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Interventional Cardiology

ACI’s Cath Lab prides itself in its state-of-the-art Interventional Cardiology program which offers its patients the most modern treatment options for heart disease.

Interventional Cardiology involves inserting catheters and other specialized devices through a small puncture in the skin. This is done to treat heart diseases and disorders, its blood supply and other major blood vessels arising from the heart. In many cases, performing Interventional Cardiology can avoid the need for more invasive open surgical procedures.

Below is a list of Interventional Cardiology procedures routinely performed in the ACI Cath Labs.

Percutaneous Coronary Intervention (Coronary Angioplasty and stenting)

Percutaneous coronary intervention (PCI), also referred to as coronary angioplasty and stenting, is a revolutionary procedure that has changed the way cardiac disease is treated over the last two decades. Prior to PCI, Coronary Artery Bypass Graft (CABG) surgery was the only way to treat cardiac disease. CABG, however, is a major surgery with inherent complications and relatively long recovery periods. In modern medicine in developed countries, PCI is three to four times more commonly performed compared to CABG in the treatment of heart disease.

PCI is used to open narrowed arteries in the blood vessels feeding the heart. If left untreated, these narrowed arteries can cause a complete blockage of the blood supply to the heart, resulting in a heart attack or irreversible damage to the organ, which may prove to be fatal. Narrowed arteries are usually identified by first doing an X-ray coronary angiogram so that the exact location and severity of the narrowing can be seen.

Like the X-ray angiogram, the PCI procedure uses thin plastic tubes called catheters inserted through a small puncture site into an artery in the leg or arm and guided by X-ray images to the blood vessels of the heart. A small inflatable balloon is guided through these catheters to the blockages in the arteries. Once in position, the balloon is then inflated to re-open the blockages in the artery. The balloon is then deflated and removed. In many instances, a thin metal sleeve called a stent is then inserted into the re-opened vessel, to ensure that it remains open while it heals.

The use of stents is one of the major developments that has led to the high success rates of modern PCI, since it prevents the collapse of the vessel after the balloon angioplasty procedure. Stent technology is continuously evolving; within the last five years a whole new category of stents, now coated with medication to prevent excessive scarring after PCI, has been proven to greatly improve the long-term success of PCIs. Known as a ‘drug eluting stent’ it is distinct from the traditional and non-medicated ‘ Bare Metal Stent’. At ACI Cath Labs, the appropriate use of drug eluting stents is now routine.

ACI prides itself in stocking the widest variety of the most modern supplies for PCI in this rapidly evolving field. This applies not only to stents, but also to balloons, guidewires, catheters and many niche devices for specific purposes. We now boast of the largest inventory of Interventional Cardiology supplies for use in the lab. We are committed to keeping abreast of the latest technological advances and adopting the best practices in modern interventional cardiology. In this way we have been able to provide the most advanced heart care available worldwide right here in Trinidad. Our success and reputation speak for itself.

Other Interventional Cardiology Procedures

Apart from opening blocked blood vessels, other types of therapeutic procedures are performed in ACI’s Cath Labs. These include procedures to open narrowed heart valves, repair aneurysms of the aorta and prevent the movement of dangerous blood clots from the veins to the lungs, among others. These procedures are described in more detail below.

Balloon Valvuloplasty is the name of the procedure used to open valves in the heart which are narrowed and therefore not functioning properly. The narrowing is usually a result of a birth defect and the procedure is commonly performed on children, adolescents and young adults diagnosed with this problem. The procedure is similar to angioplasty in that it uses an inflatable balloon guided through a catheter into the narrowed valve. The balloon is then inflated to open the valve and improve its functionality. This procedure is most commonly recommended as the procedure of choice for treating the narrowing of the pulmonary valve.

Aortic Stent Grafting is a procedure used for the treatment of the aneurysms of the aorta. The aorta is the largest blood vessel in the body which takes blood from the heart to supply the rest of the body. An aneurysm of the aorta is a potentially fatal condition in which the walls of the aorta have become weakened resulting in a bulging or enlargement of its diameter in the affected segment of the aorta. If left untreated the aorta may rupture. In aortic stent grafting, a cylindrical tube composed of a special fabric supported by a metal mesh called a stent graft is placed into the aorta under X-ray guidance to cover the area from above to below the aneurysm. The stent graft is designed to seal tightly to the aorta at points both above and below aneurysm, so that the blood passes through the graft rather than the affected area of the aorta. Since the walls of the graft is stronger than the aneurysm this reduces the further bulging of the aorta, hence the risk of rupture. This procedure is not for all aortic aneurysms and is not without risks and the interventional doctor will be able to carefully guide and advise as to whether it is appropriate for a given case.

Vena Cava Filter Implantation is a well-established procedure in which a metal filter is placed in the vena cava to prevent the migration of blood clots to the lungs. The vena cava is the largest vein in the body which takes blood from the body back to the heart and lungs. This procedure is often used to treat a condition called deep vein thrombosis, in which blood blots develop in the legs and can potentially move to the lungs where they can be fatal. The vena cava filter is implanted into the vena cava under X-ray guidance in the cath lab.

Other therapeutic procedures performed include pericardiocentesis and balloon pericardiotomy. These are cath lab procedures used in certain instances for draining fluid that has collected in the sac that surrounds the heart which is called the pericardial space. In a pericardiocentesis, a special needle is inserted under X-ray guidance into the pericardial space. Once in position the fluid is drained out of the body. In the balloon pericardiotomy, a special balloon catheter is guided into the pericardial space and once in position the balloon is inflated to create a channel for the fluid to drain out of the pericardial space into the pleural space where the fluid can be re-absorbed.