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Coronary Heart Disease (cont.)

What invasive medical procedures treat heart disease?

When angina symptoms worsen despite medications, you may need an invasive procedure in the cardiac catheterization lab to clear the blocked artery. These procedures are performed by a cardiologist, not a cardiac surgeon, and have fewer complications.

Coronary angioplasty (PTCA): This procedure is similar to coronary angiography (cardiac catheterization or a dye study to visualize the inside of coronary arteries) but is therapeutic as well as diagnostic.

  • A similar but sturdier tube (guide catheter) is inserted into an artery in your groin or arm, and a hair-thin guide wire is threaded through it into your coronary artery.
  • A much thinner catheter is threaded over the guide wire into the blocked artery.
  • This thinner catheter has a tiny balloon at the end.
  • Once the balloon is positioned at the blockage, the balloon is inflated to widen your artery and improve blood flow. The plaque is still there, just flattened against the wall of the artery.
  • The balloon catheter is then withdrawn.
  • This procedure is sometimes referred to as PTCA, which stands for its full formal name: percutaneous (through the skin) transluminal (through the hollow center of the blood vessel) coronary angioplasty.

Stent: A stent is a small, sieved, coil-like metallic tube or scaffold mounted over a balloon.

  • The balloon is inflated at the blockage, which expands the stent.
  • The balloon is then withdrawn, but the stent stays in place, keeping the artery from narrowing again.
  • Like arteries treated with angioplasty alone, arteries treated with a stent can eventually close up again.
  • The stent is a longer lasting solution for many people.

What about surgery for heart disease?

Surgery in coronary heart disease is reserved for people whose disease is either severe or is not improved or stabilized by medication and other less invasive therapies.

Coronary artery bypass grafting (CABG): This is the standard operation for blockages of coronary arteries.

  • If multiple coronary arteries are blocked, or if the left main artery shows significant blockage, bypass surgery is usually the best treatment choice.
  • The blocked parts of the arteries are detoured or bypassed with blood vessels "harvested" from your chest (internal mammary), arm (radial artery), or a leg (saphenous vein).
  • During the surgery, the heart is stopped temporarily and you are connected to a machine called a bypass pump that takes over the functions of the heart.
  • These operations are very successful and have a low rate of complications.

Off-pump bypass surgery: Sometimes surgeons can perform open heart surgery without using a bypass pump and while the heart is beating. The procedure causes fewer side effects than the standard procedure, but it is not feasible in all situations.

Minimally invasive coronary bypass (MINI-CABS): If just your front or right coronary arteries need bypass, a surgeon may replace the blocked artery with an artery from the

Medically Reviewed by a Doctor on 7/25/2016
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