The Adult Cardiology department takes care of patients affected by:
· Coronary artery disease, which is the most common form of heart disease.
We treat any kind of coronary artery disease, including bifurcations using double stent techniques and CTOs.
· Renal artery disease
· Peripheral artery disease
· Carotid artery disease
· Aortic endovascular treatment for descending and abdominal aortic disease
· Left atrial appendage occlusion, as a prevention for embolic stroke in patients,
affected by non valvular atrial fibrillation, and with a high risk of bleeding.
Our team is composed of a core of foreign doctors with both experienced and young Chinese doctors:
Dr. Francesco Lavarra, from Italy, Director of Adult Cardiology and Head of Adult Cathlab
Dr. Vasile Sirbu, from Romania, Consultant Interventional Cardiologist
Dr. Davide Sala, from Italy, Consultant Interventional Cardiologist
Dr. Stefano Naccarato, from Italy, Consultant Interventional Cardiologist
Dr. Zerrin Yldirim-Ogut, from Germany, Consultant Cardiologist
Dr. Francesco De Crescenzo, from Italy, Consultant Cardiologist
Dr. Emanuele Sagazio, from Italy, Consultant Interventional Cardiologist
Dr. Wang YuKu, expert Electrophysiologist
Dr. Liu ShiQi, Interventional Cardiologist
Dr. Yu Tie Na, Clinical Cardiologist
Dr. Liu Chao
Dr. Chang Shuang
Dr. Zhu Yue
We are equipped with 4 Cathlabs, one equipped for Hybrid Interventions (Philips), two Coronary Cathlabs (Philips) and another Cathlab with biplane view (Siemens).
Other equipment available:
· IVUS: Intra-Vessel UltraSound, this is useful to evaluate the disease and guide procedures
· iFR/FFR: this is useful to evaluate lesions and their physiology
· Rotablator: it can be used in very calcific and hard lesions that need to be fragmented, before stenting
· We have many other kinds of devices, like microcatheter, different wires, balloons, guiding catheter extensions, drug eluting balloons, etc. and these are all available in order to achieve the best possible result for our interventions.
The most frequent interventions done in our hospital are Coronary Angiography and PCIs
There are 2 coronary arteries, a left one and a right one.
Direct observation of the coronary arteries is achieved performing a Coronary Angiography. This requires an artery access (commonly the radial artery, but even femoral, brachial and rarely other arteries can be used), with wires and catheters used to reach the origin of those vessels. An injection of a contrast media is added, while recoding various X-rays images. We usually record images at 7.5 frame-per-seconds to minimize the amount of radiation exposure (instead of 15 or more fps as we feel that’s too much X-rays).
These are the images of a normal coronary arteries:
(Video from “normal” folder)
Unfortunately the coronary arteries, (as all the arteries) can be affected by diseases, the most common one is Atherosclerosis. Some risk factors like diabetes, smoking, arterial hypertension, family predisposition and hypercholesterolemia, can increase the risk of this cardiovascular disease. This disease causes arteries to narrow, this is called “stenosis”, and this can be measured as % of the section lost or blocked.
Video example of a stenosis (“non critical” folder)
Stenosis can give you an acute myocardial infarction (a heart attack) and this can lead to some thrombosis, even closing the vessel. However, most of the time, Stenosis will give effort angina and this means that when the heart is under stress, the patient can feel some chest pain. This is because not all the blood needed by the heart muscle can pass through the stenotic vessel, due to the severity of the stenosis or blockage.
The best way to address these problems is by performing a PCI, although sometimes this isn’t always possible, and in these circumstances you would require Coronary Arteries By-pass Grafting (CABG, performed by cardiac surgeons).
PCI is an intervention aimed at solving a coronary stenosis, as this is the main cause of angina or an acute coronary syndrome. With special catheters, wires and balloon, the stenosis in prepared to receive a stent, this is placed (and generally postdilated) in order to achieve the best acute and long term result of the intervention.
Easy PCI images (folder “easy PCI”)
Bifurcation treatment covers 20% of coronary disease cases and it involves a bifurcation of a vessel. In the majority of these cases, the bifurcations are addressed with a “single stent technique”, mainly due to some side branch characteristics (small, not severe disease, short ostial disease and others) in an attempt to achieve the best result and the best outcome.
However, sometimes it’s necessary to use a double stent technique (T stenting, T-and-Protrusion, mini crush or DK-crush, culotte techniques mainly).
This is an example of a LAD-diagonal bifurcation treatment using DK-crush technique:
Images (folder “Bif DK crush ok”)
The Left Main can be considered the most important coronary segment. Critical disease of this segment usually involves the LM bifurcation in LAD and LCx, two of the biggest coronary arteries.
This is an example of a LM disease and its treatment.:
Images (folder “LM”)
Chronic Total Occlusion is when the coronary arteries become occluded, without a previous infarction or without a complete necrosis of the myocardium, supplying the blood. This is due to the presence of some small collaterals that, starting from another open coronary vessel can reach the distality of the occluded vessel. These collaterals are very small and they can normally give enough blood if the heart (and the patient) is at rest. However, during some form of effort or exercise, the blood that they can supply is generally insufficient and this gives the patient symptoms like angina.
CTOs are considered the most difficult PCIs, because the vessel is completely occluded/blocked and specials wires and devices are needed to pass through the occlusion, it’s just not a stenosis.
This is an example of a recanalized CTO with an ipsilateral branch (diseased) supplying blood to the vessel, which needed to be opened.
Images of LAD CTO with DK crush stenting
Some other CTOs can have their distal vessel revascularized by branches coming from a different coronary artery. For example, the distal LAD after a CTO, can be seen only after injecting contrast media from the RCA, therefore a double injection is needed to assess the disease. It’s even possible to do this kind of recanalization
Images of a CTO with contralateral injections.
Sometimes the stenosis is so hard and calcific that it cannot by dilated well enough, before implanting a stent. Failure to expand a stent is more likely to have a bad outcome like a restenosis.
These very hard stenosis can be treated with OPN balloons or Rotablator.
An OPN balloon is a special type of balloon that can reach very high pressures, compared to the standard semi-compliant or non-compliant balloon, something like 40 atms.
A Rotablator is another device that can be used in calcific (and very hard) stenosis. It is a device that consists of a burr that vibrates and rotates at more than 160,000 rpm, this destroys the calcific segment but doesn’t significantly damage the soft tissue of the vessel.
In this intervention we performed an IVUS study, using a special catheter to assess the calcium burden with intra vascular ultrasound
Image of rotablator and images of the intervention