Interventional Cardiology at NYU Winthrop Hospital
A National Leader in Cardiac Care
Within NYU Winthrop's technologically advanced Cardiac Catheterization Laboratories, patients find superior treatment methods for cardiovascular disease.
Innovative Interventional Cardiology Treatments That Restore Heart Health
Interventional cardiology is the branch of cardiology that deals specifically with the catheter-based treatment of structural heart diseases. The procedures performed are done by initially placing a catheter into the heart, or into the arteries that feed the heart itself.
Innovative diagnostic and treatment methods used at our renowned cardiac catheterization lab include:
A cardiac catheterization is performed by placing a long, thin, hollow tube (known as a catheter) into the right or left femoral artery or femoral vein. These vessels are accessed through a small puncture site in either the left or right groin. Local anesthesia is used in the groin to permit relatively painless introduction of a small plastic tube (sheath) into the blood vessel. A catheter is then advanced through the sheath, up to the heart. This catheter can be used to take pressure readings and/or inject contrast (dye) to take pictures. This gives your doctor valuable information about your heart. Your doctor may elect to perform one or both of the following type of cardiac catheterizations.
During a Right Heart Catheterization, your doctor will place a catheter into the femoral vein and advance the catheter into the right chambers of the heart. Pressure measurements from the right side of the heart give your doctor information about how well your heart and lungs are working.
During a Left Heart Catheterization, your doctor will place a catheter into the femoral Artery and advance the catheter up the Aorta to the base of the heart. With this procedure your doctor can take pictures of the coronary arteries (coronary angiogram), take pressure readings and even take a picture of the left ventricle (the main pumping chamber of the heart). This will tell your doctor if there are any narrowing or blockages in these arteries, which feed the heart, how well the heart is pumping and if there are any problems with the aortic valve at the top of the heart. These diagnostic procedures give your doctor valuable information.
A coronary angiogram is a series of x-ray pictures showing the internal contours of blood vessels which feed the heart (coronary arteries) and is taken during a Left Heart Catheterization. This diagnostic test is usually performed when a patient is suspected of having narrowing or blockages of the coronary arteries. Narrowing or blockages of the coronary arteries is called coronary artery disease. Your physician may suspect that you have coronary artery disease based on your history, symptoms or recent stress test.
A cardiac catheterization and coronary angiogram can help your doctor determine how best to treat you. Based on the findings of your cardiac catheterization and coronary angiogram you may need:
- No additional treatment
- To be treated with medication
- A coronary intervention
- Coronary by-pass surgery
A cardiac catheterization is a diagnostic study of the heart. Coronary intervention, which is often done during a cardiac catheterization, is a type of treatment for blocked or severely narrowed coronary arteries, also known as "hardening of the arteries" or arthrosclerosis. This is a disease in which the arteries are hardened and narrowed because of plaque, which has built up along the insides of the artery walls. While some forms of arteriosclerosis occur naturally over time, arthrosclerosis involves an unnatural build-up of plaque, which is made up of fats (lipids), cholesterol (lipoproteins), calcium and other materials. These masses of plaque may eventually lead to a partial or complete blockage of the blood flow through the artery. Coronary intervention is the treatment of a patient with hardening of the arteries.
Coronary intervention refers to several possible methods of treatment that your doctor can use to attempt to open your blocked or severely narrowed coronary arteries.
Coronary Angioplasty (Stent Placement)
Angioplasty/stent means that a small balloon is inserted into an artery that is blocked or severely narrowed in your heart. This balloon may or may not have a metal mesh sleeve around it (stent).
The balloon is inflated in an attempt to push the cholesterol build-up (plaque) to the side, opening the passageway of the artery, after which, the balloon is then deflated and removed, allowing blood to flow more freely. If the balloon is one with a metal mesh sleeve around it, when the balloon is inflated, the metal mesh sleeve expands and is imbedded to the artery's wall. Once the balloon is deflated and removed, the sleeve (stent) remains in the artery, helping to keep the artery open.
Special Interventional Cardiac Procedures
Transcatheter Aortic Valve Replacement (TAVR)
Patients in need of heart valve replacement whose frail condition makes them ineligible for open heart surgery have new hope. In 2012, NYU Winthrop was selected as one of only 70 hospitals and medical centers in the United States to offer Transcatheter Aortic Valve Replacement (TAVR), and currently performs the most TAVR procedures in the region.
Patent Foramen Ovale (PFO)
The foramen ovale is a small opening located between the atria that is used during fetal circulation to speed up the flow of blood through the heart. A fetus does not use its own lungs for oxygen; it relies on its mother to provide oxygen rich blood from the placenta through the umbilical cord to the fetus. Therefore, blood can travel from the veins to the right side of the baby's heart and cross to the left side of the heart through the foramen ovale and skip the trip to the baby's lungs.
Normally the foramen ovale closes at birth when increased blood pressure on the left side of the heart forces the opening to close. If the atrial septum does not close properly, it is called a patent foramen ovale or PFO. This type of defect can be problematic in adults, and can cause strokes or heart attacks.
Interventional cardiologists can now seal this opening by performing a cardiac catheterization and placing a closure device (septal occluder) in the PFO.
AMPLATZER® ASD septal occluder
Here are two illustrations of one of the types of devices used to close a PFO.
The picture on the left shows how the device is deployed. The brief video on the right shows the device in place in a human heart.
MitraClip® Transcatheter Mitral Valve Repair
MitraClip® is a minimally-invasive treatment for mitral regurgitation, a condition in which the heart's mitral valve doesn't close tightly allowing blood to flow backward in the heart. Depending on the severity, this can lead to shortness of breath, rapid heartbeat or heart failure. For patients who cannot undergo open-heart surgery, MitraClip, which is smaller than a dime, allows doctors to access the heart with a thin tube or catheter that is guided through a vein in the leg. Most patients experience significant improvement of symptoms immediately following the procedure.
NYU Winthrop Interventional Cardiologists
Kevin P. Marzo, MD, FACC
Chief, Division Of Cardiology
William Kokotos, MD, FACS, FACC
Chief, Division of Cardiac Surgery
Ramesh Daggubati, MD
Director, Cardiac Catheterization Laboratory
Stephen Green, MD
Director, Interventional Cardiology
Richard Schwartz, DO
Director, Transcatheter Valve Program