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09/Feb/2018

Diagnosis

Description for treatment



What is it

This is a minimally invasive procedure performed in patients with aortic stenosis (narrowing) by a team of cardiologist and cardiac surgeons. It involves wedging a new valve over the old one without having the need to open the anterior chest (sternotomy). A flexible tube (catheter) is threaded up to the heart and across the aortic valve.


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08/Feb/2018

Pacemaker implantation

A pacemaker is a battery-powered device placed under the skin or the muscle (usually on the anterior chest) connected to different heart chambers with leads (cables). An electrical impulse sent through the leads will cause the heart to beat whenever is needed.



What is it

A pacemaker is a battery-powered device placed under the skin or the muscle (usually on the anterior chest) connected to different heart chambers with leads (cables). An electrical impulse sent through the leads will cause the heart to beat whenever is needed. Single chamber pacemakers have one lead, dual chamber pacemakers have two, and biventricular pacemakers have three leads (Fig 1). In addition, the Micra® and Nanostim® single chamber pacemaker have only recently
become available and are made of a capsule slightly bigger than the size of the coin (Fig. 2). The capsule contains the whole pacemaker “head” and battery, is implanted from the femoral vein (a large vein in the groin) into the right ventricle (the chamber that pumps blood into the lung), and does not require surgical incision of the chest or placement of any leads in the heart (Fig. 2). Patients are usually discharged 2 days after the operation.

Why a patient needs a pacemaker

The heart is a pump controlled by electrical signals. If the sino-atrial (the main pacer of the heart) or the atrio-ventricular node (which transmits electrical impulse from the collecting to the pumping heart chambers) are not functioning properly, a profound bradycardia (slow heart beat) can occur, resulting in shortness of breath, inability to exercise and fainting. Further deterioration up to a complete absence of any cardiac beat can happen. Biventricular pacemakers, where leads are implanted in the right and left ventricle (the 2 pumping chamber of the heart) are implanted in selected patients with heart failure, to support and improve heart functioning.

What we perform

Coronary angiography, angioplasty and stenting is performed with the newest angiography equipment (machine that visualize catheters and body structures with X-Ray), therefore reducing the amount of XRay dose and contrast media. All available Stent with (Drug-Eluting-Stent, DES) and without (Bare-Metal-Stent, BMS) drugs are available.
Non-polymeric and absorbable stent are also used. The selection of the stent type is made on the basis of coronary anatomy and specific patient risk profi le and additional diseases. Ablation in congenital heart disease


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01/Feb/2018

Left atrial appendage closure implantation

Description for treatment



What is it

The left atrial appendage is a small cul-de-sac in the wall of the left atrium (the chamber that receives oxygenated blood from the lung). This is the most frequent localization of blood clot in the heart. Blood clots can occur when fast heart beats (atrial fi brillation or fl utter) hinder proper contraction of the left atrial appendage. Blood therefore stagnates and coagulates, because it is no longer squeezed out from the appendage. Appendage occlusion avoids blood entering and clot formation. An “umbrella”- like device is implanted at the origin of the left atrial appendage, and seals its entrance, making it impossible for a clot to be created in the heart structure (Fig 5). A diff erent option is to close the appendage from the outer side of the heart with a specifi c wire tightening the neck of the appendage. This is done once the outer heart, the so called “epicardial space” (comprised between the 2 epicardial sheets, and a thin layer of fi broustissue that fixes the heart to the thorax and contains a small amount of fluid so that the heart can freely move) is reached with a puncture through the superior part of the abdominal wall. Patients are usually discharged 2 days after the operation.

Why a patient needs an atrial appendage closure

Whenever blood clots form in the appendage, there is a substantial risk that a part of it will suddenly dislodge and reach the main blood stream causing an acute ischemia (occlusion of the vessel that normally supply for blood) of the brain (stroke or transient ischemic attack) or another organ. Patients with atrial fi brillation or fl utter (2 fast heart beats originating from the heart chambers collecting blood) are more likely to develop a stroke than the general population, especially when additional risk factors (e.g. arterial hypertension, diabetes mellitus, advanced age…) are present. Oral anticoagulation
(blood thinning with drugs) is the fi rst therapeutic approach, but whenever there is a contraindication to blood thinning (because a serious bleeding already happened or the risk to develop bleeding is particularly high), percutaneous closure of the left atrial appendage is indicated.

What we perform

All available devices, including epicardial devices, are implanted and the choice will depend on the patient specifi c left atrial appendage anatomy and contraindication to oral anticoagulation (blood thinning).


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30/Gen/2018

Coronary angioplasty & stenting

Description for treatment



What is it

A coronary angiography is the procedure during which a fl exible tube (catheter) is inserted through an artery in the groin or the arm and threaded up with an X-Ray to the beginning of both coronaries (the arteries that supply with blood the heart). Contrast media is then injected to visualize any possible stenosis (narrowing of the artery) caused by accumulation of fat in the artery wall. Once visualized, the stenosis can be treated with angioplasty. This requires crossing the stenosis with a small balloon, which is then infl ated, pushing out the blockage, restoring patency and blood supply to the heart (Fig. 8). A
stent (a wire mesh tube), is almost always placed at the level of the stenosis in order to prevent re-blockage (Fig. 9). When a coronary angioplasty and stenting is performed as an emergency treatment for an acute heart ischemia or myocardial infarction (failure in blood supply due to partial or complete occlusion of one of the arteries), it is called a primary angioplasty. Patients are usually discharged 2 days after the operation.

Why a patient needs a Coronary Angioplasty & Stenting

Chest pain (angina) and shortness of breath during exercise are common if coronary stenosis (narrowing) is present. Chronic stenosis can lead to deterioration of the heart function, and acute coronary occlusion (myocardial infarction) can result in acute deterioration of the heart function and sudden cardiac death. Coronary angioplasty and stenting restores the blood fl ow to the heart, therefore relieving symptoms and supporting proper heart function.

What we perform

We off er all the diff erent current technologies in pace-maker implants including, single, double, biventricular and leadless pacemakers. Devices compatible with magnetic resonance imaging can be implanted if necessary. The type of pacemaker will be decided according to your heart’s electrical and mechanical condition.


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27/Gen/2018

Catheter Ablation

Description for treatment



What is it

Catheter ablation is the technique during which catheters (small flexible tube) with electrodes (able to record and display the electrical activity of the heart on a monitor) are threaded up to the heart, in order to identify the area causing the tachycardia (fast heart beats). An ablation (a permanent damage) of the abnormally active heart cells is achieved with the delivery of heat or cold energy. Catheter ablation is performed in the chambers collecting (the atria) and pumping (the ventricles) blood with risk and success rates that vary depending from the specifi c arrhythmia. Nowadays, so called threedimensional mapping system are routinely used in order to improve effi cacy and safety, allowing precise movements in the heart without the need to use fl uoroscopy, therefore dramatically reducing X-ray exposure (Fig. 6&7). Patients are usually discharged 2 days after the operation.

Why a patient needs a catheter ablation

Tachycardia originates from atria or ventricles. Palpitations, anxiety, shortness of breath, and an inability to exercise are usual symptoms. Syncope can occur, and tachycardias originating from the ventricle (ventricular tachycardia or fi brillation) can lead to cardiac arrest. In addition, a persistent high heartbeat can damage the heart resulting in a specifi c form of heart failure (tachycardiomyopathy). Treatment of the arrhythmia leads to symptom resolution or quick normalization of the heart function.

What we perform

Defi brillators are implanted in a hospital based setting. We off er all the diff erent current technologies in ICDs Implant including, single, double, biventricular and subcutaneous devices. Devices compatible with magnetic resonance imaging can be implanted if necessary.


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22/Gen/2018

Mitraclip

Description for treatment



What is it

The MitraClip or transcatheter mitral valve repair is a minimally invasive procedure performed in patients with a mitral valve insufficiency/regurgitation (leak) by a team of cardiologist and cardiac surgeons.
A fl exible tube (catheter) is threaded up from the femoral vein (large vein in the groin) to the heart, across the septum (wall) between the 2 atria (the 2 blood collection chambers of the heart). A small metal clip (covered by a polyester fabric) is gently moved forward from the left atrium to the left ventricle (the main heart chamber) where the valve leaks more. Retracting the clip and closing it brings the valve together again so that the regurgitation of the valve diminishes or almost disappears (Fig. 11). Patients are usually discharged 2 days after the operation.

Why a patient needs a MitraClip

mitral valve is found between the left atrium (the heart chambers which collects oxygenated blood from the lungs) and the left
ventricle (the heart chamber which pumps the blood in the body). A mitral insuffi ciency or regurgitation describes the situation in which the valve does not close properly. This results in blood leaking backwards from the ventricle, through the mitral valve in the left atrium. Shortness of breath at rest and during exercise are commonly associated with severe egurgitation. Pulmonary edema (sudden accumulation of fl uid in the lung) and (acute) failure of the main heart chamber to pump blood forward can occur in this situation. In the past, patients with advanced age or additional health problems did not qualify for “standard” cardiac surgery because the risks associated with the operation were too high. Nowadays, quality
of life can be restored with this minimally invasive procedure which is performed in general anesthesia.

What we perform

MitraClip® is performed by a team of cardiologist and cardiac surgeons working together in a combined environment (hybrid operational room). This approach increases effi cacy and safety, because the procedure can be safely switched from minimally invasive to standard cardiac surgery, if needed.


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17/Gen/2018

Tavi – Transcatheter aortic valve implantation

Description for treatment



What is it

This is a minimally invasive procedure performed in patients with aortic stenosis (narrowing) by a team of cardiologist and cardiac surgeons. It involves wedging a new valve over the old one without having the need to open the anterior chest (sternotomy). A flexible tube (catheter) is threaded up to the heart and across the aortic valve.
Expanding the new valve, which is mounted on a big wire mesh tube, pushes the old valve leafl ets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow (Fig. 10). Two diff erent approaches are possible, allowing the team to select the most safe and effi cient for each specifi c patient. The first and more common is via the femoral artery (large artery in the groin).
This is called the “transfemoral approach” and does not require any surgical incision in the chest. For patients with extensive sickness in the big artery, which does not allows placement of big catheters, a minimally invasive surgical approach with a small incision in the chest is an alternative option (“transapical approach). Patients are usually discharged 2-4 days after the operation.

Why a patient needs a TAVI

Aortic stenosis describes a narrowing of the exit of the left ventricle (the main heart chamber). This prevents blood to be properly pushed forward in the body. Diffi culty to exercise, shortness of breath and sudden loss of consciousness are usually present, and progressive failure of the main chamber to pump blood forward or sudden cardiac death are common if the sickness is not treated. Therefore, patients with a severe narrowing of the aortic valve will benefit from a valve replacement. In the past, patients with advanced age or additional health problems did not qualify for “standard” cardiac surgery because the risk of opening the chest and directly work on the heart and valve was too high. Due to its lower general risk, TAVI (Transcatheter
Aortic Valve Implantation), also called TAVR (Transcatheter Aortic Valve Replacement), nowadays can be performed in patients
at high or middle risk for a “standard” cardiac surgery operation.

What we perform

TAVI/R is performed by a team of cardiologist and cardiac surgeons working together in a combined environment (hybrid operational room). This approach increases effi cacy and safety, because the procedure can be safely switched from minimally invasive to standard cardiac surgery, if needed. Several diff erent TAVI valves are available, and the selection will be made according to the specific patient needs and operator preferences.


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13/Gen/2018

Follow up

Description for treatment



What is it

This is a minimally invasive procedure performed in patients with aortic stenosis (narrowing) by a team of cardiologist and cardiac surgeons. It involves wedging a new valve over the old one without having the need to open the anterior chest (sternotomy). A flexible tube (catheter) is threaded up to the heart and across the aortic valve.




PRENOTA UN CONSULTO CON I NOSTRI MEDICI

Dott. Goran Arandjelovic
T. 340.9204779
Dr.ssa Fedra Gottardo
T. 3284017153




PRENOTA UN CONSULTO CON I NOSTRI MEDICI

Dott. Goran Arandjelovic T. 340.9204779
Dr.ssa Fedra Gottardo T. 3284017153




Concept:  P8Design


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Concept:  P8Design