If you have cardiovascular disease, you will need a highly accurate diagnosis and appropriate treatment. Our advanced diagnostic tools and technology, and our wide range of treatment options, are the first steps to healthy living. SLUCare and Saint Louis University Hospital diagnostic and treatment options (in alphabetical order) include: Adult Congenital Heart Disease Specialty Clinic As a result of medical and surgical advances made in the past 20 years, children born with congenital heart disease are living longer and reaching adulthood more frequently. This longer life expectancy has resulted in a new adult patient population needing specialized care and services not always available through traditional heart programs. Saint Louis University cardiologists now offer an Adult Congenital Heart Disease Specialty Clinic that is designed to meet these special needs. Cardiac Catheterization Service A catheter is a thin tube that is inserted into an artery in the arm or leg through a needle. Alcohol Septal Ablation Alcohol ablation is a non-surgical way of treating an enlarged portion of the heart’s muscle mass which is preventing blood from properly flowing through the heart. By injecting alcohol through a catheter in one of the coronary arteries, the affected area in the heart is rendered inactive without the need for surgery. Angioplasty (Percutaneous Transluminal Coronary Angioplasty) and Laser Angioplasty If an area of the heart is blocked or partially blocked because of plaque buildup, a catheter is inserted in the blood vessel and guided to the area of blockage by a fiber optic camera. Then a tiny deflated balloon is passed through the catheter. The balloon is inflated at the blockage area and the plaque is pushed against the walls of the artery, restoring blood flow through the vessel. Doctors are also performing the same type of procedure using lasers instead of a balloon to clear away plaque. Atherectomy or Rotablator Therapy Atherectomy is a way to restore blood flow in a blocked or narrowed artery near the heart without having to perform open-heart surgery. By using a catheter with a rotating shaver (called a burr) at its top, plaque build-up is shaved from the artery. Atrial Septal Closure Devices A hole in the membrane between the two small upper chambers of the heart can be closed with a catheter-based technique to plug the hole without open-heart surgery. Angiography and Arteriography A coronary angiography is performed by inserting thin tubes (catheters) into the arteries found in the arm or leg. Doctors can determine if and where a blockage is by guiding the catheters into the coronary arteries and injecting a harmless dye to get a clearer picture on the X-ray. While the catheter is in the heart and the surrounding areas, it also takes pressure readings to properly analyze the heart’s performance. An arteriogram determines which arteries outside the heart and brain are damaged. Similar to an angiogram, a harmless dye is injected into the arteries to get a clearer picture on the X-ray. Coronary Stent Placement In order to keep the blood vessel open, a coronary stent (an expandable metal mesh tube) is placed in the coronary artery where the blockage is. The stent keeps the blood vessel open, avoiding the need for future surgery. Thrombolytic Therapy Thrombolytic therapy is the use of clot-dissolving drugs to open blood vessels throughout the body, including the heart and brain. Transradial Catheterization In this procedure, cardiologists access the heart through a catheter in the arm instead of the groin, allowing for a faster recovery from cardiac catheterization. Valvuloplasty (aortic and mitral) This procedure is used to improve blood flow through the heart when there are problems with the heart valves. A special catheter (a tube introduced into a blood vessel and threaded to the heart) containing a deflated balloon is inserted into the opening of a narrowed heart valve. When the balloon is inflated, the valve is stretched open; then the balloon is removed. Cardiac Rehabilitation This program is designed to restore patients with heart disease to the best level of physical and mental function possible. Services offered include assessment, exercise prescription and formal exercise sessions, smoking cessation and patient education. Cardiac Stress Testing & Nuclear Cardiology Service A variety of procedures using exercise and injectable blood flow tracers as a way of testing for cardiovascular disease are available through this service. A nuclear tomography scan and radionuclide angiogram require the injection of a small radioactive isotope into one of the veins in the arm. While exercising, a special camera scans the body and looks for and records several pictures of the isotope’s location. Any dark areas on the picture indicate to the doctor the area of the heart or vascular system where the blood isn’t flowing as it should. Positron Emission Tomography, otherwise known as P.E.T., is a highly accurate way of detecting plaque buildup in the coronary artery and ventricular dysfunction. Cardiac Surgery Coronary Artery Bypass (CABG) A coronary artery bypass graft operation is a type of heart surgery. It is sometimes referred to as CABG or “cabbage.” The surgery is done to reroute, or “bypass” blood around clogged arteries and improve the supply of blood and oxygen to the heart. These arteries are often clogged by the build-up over time of fat, cholesterol and other substances. The narrowing of these arteries is called atherosclerosis. It slows or stops the flow of blood through the heart’s blood vessels and can lead to a heart attack. During bypass surgery, surgeons take a blood vessel from another part of the body and construct a detour around the blocked part of the coronary artery. An artery may be detached from the chest wall and the open end of the vein from the leg may be removed and one end sewn onto the large artery leaving the heart (the aorta). The other end of the vein is attached or “grafted” to the coronary artery below the blocked area. Either way, blood can then use this new path to once again flow freely to the heart muscle. Cardiopulmonary bypass with a heart-lung machine is used for most coronary bypass graft operations, but at Saint Louis University Hospital some bypasses can be performed without the heart-lung machine. Off-Pump Coronary Artery Bypass (OPCAB) This procedure is a coronary artery bypass graft done without the aid of a heart-lung machine. This technique cannot be done for all patients (and does not apply to those with valve disease), but it may reduce some of the complications associated with coronary artery bypass graft and the heart-lung machine. Minimally Invasive Coronary Artery Bypass (MIDCAB) Like CABG, the surgery is done to re-route or bypass blood around clogged arteries. MIDCAB is used when only one or two arteries need to be bypassed. To perform the procedure, the surgeon makes a combination of small incisions in your chest. The cardiac surgeon usually detaches an artery from inside the chest wall and reattaches it to the clogged coronary artery. Mitral Valve Repair and Replacement When the heart valve between the left atrium and the left ventricle (mitral valve) malfunctions, it may be necessary to repair or replace it. With replacement, the surgeon replaces the damaged or dysfunctional valve with a mechanical valve or one from a pig’s heart. The malfunctioning valve doesn’t have to be replaced in all cases and often can be repaired with either a surgical reconstruction or a balloon catheter (called balloon valvuloplasty). Surgical reconstruction is mostly used for leaky, or insufficient, mitral valves, and the balloon valvuloplasty is used for mitral stenosis, or narrowing. Transmyocardial Revascularization (TMR) This innovative treatment involves the use of a laser and is mainly for those who suffer from severe angina but who have an area of their heart which cannot be bypassed because an artery is “diffusely” diseased. Where severe blockage has occurred in the artery, the laser is applied and creates 10 to 50 channels. The newly created channels may fill with oxygen-rich blood, relieving the chronic chest pain associated with angina. Or, the channels may stimulate new blood supply. Valve Replacement for Aortic Valve Stenosis The aortic valve in the heart regulates the direction and pressure of blood flowing from the left ventricle to the aorta and the rest of the body. Aortic stenosis means that the aortic valve has narrowed, forcing the ventricle to work harder to get enough blood to where it’s needed. The only way to treat aortic valve stenosis is with surgical replacement of the aortic valve. Clot-Dissolving Drug Clot-dissolving drugs are used in certain cases because they can help stop a heart attack or stroke and prevent the need for more extensive procedures. Congestive Heart Failure Program New drugs and other medical treatments are now providing options for longer, more productive lives to people with heart failure. The goals of SLUCare’s Heart Failure Program are to use medical options to successfully manage heart failure and to monitor patients closely to see if surgery is required. SLUCare cardiologists who specialize in treating patients with heart failure work closely with SLUCare cardiac surgeons when surgery – such as implantation of a ventricular assist device or surgery – is needed. Echocardiography Ultrasound waves are used to determine if the heart has been damaged. By recording around waves sent into t he chest to rebound from the heart’s walls and valves, the shape, texture and movement of the heart valves and walls are recorded on a VCR tape attached to an echocardiogram. They also reveal the size of the heart chambers and how well they’re working. This is painless procedure that poses no risk. We offer several types of echocardiograms: Stress Echo Stress echo is an echocardiograph examination taken during or after physical exercise. Transesophageal Echocardiography A transesophageal echocardiography gives cardiologists a better view of the heart. This diagnostic procedure allows the heart to be seen through the esophagus, providing a clearer image of the heart. M-Mode Studies and Two-Dimensional Studies This type of echocardiography is used to diagnose such conditions as valve disease, ventricular enlargement and congenital heart defects. Doppler Studies of the Heart The Doppler technique uses the sound waves to calculate pressure and blood flow differences in the heart and blood vessels. This information tells the doctor if a valve is narrowed or leaky. Electrocardiographic Monitoring Service Ambulatory electrocardiography, also called Holter monitoring, ambulatory E.C.G or E.K.G., makes a graphic record over a 24-hour period of the electric currents generated by the heart. It’s done while the patient is walking or moving around, with a small recorder called a Holter monitor. The main goal of ambulatory electrocardiography is to document and describe occurrences of heart rhythm disturbances. These can be random, spontaneous, sleep-related, or emotion- or stress-induced. Other recorders are used for intermittent recording over a longer period of time – weeks or months. These recorders are event recorders activated by the patient at times when palpitations or other symptoms may occur. Electrophysiology and Pacing Services This service offers the most up-to-date diagnostic and treatment techniques to manage arrhythmias and other electrical abnormalities in the heart. The experts who work in this service use technology to record electricity in the heart, to identify the site of arrhythmias, and to implant pacemakers and defibrillators. A non-surgical procedure called radiofrequency ablation is available to treat some types of rapid heart beating. For this procedure, a physician guides a catheter with an electrode at its tip to the area of the heart muscle where the arrhythmia is originating. Then a mild, painless burst of energy (similar to microwave heat) is transmitted to keep that area from conducting the extra impulses that cause the rapid heartbeats. Preventive Cardiology The SLUCare Cardiovascular Risk-Reduction Program includes comprehensive screening followed by an in-depth explanation of the risk factors for coronary artery disease. A blood test may be taken to measure cholesterol levels, to rule out or confirm diabetes, and to analyze the thyroid hormone. Vascular Laboratory The same Doppler ultrasound scanners used to look at the heart are also used to see the arteries in the neck, abdomen and legs. Pressure and flow measurements can also show how much limitation of blood flow there is in these arteries and help guide doctors as to what treatment is needed. These are all noninvasive tests. Vascular Surgery and Endovascular Treatment Center Abdominal Aortic Aneurysm Repair A minimally invasive procedure involving inserting a stent, or tube, is one way SLUCare specialists can repair an abdominal aortic aneurysm. In order to eliminate pressure on the aneurysm, the stent graft is placed through the aneurysm. During this procedure, two small incisions are made in the groin area. A catheter is inserted in the artery and guided to the aneurysm. Then a stent graft is brought through the catheter and opened up, thus providing a new channel for the blood to flow. Carotid Endarterectomy A carotid endarterectomy is a surgical procedure that removes plaque that has built up in the carotid artery (one of the arteries that supplies blood to the brain). Through a small incision, the surgeon opens the carotid artery in the neck and removes the plaque that keeps blood from flowing freely to the brain. Lower Extremity Revascularization The arteries that carry blood to the legs can become narrowed or clogged, slowing or stopping the flow of blood. Revascularization re-opens and unblocks the arteries to improve blood flow. Techniques to revascularize blocked arteries in the legs include: inserting a balloon through the skin into the blocked artery in the legs; inserting a small tube in the artery – called a stent – through a small incision to hold the blood vessel open; or by injecting clot-dissolving drugs through a catheter to restore blood flow. Varicose Vein Stripping Varicose veins are swollen, twisted, cord-like or knotted blood vessels in the legs. To remove varicose veins, a thin wire-like instrument is inserted into the vein, which then removes the diseased vein. Ventricular Assist Device (VAD) Program A ventricular assist device is a pump that takes over the workload of a failing heart, the left ventricle, which performs approximately 80 percent of the heart’s work, is implicated. Now, with an ever-increasing shortage of organ donors, the new challenge rests on keeping patients with advanced heart failure alive while they wait for a heart. Many times, a patient’s only hope during what tends to be a long wait for a new heart is to be put on a ventricular assist device. Some VADs are totally implanted (usually inside the abdomen), and others are outside the chest hooked up to the heart and aorta. Saint Louis University Hospital has one of the oldest and largest VAD programs in the United States, implanting approximately 15 devices a year. The work with ventricular assist systems by Saint Louis University School of Medicine faculty and SLU Hospital has laid the groundwork for advances in surgical techniques to sustain cardiac patients until a heart is available for transplantation. There are as many as 40,000 people in the United States who could benefit from either a heart transplant or some kind of mechanical cardiac support, but there are only enough hearts to transplant about 2,000 people a year.
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