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Angioplasty / Stenting

Angioplasty is a surgical procedure to correct a narrowed blood vessel of the heart. This procedure is carried out in a cardiac catheterization laboratory, simply known as cathlab. Patient is generally awake during the procedure. They are relaxed by providing pain relief medications before as well as after the surgery.

In this procedure, a sheath is inserted into the blood vessels. Usually, vessels of the upper leg, arm or groin are preferred. A hollow tube, catheter, is carried down the sheath to access the vessels. This catheter has a small balloon on the tip which is deployed into the coronary arteries.

When the balloon has reached the blockage site in the artery, it is inflated to widen or compress the pathway. Depending on the nature of the blockage, the inflation can last anywhere from 30 seconds to several minutes. There can be side effects in the form of chest pain which is very similar to angina. As the balloon temporarily blocks the flow of blood and oxygen that is transported to the heart, there is chest pain. Doctor should be immediately communicated if this happens.

In recent times, there is a process known as stent placing which is used in this method. It is a small mesh like device which is made of metal. It is also placed on the balloon and used when it reaches the site of obstruction. The primary function of this stent is to act as a support and keep the vessel open. This will not only improves the blood flow but will also reduce the pain of angina. After the blockage has been cleared, the balloon will be deflated and removed along with the catheter. The stent, however, will be left behind to hold the artery open.

FAQ

1. What are the benefits of stent placing?

Stent placing significantly improves the flow of blood and prevent damage to the heart muscle. It also reduces the occurrence of blockage after balloon angioplasty.

2. When can I get back to normal routine?

After the procedure, you will be kept in an observatory room for 2-3 days. After you are discharged, you can resume daily activities within a couple of days. Lifestyle changes are a must. You should follow a particular diet along with the medications that are suggested.

Balloon Valvotomy

Balloon valvotomy is the most preferred procedure for treating narrowed mitral valve. In most of the cases, it is used to treat mitral valve stenosis. This procedure can be performed on other valves too.

It is a non surgical and minimally invasive procedure in which long and slender tubes known as catheters are inserted through the artery of either groin or the arm. It is them threaded into the heart. A tiny hole is created in the wall between the upper two chambers of the heart to access the left atrium. This catheter has a balloon on the tip which is positioned directly inside the narrowed valve. The balloon is then inflated and deflated regularly to widen the opening. Once the valve is widened to its normal size, the balloon is first deflated and then removed.

Why is it performed?

The most common reason to perform this procedure is to get rid of the symptoms of mitral valve stenosis. Balloon valvotomy is recommended if you are showing moderate to severe symptoms of stenosis.

In case of no detected symptoms, there is need of this procedure if you have high blood pressure in the lungs. It is also recommended to old people who won’t be able to sustain a surgery.

What are the success rates?

The success rates of balloon valvotomy are very high. 80-95 percent of individuals who have undergone the procedure have successful outcomes and are relieved of symptoms. The results can be seen immediately.

One thing to remember about balloon valvotomy is that it does not cure the condition or make the valve normal. It just allows the valve to function normally which means that normal flow of blood is achieved. Improvement in blood flow will directly impact the symptoms. Lung congestion symptoms will be relieved as the blood pressure inside the left atrium decreases.

What are the risks involved?

When compared with an open heart surgery like commissurotomy and valve replacement, this procedure has lower risk of complications and fatality. After 5 years, around 35-50 percent of people will need another surgery.

EPS (heart electrophysiology studies)

What are electrophysiology studies?

Electrophysiology studies (EPS) are a type of medical tests which controls the rate and timing of the heart contractions. It studies the electrical activity of the heart to locate the irregular heartbeat. It is seen from where this heartbeat arises.

The results of EPS will act a diagnostic test. This will help the doctor get better understanding of the treatment method which an individual require. The options include medicine, pacemaker, Implantable Cardioverter Defibrillator (ICD), cardiac ablation or surgery. EPS do not take place in any ordinary room. They are carried out in a specially made room such as electrophysiology lab or cath lab. In both of the labs, you are given mild sedation.

Why are these tests needed?

  • These tests are done to locate the exact source of cardiac arrhythmias and other defects which might be present in the heart’s electrical system.
  • These tests are also done to see effectiveness of different drugs or therapies that are used in monitoring arrhythmia.
  • Symptoms such as dizziness, fainting, weakness and palpitation are assessed when other treatments are not working.
In this procedure, a catheter is inserted into a blood vessel. It is then threaded to your heart with the help of x-ray. Once it has been guided, recordings will be made of the heart’s electrical activity which includes stimulation of various parts of the electrical system.

What are the risks involved?
  • Arrhythmia is the most common risk involved in this test. There are abnormal heart rhythms which make you dizzy. Electrical shock is given to bring back a regular heartbeat.
  • Clotting of blood can be seen at the tip of the catheter. They break off and cause blood vessel blockage.
  • Other risks are infection, bruising and bleeding at the exact site where the catheter is inserted.

Complex Arrhythmia Ablation by 3D Mapping

What is Arrhythmia?

Arrhythmia is a group of conditions which results in irregular beating of the heart. The heartbeat can either be too slow or fast. It is caused when there is any interruption to the electrical impulses. Factors that cause this condition are alcohol abuse, diabetes, drug abuse, heart failure etc. It is identified by breathlessness, dizziness, angina, palpitations etc.

What is 3D mapping?

3D mapping of the heart is a procedure that is used in diagnosing the location of arrhythmia. They can arise from different parts of the heart such as ventricles and atria. This procedure uses a thin tube called as catheter which is inserted into a small incision made in the arm or the thigh. Another smaller electrically sensitive catheter is inserted inside the sheath and senses the electrical activity and maps it on a 3D model of the heart chambers. It is most commonly used in ablation process.

What are the risks involved?

When compared with other invasive methods, there are fewer chance of complications and risks. The only risk that can occur in this procedure is from the use of catheters. They are long and thin tubes which are inserted into the arteries and veins. It can occasionally cause damage to the blood vessels. There can also be bleeding or infection.

What happens during the ablation process?

In this procedure, local anesthesia is given to numb the legs where needles will be inserted. They are inserted into the veins of the right and left legs. A series of small tubes are inserted into the veins. Wires are passed through the tubes and guided using fluoroscopy to the heart. This induces arrhythmia which analyzes using different modalities of 3D electroanatomic mapping system. When the area that is causing arrhythmia is found, heat or cryotherapy is applied to get rid of it.

CABG (heart bypass surgery)

What is Coronary Artery Bypass Surgery?

Coronary Artery Bypass Surgery (CABG) is surgical process performed on the heart to improve the blood flow to the heart. This procedure diverts the blood flow around the section of the artery that is blocked. It bypasses the blocked artery and creates a new pathway to the heart. Healthy blood vessel can be taken from your leg, arm or chest. In some individuals, this surgery can be done to improve the function of heart and remove the possibility of fatality.

Why is CABG carried out?

This procedure is an option for the following scenarios –

  • In case of artery blockage which cannot be solved with angioplasty. It is also used if you have had unsuccessful angioplasty before.
  • Narrowing of arteries that supply blood to the heart muscle causing chest pain.
  • If you have one or more diseased coronary artery. It can either be narrowed or blocked.
What happens during the procedure?

In this procedure, you are administered general anesthesia. They may be multiple bypasses required and it depends on the severity and location of the blockages. During this procedure, the blood flow is diverted through a heart lung machine. A long incision is made in the blood to open the rib cage. This exposes the heart. During this time, a heart-lung machine takes over to circulate the blood as heart is temporarily stopped. A section of the healthy blood vessel is taken and attached above and below the blocked artery so that the blood flow is bypassed around the narrowed portion of the diseased artery.

What happens after the surgery?

You will be shifted to ICU for one or two days. Your vital signs such as heart, blood pressure etc. are monitored. You will be discharged if no complications arise. Complete recovery takes about six to twelve weeks. You will remain free of the symptoms for as long as 10-15 years.

What are the risks involved?

It is an open heart surgery and therefore a complex one. Bleeding is the most common risk. There may be infection of the chest wound. Additional risk includes memory loss, kidney problems, stroke and heart attack.

Valve Repair & Replacement (TAVI/TAVR)

Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive surgical procedure which repairs the valve without removing the old and damaged valve. Instead, a replacement valve is wedged into the aortic valve’s place. This type of a surgery is different from the standard valve replacement procedure and it is approved for people with symptomatic aortic stenosis but won’t be able to sustain an open heart surgery.

Our heart team comprises of Cardiac Surgeons, Cardiologists, Intensivists, Physicians, Cardiac Anesthesiologists and Intensive Care Experts working in synergy providing the best possible outcomes of TAVR and making sure that the patient is benefitted from this surgery.

Who needs TAVR?

TAVR is mostly needed in case of two major conditions

  • Aortic valve regurgitation
    It is a condition in which the heart’s aortic valve does not close tightly. The body does not get enough blood as some of the blood that was pumped out of the heart’s main pumping chamber is leaked back. As a result you may feel fatigued and short of breath along with swollen ankles and feet. This condition may be congenital or aorta may be enlarged due to hardening of the arteries.


  • Aortic valve stenosis
    It is a condition which narrows down our heart’s aortic valve. It prevents the valve from opening properly. This in turn blocks blood flow from the heart into the main artery and onward to the rest of the body and as a result less blood will flow. The signs develop when the symptoms are severe. This condition is caused due to calcium buildup on the valve. It is found in the blood and deposits of calcium can be there as blood repeatedly flows over the aortic valve.

How is TAVR performed?

In this procedure, you will be administered general anesthesia. You will be asleep during the procedure and will not feel any pain. To prevent blood clots, medications will be given through an intravenous line. The heart may be accessed through a blood vessel in the leg or it can be accessed by making tiny incisions in the chest and access the heart through a large artery. A hollow tube is then inserted through the access point which is known as catheter. Advanced imaging techniques are used to guide the catheter through the blood vessels to your heart and into the aortic valve. Once the position is precise, a balloon is expanded to press the replacement valve into place in the native aortic valve. As the valve is securely in place, the catheter is withdrawn from its place.

Procedure

You may spend the night in the intensive care unit for monitoring after the procedure. In most cases, you will spend two to five days recovering in the hospital. Blood thinning medications are prescribed to you to prevent blood clots.

Pacemaker Implantation

A pacemaker is a small battery operated medical device which is implanted in the chest or abdomen to treat abnormal heart rhythms. These are known as arrhythmias and it causes heart to either beat to fast or too slowly. Pacemaker is used to treat two forms of arrhythmia –

  • Tachycardia – In this condition, heartbeats are too fast.
  • Bradycardia – In this condition, heartbeats are too slow.

A small surgery is needed in implanting the pacemaker. This requires some lifestyle changes and precautions after the surgery.

Why is it needed?

Pacemaker is needed when your heart is not able to receive enough blood. It can happen in case heart is pumping quickly or slowly. This can cause different abnormalities in the body such as fatigue, fainting, shortness of breath, damage to vital organs. If it is not diagnosed in early stages, then it can result in death.

What are the components?

It has two components –

  • Pulse generator – It comprises of a sealed lithium battery and an electronic circuitry package. It is used in producing the electrical signals that make the heart beat.
  • Leads – they are insulated flexible wires that conduct electrical signals to the heart from the pulse generator.

How is the surgery performed?

Anesthesia is administered to the site where the surgery is to be performed. A small incision is made near the shoulder. A small wire is guided through the incision into a major vein near the collarbone. An x ray machine is used in guiding this wire through to the heart. With the help of this wire, an electrode will be attached to the heart’s right ventricle. The other end will be attached to a pulse generator which contains battery and electrical circuits. It will be implanted under the skin near the collarbone. After the procedure, the incision will be closed with stitches.

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About Eternal Hospital

Eternal Hospital (A unit of Eternal Heart Care Centre and Research Institute) is a state-of-the-art tertiary care hospital in Jaipur city. This landmark Healthcare Institute is the result of the vision of Dr. Samin K. Sharma, world renowned Interventional Cardiologist based at Mount Sinai Hospital, New York, USA. Founded in 2013, today it is one of the most preferred hospital not only in Jaipur but also nationally and internationally owing to the exclusive services and excellent medical outcomes delivered. Eternal Hospital brings the best in multispecialty treatment to the state of Rajasthan. Hospital with capacity of 250 bedded hospital has state-of-the-art technology focusing on the specialities like Cardiology, Cardiac Surgery, Neurology, Neuro Surgery, Orthopaedic & Joint Replacement, Spine Surgery, Nephrology, Paediatrics, Gynaecology, Critical Care, Urology, Pulmonology, Gastroenterology, Diabetes and Endocrinology and many more.

Eternal Hospital has a knowledge sharing arrangement with Mount Sinai Hospital New York USA, which has been internationally recognized for its top-performing physicians and revolutionary research centres.

ETERNAL HOSPTIAL has emerged as a destination of choice for many national & international patients owing to the exclusive services and excellent medical outcomes delivered at ETERNAL HOSPTIAL.