Cardiac Catheterisation
& Coronary Angiography

Cardiac Cathertisation is done to assess the condition of your coronary arteries. It helps identify the site and extent of blockage, and determines what type of procedure (e.g. angioplasty, stenting, or bypass surgery) will best treat your condition.

To perform Cardiac Catheterisation, a catheter (a thin flexible tube) is inserted into the artery in the groin or forearm. The catheter is guided to the opening of the coronary artery in the aorta. Contrast “dye” is injected which makes the coronary arteries visible on an x-ray.

During the procedure, a moving picture is recorded – this portion of the test is called Coronary Angiography. The contrast dye is later eliminated from your body through your urine.

Sometimes physicians immediately treat a problem such as dissolving a clot or performing an angioplasty and stenting to open blocked arteries. This depends on the location and extent of the blockage. An angiogram may determine that bypass surgery is necessary.

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Angioplasty & Stenting
(PCI or PCTA)

Angioplasty and Stenting treat the narrowing of the coronary artery to increase blood flow to the heart.

Angioplasty is a procedure in which a narrowed section of the coronary artery is dilated with a balloon catheter to relieve the blockage and therefore increase blood flow.

Stenting or stent placement is often standard procedure and reduces the chance of reclosure of the artery. Stent implantation involves an additional step after balloon-only angioplasty. After the first balloon is inflated and the fatty plaque is pushed against the artery wall, it is removed and a second balloon catheter carrying a stent is inserted. The second balloon is inflated, expanding the stent and lodging it in the artery where it remains.

A stent is a small, lattice-shaped, metal tube that is inserted permanently into an artery. It helps hold open an artery so that blood can flow through it. Drug-eluting stents are stents that contain drugs that potentially reduce the chance the arteries will become blocked again.

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Bypass Surgery - Coronary Artery Bypass (CAB) or Coronary Artery Bypass Graft Surgery (CABG)

Bypass Surgery is the most common form of heart surgery and can be performed either as Open Heart Surgery (using a heart-lung bypass machine) or Beating Heart Surgery (during which the heart-lung bypass machine is not used.)

In Bypass Surgery, diseased or blocked arteries are bypassed, using a section of vein from the leg or other part of the body to create a new route for blood to flow around the obstruction to the heart.

Single bypass, double bypass, triple bypass, or quadruple bypass refer to the number of arteries that are bypassed. On occasion, an internal artery in the chest is grafted beyond the obstruction. This is called an internal mammary bypass graft.

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Atrial Septal Defect Repair (ASD) or Ventricular Septal Defect Repair (VSD)

Artial and Ventricular Septal Defects are congenital anomalies of the heart sometimes referred to as a “hole in the heart”. Treatment for ASD, VSD, and ASVD can be minimally invasive or require more complicated surgery depending on the extent of the repair needed.

Small ASD and VSD can be repaired using a cardiac catheterization technique similar to that used in an angioplasty. During the procedure a small implant is transported via a catheter tube to the ASD or VSD site. The implant is used to plug the hole. This technique can sometimes eliminate the need for more invasive procedures, but on occasion requires revision. For larger ASD, VSD, or for more complex ASVD cases, open heart surgery may be required.

Larger ASD, VSD, or more complex ASVD cases may require open heart surgery.

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Valve Repair or Replacement

Valve Repair or Replacement most commonly treats valves that do not allow enough blood through (stenosis) or that do not seal properly and allow blood to leak backward (regurgitation or insufficiency).

Valve Repair or Replacement is performed either as Open Heart Surgery using the heart lung bypass machine or as a Beating Heart Procedure where the heart-lung bypass machine is not used. The damaged valve is surgically repaired or is replaced with a biological or a mechanical valve.

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Open Heart Surgery &
Beating Heart Procedures

Open Heart Surgery is the term used to describe surgical procedures to correct problems on the inside or outside of the heart. “Open” refers to the opening of the patient’s chest cage – not to the heart itself.

During Open Heart Surgery, the surgeon opens the chest cage to expose the heart. The beating of the heart is temporarily stopped and the body’s oxygen needs are met by a cardiopulmonary bypass (or heart-lung) machine. The heart is stopped with a cold, high potassium solution which protects the heart muscle from damage; cold saline irrigation over the heart is also used to protect the heart while it is stopped and is without its own blood supply. Once the heart is stopped, the defect can be repaired in a bloodless environment.

Beating Heart Procedure is the term used to describe minimally invasive heart surgeries that are performed through small incisions. During this approach, the heart is not stopped and therefore, a heart-lung bypass machine is not used. The most significant advantage of Beating Heart Surgery is that it reduces the risks and post-operative complications that are associated with temporarily stopping the heart during Open Heart Surgery.

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