Interventional Cardiology Conditions and Treatments

Treating Complex Heart Conditions with Interventional Techniques

Interventional cardiology can be used to diagnose and treat a wide range of conditions affecting the blood vessels, chambers or valves of the heart. These conditions can include everything from blocked arteries and venous thrombosis (blood clots in the veins or venous structures of the heart) to aortic or mitral valve disease and congestive heart failure. By performing nonsurgical procedures using catheters (thin, flexible tubes) to enter your heart or vessels (vein/artery), our interventional team can implant medical devices, close holes in the heart, open blocked arteries and veins, remove potentially dangerous blood clots, seal off portions of the heart capable of harboring blood clots and more.

Coronary Artery Disease Heart Failure Hypertension Peripheral Artery Disease Valve and Structural Heart Disease Pulmonary Embolism and Deep Vein Thrombosis (VTE)

Coronary Artery Disease

Many conditions can cause chest pain or discomfort. Some conditions that cause chest pain are less serious than others; they may be due to common situations such as irritation of the esophagus or stomach, issues with swallowing, strain from heavy physical activity, muscle injuries, inflammation of the chest wall or cartilage, panic attacks and more. However, more severe or persistent chest pain may indicate coronary artery disease, a very common condition in which one or more arteries of the heart are blocked, making it difficult for oxygenated blood to get through.

Interventional cardiology procedures may be used to improve symptoms of chest pain and shortness of breath through catheter-based techniques that open the artery(ies), which increases the overall quality of life and in emergency situations, may even be life-saving.

Depending on your coronary artery disease diagnosis, our team might recommend:

Percutaneous Coronary Interventions (PCI)

Angioplasty

Our interventional cardiologists have been successfully performing angioplasties for decades. A balloon angioplasty, also called a percutaneous transluminal coronary angioplasty (PTCA), uses a thin tube (catheter) that is inserted into a blocked or narrowed artery. Through this catheter, a tiny balloon is inserted into the artery and inflated at the site of the blockage to push back the plaque against the artery's walls and widen the path for blood flow.

Stenting

A stent is a tiny, expandable metal mesh that is placed into a newly opened area of the artery to help keep the artery from narrowing or closing again. At UChicago Medicine, interventional cardiologists routinely implant drug-coated (drug eluting) stents. These breakthrough devices minimize scar tissue growth inside the stent. Less scar tissue means there's a lower chance for restenosis or re-narrowing of the artery. Restenosis is a problem that may require further treatment with repeat angioplasty treatments or coronary artery bypass graft surgery.

Atherectomy

An atherectomy procedure is used to remove plaque from the inside of an artery. Depending on the patient and the diagnosis, different methods are used to perform atherectomies:

Rotational and orbital atherectomy involves the use of a special burr, or drill, on the tip of a catheter that rotates to shave or polish the plaque into tiny pieces.
Laser atherectomy uses a fiber which delivers laser energy precisely to the location of the blockage, heating and eventually vaporizing plaque and scar tissue prior to implantation of a stent.
Intravascular lithotripsy (IVL), is another method using technique in which pulses of ultrasonic energy are delivered to the artery through a small balloon to disrupt calcified plaque and allow expansion of a blocked coronary artery.

Hybrid coronary revascularization (HCR)

Hybrid coronary revascularization (HCR) combines total endoscopic coronary artery bypass (TECAB) and percutaneous coronary intervention (PCI), which is a truly unique therapeutic option for patients with complex coronary disease affecting many or all their coronary arteries. Conventionally, these patients often get the recommendation for open coronary artery bypass grafting (CABG) surgery or as a second choice, stenting as many of the diseased coronary vessels as possible. Using robotic technology and tiny keyhole incisions between the ribs, UChicago Medicine surgeons can perform beating heart bypass surgery on up to four diseased coronary vessels with the remainder of the blockages addressed with PCI. In this way, selected patients may derive all the benefits of both surgical and interventional approaches without the need to open the chest cavity or endure cardiopulmonary bypass. UChicago Medicine has performed the highest volume of combined TECAB HCR procedures in the United States.

Heart Failure

Heart failure occurs when the heart muscle becomes damaged and is unable to deliver enough nutrient-rich blood to meet the body’s needs. Because heart failure is a progressive condition, there is no cure, but medications, lifestyle changes and interventional cardiology can help manage the condition by alleviating symptoms to allow patients lead an active life. Used in conjunction with one another, these therapies can potentially stabilize or even gradually improve heart muscle weakness.

Interventional cardiology is a new frontier in controlling heart failure over time with groundbreaking techniques and medical devices that can help the heart function better for longer periods of time before surgery or heart transplantation is needed. Current interventions for heart failure include:

Mechanical Circulatory Support

Mechanical circulatory support devices represent a family of technologies which serve as miniaturized pumps to temporarily support a failing heart, allowing a patient to recover their own native heart function or tolerate other necessary cardiac procedures which can be otherwise taxing on a failing heart. These devices can be nonsurgically implanted in the heart for a period of hours to days and then removed either in the cardiac catheterization laboratory or in the intensive care unit. In carefully selected patients, these devices have been shown to be safe and capable of stabilizing and improving heart function.

Common MCS devices we implant include percutaneous left ventricular assist devices (LVADs), percutaneous right ventricular assist devices (RVAD), extracorporeal membranous oxygenation (ECMO), and intra-aortic balloon pump. Often these devices are used in combination to support the most critically ill patients we treat.

Investigational Devices

With heart failure interventional cardiology expanding every day, our team has been on the frontlines of innovative technologies for heart failure patients, which includes using:

CorCinch: The CorCinch device is placed around the inner walls of the ventricle and the two sides are pinched together in order to decrease the size of the left ventricle. This allows the heart to pump more efficiently and reduce heart failure symptoms.
Aortix: For patients with heart failure that is impacting the kidneys (cardio-renal syndrome), Aortix is a small pump that can be nonsurgically placed in the abdominal aorta to pump blood more efficiently to the kidneys while decreasing the stress on the heart.
CardioMems: Heart failure patients with excess fluid buildup can have the CardioMems device implanted in the pulmonary artery for reliable monitoring of fluid pressure. This miniature sensor continuously collects and transmits information securely to your heart failure care team so they can quickly identify if your condition is stable or worsening.
Greater Splanchnic Nerve Denervation: Some forms of heart failure occur in patients with normal left ventricular squeezing function (heart failure with preserved ejection fraction, HFpEF). The primary problem in these patients is increased stiffness of the left ventricle. UChicago Medicine is participating in clinical trials in which one of the two greater splanchnic nerve is de-activated, which decreases excessive blood flow back to the heart, resulting in less pressure buildup in the stiff heart, potentially resulting in relief of symptoms of shortness of breath.
Interatrial shunt Placement: HFpEF patients often have high pressure built up in the left atrium. UChicago Medicine is participating in clinical trials in which a hole in the wall between the left and right atria is created, reducing the pressure in the left atrium, potentially resulting in relief of symptoms of shortness of breath.

Hypertension (high blood pressure)

Uncontrolled hypertension (high blood pressure) affects nearly half the U.S. adult population (116 million Americans) and is a leading cause of cardiovascular and cerebrovascular complications, including heart attack, stroke, heart failure and kidney failure. The majority of hypertensive patients will not have any clear secondary cause for their elevated blood pressure. While diet, exercise, weight loss, reduction in sodium consumption and fluid intake will help control blood pressure, most hypertensive patients will also require 2-3 (or more) different blood pressures medications. Current data suggest however, that despite all these therapies, many patients will remain well above their recommended blood pressure targets.

UChicago Medicine is among a small group of medical centers nationally to offer a potentially groundbreaking new interventional therapy for the treatment of resistant hypertension. Renal denervation (RDN) is a catheter-based, nonsurgical approach in with radiofrequency energy is delivered to the lining of the arteries that supply the kidneys (renal arteries) in order to heat up (ablate) the nerves which travel within the walls of the renal arteries and are responsible, in part, for the excessive blood pressure response. To date, over a dozen trials have documented the safety of this procedure and this current investigation seeks to evaluate the effectiveness of RDN in a larger and more diverse patient population.

Pulmonary Embolism & Deep Vein Thrombosis (VTE)

In the United States, as many as 600,000 people each year suffer from venous thromboembolism (VTE) — a condition characterized by blood clots obstructing a large vein (venous thrombosis) and pulmonary embolism. Blood clots can be dangerous, and even fatal, if it is not treated in a timely manner.

Interventional cardiology can provide life-saving noninvasive treatments for embolism and thrombosis, which often includes containing and/or removing clots in arteries and veins before they reach the lungs, heart or brain. Our team has the skill and experience to work quickly and efficiently to locate and treat a clot before it becomes deadly. VTE interventional cardiology includes performing:

Inferior Vena Cava Filters

Catheter-Directed Thrombolytic Drug Delivery

Percutaneous Thrombectomy

Venous/IVC Recanalization

Pulmonary Embolectomy

For severe, life-threatening pulmonary embolism, the clot may need to be totally removed through pulmonary embolectomy. This procedure can be performed using minimally invasive catheterization techniques by making a small incision into a blood vessel near the thrombus in order to remove it and allow blood to flow freely. If the vessel is damaged, a balloon or stent may be inserted to keep the vessel open for blood flow.

Valve and Structural Heart Disease

Valve and structural heart disease is an umbrella term that encompasses the full scope of conditions caused by defects or abnormalities in heart's valves, walls and/or muscles. Heart valve conditions are either congenital (present at birth) or can form later in life due to aging, infection or underlying medical conditions.

Valve disease can occur if one or more of the four heart valves (mitral, aortic, tricuspid and pulmonary) is damaged or defective, impacting how the heart functions and can limit blood flow to the body. Many of these conditions, including congenital heart disease, acquired valve diseases, arteriovenous fistulas, heart wall damage/holes and more, can be treated or managed through minimally invasive interventional cardiology procedures rather than requiring open, traditional surgery.

Interventional cardiology procedures include:

Transcather Aortic Valve Replacement (TAVR)

Transcather aortic valve replacement (TAVR) is a minimally invasive option for patients who are looking for alternatives to traditional aortic replacement surgery, including those that are considered too high-risk for surgery. Instead of opening the chest, a small tube (catheter) is guided through an artery in the groin into the heart. The new artificial valve is compressed and fed through the catheter until it reaches the aortic valve. Once in place, the artificial valve is placed and the catheter is removed. The new valve replaces the old valve, increasing blood flow throughout the body. Patients can go home as early as the next day. We utilize both the Edwards Sapien and Medtronic EvolutPro+ valves to adapt the therapy best to our patient’s individual needs.

Trancatheter Mitral Valve Repair with MitraClip

For patients with mitral valve regurgitation (leaky valve) who are too high-risk, or don't want traditional or robotic surgery, transcatheter mitral valve repair offers an alternative. During this minimally invasive procedure, a mechanical clasp, called the MitraClip, is implanted into the heart using a catheter that is guided through the femoral vein and across the wall that separates the two upper chambers of the heart (atria). The MitraClip clamps the mitral valve leaflets together, reducing leakage and associated symptoms of regurgitation. Patients can go home as early as the next day post MitraClip treatment. Learn more about MitraClip.

Left Atrial Appendage Occlusion

The left atrial appendage (LAA) is a small pouch in the muscle wall of the left atrium. When a patient has atrial fibrillation, this pouch can collect blood that could form clots, creating an increased risk of stroke. Doctors prescribe anticoagulants (blood thinners) to help reduce this risk. Some patients have increased likelihood of bleeding and/or episodes of bleeding with this type of medication. To minimize this risk, our interventional cardiologists can seal the LAA through catheterization, preventing blood from gathering in the appendage and giving patients the ability to safely come off blood thinner therapy. During this procedure a tube (catheter) is placed in the groin into the heart, and the device is placed directly in the appendage. Patients can go home as early as the next day. We offer both the WATCHMAN and AMULET devices to seal the appendage. Once again, the device is chosen to best meet the individual patient’s needs.

Transcatheter Repair of Congenital Defects

Valvuloplasty

Transcatheter Mitral Valve Replacement

Transcatheter Pulmonary Valve Replacement

For patients with a failing pulmonary valve, there is not enough blood flowing from the heart to the lungs. Because they will benefit from a valve replacement, we can use catheterization to steer an artificial valve through the groin to the heart versus performing open chest surgery. Once we are in position, we will expand the new valve inside the existing valve and open the blood flow through the pulmonary valve to the lungs to ensure the replacement valve is working as expected.

Transcatheter Tricuspid Valve Repair

Peripheral Arterial Disease/Vascular Disease

Vascular disease occurs when there is an abnormality in a patient's blood vessels (veins and arteries), such as a blockage, bulge or narrowing of the vessel walls. Any irregularity in veins or arteries decreases blood circulation throughout the body and increases the risk for developing serious and potentially life-threatening conditions, such as peripheral arterial disease (PAD), aortic aneurysms and aortic dissections.

Since vascular disease can affect any part of the body, symptoms will vary depending on the location of the affected vessels. Interventionalists can help diagnose any damaged or blocked vessels, as well as perform nonsurgical procedures that can open obstructed veins/arteries in organs and extremities in order to prevent stroke and/or loss/amputation of limbs. Our interventional cardiologists work in conjunction with our vascular surgeons to provide less invasive vascular treatment options, such as:

Angioplasty

Intravascular Ultrasound (IVUS)

Stenting

Percutaneous Nonsurgical Revascularization

When a patient has insufficient blood flow to a limb or organ in the body, percutaneous nonsurgical revascularization can be used to restore proper blood flow by opening blocked veins/arteries before the condition gets worse, possible leading to severe damage or limb loss. Nonsurgical revascularization will help treat the symptoms associated with poor blood circulation, like pain and/or limited mobility, as well as strengthen the vessel for overall quality of life.

Atherectomy

An atherectomy procedure is used to remove plaque from the inside of an artery. Depending on the patient and the diagnosis, different methods are used to perform atherectomies:

One method, called rotational atherectomy, involves the use of a special burr, or drill, on the tip of a catheter that rotates to shave the plaque into tiny pieces.

Another method is directional atherectomy, a technique in which a small cutting device is pushed against the plaque to cut it away from the artery and remove the plaque from the body.

Hybrid Revascularization

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