Services

Glenagles JPMC Cardiac Centres offer a wide range of Non-Invasive cardiology and treatment for patients.

Non-Invasive Cardiology

 

Non-Invasive cardiology focus on the detection and treatment of heart diseases, using external tests- rather than instruments inserted into the body of a patient to evaluate and diagnose cardiac disorders. Our Cardiac Centre provides a wide range of non-interventional diagnostic tests for the assessments of patients with cardiac disorder. These are carried out at the Non-Intervensional Laboratory.

Some procedures done at this Laboratory includes:

  • Health Screening
  • Electrocardiograms
  • 24hrs Holter Monitoring
  • Exercise Stress Tests
  • 2D Echocaardiograms
  • Dobutamine Stress Tests
  • Cardiac MRI

Invasive Cardiology

 

Invasive Cardiology uses open or minimally-invasive surgery to identify or treat structural or electrical abnormalities within the heart structure.

What Is An Angiogram?
An angiogram is an examination of your blood vessels using x-ray. The doctor will insert a small tube (catheter) into the blood vessel and then he/she will inject x-ray dye (contrast) that makes the vessels visible when the x-ray pictures are being taken. This will then allow the doctor to determine how well the blood moves through the vessels of your heart.

Why Do I Need An Angiogram?
You need an angiogram because your doctor suspects that there is abnormal blood flow in one or more of your vessels. By injecting contrast through a catheter into your vessels and taking x-ray pictures, the doctor will be able to see if there is a problem and help plan a method of treatment for you.

How Do I Get Ready For My Angiogram?
It is important that you do not eat or drink anything 12 hours before the scheduled time of your examination. You may have a small amount of water with any medications you need to take. Be sure to ask your doctor if you have any questions about eating or drinking before your examination.

Prior to your angiogram you will be visited by our Consultant Cardiologist who will explain the procedure to you. At that time you should ask any questions you may have about the angiogram. If you have any allergies or problems with medications, or think you might be pregnant, you should let the doctor know and if you are allergic to X-ray dye, iodine, or shellfish, it is important to let your doctor know as soon as possible. You will be asked to sign a special form giving the doctor permission to perform the angiogram.

Everyone having an angiogram will have blood tests done prior to the procedure. Your groin will also be shaved on one or both sides where the doctor will insert the catheter. Sometimes the arm may also be prepared in this way. You would be asked to remove your jewelry and dentures if any. You will be asked to put on a hospital gown. It is a good idea to go to the bathroom to empty your bladder before you leave your room. While this examination is being done, your family can wait in one of the hospital waiting areas.

What Happens When I Get To The Cardiovascular Catheterization Laboratory?

In the Cardiovascular Catheterization Laboratory (CVL) you will see plenty of special equipment. The staff will position you on the procedure table and begin to prepare you for the procedure. This includes monitoring of your heart and blood pressure. If you do not already have an IV (intravenous) line, the nurse will insert one so that you can receive fluids and medication during the procedure.

What Is An Angiogram Like?

An angiogram involves two steps :

1. Catheter insertion
The staff will clean your skin area where the doctor will insert the catheter with an antiseptic solution. This is usually at the top of the leg (groin) or the upper arm. You will then be covered with a sterile drape. Next, the doctor will use a small needle to inject some local anesthesia to numb your skin area where the catheter will be inserted. The nurse will give you medication to relieve pain and allow you to relax. You may feel pressure or brief discomfort as the catheter is inserted. The doctor will guide the catheter through the vessel that is to be studied by watching it on a TV-like monitor. You will not feel the catheter moving through your blood vessels.

2. Taking x-ray pictures
Once the catheter is in the correct vessel, contrast dye will be injected through the catheter while x-ray pictures are being taken. You body may feel hot inside when the contrast dye is injected, but the sensation only lasts a few seconds. Several series of contrast injections and x-ray pictures may be needed to complete the examination.

Recovering
When the angiogram is completed, the doctor will remove the catheter and our staff will apply direct pressure for 10-15 minutes over the catheter site to prevent bleeding. A small dressing will be placed over the insertion site. The angiogram usually takes about one hour to complete. When you are back in the ward, you will be instructed not to bend your knee for at least 4-6 hours to prevent bleeding. Your doctor will discuss with you about the findings of your angiogram as well as the treatment options. You can usually be discharged, either the same evening or early the next day.

What Is Coronary Angioplasty (PTCA)?

Coronary angioplasty (Percutaneous Transluminal Coronary Angioplasty) is a medical procedure used to open narrowed or clogged blood vessels of the heart. A thin balloon is threaded through a blood vessel in the groin or arm into a heart (coronary) artery. The balloon is inflated to compress the blockage and stretch the artery open.

Why Do I Need Angioplasty (PTCA)?

Angioplasty is used if you have coronary artery disease (CAD) to:

1) Relieve chest pain caused by reduced blood flow to the heart
Minimize damage to the heart muscle during a heart attack , which occurs when blood flow is totally cut off to an area of the heart

2) CAD develops over time as fatty deposits, called plaque, build up on the inside walls of the coronary arteries. The built up of plaque narrows the arteries, reducing the flow of blood to the heart. This is called atherosclerosis .

How Do I Get Ready For My Angioplasty?

It is important that you do not eat or drink anything 12 hours before the scheduled time of your examination. You may have a small amount of water with any medications you need to take. Be sure to ask your doctor if you have any questions about eating or drinking before your examination.

Prior to your angioplasty you will be visited by our Consultant Cardiologist who will explain the procedure to you. At that time you should ask any questions you may have about the angioplasty. If you have any allergies or problems with medications or think you might be pregnant and allergic to X-ray dye, iodine, or shellfish, it is important to let your doctor know as soon as possible. You will be asked to sign a special form giving the doctor permission to perform the angioplasty.

Everyone having an angioplasty will have blood tests done prior to the procedure. Your groin will also be shaved on one or both sides where the doctor will insert the catheter. Sometimes the arm may also be prepared in this way. You could be asked to remove your jewellery and dentures if any. You will be asked to put on a hospital gown. It is advisable to go to the bathroom to empty your bladder before you leave your room. While this examination is being done, your family can wait in one of the hospital waiting areas.

What Happens When I Get To The Cardiovascular Catheterization Laboratory?

In the Cardiovascular Catheterization Laboratory (CVL) you will see plenty of special equipment. The staff will position you on the procedure table and begin to prepare you for the procedure. This includes monitoring of your heart and blood pressure. If you do not already have an IV (intravenous) line, the nurse will insert one so that you can receive fluids and medication during the procedure.

The doctor will use the IV line to give you fluids and medications. The medications are given to relax you and prevent blood clots. The rest of your preparation includes:

1) Staff in the lab will place ECG electrodes on your chest to monitor your heart continuously during the procedure.
2) Cleaning the shaved area to make it germ free.
3) Numbing the area (the numbing medicine may sting as it is going in).

What Is An Angioplasty Like?

Once you are comfortable, the doctor will begin the procedure:

A small cut is made in your groin or arm. The doctor threads a very fine catheter or tube through a blood vessel to the area of the coronary artery that is blocked.

A small amount of dye is injected into the tube. An x-ray is taken so that your doctor will be able to see the coronary arteries, valves, and chambers of your heart.

Once the blockage is reached, your doctor will inflate the balloon attached to the tube. The balloon will widen the artery to increase the flow of blood to the heart muscle.

A special device may be used to remove some of the plaque from the wall of the artery.

A stent is usually placed at the site to keep the artery open. The stent remains in place forever.

When the doctor finishes, the inner catheter and other devices are removed from the blood vessel. The outer catheter may remain in place, or if a closure device is used, all tubes will be removed.

Recovering

After the procedure, you will be moved to the Intensive Care Unit where:

1) You will need to lie flat in bed. Do not bend your legs. You will need to lie flat longer if no closure device is used. If the angioplasty was performed in your arm, you do not need to lie flat.

2) When the catheter is removed later, pressure will be applied to the site.

3) You will have to lie still for about 4 – 6 hours to allow the punctured site in your leg to seal completely.

4) Afterward, you may walk with assistance.

As you recover, the nurses will check:

1) Your heart rate and blood pressure.
2) Your groin or arm for bleeding.
3) The place where the tube was inserted may feel sore or tender. This may last for about one week.

Excessively slow, fast or irregular heart rhythms can severely affect the heart’s ability to pump blood throughout the body. This may cause symptoms such as fatigue, dizziness, shortness of breath, fainting and in extreme circumstance, death. When these rhythm abnormalities cannot be corrected by medications, or become intolerable, or pose a danger to your life, your doctor may recommend a pacemaker to be implanted.

The implantation is performed usually in the Cardiovascular Catheterisation Laboratory. After injection of local anaesthesia a small incision (cut) is made in the upper left chest and a small “pocket” is created under the skin to accommodate the pacemaker box. An insulated lead is then inserted through a vein in the upper chest and, guided by x-ray, is threaded until its tip lies snuggly within the heart. The other end of the lead is then connected to the pacemaker. The incision wound is closed with stitches, cleaned and bandaged.

What Is Aortic Aneurysm?
Aortic aneurysm is a bulge in the aorta which is the main artery leading away from the heart. An aneurysm is most likely a result of an accumulation of fatty deposits on the vessel wall.

What Is Aortic Stenting?

An aortic stenting involves two steps :

1. Catheter insertion
The staff will clean your skin area where the doctor will insert the catheter with an antiseptic solution. This is usually at the top of the leg (groin). You will then be covered with a sterile drape. Next, the doctor will use a small needle to inject some local anesthesia to numb your skin area where the catheter will be inserted. The nurse will give you medication to relieve pain and allow you to relax. You may feel pressure or brief discomfort as the catheter is inserted. The doctor will guide the catheter through the vessel that is to be studied by watching it on a TV-like monitor. You will not feel the catheter moving through your blood vessels.

2. Stent Deployment
When the delivery catheter is positioned inside the aneurysm, the stent is released into the blood vessel. On coming in contact with blood, the stent will expand to a preset size, on occasion ballooning may be require to expand the stent.

Electrophysiology(or “EPS”) study is a procedure used to analyze the electrical system of the heart. In this procedure, catheters are inserted into the heart via a vein in the groin. Unlike cardiac catheterization, in which catheters are inserted into the artery, catheters in an EP study generally are inserted only into the vein. No X-Ray contrast dye is used during an EP study.

During the EPS, doctors insert special electrode catheters (soft wires) into large veins in your groin. These catheters follow the vein all the way into the heart. Once inside the heart, the doctors are able to study the abnormal heart beats or rhythms. An abnormal heart rhythm is also called an arrhythmia.

EPS is performed for a variety of disorders of the electrical system of the heart. These disorders range from minor palpitations to sudden death. EPS is often times life saving in that the procedure can detect an arrhythmia prior to it ever having affected the patient and thus allow doctors to take steps proactively to avoid sudden death. Many patients who undergo EPS have curable arrhythmias and are candidates for radiofrequency catheter ablation.

Atrial Septal Defect is an abnormality of the upper chambers of the heart (atria) where the wall between the right and left atria does not close completely. This defect is present at birth (congenital).

Patent ductusarteriosus (PDA) is a condition where the ductusarteriosus, a blood vessel that allows blood to bypass the baby’s lungs before birth, fails to normally close after birth. The word “patent” means open.

Device closure of atrial septal defects and patent ductusateriosus is an effective and fairly safe alternative to surgery in infants.

The procedure involves essentially a detailed study of the size and shape of the PDA by angiography, then insertion of the appropriate occlusive device to the PDA site by special catheter under x-ray guidence through the catheter from the vessel of the groin. The result can be immediately checked by echocardiograhphy and angiography

Cardiothoracic and Vascular Surgery

 

Cardiaothoracic and Vascular surgery generally refers to surgery of the heart by opening up the chest to manage the arteries and veins, heart valves and to repair hole in the heart.

A cardiothoracic surgeon will perform surgery within the heart and lungs. This will include performing surgery to the heart and its vessels as well as the lungs.

What Is Coronary Artery Bypass Surgery?

This is commonly called CABG (pronounced as “cabbage”) or open-heart surgery. The surgery reroutes, or “bypasses”, blood around clogged arteries to improve blood flow and oxygenation to the heart.

 

Why Do I Need Surgery?

The arteries that bring blood to the heart muscle (coronary arteries) can become clogged by plague ( a buildup of fat, cholesterol and other substances). This can slow or stop blood flow through the heart’s blood vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack.

 

How Do I Get Ready For My CABG?

Once the doctor has confirmed that you will need to go for surgery and the date has been set, you and your family members will go for the pre-operative counseling. The nurse-in-charge will explain on what to expect before/during/after the surgery.

 

Knowing what to expect may help reduce the anxiety most people feel before any operation. Talking to your doctor or other people who have had the surgery may help.

 

It is important that you do not eat or drink anything 12 hours before the scheduled time of your surgery. You may have a small amount of water with any medications you need to take. Be sure to ask your doctor if you have any questions about eating or drinking before your examination.

 

If you smoke, you should stop smoking.

 

What Is Coronary Artery Bypass Surgery Like?

 

Our surgeons will take a segment of a healthy blood vessel from either your chest wall, leg or arm and use it to make a detour around the blocked section of the coronary artery.

 

A patient may have one or more bypass grafts, depending on how many coronary arteries are blocked.

Cardiopulmonary bypass with a pump oxygenator (heart-lung machine) is used for most coronary bypass graft operations.

 

During the past several years, more surgeons have started performing off-pump coronary artery bypass surgery (OPCAB). For this procedure, the heart continues beating while the bypass graft is sewn in place.

 

Recovering

 

After the surgery, the patient is moved to a hospital bed in the intensive care unit. Heart rate and blood pressure monitoring devices monitor the patient continuously for 12 to 24 hours. Medications that regulate circulation and blood pressure will be given intravenously. A breathing tube (endotracheal tube) will stay in place until the doctors are confident that the patient is awake and ready to breathe comfortably on his or her own.

 

The patient may feel groggy and disoriented, and the sites of incisions both the chest and the leg, if a segment of blood vessel was taken from the leg, may be sore. Medication for pain will be given as needed.

 

Patients usually stay in the hospital for at least eight days or longer.

 

During this time, some tests will be done to assess and monitor the patient’s condition. After discharge from the hospital, the patient may experience side effects such as:

 

  • Constipation
  • Swelling in the area from which the segment of blood vessel was removed
  • Muscle pain or tightness in the shoulders and upper back
  • Fatigue, mood swings, feelings of depression, difficulty in sleeping

 

Many of these effects usually disappear in about four to six weeks, but a full recovery may take a few months or more. The patient is usually enrolled in a physician-supervised program of cardiac rehabilitation. This program teaches stress management techniques and other important lessons (e.g, about diet and exercise) and helps the patients re-build their strength and confidence.

 

Patients are often advised to eat less fat, walk or do some physical activity to regain their strength. Doctors also often recommend following a home routine of increasing activity-doing light housework, going out, visiting friends, and climbing stairs. The goal is to return to a normal, active, healthy lifestyle.

Heart valve surgery is used to repair or replace diseased heart valves. Heart valves surgery may be recommended if the patient have a narrowing of the heart (regurgitation).

 

The surgery is an open heart surgery that is done while you are under general anesthesia. A cut is made through the breast bone (sternum). Your blood is routed away from your heart to a heart-lung bypass machine where the machine keeps the blood circulating while your heart is being operated on.

 

Valves may be repaired or replaced. Replacement heart valves are either natural (biological) or artificial (mechanical)

Atrial Septal Defect (ASD), more commonly known as “Hole in the Heart”, is a Congenital Heart Disease which is present at birth. Atrial Septal Defect is a hole in the wall (septum) that separates the upper chambers (atria) of the heart into right and left atrium. This hole (defect) can be between 0.5-2 cm in diameter. Atrial Septal Defect is most commonly closed by Open Heart Surgery.

 

The surgeon makes an incision in the middle of the chest through the breast bone (sternum) to expose the heart. The heart is stopped and its function is completely taken over by the heart-lung machine. The Atrial Septal Defect is either stitched (if small) or patched with a special mesh to close the hole. Once the procedure is complete, the heart is re-started and the chest incision is sutured. The Open Heart Surgery to correct Atrial Septal Defect is considered a major surgery and is performed under general anesthesia.

WHAT IS PATENT DUCTUS ARTERIOSUS (PDA)?

Patent Ductus Arteriosus (PDA) is an abnormal vessel connecting between the aorta and the pulmonary artery. This causes additional blood flow from the aorta to enter the pulmonary circulation resulting in vascular congestion of the lungs. This is a fairly common condition and more frequently found in premature babies.

 

HOW IS PATENT DUCTUS ARTERIOSUS TREATED?

Treatments for PDA includes:

  • Medicines
  • Catheter-based procedures
  • Surgery

 

Medicines

Some medications do help to close PDA in premature infants. Medications do not usually work in full-term infants. They work by stimulating the PDA to constrict or tighten, closing the connection.

 

Catheter-based procedures (PDA Device Closure)

These procedures are often used to close PDAs in patients who are old enough.

 

  • The staff will clean your skin area where the doctor will insert the catheter with an antiseptic solution. This is usually at the top of the leg (groin). You will then be covered with a sterile drape. Next, the doctor will use a small needle to inject some local anesthesia to numb your skin area where the catheter will be inserted. The nurse will give you medication to relieve pain and allow you to relax. You may feel pressure or brief discomfort as the catheter is inserted.

 

  • When the delivery catheter is positioned where the PDA is, the doctor will deploy the occlusive device. On successful deployment of the device, the result of the procedure can be immediately checked by echocardiography and angiography.

 

 

Surgery

 

Surgery for PDA may be performed when:

 

  • A premature or full-term infant develops health problems resulting from the PDA and is too small to have a catheter-based procedure
  • A PDA is not successfully closed by a catheter-based procedure
  • Surgery is planned for treatment of related congenital heart defects

Aortic Root Replacement Surgery (Bentall) is a surgical procedure for the repair of an ascending aortic aneurysm or an aortic root aneurysm that is accompanied by aortic valve incompetence. Less commonly, this procedure is used to repair aortic dissection affecting the aortic root and valve. The procedure uses a composite aortic graft (ie, a vascular tube graft with an attached mechanical or biologic valve) to replace the proximal ascending aorta and the aortic valve. Circulation to the coronary arteries is maintained by implanting the proximal end of the coronary arteries into openings made in the aortic graft.

What Is Atrial Fibrilation?

Atrial fibrillation (AF) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). Heart beats in a normal heart begin after electricity generated in the atria by the sinoatrial node spreads through the heart and causes contraction of the heart muscle and pumping of blood. In AF, the regular electrical impulses of the sinoatrial node are replaced by disorganized, rapid electrical impulses which result in irregular heart beats. Atrial fibrillation is often asymptomatic, but may result in symptoms of palpitations, fainting, chest pain, or even heart failure. These symptoms are especially common when atrial fibrillation results in a heart rate which is either too fast or too slow. In addition, the erratic motion of the atria leads to blood stagnation which increases the risk of blood clots that may travel from the heart to the brain and other areas. Thus, AF is an important risk factor for stroke, the most feared complication of atrial fibrillation.

 

Atrial Fibrilation Surgery

  • Cox-Maze SurgeryThis procedure requires the surgeon to perform a major operation where the surgeon would have to open the breastbone and stop the heart. “Maze” refers to the series of incisions made in upper chambers of the heart, which are arranged in a maze-like pattern. The intention was to eliminate AF by using scarred tissues to block abnormal electrical circuits that AF requires. This procedure requires an extensive series of incisions inside the heart through both atria, vertical incision through the breastbone and the use of the heart-lung machine.
  •  
  • Thoracoscopic Atrial Fibrillation SurgeryIn this new minimally invasive video assisted thoracoscopic microwave procedure, surgeons insert three thoracoscopes — small telescopes — into the chest through small incisions. This allows the surgeon to guide a catheter around the left atrium to create a scar tissue. The surgeon then uses microwave energy to destroy the portion of the heart surface that causes the elevated heart beat associated with AF.