION & ANEURYSM

AORTIC DISSECTION

Aorta is the largest artery in the body and arising directly from the heart. Aortic dissection occurs when a tear develops in the wall of the aorta. As the tear extends along the wall of the aorta, blood can flow in between the layers of the blood vessel wall (dissection). This can lead to aortic rupture or decreased blood flow to organs. In most cases, the symptoms begin suddenly, and include severe chest pain. The pain may mimics heart attack. The pain is usually described as tearing or stabbing and radiating to the shoulder blades.

There are 2 types of aortic dissection:

• Type A – aortic dissection which involves ascending aorta and arch
• Type B – aortic dissection which involves descending aorta

Aortic dissection is a medical emergency requiring immediate treatment. Treatment may include surgery or endovascular repair depending on the location of the dissection.

AORTIC ANEURYSM

Aortic aneurysm is a bulge or ballooning in its wall. If an aneurysm grows large, it can burst and cause dangerous bleeding or even death.

There are 2 types of aortic aneurysm:

• Thoracic aortic aneurysms – these involves the part of the aorta running through the chest cavity
• Abdominal aortic aneurysms – these involves the part of the aorta passing through the abdomen

CT aortogram is helpful in the diagnosis of this condition. Small aortic aneurysms which are not causing any symptoms are monitored over time until they become large. When an aortic aneurysm is large or associated with symptoms, it should be repaired by surgery or by endovascular approach like EVAR or TEVAR.

EVAR & TEVAR

EVAR (abdominar EndoVascular Aneurysm/Aortic Repair) and TEVAR (Thoracic EndoVascular Aneurysm/Aortic Repair) are newer techniques used to treat pathology of the aorta, like aortic aneurysm and dissection. The procedure involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. Incision is made in both side of groin to cannulate femoral arteries.

It is similar to the approach used for coronary angiography and angioplasty. Then stent-graft is introduced through the femoral artery in the groin and with the use of x-ray guidance and specially-designed instruments, the aneurysm can be repaired from inside the aorta by deploying the stent-graft.

The stent graft provides a new channel for the blood to flow through, reducing the pressure on the diseased area of the artery and helping to prevent a rupture. The recovery time for endovascular repair is less than the recovery time for open abdominal or open chest repair.

An ST-segment Elevation Myocardial Infarction (STEMI) is the most serious form of heart attack in which a coronary artery is completely blocked, resulting a large part of the heart muscle being unable to receive blood. Let’s see how to survive this most dangerous form of heart attack.

Habits influence how we live our lives and our health. So what are the good habits you follow in your daily life for your heart? Here’re some of the good and heart healthy habits that everyone needs to focus for a healthy heart.
Follow our Facebook Page (/TejasPatel.Cardiologist) & learn more ways and health tips to prevent heart disease at any age 20s, 30s, 40s, 50s and beyond.

Who don’t like cheese? However it has more fat content, which makes people skeptical about eating cheese. Cream cheese comes in numerous forms: brick, regular, whipped, light, fat-free and Neufchatel and a dozen more or the type.

And among different kinds of cheeses, is cream cheese healthy?

It totally depends on which kind you choose. Whipped cream cheese could be a better option when it comes to a healthy heart. So if you are a cream cheese lover, give it a touch of whip.
Regular cream cheese has a fair amount of fat, especially the artery-clogging kind, for a pretty moderate serving. But cream cheese can still grace your morning whole-wheat bagel. Reach for the whipped type in the dairy case. You can save about half the calories and saturated fat.
Whipped cream cheese incorporates air (from whipping) so it seems as if you’re eating more. Two tablespoons have 80 calories, 8 grams of fat and 5 grams of saturated fat. (source: blog.foodnetwork.com)
The verdict: If you are a cream cheese lover, give it a touch of whip.To make a little go even further, have some whipped cream cheese bagels. Beyond the traditional uses, cream cheese can enhance the taste of many healthy recipes like mashed potatoes, fruit pizza, etc. As always, the key is to check for your heart and say #IAmHeartHealthy.