Interventional cardiology is a branch of medicine that is developing very dynamically. The effects of treatment are in some cases so spectacular that patients often speak of a miracle of recovery. When and what life-saving cardiological procedures are performed by cardiologists?

Invasive cardiologyis a chance for many patients to recover quickly. And it is not about a miracle, but about more and more accurate diagnostics, modern drugs, as well ascardiological procedures- more or less invasive - that restore the heart to fitness. While in some cases major cardiac surgeries that require opening the chest are still needed, it is increasingly possible to treat heart conditions with less invasive procedures.

Of course, it is connected with faster return to active life, less burdensome rehabilitation and better prognosis for the future. Thanks to state-of-the-art equipment, it is possible to reach the heart through the blood vessels. This is how abnormal openings in the septum of the heart are closed, parts of the heart where thrombi form are stitched up, narrowed or not closed valves are repaired, and the coronary vessels are widened.

Cardioversion

Cardioversion is a relatively safe procedure that allows you to restore the normal heart rhythm in patients with atrial fibrillation and with ventricular and supraventricular tachycardia. It is performed with a device similar to a defibrillator used in the event of cardiac arrest.

  • Before the procedure: an EKG is taken, an echo of the heart. Patients with atrial fibrillation and flutter must be treated with anticoagulants for 4 weeks to avoid possible vessel embolism. Before the procedure, the patient must not eat for at least 6 hours.
  • How it's done: the patient is given short-term general anesthesia. When he falls asleep, the doctor applies electrodes to the chest and triggers an electrical impulse (sometimes consisting of several impulses) to restore the heart's normal rhythm.
  • After treatment: it may happen that the skin where the electrodes are applied will be irritated, but there is no need to apply ointment. You should visit your doctor regularly after the procedure. If the rhythm disturbances recur, the patient is taking anti-arrhythmic drugs. Moderate exercise is recommended.

RF ablation

RF ablation isthe procedure most often performed in patients with tachycardia, atrial fibrillation or with a significant number of ventricular additional contractions.

  • Before the procedure: on the day of the procedure, the patient should be fasting and have both groin shaved.
  • How it's done: only the place where the special needle will be inserted is anesthetized. It can be a femoral artery or vein, and sometimes it can be a subclavian vein. Then the needle is removed and the so-called a vascular shirt. It allows the electrode to reach the place where the arrhythmia is formed. Ablation is most often performed with radio frequency current, cold is used less often (so-called cryoablation). This process is controlled by a computer. Radio waves or low temperature damage the part of the circuit where the tachycardia occurs or they destroy the cells that produce the abnormal beats. They can also isolate the places where the arrhythmia occurs. This is the most complicated part of the procedure, which can take up to several hours. The patient experiences ablation as a strong burning sensation in the chest, therefore painkillers are administered during the procedure.
  • After the procedure: after removing the electrode and the sheath, a dressing is put on the vein and pressed with a special bag. The patient must lie flat on their back for at least 6 hours for the vein to heal. For a week, you should save yourself (do not squat, bend over, lift, do not walk too long) to avoid the so-called late bleeding from a punctured vein or artery. The effectiveness of ablation treatment of cardiac arrhythmias is very high, but sometimes the procedure has to be repeated.

Percutaneous aortic valve implantation

Until recently, replacing a damaged heart valve required major cardiac surgery that was only possible after opening the chest. Currently, an artificial valve can be inserted through the skin. Before surgery: the patient must take acetylsalicylic acid a week before to avoid the formation of thrombosis in the artificial valve. On the day of the procedure, she should be on an empty stomach and have both groin shaved.

  • How it's done: Following general or local anesthesia, a puncture is performed on the femoral artery. Through them, special guides and catheters are inserted up to the initial section of the aorta and the left ventricle. The operation of doctors is controlled by X-ray rays and by the head of the device for the echo of the heart placed in the esophagus. These devices help to precisely insert the collapsed artificial valve and position it in the center of the damaged one.
  • After the procedure: the patient must lie down for 24-48 hours for the artery or vein to heal. RightThe position of the valve is checked by echocardiography. After 3-7 days, the patient leaves the hospital. Maybe return to his activities. However, systematic check-ups are necessary with a cardiologist so that he can check for the development of bacterial endocarditis. People with an artificial valve must avoid infection (e.g., get vaccinated against the flu), exercise moderately, and be overweight and obese.

Pacemaker

The pacemaker not only keeps the heart from beating too slowly, but also stops the arrhythmia and improves heart contraction. Pacemakers are implanted in people suffering from heart blocks, bradycardia, sinus node disease or so-called rapid arrhythmias.

  • Before the procedure: basic laboratory and cardiological tests are performed already in the hospital.
  • How it's done: A pacemaker is implanted under local anesthesia under X-ray control. The doctor cuts open the skin on the chest and creates a pocket in it for the device. One or two electrodes are inserted through the selected large vein into the heart and then connected to a pacemaker. When the device is programmed and checked, the skin is stitched. After the procedure, the patient can eat and walk.
  • After the procedure: a few hours after the procedure or on the second day, a chest X-ray is done to check the position of the apparatus and the quality of the electrode connections with the heart. The seams are removed after a week. The patient must be under the care of a specialist and regularly have an EKG. Every doctor and imaging technician should inform them that they have a pacemaker. He must also avoid being in a strong magnetic and electric field and not manipulate with electrical devices.

Rotablation

Rotablation is a method reserved for patients who have severely changed vessels, often 90% affected by atherosclerotic plaque. Such vessels cannot be expanded with ballooning.

  • Before the procedure: the patient must undergo such examination as before angioplasty. It must be prepared for the procedure through appropriately selected pharmacotherapy.
  • How it's done: general anesthesia is not necessary to perform the procedure, local anesthesia is enough. The patient's femoral artery is punctured under the control of the X-ray machine. It then introduces the catheter, followed by the boron rotating at a speed of 120,000 to 140,000 revolutions per minute. By gently shifting this diamond drill bit, the atherosclerotic plaques are sheared. The gills are so fragmented that they can move freely with the blood, posing no threat. After the plaque is removed, the patient is put in a covered stentan antiproliferative drug that prevents restenosis, i.e. re-narrowing of the coronary vessels.
  • After the procedure: the patient recovers quite quickly. For a few weeks, he should take precautions, but most of all take medications to protect him from the blood clot that may form inside the stent.

Cardioverter-defibrillator implantation

This small electronic device detects dangerous arrhythmias and at the right moment sends an electrical impulse to normalize the work of the heart. They are implanted in patients who have or may develop cardiac arrhythmias, such as ventricular tachycardia or fibrillation.

  • Before the procedure: the decision to use this treatment method is made by a cardiologist after performing a complete set of general and cardiological examinations.
  • How it is done: the patient is under general anesthesia and the procedure itself is X-ray controlled. First, the skin on the chest is cut open to create a pocket in which the device will be placed. To connect them to the heart, electrodes are needed. They are inserted through the subclavian vein.
  • After the procedure: after waking up from anesthesia and a short rest, the patient can walk and eat. The seams are removed after a week. During this time, the patient is in the hospital, and before leaving the hospital, the device is checked again under general anesthesia to make sure that the device is working properly. The patient must avoid strong magnetic and electric fields, e.g. not carry a mobile phone in his breast pocket.

Coronary angioplasty, i.e. ballooning

Coronary angioplasty, i.e. ballooning, consists in widening the narrowed or restoring closed arteries with the use of special balloons. It is performed in people with ischemic heart disease. The treatment reduces the symptoms of angina and may protect against a heart attack.

  • Before the procedure: the patient should have the blood group marked and basic morphological and biochemical tests performed. On the day of the procedure, she should be on an empty stomach and have her groin shaved.
  • How it is done: the procedure is performed in the operating room of the hemodynamics laboratory without general anesthesia. The patient receives local anesthesia in the groin or forearm. The doctor places a needle into the femoral or radial artery, then changes it into a vascular sheath, through which he introduces catheters to the site of aortic or coronary narrowing. A balloon reaches there through the catheter and is filled with fluid under high pressure. When the artery expands after a few minutes, a stent is set up in place of the balloon, i.e. a metal scaffold that keeps the artery open.
  • After the treatment: if the treatment wasperformed by the femoral artery, the patient must lie flat on his back for several or even several hours for the artery to heal. This does not apply to people who underwent surgery through a radial artery. For a week, you should save the punctured leg, do not lift, do not squat to avoid bleeding. It is worth adding that the treatment does not cure the disease, but only eliminates its effects, so the patient must be under the care of a doctor, take care of the proper weight, be physically active (as far as possible) and keep cholesterol, triglycerides and sugar in check to make the disease like was the slowest.

Surgical treatment of atherosclerosis

In the treatment of atherosclerosis, surgical procedures to remove atherosclerotic plaque, angioplasty (widening of the arteries and flattening the plaque), bypasses (implantation of vascular prostheses). Source: "Operating room" (FOKUS TV).

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