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 A cardiac catheterization (heart cath) is a procedure where special tubes called catheters are passed through the chambers of the heart through a vein or artery. Diagnostic catheterization allows us take pictures of the heart and vessels, to measure pressures, and enables us to obtain important information on the heart condition. Diagnostic and interventional (see below) catheterizations are performed under light sedation or general anesthesia. Patients are often discharged the same day or the next morning, depending on the procedure.
We also offer a full range of interventional catheterizations that can treat various heart conditions without surgery. Procedures offered include:
Valvuloplasty
Angioplasty
PDA closure
Coil Embolization of vessels
Stenting of Coarctation of the aorta and other vessels
Atrial Septal Defect (ASD) Closure
Patent Foramen Ovale (PFO) Closure
Ventricular Septal Defect (VSD) Closure
Mitral Valvuloplasty
Catheter Ablation
Dr. Carl Garabedian has applied his congenital heart cath tools to help treat adults with serious life threatening complications following coronary artery surgery which are not amendable to surgical intervention. These procedures include closure of paravalvular leaks (leaks around a surgically implanted valve), closure of coronary artery fistulas, closure of post infarct ventricular septal defects, mitral valvuloplasty and aortic valvuloplasties. Many of these patients have no further surgical options, or only very high risk options, and improvement in symptoms is frequently seen.
Valvuloplasty for Aortic or Pulmonary Valve Stenosis
This procedure is performed for patients with significant stenosis of the aortic or pulmonary valves. Blood flow out of the heart is limited when the aortic or pulmonary valves become thickened and do not move well. This forces the ventricles, the main pumps of the heart, to work under additional stress to eject blood. The walls of the ventricle will thicken with time and if untreated, can lead to heart failure. Valvuloplasty is the procedure of choice for these conditions and can be performed on patients at any age or size. The procedure is performed by passing balloon tipped catheters into the heart and across the narrowed valve. The balloon is temporary (5-10 seconds) inflated and when deflated, the valve is less obstructing. These procedures are often performed under general anesthesia (depending on age and severity of the illness) and the patient usually spends 24 hours in the hospital.
Angioplasty
This procedure allows us to open stenotic (narrowed) vessels by inflating balloons across the narrowed region. The stretching makes small "tears" in the vessel lining allowing the vessel to remodel (heal) without the stenosis. Narrowing of the vessels can occur naturally or may be secondary to surgical scars. When angioplasty fails, stenting of the vessels is considered.
Patent ductus arteriosus (PDA) closure
 A patent ductus arteriosus (PDA) is an abnormal vascular connection between the aorta and pulmonary artery. The vast majority of PDAs (excluding those in small premature infants) can be closed in the catheterization laboratory without the need for surgery. The Amplatzer Ductal occluder is used to close large PDAs whereas small PDAs can be closed with coils (stainless steel springs with nylon "hairs") Both devices are delivered into the PDA's abnormal vessels to eliminate blood flow through the vessel. Patients are routinely discharged home on the same day as the procedure.
Stenting of Coarctation of the Aorta and other vessels
 A stent is a metallic frame that can be expanded in anarrowed vessel. Stents are used to open narrowed regions that are not safe to open with or fail angioplasty. Stenting is also used in older children and adults when the narrowed vessel can be opened to an adult size. Stents are frequently used to treat children and adults with pulmonary artery narrowing (often seen in patients with Tetrology of Fallot) and coarctation of the aorta. Patients who have had previous surgical repairs for coarctation of the aorta may have a mild residual narrowing that leads to high blood pressure. Stenting can improve the patient's hypertension and minimize or eliminate the need for blood pressure medications.
Coil Embolization
Many abnormal vessels can develop in patients with congenital heart disease. Coils are delivered to these areas in order to eliminate flow to unwanted areas. Coiling complements or minimizes the risks of the planned surgical procedure.
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Atrial Septal Defect (ASD) Closure
We offer transcatheter closure of atrial septal defects. An atrial septal defect is a connection between the left and right atrium that allows extra blood to enter the right heart and lungs. In the past, this required an open-heart operation. We now use the Amplatzer ASD occluder to close these defects if amendable to device closure. Not all ASDs can be closed without surgery and your doctor can tell you if you are a candidate for transcatheter closure. The procedure is usually performed under general anesthesia with transesophageal or intracardiac ultrasound guidance. The procedure takes less than two hours and the patient is typically discharged home the next day. Please see the Amplatzer web site for more information.
For those patients who are not candidates for device closure, all surgical options will be discussed which include mini-thoracotomy or robotic surgical approaches.
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Patent Foramen Ovale (PFO) Closure
The PFO is a small communications between the upper chambers of the heart found in 10-25% of the population. This is a natural communication in the fetus and typically closes in the first few weeks of life. Persistent PFOs in patients who have Transient Ischemic Attacks (TIAs) or strokes without the typical causes of stroke (also known as cryptogenic stroke) is being studied. The PFO usually lets blood flow from the left to right side of the heart. However, if the person valsalvas, (coughs, strains, has a bowel movement...) the direction of flow can switch by allowing blood, and potentially clots, to pass from the right side of the heart to the left. This could potentially allow a blood clot to flow from the venous system into the arterial, which can then travel to the brain.
Ongoing research is looking at the association of PFOs and recurrent migraines. The PFO can also be a cause of cyanosis (low oxygen levels) in patients with right sided heart problems. In the past, closing these holes required an open-heart surgery. We now use the CardioSeal Septal Occluder and the Amplatzer family of devices to close PFOs without open heart surgery. The procedure is relatively simple, taking less than one hour with discharge from the hospital the same day with infrequent complications. The procedure is usually performed under light sedation with intracardiac echocardiography (ICE) guidance. Please see the section on the PFO and adult for indications for this procedure.
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Ventricular Septal Defect (VSD) Closure
The vast majority of VSDs require surgical repair. The Amplatzer company is working on a device to close the majority of these defects but so far there have been complications that outweigh the low surgical risk of repair.
Rare VSDs in the muscular septum cause significant heart failure and require closure. These muscular VSDs are difficult for the surgeon to visualize and completely close by standard surgical techniques. We have used both the CardioSEAL and Amplatzer muscular VSD occluder to close these defects. The majority of defects closed in infants and small children are part ofa "hybrid" procedure where the surgeon will expose the defect and the device is then delivered by the pediatric cardiologist. For larger children and adults with post-infarct (after a heart attack) VSDs,these procedures are often preformed in the catheterization laboratory and patients are frequently discharged the same day.
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Mitral Valvuloplasty
Mitral stenosis (narrowing) is becoming a rare disease with the advent of antibiotics to treat strep throat and prevent subsequent rheumatic fever. For patients with rheumatic mitral stenosis or the child with congenital mitral stenosis, pulmonary hypertension and heart failure can occur. Mitral valvuloplasty is performed under general anesthesia and with transesophageal echocardiography (TEE) guidance. A catheter is passed from a vein into the heart and a hole is punctured in the atrial septum to gain access to the mitral valve. The Inoue balloon is advanced across the puncture site and then quickly inflated across the valve. Patients are often discharged home the next day. Rarely this procedure will need to be repeated if the mitral stenosis reoccurs.
Catheter Ablation
Many types of heart rhythm disturbances resulting in a rapid heart beat can be treated with catheter ablation. The most common indications are supraventricular tachycardia, and Wolff-Parkinson-White syndrome. Northwest Center for Congenital Heart Disease and the electrophysiology laboratory at Sacred Heart Children’s Hospital offer both radiofrequency and cryoablation.
Radio frequency ablation applies heat at radiofrequency to the tip of the ablation catheter for precise ablation at temperatures varying from 50 to 65º C. This is a very effective method for ablating these arrhythmias. Cryoablation, which is a newer technology, generates intense cold (at temperatures between -80 and -90º C.) to the tip of the catheter, with slightly less effective results but with a much lower risk of complications.
Catheter ablation can often cure supraventricular tachycardia and Wolff-Parkinson-White syndrome. In addition, it is often an effective treatment for atrial flutter and certain types of ventricular arrhythmias that do not respond well to treatment with medication. The expected hospital stay after catheter ablation is less than 24 hours, with a generally rapid recovery. Followup after an ablation procedure is specific to the condition for which the ablation was performed and with supraventricular tachycardia or Wolff-Parkinson-White syndrome there are usually three followup visits required (one visit two weeks following ablation, the next visit four months following ablation, and the final visit one year after ablation).
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