Heart disease is the leading cause of deaths in Australia. This occurs when fatty deposits or ‘plaques’ build up in the arteries of the heart, narrowing, or in some cases blocking the artery completely and ceasing adequate blood flow through the body. If your Heart of Melbourne cardiologist believes you may have some degree of plaque in your arteries, they may suggest a Coronary Angiography, as one of the most precise manners of viewing and assessing the disease.
While this procedure is very common, and only takes 20 - 30 minutes, it is minimally invasive requiring it to be performed in a specialised catheterisation laboratory in a hospital. As Heart of Melbourne maintains a broad network with many private and public hospitals, it is possible for us to be quite flexible in booking your angiography procedure. Concerns regarding fasting or changes to your medications can be discussed at your consultation prior to the procedure booking.
When you attend the hospital for your angiography, you will be required to change into a gown, and taken to the lab to begin the procedure. A light sedative may be given to assist in relaxing you, and a local anaesthetic will be administered to the site of the catheter insertion. The catheter will be inserted into an artery, usually in the wrist or groin, and guided under X-ray to the heart. An injection of dye will be administered and join the flow of blood through the heart. The dye, which appears dark on the images, gives clear vision of any areas of narrowing or potential blockage.
If there is very little blockage on your images, and the dye flows well, it is considered a normal study. However, if there is evidence of narrowing, or plaque build ups, your cardiologist may need to employ techniques to alleviate them, and improve blood flow through your heart.
Our Interventional Cardiologists at Heart of Melbourne are highly trained and utilise state of the art technologies to complete these procedures through the wrist (radial) artery for almost all their patients.
For a normal study, there is very little down time after the procedure, and while you will need to be in recovery in hospital for a few hours and have a friend or family member drive you home after sedation, you should be able to continue normal activities within a couple of days. For any abnormal results after a coronary angiography, your Heart of Melbourne cardiologist will be able to discuss the many paths forward.
Our extensive experience in treating heart disease and preventing further cardiac damage, allows Heart of Melbourne to achieve excellent outcomes for our patients, and is the reason that our cardiologists are sought after to consult in private and public hospitals and alleviate the burden of heart disease Australia wide
Coronary Angioplasty, Stenting, & PCI
If a coronary angiography shows abnormal collections of plaques in your heart, there is a greater risk of heart attacks or strokes occurring. To relieve this risk, our Heart of Melbourne cardiologists have specialised in ways to open the narrowings through minimally invasive techniques or interventions, known as ‘plasty’, ‘stenting’, or ‘percutaneous coronary interventions - PCI’s’. This form of intervention follows the same procedure as coronary angiography, in that a small entrance is made in an artery, and a catheter is passed into the heart. As with angiography, these types of interventions will be performed in the catheter lab at a hospital, and you will be lightly sedated to ensure the procedure is not painful or distressing. ‘Percutaneous’ refers to anything that occurs through the skin, which in this case means removing the need for traditional surgery, reducing the risk of any scarring, and dramatically improving recovery time with very little down time afterwards.
In the catheter lab, the area will be draped with a sterile sheet, and antiseptic solution will clean the area to inhibit infections. A catheter with a small balloon at the end will be fed through an artery - usually in the wrist, and under X-ray guidance, will be positioned into the narrowed blood vessel. The balloon is surrounded by a mesh known as a stent, and when the catheter is in line with the narrowed area, it is inflated, pressing the mesh into the walls of the blood vessel and ‘squashing’ the plaques, in turn widening the area for blood to flow. The balloon and catheter are removed, leaving behind the mesh to hold open the vessel, and allow greater blood flow, improving oxygen circulation, and minimising the risk of clots becoming lodged. The mesh binds to the artery wall, and after about a month will be a permanent foundation to avoid the vessel becoming blocked again. An overnight stay is usual with this procedure, as it allows for monitoring and rest, and you will be able to resume normal activities after approximately one week. Anti-clotting medication will be prescribed to you after the procedure, if you are not already taking it, and your Heart of Melbourne cardiologist will be able to answer any further questions you may have.
Right Heart Catheterisation (RHC)
While a coronary angiography looks at the road map of your blood vessels and checks for congestion, a right heart catheterisation study measures the pressures in the right side of your heart and your lungs to assess various types of heart functions, connections between the different chambers, oxygen levels, and pulmonary hypertension.
If your Heart of Melbourne cardiologist believes you require an RHC, you will follow the protocol of other coronary studies. Our team will arrange for you to attend a public or private hospital, and you will arrive a few hours prior to your procedure time. Questions regarding fasting or medications can be answered by our staff prior to the day of your procedure. You will be asked to change into a gown, and be taken to the cardiac catheterisation lab, a theatre-like room with highly specialised equipment. You may be offered a light sedation to ensure the most possible comfort during the procedure, and a local anaesthetic will be administered over the site of a large vein. A catheter will be inserted into the vein, and guided under X-ray to your heart. The catheter is equipped to take measurements of pressure while it is in the chambers, and the doctor will be able to see immediately if the readings are normal, or abnormal. The catheter will be removed and a small dressing applied. The procedure usually takes about an hour to complete.
While you spend a few hours in recovery, your Heart of Melbourne cardiologist will speak with you about your results, and what treatment, if any, is required. After you have been monitored, a friend or family member will be able to escort you home, and you should be able to return to your normal activities after 24 hours.
Intracoronary Imaging and physiology (IVUS, OCT, & FFR)
At Heart of Melbourne, we work to provide accurate, timely diagnoses, and offer the most appropriate and accessible treatment options for our patients. Intracoronary imaging and physiology involves the use of traditional methods of scanning, and adapting them to provide detailed and highly specified imaging and functional assessment (like a stress test) from within the blood vessels. There are variations of these techniques that can be used in these cases, including intravascular ultrasound (IVUS), fractional flow reserve (FFR) testing, and optical coherence tomography (OCT).
Intravascular ultrasound uses a catheter inserted into a vessel, like in coronary angiography. However in this type of scan, the catheter tip is equipped with a tiny transducer that produces sound waves from within the blood vessel, giving the cardiologist a real time view of the structures and sizes of the vessel and any blockages or narrowing.
Optical coherence tomography (OCT) is very similar to IVUS, in that a catheter is inserted into a vessel to create images from within. However, as with IVUS and sound waves, OCT imaging uses light waves to provide a view for the cardiologist. The OCT method can be much more specific and provides much higher resolution in cases which may have complex abnormalities for investigation. This is a very specialised test requiring specific expertise and only available at selected places. Our Heart of Melbourne interventional cardiologists are highly trained and have access to utilise these state of the art technologies, and treat their patients the best possible way.
Fractional flow reserve (FFR) imaging is a technique that looks at the maximum possible blood flow through an artery that may have narrowing, or plaques, and compares the measurement to that of a completely healthy vessel. With this technique, the cardiologist can assess how much blood is currently passing through your artery, if it is an acceptable amount, or if there is limitations from narrowing or blockages, in which case further treatment may be required.
All of these imaging types are only performed by highly trained cardiologists, and at Heart of Melbourne, we hope to utilise every available avenue to find the diagnosis and best possible treatment for our patients.
Transcatheter Aortic Valve Implantation (TAVI)
Transcatheter aortic valve implantation (TAVI) is a minimally invasive heart procedure to replace a narrowed aortic valve (aortic valve stenosis). This procedure is performed through your groin and is recommended for people who cannot undergo an open heart surgery for the treatment of their narrowed valve. Transcatheter aortic valve implantation is sometimes called transcatheter aortic valve replacement (TAVR).
Aortic valve stenosis occurs when the heart's aortic valve thickens and calcifies, and is not able to open fully. This limits blood flow from your heart to the rest of your body. Severe aortic stenosis can cause chest pain, dizziness, collapse, shortness of breath, or sudden cardiac death.
During a TAVI procedure, an artificial valve made of natural animal heart tissue will be implanted into your heart without requiring an open heart surgery. It is a minimally invasive procedure,
Minimally invasive surgery helps to give you a better chance of recovering quicker after your surgery. Your cardiologist will decide if you are suitable for TAVI or not.
The TAVI procedure takes place in hospital. You will be given either conscious sedation, or in some cases general anaesthesia. A catheter is inserted into an artery in either your groin or underneath your collarbone. A balloon is positioned within the aortic valve and gently inflated to open up the valve. Using the same technique, your cardiologist then implants a new aortic valve over the balloon. The balloon is deflated and removed from the body. A stitching device is used to close the hole in the leg arteries.
You may spend the night in the intensive care unit for monitoring after your procedure. Generally, you'll spend about two to five days recovering in the hospital.
TAVI may relieve the signs and symptoms of aortic valve stenosis and improve your overall health and quality of life. TAVI can also reduce the risk of death.