قسطرة القلب وتركيب دعامة - مقال انظر حولك

امراض القلب

Cardiac catheterization and stent placement. Cardiac catheterization and stent placement have become easy and routine medical procedures for treating vascular and heart diseases. It is important to follow a specialized doctor, and it is vital to choose a large and advanced hospital to perform this procedure.

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What are cardiac catheterization and stent?

Cardiac catheterization and stent implantation Cardiac catheterization is a procedure used to detect the presence of disease in the coronary arteries, heart muscle, and valves within the heart.
It is performed by inserting a catheter through an artery and/or vein; The catheter is then advanced into the heart.
“Coronary angiography” refers to the part of the examination that involves injecting a contrast dye into the coronary arteries.
If blockages in the coronary arteries are detected, these arteries can be opened through a procedure known as angioplasty or stent implantation.
Diagnostic cardiac catheterization may be performed as an outpatient procedure.
Patients can stay overnight after the procedure depending on the results of the catheterization or after angioplasty/stent implantation.

See also: What is therapeutic catheterization in children?

إقرأ أيضا:ضعف عضلة القلب الانبساطي – مقال انظر حولك

Cardiac catheterization and stent placement

Coronary artery disease is narrowing or blockage of the coronary arteries (heart). After an interventional procedure, the coronary artery is opened, increasing blood flow to the heart.
Cardiac catheterization (also called cardiac catheterization or coronary angiography) is an imaging procedure that allows your doctor to evaluate the function of your heart.
Cardiac catheterization is used to evaluate or confirm the presence of coronary artery disease, valve disease, or disease of the aorta.
Evaluation of myocardial function.
Determine the need for further treatment, such as an interventional procedure or coronary artery bypass grafting.
In cardiac catheterization, a catheter, which is a long, narrow tube, is inserted through a plastic insertion sleeve (a short, hollow tube that is inserted into a blood vessel in your arm or leg).
The catheter is guided through the blood vessels into the coronary arteries with the help of a special X-ray machine.
Through the pre-catheter, the contrast material is injected, which moves within the heart chambers, as well as the heart valves, arteries, and main veins.
This procedure is called coronary angiography, where an X-ray is taken.
Digital images of contrast material are used to locate narrowing or blockage in a coronary artery.
Additional imaging procedures called intravascular ultrasound (IVUS) and fractional flow reserve (FFR) may be done along with cardiac catheterization in some cases to get detailed pictures of the blood vessel walls.
Both of these imaging procedures are currently only available in specialty hospitals and research centers.
With IVUS, a miniature sound probe (transducer) is placed on the tip of a coronary catheter.
The catheter is passed through the coronary arteries, and using high-frequency sound waves, detailed images of the inner walls of the arteries are produced.
IVUS intravascular ultrasound produces an accurate picture of the location and extent of plaque (cholesterol and fatty deposits).
With Fractional Flow Reserve FFR, a special wire is passed through the artery and a vasodilator medication is given. Functionally, this test performs a high-quality stress test of a short segment of the artery.

Arteriosclerosis

Atherosclerosis (sometimes called hardening or blockage of the arteries) is the buildup of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries that restrict blood flow to the heart.
Atherosclerosis can affect the arteries in the heart, legs, brain, kidneys and other organs.
Atherosclerotic heart disease (coronary artery disease) is a narrowing or blockage of the coronary arteries (heart).
Coronary arteries are shaped like hollow tubes through which blood flows freely.
The walls of the coronary arteries are usually smooth and elastic. Atherosclerosis occurs when the normal lining of the arteries deteriorates.
The walls of the arteries become thicker and fat and plaque accumulate on the walls of the coronary arteries, which prevents or restricts the flow of oxygen-rich blood to the heart muscle.
Without enough blood, the heart becomes starved of the vital oxygen and nutrients it needs to function properly. This can cause chest pain called angina.
When one or more coronary arteries are completely blocked, a heart attack (myocardial injury) may occur.

Experience is important

Catheterization and interventional procedures require special expertise.
A doctor’s credentials and experience lead to better results.
Likewise, the hospital must be ideally equipped to perform cardiac catheterization procedures as well as stent placement.
The professional nursing team is also a key factor in the success of cardiac procedures, as well as the success of these procedures during the recovery period.

What is an interventional procedure?

An interventional procedure is a non-surgical treatment used to open narrowed coronary arteries to improve blood flow to the heart.
An interventional procedure may be performed during diagnostic cardiac catheterization when an obstruction is identified, or it may be scheduled after catheterization has confirmed the presence of coronary artery disease.
The interventional procedure begins in the same way as cardiac catheterization.
Once the catheter is in place, one of these interventional procedures is performed to open the artery: balloon angioplasty, stent placement, and perforation or clipping of the balloon.

1- Balloon angioplasty

A procedure in which a small balloon is inserted into the tip of a catheter near a blocked or narrowed area of a coronary artery.
The technical name for balloon angioplasty is transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI).
When the balloon is inflated, fatty plaques or blockages are compressed on the artery walls and the diameter of the blood vessel is expanded to increase blood flow to the heart.
This procedure is sometimes complicated by reflux and narrowing of the blood vessels.

2- Balloon angioplasty with stent

In most cases, balloon angioplasty is performed in conjunction with a stenting procedure.
A stent is a small metal mesh tube that acts as a scaffold to provide support within a coronary artery.
A balloon catheter placed on a guidewire is used to insert the stent into the narrowed artery.
Once in place, the balloon is inflated and the stent expands to the size of the artery and remains open.
The balloon is deflated and removed, and the stent remains in place permanently.
Over a period of several weeks, the artery heals around the stent. In this way, restenosis is reduced to some extent.
Angioplasty with a stent is recommended for patients who have blockages in one or two coronary arteries.
If there is a blockage in more than one coronary artery, coronary artery bypass surgery may be recommended.

3- Drug-eluting stents (DES)

Drug-delivered stents contain a drug that is actively released into the site of stent implantation.
Drug-eluting stents have a thin drug-filled surface to reduce the risk of restenosis.
Concerns were raised in 2006 about the safety of drug-filled stents due to the risk of blood clots forming on the stent, causing a heart attack.
The FDA continues to feel that drug-eluting stents, when used for approved indications, are safe and effective.
If you receive a drug-eluting stent, your doctor will prescribe certain medications for several months after the procedure to prevent the risk of clotting in the stent.
It is very important to continue taking your medications as prescribed until your doctor tells you otherwise.
If you have concerns about drug-eluting stents, please talk to your doctor.

See also: What is the meaning of catheterization?

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4- Rotation process

It is a percutaneous atherectomy.
In this procedure, a special catheter, with a coated tip, is guided to the point of narrowing in the coronary artery.
The tip rotates at high speed and grinds away the plaque on the artery walls.
This process is repeated as needed to treat the blockage and improve blood flow.
The microscopic particles are safely washed into the bloodstream and filtered by the liver and spleen.

5- Cutting balloon catheter

The balloon catheter for cutting has a balloon tip with small blades.
When the balloon is inflated, the blades are activated.
Small blades register the plaque, and then the balloon compresses the fatty material into the arterial wall.
This type of balloon may be used to treat plaque buildup within a previously placed stent (restenosis) or other types of blockages.

Preparing for cardiac catheterization and stent placement

You should not eat or drink after midnight the evening before the procedure except for sips of water with your medications (unless your doctor tells you otherwise).
You should not drink coffee or any caffeinated beverages/drinks the day before and the morning of the procedure.

1- Allergies

Please discuss all types of allergies you have with your doctor, especially those listed below.
IVP stain/contrast agent allergy, iodine allergy.
Allergy to rubber/latex products.

2- Medicines

Discuss your medications with your doctor – he or she may want to stop or adjust doses several days before or on the day of your procedure, especially those listed below.
Anticoagulant medications.
aspirin.
Diabetes medications.

3- Blood tests, EKG, and chest X-ray

Ask your doctor if all required pre-procedure tests have been completed or scheduled before your cardiac catheterization procedure.
Before the procedure you will be in contact with your doctor to ensure you have had the appropriate pre-procedure tests, including ECG and blood tests (complete blood count with platelets, biochemistry profile, PT/PTT/INR).
Additional information will be requested, such as echocardiogram reports, stress tests, CT scans of the heart, previous cardiac catheterization, and operative reports for coronary artery bypass surgery.

What should I bring?

We recommend bringing a family member with you to wait with you before the procedure.
Please bring a gown with you to wear while waiting for the procedure.
We recommend wearing comfortable, easy-to-fold clothing.
You may be admitted to hospital after the procedure, so pack personal hygiene items and any other items you want to make your stay more comfortable.
Please leave all valuables at home or with a family member.

Instructions after cardiac catheterization and stent placement

A responsible adult should drive you home. You will not be discharged from the hospital unless there is someone available to drive you home.
If it is more than a two-hour drive home, we suggest you stay overnight at the hospital or a nearby hotel for your convenience.
The medical team can help you make the necessary arrangements, then ask a family member to drive you home the next morning, after you have rested.
While driving home, stop every hour and walk for 5 to 10 minutes.
If you are traveling home by plane, stand to stretch your legs and walk down the aisle at least every hour. Please ask your doctor when you can resume driving.
We strongly discourage using public transportation.
You should go home and rest for the rest of the day and evening.
You don’t have to maintain bed rest but you don’t have to be too active.
Do not shower for the first 24 hours after the procedure, but gently wash the site with soap and water, rinse well and allow to dry.
Do not use tub baths for the next five days (including jacuzzis, spas, and swimming pools).
The transparent bandage over the groin area should be removed 24 hours after discharge from the hospital.
You should drink plenty of fluids for 2-3 days after the test. This will help your kidneys “flush” the dye out of your body.
For all patients, continue to take medications as prescribed.
If you are taking metformin (Glucophage), do not restart it until 48 hours after the procedure.
If you are taking warfarin (Coumadin), consult your doctor to determine when to resume.

Exercise activity restrictions

Avoid heavy lifting (anything over ten pounds), excessive bending, and strenuous exercise for five days.
Contact your primary cardiologist to arrange a follow-up visit.
If you have a stent in place, tell your doctor that you have a stent.
Do not have an MRI for six weeks unless it is an emergency

Symptoms to report

If you notice or experience any of the following, you should notify your physician when calling in the cardiac catheterization laboratory. The likelihood of such events occurring is small, but it is important to know what to do:
Look for any change at the site where the procedure was performed, such as bleeding, increased area of bruising, or swelling.
It is common to have some discoloration, such as a black and blue mark where the procedure was performed.
If bleeding occurs, apply pressure to the site, lie down, and tell your doctor.
Any tingling, numbness, pain or coldness in the leg/arm outside the site where the procedure was performed.
Any signs of infection (i.e. temperature greater than 100 F, drainage/warmth/redness in the leg/arm area where the procedure was performed).
Difficulty urinating, sudden and severe chest pain, shortness of breath, and/or mental status changes.

Steps for cardiac catheterization and stent placement

An intravenous (IV) line will be placed in your forearm.
A blood pressure monitor will be placed on your arm, and ECG stickers will be placed on your chest to monitor your heart rhythm.
You will be taken to an operating room known as the “cardiac catheterization laboratory.”
During the procedure, you will receive a local anesthetic before a catheter is inserted into an artery or vein.
This catheter is usually inserted through an artery or vein in the groin.
The doctor inserts the catheter into the heart, and a contrast dye will be injected.
You may feel a warm sensation or redness in your body when this dye is injected.
You may feel chest pain during part of this procedure.
After the procedure you will be taken to the post-procedure room for observation.
This time, the tube in the artery and/or vein may be removed.
The doctor or nurse will apply pressure to this site to prevent bleeding.
For some patients who have angioplasty or stenting, the tube will be removed later in the hospital.
For patients admitted to the hospital, you will be transferred to the inpatient unit for post-procedure care.

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Heart catheterization and stent placement are not difficult medical procedures these days, just follow your cardiologist’s instructions, before, during, and after the procedure, and you will be back to your normal life within a month.