Structural Heart Disease Interventions
ASD (Atrial-Septum Defect) and PFO (Perforated Foramen Ovale)-Closure
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Treatment
ASD and PFO closure procedures are nearly identical
What is the ASD/PFO closure procedure?
The ASD is a defect of the atrial septum, the thin wall separating right from left atrium which is persistent from birth. The PFO is a small hole remaining in this same wall. These conditions are common, but usually present no or very mild symptoms and can go undetected for years. In the past, open heart surgery was necessary to close this little defect.
For many years now we have minimally invasive procedures available. We place a little catheter into the vein in your groin and advance catheters and the closure device all the way into the heart fitting it into the hole to close it completely.
The PFO Occluder is a self-expandable double-disc device made out of wire mesh. The procedure is monitored continuously on the large Xray display and also via a transesophageal Echocardiography (TEE), which is being placed throughout the procedure.
At the end, we control proper closure by the device and remove all catheters and wires. The access site is being closed with a pressure bandage.
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Why would you need to close the ASD or the PFO?
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In case you become symptomatic with shortness of breath or with neurologic events like strokes and TIA's (Transient ischemic attacks), the little defect in the atrial wall must be closed to avoid further complications.
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Risks involved
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Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. Prior to your procedure, you will discuss your individual potential risks with your doctor.
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Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
Preparing for your procedure
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You must be fasting at least 6 hours prior to the procedure.
Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications, may need to be paused some days prior.
Insurance coverage
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ASD/PFO closure is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Recovering from your procedure
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You will not receive general anesthesia during your procedure; however, light sedation will be administered to make you feel more comfortable. You will be transferred to the regular room until you are ready for discharge.
You will be given written post procedure discharge instructions that will advise you about return to normal physical activity.
Treatment
Left Atrial Appendage Occlusion (LAAO)
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Left atrial appendage occlusion, known as LAAO or LAA closure, is a minimally invasive procedure used to reduce the risk of a stroke in patients who have atrial fibrillation (AF).
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What is a LAAO?
The left atrial appendage is a small pouch attached to the left atrium. With every heartbeat blood enters this appendage, but it tends to pool for a while before it is ejected back into the main area of the left atrium. This is how intracardiac clots increasing the risk for strokes are formed.
The good news is, the entrance can easily be identified and sealed off as if putting a cork on a bottle.
Prior to the closures procedure, your cardiologist may perform a Transesophageal Echocardiography and a Heart CT to measure the exact structure of the appendage.
The LAAO is normally carried out under local anesthetic and sedation, no general anesthesia is required. A special catheter is fed to the heart via a vein in the groin and places the closure device at the exact position in the heart that seals off the left atrial appendage, preventing blood reaching into this attached pouch but also preventing clots exiting from it.
All catheters and wires will be removed, and a compression bandage will seal off the puncture site in the groin
Why do I need LAAO?
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The erratic heartbeat in patients with AF can lead to blood clots collecting in the heart, and these can travel to the brain causing a stroke. When blood collects in the heart it tends to 'pool' in the left atrial appendage, a small sack found at the top of the heart's upper left chamber (left atria). The closer device will eliminate this risk.
For the same reason, most patients with atrial fibrillation will be placed on anticoagulation treatment (blood thinning). Unfortunately, this treatment is not well tolerated by everyone, severe spontaneous bleeding being the worst side effect. In this case, the closer of the left atrial appendage is an important alternative tool to reduce the risk of strokes.
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Risks involved
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Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. Prior to your procedure, you will discuss your individual potential risks with your doctor.
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Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
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Preparing for your procedure
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You must be fasting at least 6 hours prior to the procedure.
Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications, may need to be paused some days prior.
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Insurance coverage
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The LAA Occluder is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Recovering from your procedure
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You will not receive general anesthesia during your procedure; however, sedation will be necessary to make you feel more comfortable. You will stay in the monitored observational area for at least 8 hours after the intervention, then you will be transferred to the regular room until you are ready for discharge.
You will be given written post procedure discharge instructions that will advise you about return to normal physical activity.
Treatment
TASH: Transluminal Ablation for Septal Hypertrophy
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Minimally invasive procedure to reduce the oversized area of the septum which causes the outflow obstruction in HOCM (Hypertrophic Obstructive CardioMyopathy)
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What is TASH?
Simiilar to an angioplasty procedure your interventional cardiologist will access through your wrist artery (radial artery) and navigate with wires and catheters to the thin septal arteries of the heart, which is supplying blood to the thickened septum.
The right choice is being determined with Echocardiographic contrast imaging, and once the right position of the catheter is being confirmed, Alcohol is being applied to the vessel causing it to immediately occlude. The result is a small, localized heart attack, which the patient may feel.
Sedation and pain control will be applied. The oversized septal muscle obstructing the left ventricular outflow tract will thereby shrink.
Once flow termination has been demonstrated, all catheters are being removed and the access site closed with a wrist band like device.
Prior to starting the procedure, we will place a transitory, intravenous pacemaker, in case of transient bradycardia during or after the procedure.
This intervention is a minimally invasive alternative to open heart surgery.
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Why would you need a TASH procedure?
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Only when highly symptomatic with shortness of breath and heart failure do patients require this intervention. Many patients remain stable throughout their life, others will deteriorate quickly once the septal size increases obstructing the outflow tract from the heart through the aortic valve into the aorta.
The amount of blood leaving the heart is significantly reduced, similar to severe aortic valve stenosis, only that the obstruction occurs in the muscle in front of the valve.
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Risks involved
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Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. Prior to your procedure, you will discuss your individual potential risks with your doctor.
​
Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
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Preparing for your procedure
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You must be fasting at least 6 hours prior to the procedure.
Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications, may need to be paused some days prior.
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Insurance coverage
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TASH is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Recovering from your procedure
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You will not receive general anesthesia during your procedure; however, sometimes light sedation may be necessary to make you feel more comfortable. You will stay in the CCU/ICU for at least 48 hours after the intervention to monitor for arrhythmias and to control the symptoms, then you will be transferred to the regular room until you are ready for discharge.
You will be given written post procedure discharge instructions that will advise you about return to normal physical activity.
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Transcatheter Aortic Valve Implantation (TAVI)
Treatment
This is a non-surgical, minimally invasive aortic valve replacement procedure to treat severe aortic stenosis.
The procedure
The access sites for this procedure are through the artery at the top of the leg (femoral artery) . The procedure can be done under sedation (local anesthetic) and usually takes approximately 1-2 hours.
Once the access has been achieved, a transitory pacemaker will be inserted through the left groin and a Transesophageal Echo probe (TEE) may be inserted and placed to visualize the aortic valve.
Through the large arterial access, catheters and wires and the valve carrying catheter will be advanced until in good position, as controlled by Xray imaging and TEE imaging.
Once in place, the heart will be stimulated to a very high rate so that the heart nearly stops beating, at this moment the valve will be expanded into permanent position and the heart returns to its normal heart rate.
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Risks involved
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There are a few risks involved.
Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. Prior to your procedure, your physician will discuss any potential risks with you in detail.
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Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
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Insurance coverage
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TAVI (aortic valve replacement, non-surgical) is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Preparing for your procedure
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You will need thorough evaluation and measuring of your aortic valve and aorta, as provided by TEE (transesophageal Echocardiography). Also, you may need an angio-CT scan of the arteries of your legs to ensure that the large catheter carrying the valve will fit through your arteries without causing damage. In certain cases, Echo-Doppler exams may be sufficient.
Apart from this, you must be fasting at least 6 hours prior to the procedure.
Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications, may need to be paused some days prior.
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Recovering from your procedure
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You will not receive general anesthesia during your procedure; however, sedation will be necessary to make you feel more comfortable. You will stay in the monitored observational area for at least 24 hours after the intervention, then you will be transferred to the regular room until you are ready for discharge.
You will be given written post procedure discharge instructions that will advise you about return to normal physical activity.
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