IN PATIENT (INVASIVE)



Dr. Kiwan has devoted his career to the very latest in cardiovascular innovations, advancements and patient procedures since 1985. The following inpatient procedures are all performed in exceptional well-equipped facilities along with a highly qualified team of nurse/nurse practitioners, technicians and a medical support staff specifically trained in cardiovascular care..


CORONARY



  • Coronary Angiography

  • Coronary Balloon Angioplasty

  • Coronary Stenting

RENAL


  • VALVULOPLASTY (BALLOON DILATATION)

CORONARY

  • Mitral
  • Aortic
  • Pulmonary

Balloon Angioplasty

– (PTCA or Percutaneous Transluminal Coronary Angioplasty) is a procedure in which a small balloon-tipped catheter is placed into the artery where there is a narrowing. The balloon is inflated at the blockage to push the plaque and fatty deposits against the artery wall. The balloon is then deflated and removed, allowing blood to flow without difficulty.


Coronary Stenting

– In about 90% of all balloon angioplasty procedures a stent is also used. A stent is a tiny metal mesh tube that is inserted into a narrowed artery by a balloon- tipped catheter. When the balloon is inflated the stent opens out to the size of the artery. The balloon is then deflated and removed while the stent remains in place. This provides support for the arterial wall, keeping the artery open. Some stents are self-expanding and do not require a balloon to open them.

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Rotoblation

– A procedure in which a catheter with a rough diamond-coated tip is inserted into the narrowed artery. This tip spins at high speeds grinding the hardened plaque creating an opening. This procedure may be followed by balloon angioplasty and sometimes a stent, to smooth the edges and keep the artery open.


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Valvuloplasty

– A non-surgical treatment for heart valve stenosis (a narrowing of the heart valve). During this procedure the narrowed valve is stretched open by a balloon-tipped catheter. The balloon is inflated until the valve is expanded; then the balloon is deflated and removed. Mitral Baloon Valvuloplast.

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Cartoid Stenting

– The carotid arteries are located on each side of the neck and supply blood to the brain. Carotid artery stenting is done to prevent future strokes in people with a blockage in the carotid artery. This is a non-surgical procedure in which a metal mesh cylinder is inserted into the carotid artery by a balloon-tipped catheter. The balloon is inflated which expands the stent to the artery wall thus opening the blood vessel. The balloon is deflated and removed and the stent remains in place to keep the artery open.


Alcohol Septal Ablation HOCM

– A technique in which ethanol is injected directly to the heart in order to treat thickening heart muscle cells in patients diagnosed with Hypertrophic Obstructive Cardiomyopathy. The alcohol septal ablation procedure begins with physicians inserting a small catheter into an artery in the groin, and then threading it to the heart. The treatment decreases the thickened muscle that divides the heart’s two chambers so that it can retract, restoring normal function. After treatment, patients will notice significant improvement almost immediately.


PFO Closure

– A Patent Foramen Ovale means a “hole” between the right and left atrium. A patient who has PFO has an increased chance of stroke., It is recommended that PFO’s be closed in such patients particularly those with mini-strokes(transient ischemic attacks or TIAs). And, although traditional methods of closing PFO would involve open-heart surgery, modern medicine and technological advancements now make it possible to use special cardio devises and new treatments in which recovery is quick and the patient is discharged from the hospital in less than 24 hours without the need to open the chest.


ASD Closure

– Atrial septal defects (ASD) are congenital irregularities. When the opening between the wall and the two atria or septum does not close at birth as it is supposed to, the blood to bypass the lungs does not occur correctly. The size of the ASD can be very small or more than an inch in diameter. The higher blood pressure in the left atrium pushes blood into the right atrium, adding additional supply of blood to the heart. This added volume increases both the workload of the right ventricle and the flow of blood in the lungs. Larger defects may cause symptoms including shortness of breath, sweating a lot with activity, increased breathing rate, or decreased growth. Congestive failure may develop, with cough and swelling of the legs and ankles. Occasionally, the added strain on the heart results in irregular heart beats. Patients who are found to have an ASD should have it closed. In the past ASD closure required surgery, now ASD closure is a “knifeless” procedure. This procedure is very safe, and prevents the patient from suffering blood clot and heart rhythm and pumping disturbances.


CARDIAC CATH AND CORONARY ANGIOGRAPHY


How Long Does It Take?

The actual left heart cath procedure usually takes approximately 10 to 15 minutes. However, it may take longer if the patient has unusual anatomy of the arteries and there are technical difficulties. Additional time will be needed if the patient has had prior bypass surgery since additional pictures of the bypass vessels are needed. This can add another 10 to 15 minutes to the procedure time. An additional 10 to 15 minutes are needed if the patient requires right heart catheterization.
Approximately three to four hours after the procedure, the patient gets out of bed. The patient is usually discharged within six hours of the procedure unless additional treatment or procedures are required. A little soreness and a Band-Aid are usually the only traces of the procedure. Some patients may display a bruise at the site.
Following discharge, the mild soreness and slight bruising should resolve. However, some patients may experience tenderness and mild pain that can last a few days. If there was bruising at the time of discharge, the area of discoloration may increase in size. This does not necessarily indicate additional bleeding and may be due to the spread of blood pigments under the skin. However, you must notify your cardiologist if you note an increased swelling, particularly if it pulsates. Persistent fever is rare and also requires that the patient contact the cardiologist’s office. You may be instructed to drink plenty of fluids on the night of the procedure to compensate for the urinary fluid loss induced by the contrast material.

How Safe is the Procedure?

Cath is a relatively safe procedure and is carried out all over the world on an outpatient basis. However, it must be recognized that the procedure is frequently carried out in patients with heart disease and that catheters have to be inserted into blood vessels. Despite this, the risk of a serious complication is estimated to be less than 4 and probably around 1 to 2 per thousand. Rare serious complications can include death, a heart attack, stroke and need for emergency surgery. Occasionally, patients may exhibit a rash as an allergic reaction to the contrast material. Serious allergic reactions are rare and can usually be controlled. Rarely, the contrast material may affect kidney function. This problem is more likely to occur if the patient has underlying kidney disease, and is more likely among diabetics than among non-diabetics. Other infrequent complications can include bleeding that requires blood transfusion or surgical repair, blood clots, and a sustained abnormal cardiac rhythm.

What is the Reliability of the Test?

Cardiac Cath is the “gold standard” against which all other coronary diagnostic tests are measured. However, it should be remembered that it can only pick up “fixed” Coronary Artery Disease (CAD) and may miss coronary spasm where the blockage may come and go. In these cases, medications can be used to provoke and confirm, or exclude, the presence of spasm.