Cardiology

Coronary angiogram
A minimally invasive procedure that uses radio-opaque dye to assess the blood supply to the heart via a thin, flexible catheter inserted through the femoral or radial artery under local anaesthetic.

Right heart studies
A minimally invasive procedure that diagnoses certain heart, valve and lung conditions. It involves insertion of a thin, flexible catheter via the femoral vein under local anaesthetic.

Percutaneous coronary intervention (PCI) +/- coronary stent insertion
A somewhat more invasive non-surgical procedure involving the ballooning of plaque in one or more of the coronary arteries and the placement of coronary artery stent to improve blood flow to the heart muscle. It is done under local anaesthetic, usually via the femoral or radial artery.

Coronary artery rotoblation and stent insertion
A procedure that involves a catheter especially designed to ‘bore out’ a narrowing in a coronary artery that might not otherwise respond to ‘traditional’ percutaneous coronary artery intervention due to marked calcification.

Speciality diagnostic intravascular imaging

• Intravascular ultrasound (IVUS).
• Fractional flow reserve testing (FFR).
• Optical coherence tomography (OCT).

These are cardiac intravascular imaging options similar to a coronary angiogram. They allow the cardiologist an optimal assessment of coronary artery disease. This imaging uses ultrasound or CT via a fine flexible catheter threaded to the coronary artery.

Cardiac electrophysiology is the study of normal and abnormal electrical behaviour of the heart.

Electrophysiology Studies (EPS)
A study of the electrical pathway within the heart under a controlled situation in a cardiac catheter theatre. It helps identify where an abnormal electrical circuit may be originating to cause an arrythmia and guide treatment options.

EPS may be indicated for:

• Symptomatic heart palpitations, racing heart, unexplained dizziness or blackouts.
• Investigate an irregular heartbeat and management options.
• Assess risk of life-threatening irregular heartbeats (arrhythmias).
• Assess the need for implantable cardiac device.
• Assess the need for a radiofrequency catheter ablation (RFA).

Radiofrequency Ablation (RFA)
Radiofrequency energy (heat) or cryoablation (cold) is used to cause a small scar in an area of the heart electrical system identified during EPS as the site of an abnormal heart rhythm, resulting in a break in that circuit.

RFA may be undertaken when medications fail to control an abnormal heart rhythm. It may be a more appropriate treatment for some abnormal arrhythmias over medications such as:

• Atrial flutter (AF).
• Atrial fibrillation.
• Supraventricular tachycardia (SVT).
• Ventricular tachycardia.

Pulmonary Vein Isolation (PVI)
During this procedure, radiofrequency energy (heat) or cryoablation (cold) are used to cause a small scar in the abnormal circuit and may treat atrial fibrillation.

A normal heart rate is 60 to 100 beats per minute. A heart rate of more than 100 beats per minute is called a tachycardia. During an episode of SVT, the heart beats about 150 to 220 times per minute, but it can occasionally beat faster or slower.

Implantable cardiac devices
Implantable cardiac devices monitor, assess, manage and in some instances deliver therapy for heart electrical problems. Devices may include:

• Loop recorder – diagnostic only.
• Permanent Pacemaker (PPM).
• Biventricular Pacemaker.
• Implantable Cardioverter Defibrillator (ICD).

The Wesley advanced structural heart disease program is led by expert cardiologists, cardiothoracic surgeons and imaging specialists, working collaboratively to provide comprehensive leading-edge care. The Wesley Hospital is a nationally accredited MitraClip and Transcatheter Aortic Valve Replacement/Implant (TAVR/I) hospital. We are also an established training, clinical trial and research centre. We offer cutting-edge technology after careful assessment, review and discussion with patients and their treating heart team.

Transcatheter Aortic Valve Replacement/Implant (TAVR/TAVI)
TAVR/TAVI has become an accepted technique to treat aortic valve disease in Australia. Historically, aortic valve disease has been managed with open heart surgery to implant a new valve. TAVR/TAVI is a less invasive procedure where a new valve is taken up to the heart through a tube in the leg artery or the artery under the collarbone or the neck. Careful assessment by our multidisciplinary team of specialists is undertaken to provide the most appropriate treatment option.

MitraClip
The MitraClip is a device used to treat mitral valve regurgitation and may be offered as an alternative to open heart mitral valve surgery. This less invasive procedure involves taking a repairing device to the heart via a tube in the femoral leg vein. Careful assessment by our multidisciplinary team is undertaken to provide the most appropriate treatment option.

Transcatheter Alcohol ablation of Septal Hypertrophy (TASH)
TASH is a method of treating thickened heart muscle that causes an obstruction of blood flow from the heart, seen in diseases such as hypertrophic obstructive cardiomyopathy (HOCM). It involves a controlled procedure using a specially prescribed strength of alcohol injection to the heart muscle to reduce this thickened, obstructive heart tissue.

Atrial-Septal Defect (ASD) / Ventricular-Septal Defect (VSD) / Patent Foramen Ovale (PFO) / Paravalvular Leak (PVL) Closures
These minimally invasive procedures are treatment options to repair or close abnormal openings within the heart structure. A repair device is guided through the femoral vein to the heart before being released under specialist imaging to close the opening. It may be an alternative to open heart surgery after careful consultation and assessment with your cardiologist and other treating specialists, such as a neurologist.

Paravalvular leak (PVL) may sometimes occur after heart valve surgery or a percutaneous procedure. PVL closure involves a plug-like device contained in a small flexible catheter being guided via the femoral vein to the heart and deployed, essentially closing the leak. It is an option a cardiologist may consider only if the leak is considered clinically significant.

Left Atrial Appendage Occluder (LAAO)
The left atrial appendage is a small pouch found attached to the top left chamber of the heart. It may become a ‘reservoir’ for blood clots in people with atrial fibrillation. LAAO may be an option in some cases where severe bleeding becomes a risk due to blood thinning medication. It involves guiding an occluder device via the femoral vein to the heart and the placement of an occlusion device, essentially blocking off the left atrial appendage.

Percutaneous Balloon Aortic Valvuloplasty (PBAV)
A procedure undertaken via the femoral artery using a balloon tip catheter guided to a narrowed valve in the heart. The balloon at the end of the catheter is inflated under X-ray imaging once in position. This will open and widen these valve leaflets, with the balloon and catheter removed at the end of the procedure. However, it is not a long-term solution to a narrowed diseased heart valve.

All referrals to:

The Wesley Hospital Structural Heart Program Co-ordinator
0429 148 772
twh.structuralheart@uchealth.com.au

Our ST (segment) Elevation Myocardial Infarct (STEMI) program is an arrangement with the Queensland Ambulance Service (QAS) for the management of urgent heart attacks (acute coronary syndrome), including direct cases to the Cardiac Catheter Theatre. QAS has a direct line to the on-call cardiologist at all times.