What types of heart disease can be treated with catheter-based procedures?
The Structural Heart Disease Program at Adventist Health White Memorial offers approximately 18 procedures that treat the heart’s structural abnormalities. Here are some of the most common diseases and conditions we treat:
Aortic valve stenosis, which occurs in about 15% of people age 75 and older. The condition makes it difficult for the aortic valve to open, and patients experience symptoms such as shortness of breath, dizziness, fainting, fatigue, weakness, chest pain and heart failure. TAVR (transcatheter aortic valve replacement) corrects this condition with a prosthetic heart valve that is implanted via catheter in a minimally invasive procedure. TAVR can help patients improve both the quality and length of their life.
Mitral valve disease, which affects the heart valve between the upper and lower chambers on the left side of the heart. There are two main types of this disease. In one type, the valve clogs and narrows, which limits the flow of blood and causes the patient to have heart dysfunction. The catheter-based solution for this condition is a procedure similar to angioplasty to open the clogged valve. Called valvuloplasty, the procedure uses a specialized balloon to open the narrowed valve.
In the second — and more common — mitral valve disease type, the valve becomes leaky (regurgitant). Instead of flowing forward as it should, blood flows back, causing heart dysfunction. To solve this “leaky valve” problem, a structural heart cardiologist can insert a metal clip device, via catheter, through a small hole in the skin of the groin. After it is threaded up to the heart, the clip joins together the two leaflets of the mitral valve, which reduces the leakiness. This is all done without any surgical incisions.
Hypertrophic obstructive cardiomyopathy, another congenital (present-at-birth) disease, which results in thickening of the heart muscle. This makes it difficult for the heart to pump blood into the body. In most cases, cardiologists first try medication to treat this problem. However, if the medication doesn’t work, there is an option for open-heart surgery or a catheter-based treatment called alcohol septal ablation. In this relatively novel procedure, the structural heart specialist uses a tiny, controlled amount of alcohol to directly and specifically destroy the unwanted muscle tissue. This treatment typically helps the heart more efficiently pump blood.
Congenital defects of the walls of the heart, which encompass a group of conditions, including patent foramen ovale (PFO) and atrial septal defect (ASD). Both of these conditions — which the patient is born with — result in a hole in the heart. This hole can be due to an incomplete closure of the wall inside the heart (in the case of PFO) or from the wall not forming at all (in the case of ASD). The hole can interrupt the natural flow of blood within the heart and can create a variety of health problems, including stroke and heart failure. The catheter-based treatment for both conditions involves implanting a small, quarter-sized device across the hole. Over time, living tissue grows across the device and seals the hole completely on either side of the wall inside the heart.
Left atrial appendage, which is involved in atrial fibrillation, an electrical problem in the heart that results in arrhythmia (an abnormal rhythm of the heart). This arrhythmia — specifically, atrial fibrillation — can cause a blood clot to form in the small appendage of the left upper chamber of the heart. The condition is usually treated with specific blood-thinning medicines to prevent blood clots, which can travel to the brain and trigger a stroke. Some patients are poor candidates for blood-thinning medicines and, therefore, are at higher risk for forming clots and having a stroke. The catheter-based treatment for this condition is to implant a left atrial appendage occlusion device. This device acts as a scaffold and helps to close off the left atrial appendage to keep blood from pooling inside it and potentially forming clots.