Coronary angiogram and angioplasty

A coronary angiography is used to visualise the coronary arteries, the blood vessels that supply blood to the heart, through a series of X-ray pictures. This is to check for narrowing or blockage of the coronary arteries and abnormalities in the heart muscle or heart valves.

Coronary angiograms are under the umbrella group of procedures known as cardiac catheterisations. Cardiac catheterisation procedures are used to diagnose and treat heart and blood vessel conditions. A coronary angiogram is the most common type of cardiac catheterisation procedure used to diagnose heart conditions.

The cardiac catheterisation procedure is commonly combined with an interventional procedure called angioplasty where a stent, a small wire mesh tube, is inserted into the artery to help to prop the artery open and prevent narrowing.

This insertion is via the wrist (radial artery) or groin (femoral artery) using a large needle puncture. Both methods are safe and effective and the approach you choose depends on your personal and medical circumstances.

Minimally invasive cardiac procedures

Some examples of minimally invasive cardiac procedures include: 

  • Minimally Invasive Bypass Surgery

Bypass surgery is meant for patients with clogged coronary arteries of the heart and medications, ballooning or stenting can no longer help. It redirects the blood around a section that is blocked. 

It involves taking a healthy blood vessel from the leg, arm or chest and connecting it below and above the blocked portion to provide an alternative pathway for blood to flow through. Various types of bypass surgery can now be performed using keyhole surgery which is minimally invasive. 

  • Minimally Invasive Mitral Valve Surgery

This deals with the mitral valve situated in the left heart chamber. When it leaks or is blocked, high pressure builds up in the left atrium, which then results in high lung pressure or irregular heart rhythm known as atrial fibrillation. The keyhole mitral valve surgery is used to access the mitral valve so that the surgeon can repair it. 

  • Minimally Invasive Aortic Valve Surgery

The aortic valve propels blood into the aorta, the main blood vessel leaving the heart. It can deteriorate as we age and become blocked, a condition known as aortic valve stenosis, or it could also leak. Aortic valve replacement surgery can be done in a minimally invasive way through the chest to replace the valve. 

  • Minimally Invasive Tricuspid Valve Surgery

This is used to treat leakage of the tricuspid valve in the right side of the heart. The tricuspid valve prevents blood from flowing backwards when it is pumped out, so leakage can cause serious symptoms and result in heart failure. 

  • Minimally Invasive Closure of Atrial Septal Defects

The septum is the wall between the left and right sides of the heart. Some people are born with congenital heart defects such as a hole between the left and right atria of the heart, causing changes in pressures within the heart. The hole can be closed with a keyhole surgery. 

  • Minimally Invasive Arrhythmia Surgery (Atrial Ablation)

This uses radiofrequency-induced heat to burn and scar the inside of the heart, a technique called ablation, to help to break up some of the electrical signals that cause irregular heartbeats. 

Today, many minimally invasive valve procedures can be done via the groin. They include: 

  • Transcatheter aortic valve replacement

Procedure to replace a diseased valve with a man-made valve. 

  • Mitral clip

To treat mitral valve replacement.

  • Percutaneous transvenous mitral commissurotomy (PTMC)

To treat mitral valve stenosis.

  • ASD Closures

Electrophysiological procedures

An electrophysiological (EP) procedure is done to assess your heart’s electrical activity and is used in the diagnosis of abnormal heartbeats and rhythms, such as arrhythmia. 

Electrodes will be placed on your chest and they connect to monitoring equipment. Your blood pressure will also be monitored. First, a catheter will be inserted into the blood vessels that enter the heart, either through your groin or your neck, followed by wire electrodes that measure electrical activity. The positioning of the catheters inside your heart will be closely monitored on the screen. 

Medications are sometimes used to induce the arrhythmia so that doctors can diagnose and treat it. Induced arrhythmias are handled by experienced personnel with highly-specialised equipment in a controlled environment. They help doctors understand your arrhythmia and prevent future occurrences.

Implantable cardioverter-defibrillators (ICD) insertion

An implantable cardioverter-defibrillator (ICD) is a device placed in your chest to detect and stop abnormal heartbeats or arrhythmias. It is designed to continuously monitor the heartbeat and deliver electric pulses to restore normal heart rhythm when necessary. 

There are two types of ICD: 

  1. A traditional ICD – implanted into your chest and attached to the heart with invasive surgery 
  2. A subcutaneous ICD – implanted under the skin attached to an electrode that runs along the breastbone but does not connect to the heart.

During surgery, the doctor will guide wires into veins to your heart and attach the leads to the heart. The other end will be attached to the shock generator that is implanted beneath your collarbone. The entire procedure takes about a few hours. Once implanted, the ICD will be tested and programmed accordingly.  

Pacemaker Insertion

A pacemaker insertion is the implantation of a small electronic device, usually in the chest just below the collarbone, that helps to regulate electrical impulses in the heart. A pacemaker may be required when there are issues with the electrical conduction system of the heart. The pacemaker signals the heart to beat when the heartbeat is too slow or irregular. 

The insertion of a pacemaker is done with local anaesthetic. A catheter is inserted and the lead wire is put through into the blood vessel. One, two or three lead wires may be inserted depending on the type of device. Then, the pacemaker generator will be placed below the collarbone through the incision after the lead wire is attached. An electrocardiogram (ECG) will be used for observation to ensure that the pacemaker is working properly.

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We believe in providing affordable cardiovascular medical care for adults living in heartland areas. A specialist heart clinic accessible to all those living in the northern areas of Sembawang, Admiralty, Yishun, Woodlands and Canberra.

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