Structural Heart
This growing subspecialty of cardiology addresses abnormalities and diseases that affect the heart’s valves, chambers, and walls, as well as the blood vessels connected to the heart. Some of these defects are present at birth while others develop over time. Open-heart surgery used to be the only option to treat these defects or replace damaged heart valves. Now, we have the technology and expertise to make these repairs minimally invasively through the catheter-based procedures described below.
Transcatheter Aortic Valve Replacement (TAVR)
TAVR is used to treat aortic stenosis (AS), a common valve disease affecting many older Americans. In aortic stenosis, the aortic valve narrows and cannot fully open, forcing the heart to work harder to pump blood and impeding blood flow to the rest of the body.
Before the development of TAVR, open surgery was the only approach to valve replacement for aortic stenosis. With TAVR, a catheter with a balloon at its tip is threaded up to the heart with the help of guided imagery. When the catheter reaches the damaged valve, the ballon is inflated to open the valve walls. Then, the replacement valve is threaded up the catheter. Once the new valve is in place, it is opened, pushing aside the flaps of the original defective valve and effectively replacing it.
Transcatheter Valve Repair with MitraClip™
In mitral regurgitation, the mitral valve between the heart’s two left chambers doesn’t close completely. Blood flows backward into the heart (regurgitation). Left untreated, mitral regurgitation progresses, ultimately leading to heart failure. In the minimally invasive MitraClip procedure, the MitraClip device is introduced into the body via a catheter in the femoral vein and threaded up to the heart. The MitraClip is positioned over the leaky mitral valve. The device holds together the flaps of the leaking valve so it can open and close effectively, reducing the backflow of blood.
Patent Foramen Ovale (PFO) & Atrial Septal Defect (ASD) Closure
Patent foramen ovales and atrial septal defects are abnormal openings in the heart’s atria. Advances in catheter-based interventions have made it possible to close these openings minimally invasively. A closure device made of biocompatible materials is added to the tip of the catheter and threaded up to the hole in the heart, where it's released to cover the opening. Over time, heart tissue grows over the device and permanently seals the opening.
Reducing Stroke Risk from AFib with the WATCHMAN™ Device
Atrial fibrillation (AF or AFib) is a type of arrhythmia, or irregular heartbeat, that affects the upper chambers of the heart. In AFib, the heartbeat suddenly becomes rapid and irregular. Not only does this cause the heart to pump less efficiently, but it increases the risk of stroke. That’s because blood can pool in the left atrial appendage (LAA), a pouch-like structure in the left atrium of the heart. The pooled blood can form clots which may detach, travel to the brain, and cause a blockage. One way to reduce stroke risk from AFib is to prescribe blood thinners. However, blood thinners are not always well tolerated and increase the risk of bleeding if you are injured.
For many, the WATCHMAN FLX™ implant is a welcome alternative to blood thinners. This one-time procedure potentially reduces your stroke risk for a lifetime. The WATCHMAN FLX device is about the size of a quarter. A catheter is first inserted into the body through a vein in the groin and guided up to the LAA. Then, the WATCHMAN FLX device is introduced through the catheter. Once the device is properly positioned, it opens like an umbrella, closing off the LAA. Over the next six weeks, heart tissue grows over the implant, creating a permanent barrier against clots. Blood thinners may be discontinued once the LAA is sealed.
CardioMEMS™
CardioMEMS™ is an implantable device that helps cardiologists monitor a patient’s heart failure remotely by measuring pulmonary artery pressure (PAP). A small sensor is minimally invasively implanted in the patient’s pulmonary artery. The sensor measures PAP and wirelessly transmits the data to a home monitoring unit. The patient takes daily readings and the data is sent to their cardiologist who can then adjust their treatment regimen as needed. While CardioMEMS™ is not a cure for heart failure, the device can:
- Enables doctors to know if the heart failure is worsening before symptoms arise – if this is detected early, symptoms may be addressed via a change in medication
- Reduce hospitalizations for heart failure
- Give heart failure patients a measure of control over their treatment and improve their quality of life.