Procedures required Flashcards
(31 cards)
intravascular ultrasound (IVUS)
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Intravascular ultrasound (IVUS) is a diagnostic procedure that uses sound waves to create images of the inside of blood vessels. It’s also known as endovascular ultrasound or intravascular echocardiography.
During an IVUS, a doctor threads a catheter with a small ultrasound transducer through an artery or vein to the target location. The transducer then generates sound waves to produce images of the blood vessels. IVUS can be used to:
- Evaluate the coronary arteries that supply the heart
- Show the degree of narrowing or thickening of an artery
- Reveal plaque buildup that may have previously been removed
- Provide detailed anatomic information about lesion characteristics
- Screen for calcium before stent implantation
- Guide the sizing for stents and balloons
- Optimize stent expansion
- Identify complications
optical coherence tomography (OCT)
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Optical coherence tomography (OCT) in a cath lab refers to a high-resolution imaging technique used during cardiac catheterization, where a special catheter equipped with an OCT probe is inserted into a coronary artery to produce detailed cross-sectional images of the vessel wall using near-infrared light, allowing doctors to precisely assess the characteristics of plaque buildup and guide treatment interventions like stent placement with greater accuracy than traditional angiography alone; essentially acting like a microscopic view inside the coronary artery.
Key points about OCT in a cath lab:
High resolution imaging:
OCT provides significantly more detailed images of the coronary arteries compared to other intravascular imaging methods like intravascular ultrasound (IVUS), allowing for better visualization of plaque composition and features like cap thickness.
Plaque characterization:
By visualizing the different components of plaque (lipid, fibrous tissue, calcium), OCT helps cardiologists identify high-risk plaque features that may be prone to rupture.
Stent guidance:
OCT is often used during coronary angioplasty to precisely assess stent placement and ensure optimal apposition to the vessel wall.
Invasive procedure:
Like other intravascular imaging techniques, OCT requires a catheter to be inserted into the coronary artery, making it an invasive procedure.
intracardiac echocardiography (ICE)
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Intracardiac echocardiography (ICE) is a unique imaging modality able to provide high-resolution real-time visualization of cardiac structures, continuous monitoring of catheter location within the heart, and early recognition of procedural complications, such as pericardial effusion or thrombus formation.
transcatheter aortic valve implantation (TAVI/TAVR)
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Transcatheter aortic valve implantation (TAVI), also known as transcatheter aortic valve replacement (TAVR), is a minimally invasive medical procedure where a new aortic heart valve is placed inside a patient’s existing damaged valve using a catheter inserted through a blood vessel in the groin, typically used to treat severe aortic stenosis (narrowing of the aortic valve) in patients who are considered high-risk for open-heart surgery; essentially, it replaces a faulty aortic valve without requiring a full chest incision.
Key points about TAVI/TAVR:
Procedure:
A thin, flexible tube (catheter) is inserted into a blood vessel in the leg and guided up to the heart where a new artificial valve is positioned and expanded inside the old, narrowed valve.
Benefits:
Considered a less invasive alternative to traditional open-heart surgery, allowing patients who may be too frail for major surgery to still receive treatment for a narrowed aortic valve.
Conditions treated:
Primarily used to treat aortic stenosis, a condition where the aortic valve doesn’t open fully, restricting blood flow from the heart.
Important considerations:
While minimally invasive, TAVI still carries risks and requires careful patient selection based on their health status and anatomy.
flow reserve (IFR, FFR, RFR)
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To determine the need for percutaneous coronary intervention, physiology indices such as fractional flow reserve (FFR) and resting full-cycle ratio (RFR) are used to identify functionally significant epicardial coronary stenoses at stress or rest.
valvuloplasty
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A valvuloplasty, also known as a balloon valvulotomy, is a minimally invasive procedure that opens a narrowed heart valve. A cardiologist performs the procedure using a catheter, a thin, flexible tube that’s inserted into a blood vessel in the groin and advanced into the heart. Once the catheter reaches the valve, the cardiologist inflates a balloon to widen the valve and improve blood flow.
Valvuloplasty can help with symptoms of heart valve disease, such as chest pain or shortness of breath. It can also help avoid or delay valve replacement surgery, and may be used as a temporary solution while waiting for surgery.
During the procedure, you may feel some chest discomfort when the balloon inflates, but it shouldn’t be painful. The balloon may be inflated and deflated multiple times to fully open the valve. The procedure takes about two hours.
ventricular assist device implantation
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Ventricular assist device (VAD) implantation is a surgical procedure that places a mechanical pump inside the chest to help the heart pump blood:
Purpose
VADs help patients with heart failure by reducing the heart’s workload and improving blood flow. They can be used as a temporary bridge to a heart transplant, or as a permanent solution for patients who aren’t eligible for a transplant.
Procedure
During the procedure, a surgeon makes an incision in the chest, inserts tubes into the heart, and attaches the pump. The pump can be implanted inside the upper abdomen or on the outside of the body. The pump is connected to a control system and battery pack, which are worn outside the body.
Benefits
VADs can help patients feel better and live longer. They can also improve symptoms like fatigue and breathlessness.
Types of VADs
VADs can be implanted in either the left or right ventricle, but are most often placed in the left ventricle (LVAD).
intra-aortic balloon pump (IABP)
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An intra-aortic balloon pump (IABP) is a mechanical device that helps the heart pump blood by inflating and deflating a balloon in the aorta in time with the heart’s beat. It’s typically used in emergency situations to treat conditions like severe heart failure or an emergency heart valve problem.
Here’s how an IABP works:
**Catheter: **A thin, flexible tube called a catheter is inserted into the femoral artery and threaded through to the aorta.
Balloon: A long, sausage-shaped balloon is attached to the tip of the catheter.
**Console: **A computer console is attached to the other end of the catheter and controls the inflation and deflation of the balloon.
**IABPs are used to: **
Increase blood flow to the coronary arteries
Reduce the heart’s workload
Create diastolic augmentation, which can help the coronary arteries
Reduce afterload, which can increase cardiac output
IABPs are usually only used for a few days or hours, and are followed by long-term treatment like valve surgery or a left ventricular assist device (LVAD).
distal embolic protection device placement/retrieval
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A distal embolic protection device placement/retrieval refers to a medical procedure where a small filter-like device is positioned in a blood vessel beyond a targeted lesion to catch debris or plaque particles that might dislodge during a vascular intervention like angioplasty or stenting, and then later retrieved to remove the trapped debris from the body; essentially acting as a protective barrier to prevent embolization (blockage) in smaller blood vessels downstream from the treatment site.
Key points about distal embolic protection:
Function:
The device, often a small filter on a guidewire, is placed past the target lesion where it expands to capture debris released during the procedure.
Retrieval process:
Once the intervention is complete, the filter is carefully retrieved using a special catheter, removing the trapped debris with it.
Applications:
Commonly used in procedures like carotid artery stenting, peripheral vascular interventions, and coronary angioplasty where there is a high risk of plaque dislodgement.
ventricular septal defect closure
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Ventricular septal defect (VSD) closure is a surgical or catheter-based procedure that repairs a hole in the wall between the heart’s lower chambers:
Surgery
A surgeon uses stitches or a patch to close the hole during open-heart surgery. This procedure requires a heart-lung machine and a chest incision.
Catheter-based procedure
A thin, flexible tube (catheter) is inserted through a small incision in the groin, guided through the blood vessels to the hole, and used to place a device to close the hole. This procedure typically takes one to two hours, and patients are often able to go home within 24 hours.
Ventricular Septal Defect Closure - Dr. Chandan Saurav Mahapatro
A VSD is a common congenital heart defect that allows blood to leak from the left ventricle to the right ventricle instead of flowing to the rest of the body. Small defects may close on their own, but moderate and large defects often require surgical closure.
**Symptoms of a VSD include: **
Shortness of breath
Fast breathing
Frequent respiratory infections
Slow growth
Paleness
Fast heart rate
patent foramen ovale/atrial septal defect closure
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A “patent foramen ovale/atrial septal defect closure” is a medical procedure where a small opening in the wall between the upper chambers of the heart (atria), called a patent foramen ovale (PFO) or atrial septal defect (ASD), is sealed using a small device inserted through a catheter, essentially closing the hole to prevent abnormal blood flow between the chambers; this procedure is usually done when the opening doesn’t naturally close after birth and could potentially lead to complications like stroke.
Key points about PFO/ASD closure:
What it is:
A minimally invasive procedure where a doctor inserts a catheter into a vein, threads it to the heart, and then deploys a small device to close the opening in the atrial septum.
Why it’s done:
To prevent paradoxical embolism, a condition where a blood clot from the veins travels through the PFO to the brain, potentially causing a stroke.
Who might need it:
People diagnosed with a PFO or ASD, especially if they have a history of stroke, migraine headaches, or other risk factors.
Procedure details:
An echocardiogram is used to visualize the heart and locate the opening.
A catheter is inserted into a vein in the groin and guided to the heart.
The closure device is deployed at the site of the opening, where it expands to seal the gap.
pacemaker implantation (permanent)
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A permanent pacemaker implantation is a surgical procedure where a small electronic device, called a pacemaker, is placed under the skin of the chest to regulate the heart rhythm by delivering electrical impulses when needed, typically used to treat conditions where the heart beats too slowly; it consists of a battery-powered generator and thin wires (leads) that are threaded into the heart muscle to stimulate contractions.
Key points about permanent pacemaker implantation:
Function:
Helps maintain a regular heartbeat by providing electrical impulses to the heart when the natural rhythm is too slow.
Placement:
The device is implanted under the skin in the upper chest, usually just below the collarbone.
Components:
Includes a small battery-powered generator and thin wires (leads) that are inserted into the heart chamber.
Procedure:
A small incision is made in the chest, a pocket is created, and the leads are carefully positioned within the heart using a catheter, then the generator is placed in the pocket.
generator exchange
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A “generator exchange” in medical terms refers to a procedure where the battery component (called the “generator”) of a cardiac implantable device, like a pacemaker or defibrillator, is surgically removed and replaced with a new one, while leaving the existing leads (wires connecting the device to the heart) in place, if they are still functioning properly; essentially, just swapping out the old battery for a new one within the implanted device.
Key points about generator exchange:
Purpose:
This procedure is done when the battery of the implanted device is nearing the end of its lifespan and needs to be replaced.
Procedure:
A small incision is made near the device, the old generator is disconnected from the leads, removed, and a new generator is connected to the same leads and implanted in its place.
Minimal invasiveness:
Compared to a full device replacement, a generator exchange is considered a minimally invasive procedure
defibrillator implantation
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An implantable cardioverter defibrillator (ICD) is a small, battery-powered device that’s placed in the chest to treat and prevent life-threatening irregular heart rhythms:
What it does
An ICD monitors the heart’s rhythm and delivers an electrical shock to correct abnormal rhythms. This can help prevent sudden cardiac arrest.
How it works
An ICD has a pulse generator with a battery and computer, and one or more leads that connect to the heart. The leads transmit electrical signals to and from the heart muscle.
When it’s used
An ICD is used to treat conditions like ventricular tachycardia and ventricular fibrillation, where the heart’s lower chambers beat too quickly or erratically.
How it’s implanted
The ICD is usually implanted under the skin, just below the collarbone. The procedure involves making an incision, placing the leads into a vein and then into the heart, and connecting the leads to the pulse generator.
How long it lasts
ICDs and their leads typically need to be replaced every 5 to 10 years.
Driving restrictions
People with ICDs may have driving restrictions. Your doctor can advise you on what’s best for your situation.
arrhythmia ablation
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Arrhythmia ablation, also known as cardiac ablation or radiofrequency ablation, is a procedure that treats irregular heartbeats, or arrhythmias. During the procedure, a doctor uses a catheter to destroy small areas of heart tissue that are causing the arrhythmia. This can help restore a normal heart rhythm.
A doctor might recommend arrhythmia ablation if:
Medications aren’t controlling the arrhythmia
Medications are causing serious side effects
The arrhythmia is a certain type that responds well to ablation, like Wolff-Parkinson-White syndrome or supraventricular tachycardia
The patient has a high risk of sudden cardiac arrest or other complications
Here are some details about the procedure:
How it’s done
A doctor inserts a catheter through a blood vessel in the groin, arm, leg, or neck and threads it up to the heart. The catheter records the heart’s electrical activity to pinpoint the source of the arrhythmia. Then, the doctor uses heat or freezing to destroy the tissue causing the arrhythmia.
How long it takes
The procedure can take 2–4 hours.
Recovery
Patients usually need to stay in the hospital overnight and lie flat on their back for a few hours after the procedure. Most people can drive after a few days, but it depends on the type of procedure and vehicle. Patients should avoid heavy lifting for at least two weeks.
Success rate
Catheter ablation is a safe and effective treatment, with cure rates of 85–98% for the most common arrhythmias.
peripheral angiography
Up to Five Repetitions for Each Procedure
Peripheral angiography, also known as an extremity angiogram or peripheral vascular angiogram, is a minimally invasive imaging test that uses X-rays and dye to map blood vessels in the arms, legs, hands, and feet:
A healthcare provider might order a peripheral angiography to help diagnose peripheral artery disease (PAD), a condition that occurs when plaque builds up in the arteries, making it difficult for blood to flow. A peripheral angiography can help identify areas where blood flow is blocked, which can lead to painful leg cramps or slow healing of foot wounds.
**During the procedure, a patient: **
* Lies on an X-ray table
* Receives an IV with fluids and medications like sedatives
* Receives a local anesthetic injection at the insertion site
* Has a small incision made in the groin or arm
* Has a thin tube called a catheter inserted into the artery
* Receives an injection of contrast dye through the catheter
* Has X-rays taken to identify areas where the contrast dye shows plaque buildup
Peripheral angiograms are generally safe, but they do have some risks, including:
* Exposure to radiation from the X-rays
* Allergic reaction or kidney damage from the contrast dye
After the procedure, the patient is taken to a recovery area and may be able to go home the same day or may need to stay overnight
electrophysiology study
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An electrophysiology (EP) study, also called an invasive cardiac electrophysiology test, is a series of tests that evaluate the heart’s electrical activity and diagnose abnormal heart rhythms:
Procedure
A cardiologist inserts thin wire electrodes into a vein in the groin or neck and threads them through the vein into the heart. The electrodes measure the heart’s electrical signals and can also stimulate the heart tissue to cause an abnormal rhythm.
Purpose
The EP study helps identify the type and location of heart rhythm problems. It can also help determine how well a medication is working.
Results
Based on the results, a doctor may recommend treatment options such as medication, surgery, catheter ablation, or an implantable cardioverter defibrillator (ICD) or pacemaker.
Preparation
Before the EP study, you may need to undergo blood tests and an electrocardiogram (ECG). You may also need to avoid taking certain medications for several days.
Recovery
After the procedure, you’ll be monitored in a recovery area. You may feel a small pinch at the insertion site, but you should feel fine within 8 to 12 hours. You should avoid vigorous activity until approved by a physician.
intravascular lithotripsy (e.g., shockwave)
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Shockwave IVL is a minimally invasive procedure that allows. physicians to safely break up problematic calcium deposits through the use of sonic pressure waves.
transcatheter mitral valve repair
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Transcatheter mitral valve replacement (TMVR) is a minimally invasive procedure that replaces a damaged mitral valve without open-heart surgery:
- A catheter is inserted into a blood vessel in the chest or leg
- The catheter is guided to the heart
- A replacement valve is inserted through the catheter and guided to the heart
- A balloon is expanded to press the valve into place
TMVR can treat: mitral valve stenosis (narrowed mitral valve), mitral valve regurgitation (leaky mitral valve), and a mix of the two.
TMVR is an option for some people with mitral valve disease who aren’t good candidates for open-heart surgery. The procedure has several advantages, including: No surgical access through the chest, Faster recovery time, No need for a heart lung bypass machine, No incision that has to heal, and No dilution of the blood.
atrial appendage closure device implantation
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Atrial appendage closure device implantation is a minimally invasive procedure that closes off the left atrial appendage (LAA) of the heart to reduce the risk of stroke:
Procedure
A catheter is inserted into a vein in the leg and guided to the LAA. A small device is then pushed through the catheter and implanted in the LAA, where it opens up and seals off the appendage.
Benefits
The procedure is an alternative to blood thinners, which can have risks and may not be well tolerated. The device is permanent and doesn’t require regular blood tests or food and drink restrictions.
Recovery
Patients typically go home the same day and return to work a few days later. Blood thinners are usually prescribed for the first three to four months to prevent blood clots.
Devices
Some examples of atrial appendage closure devices include the Watchman and AtriClip:
Watchman: A parachute-shaped device that opens up like an umbrella. It’s approved by the FDA for patients with nonvalvular atrial fibrillation who aren’t good candidates for long-term blood thinners.
AtriClip: A small device that clamps off the LAA. It’s used as part of a minimally invasive procedure.
extracorporeal membrane oxygenation system placement (ECMO)
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Extracorporeal membrane oxygenation (ECMO) is a procedure that involves placing plastic tubes (cannulas) into a patient’s body to provide life support when their heart or lungs are too sick to function:
Procedure
A surgeon or other medical professional places two cannulas into large blood vessels in the neck, chest, or groin. One cannula drains deoxygenated blood from the body, and the other returns oxygenated blood to the body.
Purpose
ECMO temporarily replaces the function of the heart and lungs, allowing them to rest and heal. It can be used to keep a patient alive during surgery or while waiting for a transplant.
Types of ECMO
There are two types of ECMO:
** Venovenous (V-V): **Used when the heart is functioning well, but the lungs need to rest.
Venoarterial (V-A): Used when both the heart and lungs need to rest.
ECMO can be used for days or weeks. Patients may be given sedatives or pain medication to keep them comfortable, but some patients are able to stay awake and talk
coronary angiography
Up to Five Repetitions for Each Procedure
A coronary angiogram, also known as cardiac catheterization, is a procedure that uses X-rays to examine the heart’s blood vessels and diagnose heart conditions:
Procedure: A thin, flexible tube called a catheter is inserted into an artery in the arm or groin and guided to the heart. A contrast dye is injected through the catheter to highlight the blood vessels. X-rays are taken to show how the dye moves through the heart.
**Purpose: **The procedure can help diagnose coronary heart disease, angina, heart arrhythmias, aneurysms, and birth defects. It can also help plan treatments, such as angioplasty or coronary artery bypass grafting (CABG).
Results: An abnormal result can indicate a blocked artery, and the test can show how many arteries are blocked, where, and how severe the blockages are.
Risks: The risk of complications is higher for older adults, but it’s still low.
Sedation: You may be given a sedative through an IV, or you may be given a combination of medicines to put you in a sleep-like state.
**Length: **An uncomplicated coronary angiogram can take an hour or longer.
aortography
Up to Five Repetitions for Each Procedure
Aortography is a minimally invasive X-ray procedure that uses a catheter to inject a contrast dye into the aorta, the body’s main artery, to examine it. It’s used to diagnose aortic diseases, such as aneurysms, and to plan treatments.
Here’s what happens during an aortography:
1. You’re given a mild sedative to help you relax.
2. A local anesthetic is injected into your groin or arm to numb the area.
3. A radiologist or cardiologist inserts a needle into your groin blood vessel.
4. A catheter is passed through the needle and into the aorta.
5. The doctor injects contrast dye into the aorta.
6. X-rays are taken to visualize the aorta and its associated vessels.
Aortography is no longer the primary diagnostic tool for aortic diseases because less invasive and more sensitive methods are available. However, it’s still the preferred method for guiding endovascular treatments
vascular closure devices (e.g., permanent, nonpermanent)
Up to Five Repetitions for Each Procedure
A vascular closure device (VCD) is a medical device used to seal a puncture site in an artery after a procedure, typically by deploying a small mechanism like a suture, collagen plug, or clip, to achieve immediate hemostasis (stop bleeding) without the need for prolonged manual compression; “permanent” VCDs would remain in the artery while “non-permanent” ones would dissolve or be absorbed by the body over time, with common examples including suture-based devices like Perclose and collagen-based devices like Angio-Seal.
Key points about vascular closure devices:
Function:
They are used to close small punctures made in arteries during procedures like angiography or angioplasty, reducing the need for prolonged bed rest and discomfort associated with manual compression.
Mechanism:
Depending on the design, VCDs can use sutures to tie a knot within the artery wall, deploy a collagen plug that is absorbed by the body, or use a small metallic clip to seal the puncture site.
Types of VCDs:
1. Suture-based (non-permanent): Devices like Perclose or X-Site that use a suture to close the artery, with no residual material left behind.
2. Collagen-based (non-permanent): Devices like Angio-Seal that use a collagen plug to seal the puncture site, which is eventually absorbed by the body.
3. **Clip-based (potentially permanent): **Devices like StarClose that use a small metallic clip to close the artery.
Important considerations regarding VCDs:
Patient suitability:
Not all patients are suitable for VCD use due to factors like vessel size, anatomy, and bleeding risk.
Complications:
Potential complications include bleeding at the puncture site, vessel damage, or allergic reactions to the device material.
Cost:
VCDs can be relatively expensive compared to manual compression, which is why their use is often carefully considered.
