Haemodynamic and Interventional Cardiology unit
The Haemodynamic Unit at the Clínica has the most advanced technology for diagnosis and treatment of coronary diseases.
We have vast experience both in the most common and more advanced treatments. Furthermore, we use functional and vascular imaging testing. We have also started a percutaneous implantation of aortic valves programme.
We don´t have waiting lists for carrying out operations, as they are carried out immediately after diagnosis or, if they require preparation, within 24 hours.
The Haemodynamic Unit at the Clínica Universidad de Navarra, like the other departments in the Clínica, offers efficient and effective personalised patient care.
Haemodynamics is a speciality of Cardiology which studies the functional and anatomical status of the heart by introducing thin catheters in the groin, arm or neck arteries and veins.
Our treatments are less aggressive for the patient, with a quicker recuperation period and less complications than cardiac surgery.
Despite the volume of patients, there is no waiting list in the Haemodynamics Unit to perform surgery because these operations are performed the day of the diagnosis or, if preparation is needed, in 24 hours".
Simple or complex percutaneous Coronary Angioplasty (coronary interventionism)
The percutaneous treatment of lesions in the coronary arteries: This is one of the most advanced treatments for myocardial ischemia or ischemic cardiopathology.
The procedure consists in dilating a blood vessel using a catheter, whilst the limb´s distal extreme has a collapsed balloon inside which inflates upon reaching an obstructed area, allowing the blood vessel light increase its diameter at this point and restore the blood flow.
The catheter (a very fine, flexible tube) is implanted through puncturing the femoral or radial artery (in the wrist), from where it will reach the coronary artery. 75% of patients with coronary stenosis are candidates for this percutaneous operation; the rest, require surgical treatment and others are only candidates for pharmacological treatment and preventative methods.
Prosthesis or stents are used to treat 96% of angioplasties; for the remaining 4%, only a balloon is used. In our centre, we have a success rate for lesions treatments of 95%.
Optical Coherence Tomography (OCT) and Intravascular ultrasound (IVUS)
These two techniques are successful in both the short and long term and aid doctors when carrying out percutaneous operations.
Percutaneous Implantation of Aortic Valve Prosthesis
The Clínica was the first Navarran hospital to replace aortic valves with a percutaneous implantation, without the need to open up the chest during surgery.
Inserting the valve via catheterisation only requires a 6mm incision in the groin. Consequently, by not having to use open surgery, the postoperative hospitalisation period is reduced.
This procedure is especially recommended for patients with severe stenosis aortic valve problems who are not candidates for heart surgery.
Percutaneous closure of foramen oval
The foramen oval, which is generally tube shaped, is an orifice found in the septum between the atria which are open in 25% of the population. Occasionally, it seems to be associated with strokes in young people.
Nitinol prosthesis is used to seal or close said foramen, it is accessed through the femoral vein and only requires a local anaesthetic.
Percutaneous closure of atrial septal
The atrial septum is a large orifice, situated in the septum between the atria, caused by a congenital mutation in the development of the septum and associated with cardiac arrhythmias and pulmonary hypertension.
By using nitinol prosthesis, with or without anaesthetic and transesophageal or intracavitary ultrasound we can close said orifice, they access it through the femoral vein and only use local anaesthetic.
Closure of left atrial appendage
Doctors implant a plug which blocks the appendage in patients with nonrheumatic auricular fibrillation who have experienced problems when taking Sintrom® (haemorrhaging, etc.). This procedure is more complex as doctors must pass through the atrial septum using a needle, which, once again, is accessed through the femoral vein. It is carried out with a transesophageal ultrasound as a guide under general anaesthetic in the catheterization laboratory.
Vulnerable plaque study
During coronariography, specialists can complete a study (del árbol?) using optical coherence tomography (OCT) and intravascular ultrasound (IVUS) which will allow them to study the characteristics of the supposedly healthy lesions or arterial wall more deeply.
Digitalised Haemodynamics Room
Currently, the Haemodynamic room is called the catheterization or interventional cardiology laboratory, and more and more complex examinations and treatments are carried out here.
It has an X-ray Arc and an operating table for the patient to undergo their diagnostic testing and treatments. Normally, a contrasting iodine injection is used to create the images. These images are then viewed on a screen and another screen registers the patient´s data. The majority of procedures carried out don´t require general anaesthetic.
- Intracoronary Ultrasound: This technique uses a 1mm catheter and a miniature ultrasound emission system (transducer) in the distal end of the limb which is then connected to a console generating real time grayscale images. The intracoronary ultrasound evaluates the normal coronary artery wall, arteriosclerotic changes in the anatomy and dimensions of the coronary artery, the main components of the ateroma, the coronary arterial changes in response to operations and any restenosis changes.
- Virtual Histology: a unique technique which is capable of providing specialists with differentiated information and a percentage for the four components of the atheromatous plaque: fibrotic, lipids, calcium and necrotic contents, which relates information about the severity of the plaque and risk of suffering a rupture, thrombosis or heart attack. The information is collected in the same ultrasound catheter that uses specific software to transmit the grayscale images to colour to more clearly locate the fat (lipid) content of the atheromatous plaque, for a better estimation of the patient´s vulnerability.
- Optical Coherence Tomography (OCT): Like a type of scan, this technique produces high resolution images using light from a laser source to identify microscopic structures in the biological tissue. This allows specialists to more clearly see the interior of the coronary artery, evaluate the state of the coronary arterial walls and detect ´high risk´ or ´vulnerable´ plaques, which can cause heart attacks, angina or sudden death upon rupturing. This procedure is very useful for viewing the final result of the implantation of intracoronary stents.
The pressure guide is a very useful diagnostic tool for making sure that the stenosis that the specialists are trying to dilate is the condition responsible for the lack of blood flow to the cardiac muscle.
- Rotablator: a device for carrying out rotational atherectomy. It eliminates the hard and calcified atheromatous plaque.
- Intra-aortic balloon counterpulsation (IABP): made up of a balloon, situated in the descending aortic artery, connected to a console that supplies gas – helium –to inflate and deflate the balloon in synchrony with the contraction of the heart. During the contraction (cardiac systole), the balloon deflates enabling the blood to leave through the left aortic ventricle; during the relaxation of the heart (diastole), the balloon inflates and aids heart perfusion and cardiac function. This is recommended for patients in cardiogenic shock, patients with myocardial ischemia and heart surgery patients.
Stents are metallic devices of different designs that are percutaneously inserted into the coronary arteries to correct the narrowing of the interior of the artery due to thrombosis or fibrotic or fatty plaque known as ateroma. They are used in approximately 96% of angioplasty cases.
Types of Stents:
- Metallic Stents: metallic mesh which is folded when inserted and attached to an angioplasty balloon. It is then unfolded in the coronary artery and stays secured to the wall. This stops the artery from collapsing and abruptly closes once the balloon is deflated.
- Pharmacologically Active Stents: this is the most advanced equipment for treating myocardial ischemia. With these, doctors have excellent long term results in reducing the stenosis rate (reproduction of arterial narrowing). They also decided on a specific drug dose to limit excess tissue growth inside the artery.
- Bioresorbable Stents: recently, we have incorporated a new therapeutic procedure to our list of treatments. This type of stent avoids some of the complications of the above stent designs.
Thanks to this treatment and since I stopped taking the anticoagulant, I lead an active and normal life. I don’t take the pills and I’m delighted.”
Patient with atrial fibrillation treated with the new catheterisation technique