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Cardiology and Ophtalmology

Cardiology

and Ophtalmology

Coronary catheterization and Angioplasty

Marian Futyma, MD, PhD

Friday, 8:00 AM-11:00 AM

Tuesday, Wednesday, Thursday, 1:00 PM-3:00 PM

Funded under the NFZ (Polish National Health Fund)

Private medical consultations

 

Wojciech Stecko, MD

 

Thursday, 3:00 PM-5:40 PM

 

 

Coronary catheterization is a diagnostic test that allows for showing the anatomy of coronary arteries. On the basis of its result and the clinical picture of the disease, the patient with coronary heart disease may be scheduled for treatment using one of the three therapeutic procedures:

• conservative treatment, i.e. taking medications

• percutaneous coronary angioplasty, i.e. widening arteries with the use of a balloon catheter, or the implantation of a stent

• coronary artery bypass surgery, i.e. implanting bypasses (a surgical procedure on the heart)

Coronary catheterization is performed in the Catheterization Lab.

Before the procedure, the patient should present a set of basic cardiac test results – the ECG, the cardiac stress test, the echocardiogram, and should have the blood type test results, the levels of electrolytes in serum, and the blood coagulation parameters. Before the procedure, the patient should be on an empty stomach. The procedure is carried out under a local anaesthetic through the femoral artery (the groin) or through the radial artery (the wrist). After anesthetization of the subcutaneous tissue, a catheter is introduced into the vessel (vascular sheath). The anaesthesia and the introduction of the sheath may cause unpleasant sensations. Catheters are introduced to the coronary vessels through the vascular sheath, and a medical contrast medium is injected through these catheters in order to enhance the visibility of the arteries. After enhancing the visibility of the vessels, if there is such a need, ventriculography (i.e. the injection of the medical contrast to the left ventricle) and the examination of the iliac arteries are performed. Both injections may cause heat sensations in the chest and limbs. After the procedure the sheath is removed, and when the bleeding is stopped, on the hemodynamic table a compression bandage is applied for 6-8 hours.

The patient is transported to the Cardiology Unit. The patient must lie; they cannot bend legs or sit for 8 hours. In order to expel the contrast medium, the patients has to drink around 2 litres of still mineral water.

Coronary catheterization is an invasive procedure. During the procedure complications may occur:

• local vascular complications – 0.57% (a hematoma, pseudoaneurysm, an arterio-venous fistula, artery perforation, acute artery occlusion), sometimes require surgical treatment. In exceptional cases, these complications might result in the loss of a limb.

• other: death rate – 0.14%, myocardial infarction (heart attack) – 0.07%, cerebral ischaemia – 0.07%, perforation of large vessels (incidental cases), aggravation of heart failure symptoms, aortic dissection , worsening of kidney function – on rare occasions they require the dialysis therapy; allergic reactions to the contrast medium.

 

CORONARY ANGIOPLASTY

Coronary angioplasty consists in dilating a narrowed vessel using a catheter with a balloon. The way of access to the narrowed vessel is the same as in the case of coronary catheterization

- local anaesthesia, insertion of the vascular sheath, and the introduction of the catheter to a coronary vessel. In most cases, the procedure is carried out right after coronary catheterization using the previously introduced vascular sheath. A guide wire (a wire that is introduced to the vessel past the narrowed area) is advanced through the catheter, then a second catheter with the balloon on its tip is inserted over this wire and advanced to the level of the narrowing. Then the balloon is filled with the contrast medium under the pressure of a dozen or so atmospheres. This is the way the vessel is widened. If the results are not adequate, a stent (i.e. a mesh tube made of metal, which is designed keep the vessel dilated) is implanted in the same area, in a similar way to the one mentioned above. Stents are safe for patients, they do not corrode, they are not rejected by the body, and the patient will not feel the stent. During the inflation of the balloon, the patient may experience coronary pains. One inflation usually takes between 30 to 90 seconds. The procedure of angioplasty carries the same risks as coronary catheterization, and other specific to the procedure itself: the embolism of the coronary artery, the occlusion of the coronary artery, myocardial infarction, rupture of the coronary artery, cardiac tamponade, dangerous arrhythmias.

The complications arise with a frequency dependent on changes in the vessel morphology, the extent of changes, and the level of heart damage before the procedure. In the changes that are ‘mild’ and ‘moderate’ they do not exceed 1%, in the case of ‘severe’ changes they approach 5%. In the era of stents, the complications related to vessel damage are treated during the procedure itself -- by implanting a stent. During coronaroplasty, the patient receives heparin, a drug which reduces blood coagulation. This is why the vascular sheath is removed after 5 to 6 hours and the compression bandage is applied, then the patient lies for 6-8 hours and has to drink around 2 litres of liquid. Because of using heparin, the number of local complications – hematomas -- may rise.

Coronary artery bypass surgery is performed in cardiac units and consists in creating connections between the aorta and the part of the vessel outside the narrowing, which are made from patient’s own arteries or veins.

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