Structural Heart Disease and Interventional Cardiology

The renowned specialists affiliated with Memorial Hermann Heart & Vascular have extensive experience in diagnosing and treating structural heart disease. Our innovative team is at the forefront of developing and utilizing cutting-edge interventional cardiology techniques to provide the best possible outcomes.

In the past, most structural heart diseases were treated with traditional open surgery. This type of surgery is still appropriate for some patients, but new, minimally invasive procedures performed by interventional cardiologists are providing a better option for many. The newer procedures offer less surgical risk, faster recovery, shorter hospital stays and fewer complications.

What is Interventional Cardiology?

Interventional cardiology is a subspecialty of cardiology that focuses on minimally invasive procedures to treat structural heart disease (including congenital heart defects), coronary artery disease, heart-valve disease, and vascular disease. These procedures involve catheter-based and stenting techniques and are usually performed in a cardiac catheterization laboratory (cath lab).

The field of interventional cardiology represents a revolutionary way to treat heart and vascular disease. Without the risks and lengthy recovery time associated with traditional open surgery, interventional cardiology utilizes the newest technology and procedures to effectively treat cardiovascular disease. Patients who need artery repair, valve repair or replacement, or other heart-defect repair may be good candidates for interventional cardiology procedures.

Stent Placement

A heart stent is a tiny device made of expandable wire-mesh tubing that is permanently inserted into a coronary artery to keep it open. Stents are inserted during an angioplasty procedure. Angioplasty opens clogged or narrowed arteries, and stents support the newly opened arteries and keep them open. This reduces the risk of heart attack. There are two types of stents:

Drug-Eluting Stents: These devices are coated with medication and are the most common type of cardiovascular stent. The medication is slowly released to help prevent scar tissue from forming, which makes it less likely for the artery to narrow again.

Bare Metal Stents: These devices do not contain medication. They act as structural support to hold the arteries open and are often the preferred choice for patients who have a higher bleeding risk.

Atherectomy

Atherectomy is a minimally invasive procedure that is effective for treating vascular disease. Physicians use catheters with specialized blades or lasers to reach the clogged artery and grind away the plaque, to make an artery wider, which allows better blood flow.

Laser Therapy

As an alternative to surgery, laser therapy is used to treat atherosclerosis and other conditions. Targeted laser energy can reduce inflammation and regenerate tissue to help restore cardiovascular function.

Percutaneous Coronary Intervention (PCI)

This minimally invasive procedure incorporates both angioplasty and stenting. It can be used to treat the most severe type of heart attack known as ST-Elevation Myocardial Infarction (STEMI). Physicians must restore blood flow immediately in order to prevent death, and PCI may be successful.

Structural heart diseases are defects in the heart’s structure, including the valves, chambers or muscles. Some structural heart diseases are present at birth (congenital) and others develop throughout the years.

This is different from coronary heart disease which is caused by a buildup of fatty deposits (plaque) in the arteries and blood vessels. Structural heart disease is a problem with the physical structure of the heart that affects its ability to function properly.

Structural heart disease may not show any symptoms in the early stages. When the disease has progressed, you may notice some of the following signs:

• Chest pain or tightness
• Fatigue or shortness of breath
• Irregular heartbeat
• Dizziness or fainting

Causes of Structural Heart Disease

The cause of congenital (present at birth) structural heart disease is often unknown. Heart problems that develop later in life may be caused by an infection or illness, or other underlying conditions. Risk factors for developing a structural heart disease include:

• Atherosclerosis
• High blood pressure
• Previous heart attack
• Rheumatic fever
• Cardiomyopathy
• Certain medications

Congenital Heart Disease

Congenital heart defects are present at birth and are the most common type of birth defect. This type of heart disease is an abnormality in the structure of the heart that occurs while the fetus is developing in the uterus. Sometimes symptoms appear at birth, while other patients may not experience problems until later in life.

Heart Valve Disease

Heart valve disease can also be called valvular heart disease. Heart valve disease occurs when one or more of the four heart valves do not function correctly. Your heart has four valves (mitral, aortic, tricuspid, and pulmonic) that control and maintain the flow of blood. The valves have tissue flaps that open and close each time your heart beats. The opening and closing of the flaps directs blood flow in the right direction so it can reach the rest of your body. When the valves do not open or close correctly, the blood flow is disrupted.

Two of the most common valvular diseases are:

Mitral Regurgitation: Mitral regurgitation (MR) is a condition in which the heart's mitral valve (dual-flap valve between the left atrium and the left ventricle) is diseased and allows the blood to flow backwards or regurgitate, into the atrium, each time the left ventricle contracts. This reduces the amount of blood that flows to the rest of the body. As a result, the heart may try to pump harder, which may lead to congestive heart failure.

Aortic Stenosis: Aortic stenosis occurs when the heart’s aortic valve becomes too narrow. This is a common but serious heart-valve disease that is often caused by the aging process. Occasionally, aortic stenosis is caused by a birth defect, rheumatic fever or radiation therapy.

Heart Muscle Abnormalities

Hypertrophic cardiomyopathy occurs when a thickening of the heart muscle makes it hard to effectively pump blood. Symptoms can include shortness of breath or chest tightening while exercising, although many patients do not experience any signs of the disease. This condition often runs in families and is a common cause of sudden cardiac death.

Chronic Total Occlusion (CTO)

Chronic total occlusion (CTO) is a complete, or nearly complete, blockage of a coronary artery that is present for at least three months. CTO significantly reduces blood flow to the heart muscle and increases the risk of heart attack. This condition occurs in patients who suffer from coronary artery disease (CAD). A coronary artery becomes completely blocked when there is a severe buildup of plaque, a condition known as atherosclerosis. With CTO, patients may have chest pain, shortness of breath or suffer a heart attack.

Patent Foramen Ovale (PFO)

A PFO is a hole in the heart that develops as a congenital (present at birth) heart defect. The foramen ovale is a flap-like opening that allows oxygenated blood to pass through the baby’s heart and bypass the lungs. When this flap does not close properly after birth, the result is a PFO. This condition causes an increased risk of stroke because blood clots can travel from the heart, through the hole, to the brain.

Early diagnosis can lead to more treatment options and better outcomes. In addition to a physical exam, cardiologists may perform various diagnostic tests to detect structural heart disease.

Echocardiogram

This noninvasive, painless test uses sound waves to create images of your heart. Different types of echocardiogram tests can evaluate the shape of the heart and the function of the heart muscle and valves.

Electrocardiogram (ECG or EKG)

An ECG or EKG machine records the electrical activity in the heart. Sensors (electrodes) are attached to the chest and send signals to the machine that creates visual graphs of heart activity.

Cardiac CT

A cardiac computerized tomography (CT) exam is an imaging test that can be used to evaluate the structure of the heart. Cardiac CT takes images with or without the use of a catheter or contrast dye.

Cardiac MRI

Similar to a cardiac CT exam, a cardiac magnetic resonance imaging (MRI) exam takes images of the coronary system to look for abnormalities. A cardiac MRI can be used to identify many conditions including atherosclerosis and congenital heart disease.

Nuclear Medicine Scan

Using trace amounts of a radioactive material along with a special camera and a sophisticated computer system, a nuclear-medicine heart scan can provide information about your cardiac structure, function and blood flow.

Some patients with structural heart disease do not require any treatment. When treatment is necessary, interventional cardiologists and surgeons will recommend a plan to address the specific type of disease. Options range from medications to minimally invasive procedures to open surgery.

Medication

Medications can improve symptoms by addressing underlying problems. Treatment may include daily medication to control high blood pressure or high cholesterol. Blood thinners are also used.

Minimally Invasive Procedures

Some patients are not strong or healthy enough to undergo open-heart surgery. In those cases, surgeons may recommend a minimally invasive surgical procedure instead. The highly trained specialists at Memorial Hermann are experienced with the latest technology and procedures to address heart needs with the most conservative approach possible.

Heart-Valve Repair

In minimally invasive valve-repair surgery, also called least invasive valve surgery (LIV), the surgeon makes a small incision in the chest that allows them to see the valve and repair the damage. Common types of heart valve repair include minimally invasive aortic surgery and minimally invasive mitral valve surgery.

Valvuloplasty

A balloon-tipped tube is threaded through a blood vessel and into the faulty heart valve. The balloon is inflated to widen the opening of the valve, then deflated and removed along with the tube.

Ablation

Heat therapy (ablation) can be used to destroy diseased tissue. Catheters (thin, flexible tubes) are threaded through the blood vessels to reach the abnormal heart tissue. The cardiologist then uses a small cutter or radiofrequency energy to remove the abnormal tissue.

Mitral Valve Repair and Replacement

When the mitral valve malfunctions, the flaps of the valve become thick or stiff and may fuse together. If the valve does not open or close properly, the heart may become damaged.

In a minimally invasive procedure, the surgeon can repair the defective valve through a small incision in the chest and the cardiologist can repair through a small puncture in the groin.

Transcatheter Edge to Edge (TEER) with MitraClip^® :The MitraClip^® system involves inserting a tiny clip, through a catheter, into the heart to repair the mitral valve. The clip is inserted through an artery and does not involve incisions in the chest.

Sometimes the mitral valve cannot be effectively repaired. In these cases, a valve replacement may be recommended. During valve-replacement surgery, the mitral valve is removed and replaced with an artificial valve.

Aortic Valve Replacement (AVR)

With traditional open surgery, the surgeon makes a large incision in the chest, temporarily stops the heart, and places the patient on a bypass machine while the replacement valve is placed. In a minimally invasive AVR procedure, the surgeon works through a small incision or incisions, and the heart continues to beat throughout the procedure.

Transcatheter Aortic Valve Replacement (TAVR)

This procedure is appropriate for patients with severe aortic stenosis (thickening of the aortic valve that prevents it from fully opening) who are at an intermediate or high risk for significant complications from traditional open-heart surgery. In a TAVR procedure, a new, artificial aortic valve is collapsed and inserted through a catheter in the chest or leg. Once the device is in the correct position, it is expanded and stays in place to take over for the diseased or damaged aortic valve.

Protected Percutaneous Coronary Intervention (PCI)

Some patients are considered too high-risk to undergo minimally invasive procedures without additional support for their coronary system. A protected PCI involves utilizing a support device, such as the Impella® heart pump, to maintain cardiac function during the procedure. With this assistance, patients are better able to withstand the procedure.

Left Atrial Appendage Occlusion (LAAO)

Patients with atrial fibrillation (AFib) may be at a higher risk of stroke caused by blood clots that form in the left atrial appendage (LAA). The LAA is a small pocket (or recess) connected to the upper left chamber of the heart that, in people with AFib, can allow blood to pool and collect and increase the likelihood of a clot forming and traveling to the brain to cause a stroke. A left atrial appendage closure device reduces this risk.

Patent Foramen Ovale (PFO) Occlusion

The Amplatzer™ Talisman™ PFO Occlusion System is the first FDA-approved device for PFO patients who are at risk of recurrent strokes. This minimally invasive procedure seals off the opening in the heart, preventing blood clots from escaping and traveling to the brain. Memorial Hermann-affiliated interventional cardiologists are the first in the world to use this occlusion system to treat PFO.

Open-Heart Surgery

Open-heart surgery is the traditional surgical method that involves making a large incision in the chest and cutting through the breastbone (sternum) to reach the heart. Open-heart surgery is used to treat a wide range of cardiovascular conditions, including heart-valve disease, and congenital (present at birth) heart defects.

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