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Full-Service Digital Echocardiography
Transthoracic Echocardiogram - This procedure is a test that uses sound waves to create a picture of the heart in order to examine its size, shape and motion. It is useful in diagnosing heart valve dysfunction and to assess how strong the heart is beating, as well as for demonstrating fluid collections around the heart and looking at congenital abnormalities. The procedure is easily performed in either a clinic or in the hospital by rubbing a probe over the chest.
Transesophageal Echocardiogram - The transesophageal echocardiogram takes pictures of the heart from within the esophagus in order to offer better views than can be assessed with the probe on the chest. The throat is numbed with medication to enable the patient to swallow a tube with a tiny 'sonic camera' at its end. It usually takes less than an hour, after which patients are allowed to go home.
Stress Echocardiogram - During a stress echocardiogram, patients are asked to either briefly exercise or to take a medication which mimics exercise for the heart in order to monitor how well the heart performs before, during and after exercise. The views provided by the echocardiogram may be used to determine if portions of the heart are not receiving enough blood and are at risk for a heart attack.
Stress Testing
Treadmill (Exercise) Testing - There are several different types of stress tests. The most common stress test, also known as a treadmill test, is a recording of the electrical activity of the heart during physical stress, or exercise, and tests the heart's reaction to stress, or the increased demand for oxygen. Patches, or electrodes, are placed on the chest and attached to the stress machine by wires to allow the stress machine to record the heart's electrical activity while the patient walks on the treadmill. Heart rate, blood pressure, EKG and symptoms are monitored during this test.
Electrophysiology
Standard 12-lead Electrocardiogram (EKG) - This is a test that measures the electrical activity of the heart. Patches or electrodes are places on the chest and attached to the EKG machine by thin wires to allow the EKG machine to record the heartÃs electrical activity in a waveform. The EKG helps the physician to assess the presence of either an old or an impending heart attack, and to better diagnose abnormal rhythms (arrhythmias) of the heart.
Holter Monitoring and Event Recording - A holter monitor continuously records the electrical activity of the heart (or the heart rhythm) during normal activity for a 24-hour period. Patches, or electrodes, are placed on the chest and attached to a small heart-recording monitor by thin wires. At the completion of the 24-hour period, the monitor is returned to the physicians and reviewed for arrhythmias. Sometimes patients are asked to keep the monitor on for a longer time, or to record any abnormal sensations they feel while the monitor is on, to see if the sensations are related to arrhythmias. This is known as event recording.
Cardiac Pacemaker Implantation and Monitoring - Cardiologists at Bassett are skilled in placing pacemakers in the heart to help those with either slow heartbeats or abnormal electrical conduction through the heart. These pacemakers may then be monitored to accurate function either in Bassett Outpatient Clinics or over the telephone.
Cardiac Catheterization
Cardiac cathetherization is a common, non-surgical procedure that allows the cardiologist to study the vessels of the heart and the function of the heart and its valves. During the procedure, a catheter (a thin, flexible, narrow tube) is inserted through a small needle incision in an artery or vein located in the groin or arm and is monitored via x-ray as it is threaded through the main blood vessel leading into the heart. During coronary angiography, contrast dye is injected through the catheter into the coronary arteries to increase visibility of the vessels while images are recorded. Other catheter tests, which measure blood pressures in the heart chambers, blood flow through the valves and muscle function, can reveal tightened valves and congenital abnormalities.
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Interventional Cardiology
Angioplasty - Coronary artery disease involves the progressive development of atherosclerotic (or cholesterol-filled) plaques in the arteries of the heart. These may eventually block flow to the heart muscle, causing chest pain (or angina) or even death of the heart muscle (a myocardial infarction, or heart attack). Coronary angioplasty involves passing a small, thin catheter with a balloon in its tip into the heart vessel and inflating the balloon to 'push' the blockage against the vessel wall, allowing better blood flow.
Heart attacks result from blood clots that develop on the surface of a ruptured cholesterol plaque, and are often treated initially with medications to dissolve the clot ('clot-busters'). In emergency situations, as when a patient is experiencing a heart attack, immediate angioplasty has been proven to be even more effective than the 'clot-buster' medications in saving lives and preventing future heart attacks.
Stent Placement - Stents are small, rounded metal cylinders resembling tiny rolls of chain-link fencing. They may be placed in the heart artery at the time of angioplasty in order to more reliably keep the vessel open long-term than can be done with angioplasty alone.
Drug-eluting stents are the newest advance in stenting technology, and this technology is available at Bassett. These stents are impregnated with drugs that tend to inhibit the regrowth of tissue within the stented area better than any device currently used to treat coronary artery disease. This advance in the treatment of heart disease will likely result in a decrease in the need for repeat procedures in many individuals and, thus, hopefully help reduce associated medical costs.
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Open Heart Surgery
Coronary Artery Bypass Surgery - The cardiac surgeons at Bassett Healthcare are skilled in the performance of Coronary Artery Bypass Graft surgery, or CABGs. These operations take arteries from the chest and arms, along with veins from the legs, to serve as new routes for blood to pass around cholesterol blockages (atherosclerotic deposits) in the heart vessels. The operation is aimed at relieving the common symptoms of coronary heart disease, such as angina and shortness of breath, and allowing for a longer and healthier life. Besides the traditional bypass operation that has been performed for years, the surgeons at Bassett bring several state-of-the-art advances to these procedures to make them safer and even more effective for patients:
Off-Pump Techniques: The Division Head of Cardiac Surgery at Bassett has long-standing expertise in performing and teaching a relatively new procedure, off-pump coronary artery bypass surgery. This operation, also called beating-heart surgery, allows surgeons to perform coronary artery bypass grafts without placing patients on the heart-lung machine, in order to avoid some of the side effects of this device. Many studies have shown that by avoiding the heart-lung machine patients are less likely to need blood transfusions, spend less time on the breathing machine and in the intensive care unit after the operation, and even return home to their families sooner. Some have even shown a protective effect against strokes that may occur in some heart surgery patients.
Arterial Revascularization: Due to the tendency for vein grafts to develop the same type of atherosclerosis over time that is present in the heart vessels, many cardiac surgeons have turned to the use of arteries from both the chest wall (the internal mammary artery) and the forearm (the radial artery) for bypass operations. Studies have shown that these arteries stay open longer than the veins, to provide longer lasting protection from angina and heart attacks. Bassett cardiac surgeons employ these techniques on a regular basis.
Endoscopic Vein Harvesting: Because of the limited number of arteries available for use in coronary artery bypass graft operations, in many patients leg veins are also needed. To obtain these veins, long incisions - sometimes extending from the groin to the ankle -- have been routinely used. These incisions often produce more discomfort and disability for patients after surgery than do the incisions in the chest. Cardiac Surgeons and the Physician Assistants at Bassett now use specialized instruments and tiny cameras that allow them to remove the veins safely through two or three very small incisions. The result? Fewer infections, less pain, and less swelling in the legs after the operation is completed, which enables patients to be up and around faster, and not be bothered by wound care problems once home. The incisions are also cosmetically more appealing.
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Heart Valve Surgery - Rheumatic fever, congenital defects, and even just deterioration with age may cause heart valves to become either slowly narrowed -- preventing the proper flow of blood through them -- or may lead to progressive backward leaking - limiting the amount of blood the heart can pump. Both of these conditions abnormally increase the workload of the heart and can lead to debilitating heart failure long-term. Bassett's Cardiac Surgeons are skilled at operations that correct these problems by either replacing or repairing the diseased valves.
Heart Valve Replacement: In the majority of cases, the diseased valve must be removed and replaced with an artificial valve to relieve symptoms and prolong life. Bassett surgeons work with their patients to determine which type of valve best meets their lifestyle and characteristics, whether it is a mechanical valve (made out of cloth and metal), a cow or pig valve, or even the newer stent-less valves.
Heart Valve Repair: One of the valves in the heart (the mitral valve) in some cases may be fixed, or repaired, rather than replaced, to the advantage of the patient. These highly technical operations utilize the skills of both the surgeons and the anesthesiologists in precisely tailoring the repair in order to stop the leaking which commonly leads to the operation. These techniques may allow patients to avoid having to take blood-thinning medication for the rest of their lives, which is often required when valves are replaced rather than repaired.
Aortic Homografts: In some patients who develop infections in their own valves, the best solution may be to use valves taken from cadavers. One of Bassett's cardiac surgeons has undertaken specialized training in England in this technically difficult operation and is able to offer it to our patients. Besides being more resistant to infection than other valves, the cadaver valves also allow more blood to pass from the heart.
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Additional Heart Operations - Besides some of the more common open-heart operations listed above, the cardiac surgeons at Bassett are capable of performing a variety of other procedures in order to provide a comprehensive service to those with heart disease.
Repair of septal defects: Abnormal holes between the pumping chambers of the heart may cause the heart to work harder and in doing so potentially leading to life-threatening heart failure. These may be present either from birth ('congenital') or may less commonly result from a heart attack, and frequently need to be closed (or 'patched') in order for the heart to work properly and most effectively. BassettÃs surgeons have the experience and expertise to address these challenging problems.
Removal of blood clots from the lungs: In some patients, a potentially life-threatening problem may develop when blood clots in the legs break free and travel up through the heart and lodge in the arteries running to the lungs. These may prevent blood from circulating from the heart to the rest of the body. In rare instances, emergency operations to remove these clots may be life saving.
Removal of cardiac tumors: Rarely, tumors may invade the heart and need to be removed. These operations are complex, and often require sewing the heart together afterwards or replacing part or all of a heart valve in the process. Fortunately, the Cardiac Surgeons at Bassett have the experience to know how best to approach the tumor and likewise how to insure its safe removal.
Repair of aneurysms, dissections, and trauma to the thoracic aorta: Leaking of blood from the aorta (the large blood vessel carrying all of the blood from the heart) may be an acute, life-threatening event. It is usually caused by an aneurysm (an abnormal local swelling of the aorta), a dissection (a spontaneous tear in the aorta), or from a car accident. These patients often need immediate attention and the skill of the type of cardiac operative team as is present at Bassett. Sections of the aorta may be replaced, and in some cases, careful medical management in the intensive care unit may help to avoid the complicated operation.
Repair of Trauma to the Heart - Bassett Hospital is a Level II Trauma Center, and with the institution of the heart surgery program it is now able to handle practically all victims of either blunt trauma (including car accidents and falls) and penetrating trauma (knife and gun shot wounds). The Cardiac Surgeons at Bassett are experienced in the emergency care of injuries to the heart and aorta, and are certified to teach the national course in Advanced Trauma Life Support.
Treatment for Accidental Hypothermia - For victims of severe cold injuries, either outdoors or in the water, Bassett now has the capabilities to resuscitate and revive these patients, in some cases using the heart-lung machine to save a life. In conjunction with the Emergency Medical Systems in the region and BassettÃs own skilled Emergency Department personnel, this care can be delivered quickly and effectively.
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