Peripheral Artery Disease (PAD)
When a patient is diagnosed with aortic valve stenosis and he or she is not a good candidate for surgery, transcatheter aortic valve replacement is a minimally invasive treatment option. Without opening up the person’s chest, the TAVR procedure relieves the side effects of the condition, which include tightness in the chest, fatigue, shortness of breath, chest pains, and heart palpitations.
Aortic valve stenosis is a type of heart disease in which blood isn’t able to flow freely from the heart to the rest of the body. This happens when the aortic valve is unable to open completely, restricting the space in which the blood has to circulate. TAVR surgery, or transcatheter aortic valve implantation (TAVI) as it’s sometimes known, uses a catheter to insert a balloon into the artery. The procedure expands the natural valve and leaves a replacement one to take over the function of carrying blood away from the heart.
A traditional valve replacement requires open heart surgery with a sternotomy, and involves removing the malfunctioning piece of the valve and replacing it with a manufactured one. This may be a mechanical version or a replacement valve made from animal tissue. TAVR is a somewhat new procedure that was just approved by the FDA and uses a small incision to access the collapsing artery as opposed to surgically separating the patient’s chest.
A patient undergoing TAVR surgery will have a catheter inserted into and threaded through the aortic valve. At the end of the catheter, a small balloon device will inflate once inside the aortic artery, expanding the restricted walls. Attached to the balloon is a replacement valve, which is condensed upon entry into the artery. The inflating of the balloon pushes the natural, faulty valve out of the way, and drops the replacement in its place at the narrowed portion of the aortic valve.
As soon as the surgeon deflates the balloon and blood is allowed to pass through again, the replacement valve takes over the regulation of blood flow. The new valve is essentially an inflated, artificial version of the natural artery and provides immediate improved circulation.
The catheter is generally inserted into the aortic valve via one of two methods:
Which approach is right for each individual is determined by the surgeon or cardiologist based on the patient’s other health issues and risks of complications.
While every case of aortic valve stenosis is different and every patient needs to be assessed individually, overall health is the major factor in whether someone is a good candidate for TAVR. Transcatheter aortic valve replacement is generally suggested for those whose health makes open heart surgery too risky. If a patient is determined to be especially prone to complications from traditional valve replacement due to other medical conditions, they may also be deemed a good candidate for TAVR or TAVI. Because of these conditions, most of the patients who undergo this procedure are over the age of 70.
TAVR/TAVI can be an effective procedure for treating valve stenosis heart disease in many who formerly did not have a solution. With a less invasive approach and shorter recovery time, transcatheter aortic valve replacement is improving quality of life for patients whose disease has limited them.
Vascular studies are a noninvasive (the skin is not pierced) procedure used to assess the blood flow in arteries and veins.
A transducer (like a microphone) sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the skin at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the blood vessels, where the waves echo off of the blood cells. Blood pressure cuffs are inflated on the limb and blood pressure in the limb is measured using the Doppler transducer.
A carotid artery duplex scan is a type of vascular ultrasound study done to assess occlusion (blockage) or stenosis (narrowing) of the carotid arteries of the neck and/or the branches of the carotid artery.
Other procedures are done to assess blood flow in the abdominal aorta and lower limbs.
Like an echocardiogram, the transesophageal echocardiogram uses ultrasound to create images, however the images are much clearer.
TEE involves passing a special ultrasound scope through your mouth into your esophagus and close to the heart to take images. This test gives your physician more detailed answers of your heart function.
You should not eat or drink 4-6 hours prior to the procedure. Your physician will go over the results after the test has been completed.
This test would be scheduled as an outpatient procedure at the hospital and takes approximately 30-45 minutes.
Heart Rhythm Monitors come in two different types: Holter Monitors and Event Monitors.
A Holter monitor is a portable device worn continuously for 24 hours. This is helpful in observing for occasional arrhythmias (abnormal heart rhythms) that would be difficult to identify on an EKG.
Event monitors are 15-day medical devices that record the heart’s electrical activity. Doctors most often use these monitors to diagnose arrhythmias. Event monitors require patient activation to record heart rhythms.
There is no preparation necessary prior to this appointment.
It will take approximately 20 minutes to apply the Holter monitor in our office. A follow-up visit will be scheduled 10-14 working days after the test for a provider to go over the results.
A diagnostic ultrasound image is produced by specialized equipment and uses high-frequency sound waves to view areas inside the body.
A painless and harmless test that uses high-frequency sound waves to create images of the insides of the the two large arteries in your neck.
Uses reflected sound waves to produce a picture of the organs and other structures in the upper abdomen. An abdominal ultrasound can evaluate the abdominal aorta which is the large blood vessel (artery) that passes down the back of the chest and abdomen
An ultrasound study to look at the blood flow in the legs.
An ultrasound of the deep veins of the legs to look for blood clots.
Congestive heart failure is diagnosed when the heart is unable to pump adequate amounts of blood to meet the demands of your body's organs.
A normal heart on the left and a congested heart on the right.
When this happens some, or all, of the following symptoms may be present:
If you are diagnosed with congestive heart failure, know that you will be in good hands with CVC’s caring, specialized group of physicians and staff. At the Congestive Heart Failure Clinic, our staff helps you understand the disease, maps the road for your quickest recovery and helps you maintain a healthy lifestyle to manage the disease.
For more information, your provider can give you a copy of the “CVC Congestive Heart Failure Patient Handbook” which is available to patients in our office.
Cardiac catheterization is a test to evaluate the health of your heart and coronary arteries.
It is used to monitor the blood flow and blood pressure in the chambers of your heart and blood flow within your coronary arteries. Defects in the movement of the heart wall can also be detected. A catheter is inserted through the groin and guided through the artery up into your heart. Once the catheter is inside the heart, the physician can measure the pressures in the main pumping chamber of the heart and take images.
Should your coronary arteries be blocked, your doctor will perform a Percutaneous Coronary Intervention (PCI) with the use of a catheter. This is a thin flexible tube that serves as a guide wire with a balloon attached that will open and improve blood flow to your heart.
Common types of PCI include Angioplasty and Stenting.
Inform your doctor if:
You will need to arrange for transportation home after the procedure. You may not eat or drink for 4-6 hours prior to the test. Your doctor will inform you if you need to discontinue any of your medications the day of the test. You will need to remove all jewelry and nail polish.
This test takes approximately 1-2 hours in the hospital setting. The doctor will talk to you about how the procedure went after completion. You will also need to be scheduled for a follow-up visit at one of our outpatient clinics within two weeks.
Ambulatory Phlebectomy or “hook” phlebectomy is a micro-extraction procedure used to remove varicose veins, both large and small, which are close to the surface through very small (1/8 inch) micro-incisions.
The micro-incisions are so small that they are closed with sterile tape and not stitches. Once healed they are rarely visible. Bruising will occur and will take a few weeks to go away. A compression bandage is worn for only 3 or 4 days. When removed patients are amazed how good the leg looks with the “ropey” veins gone. Then a compression stocking is worn for another week. Patients can return to normal daily activities including work the next day and walking is encouraged.