Coronary heart disease

Coronary heart disease is the leading cause of death worldwide, according to the World Health Organization. It usually presents with precardiac pain during exercise (effort angina), but can also occur at rest (unstable angina) or as an acute coronary syndrome.

Depending on the distribution of lesions in the coronary arteries, treatment is either surgical or percutaneous. Today, the technique of angioplasty has evolved dramatically since its initial conception by Dr. Gruentzig, including in addition to balloons and stents, special atherectomy tools (rotational atherectomy, orbital atherectomy), Laser atherectomy), intracoronary imaging methods (IVUS, OCT) physiologic assessment (FFR, IFR) as well as innovative hemodynamic support pumps (Impella).

In addition to the typical atherosclerotic lesions, chronic total occlusions as well as obstructions in venous and arterial grafts (LIMA, RIMA, saphenous vein grafts) can be treated percutaneously.

Structural heart diseases

Structural heart diseases are defined as diseases related to the heart valves. They are the newest chapter of Interventional Cardiology, following the spirit of the times towards minimalist therapies with rapid recovery for the patient and excellent results. Percutaneous treatment of severe aortic stenosis (TAVI), mitral regurgitation (both with the Mitraclip device and percutaneous valve placement in the mitral -TMVR), pulmonary valve insufficiency (Melody valve placement), and tricuspid insufficiency as palliative treatments for patients at high surgical risk and evolving into equivalent treatments with traditional surgery. Multiple studies regarding TAVI (PARTNER trials, EVOLUT trial, SURTAVI trial) and Mitraclip (COAPT trial), have established the position of percutaneous treatment of structural heart disease in modern medical reality.

Chronic Thromboembolic disease

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a disease due to the presence of organized thrombi in the pulmonary arteries. These clots cause narrowing or even blockage of the pulmonary arteries, resulting in the appearance of pulmonary hypertension (elevated pressure in the arteries), which in the long run leads to failure of the right ventricle of the heart. Many patients with acute pulmonary embolism may suffer from CTEPH in the future. However, the majority of patients with CTEPH do not have a diagnosis of acute pulmonary embolism, but have concomitant diseases of the blood coagulation mechanism. The prognosis of the disease, without treatment, is poor, with low survival rates at five years.

First line treatment is surgical treatment with pulmonary endarterectomy. Pulmonary angioplasty (BPA) is offered to patients who are considered non-operative or do not have the availability of surgery.

Congenital heart diseases

Congenital heart disease is defined as heart disease that is present at birth. The range of these diseases is extremely large and their treatment varies from simple monitoring to surgery, depending on the nature of the disorder.

The open oval foramen (PFO) allows the right atrium to communicate with the left atrium, which is normal in a fetus but is blocked within weeks of birth. Closure of the open oval foramen (PFO closure) is indicated in patients with cryptogenic stroke, ie after a stroke where there is no other possible etiology other than the open oval foramen.

At the same time, in patients with pulmonary valve atresia, right ventricular hypoplasia or tricuspid valve atresia, who during childhood underwent surgery with Fontan, the development of venous-venous and arteriovenous collaterals is common. These collaterals increase the volume of blood in the right circulation, thereby increasing the pressures and making the Fontan system dysfunctional. In such cases, venous-venous and arteriovenous collateral communications are blocked with coils to reduce the burden on the right circulation.

Finally, hypertrophic cardiomyopathy is the thickening of the heart wall, which in addition to chronic hypertension, can also be due to genetic factors. A percentage of patients with hypertrophic cardiomyopathy show symptoms of shortness of breath, fatigue, angina and palpitations due to the presence of a dynamic obstruction between the left ventricle and the aorta, which mimics the symptoms of severe aortic valve stenosis. In patients suffering from obstructive hypertrophic cardiomyopathy, the treatment of choice is myomectomy, which is performed surgically. In specific cases, however, ablation of the interventricular septum can be performed percutaneously (alcohol septal ablation), where sternotomy is avoided and remission of symptoms is achieved with rapid recovery of the patient.

Peripheral arterial disease

Peripheral arterial disease is characterized by the deposition of atherosclerotic plaques that cause narrowing of the arteries of the systemic circulation, with the exception of the heart and brain. The main causes, as in coronary heart disease, are smoking, chronic hypertension, diabetes, chronic renal failure and dyslipidemia. The symptoms depend on the affected arteries, and on the lower extremities are usually intermittent claudication (pain in the calves when walking). In more chronic diseases it can develop into severe limb ischemia, which requires immediate treatment to restore perfusion. When it comes to the arteries of the kidneys, it presents with severe arterial hypertension, which does not respond to medication with multiple drugs.