Coronary angiography, coronary angioplasty, the insertion of a coronary stent and cardiac surgery are common investigative and interventional procedures. This chapter offers a detailed description of those procedures.
After you recover from a heart attack your doctor may recommend you undergo the procedure known as 'coronary angiography'. The coronary angiography may be performed during your stay in hospital or as an elective procedure at a later time. Coronary angiography is an X-ray procedure that is used to examine the arteries of your heart with a special camera.
The procedure is performed in a catheterisation laboratory.
The test enables doctors to detect the presence of any coronary disease in arteries narrowed or blocked by atherosclerosis (fatty deposits). It also assesses how well the chambers of the heart are functioning. The total procedure generally lasts from 1 to 2 hours and you will be awake throughout the procedure.
When transferred to the cardiac catheterisation laboratory you will be asked to lie on a narrow bed under an X-ray camera.
A local anaesthetic is given in the groin or elbow crease and the doctor inserts a thin plastic tube (catheter) into an artery in either the groin or elbow and threads it into the section of the aorta (main artery in the body) from where the coronary arteries originate. This procedure is completely painless.
A dye is then injected through the tubing into the coronary arteries and the heart chambers. Pictures are taken and recorded on videotape and cine film. The doctor gives several injections of dye while taking X-ray photographs, moving the bed so that the vessels can be viewed from several angles. (You are secured to the bed.)
You may feel a sensation of warmth, flushing or tingling when the dye is injected but the sensation lasts only 20 to 30 seconds.
Once the procedure is finished the catheter is removed and a pressure bandage or pressure device is applied over the area of insertion to prevent bleeding.
On returning to the ward you will be asked to rest keeping your leg or arm straight. It is also necessary for you to drink plenty of fluids so as to flush the dye from your system. The doctor will discuss the results of the investigation and recommendations for further treatment with you before you leave hospital.
CORONARY ANGIOPLASTY (BALLOON DILATATION)
This is a procedure using a similar technique to coronary angiography. However, the procedure is different in that a balloon-tipped cardiac catheter is inflated to try and flatten the fatty deposits (atheroma) against the artery wall and enlarge the passageway for increased blood flow.
This technique may be recommended by your doctor as an alternative form of treatment to coronary artery bypass surgery.
Patient selection for this treatment is dependent on the number of arteries narrowed and the severity of the coronary artery disease.
All patients will have previously undergone coronary angiography. The decision for 'balloon dilatation' is discussed with you by the specialist who performs this procedure.
The procedure carries with it a small risk of surgical intervention. It is therefore normal practice to have a
cardiac surgeon and theatre facilities available during the 'balloon' treatment.
The hospital stay is usually about 1 day.
You will be asked to fast for 4 hours prior to the procedure and your groin will be shaved.
On transfer to the catheter laboratory a local anaesthetic is given in the groin and a narrow catheter with a balloon tip is passed into a blood vessel and advanced to the narrowed coronary artery requiring dilatation.
The balloon-tipped catheter is then inflated to stretch the wall of the artery at the site that is narrowed.
The procedure takes approximately 2 hours.
To minimise the small risk of bleeding post procedure a small tube is left in the groin for a few hours. When the tube is removed a pressure bandage is applied.
You will be required to remain resting in bed keeping the leg straight for 4 hours following removal of the tube from the groin.
The specialist will discuss the results of the procedure with you as soon as he or she has reviewed the X-ray films taken during the procedure.
A stent is a small metal-coiled device used to provide structural support to a vessel in order to keep the artery open. A coronary stent is implanted following coronary angioplasty. If you are to receive a coronary stent, your doctor may ask you to follow certain instructions. For several days prior to the procedure you will be asked to take aspirin and other prescribed medications. You will need to let your doctor know if you:
cannot take aspirin
are taking any medications
have any history of drug allergies
have a history of bleeding problems.
Sometimes following coronary angiography your doctor may recommend coronary artery bypass surgery.
This surgery uses a vein or artery from the leg or from behind the breastbone to increase the supply of blood to the heart by bypassing an obstruction in one or more arteries.
One end of the vein graft is sewn into the aorta above the original opening to the coronary artery. The other end is attached to the coronary artery below the obstruction. That is why the operation is called a coronary artery bypass graft.
Immediately after the operation you will spend 12 to 24 hours in the Intensive Care Unit. The remainder of your hospital stay (about 5 to 7 days) will be spent in a cardiac surgical ward.
Cardio & Blood