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Cardiac Services
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Angiography Procedures

Angiography

Angiography is an X-ray study used to visualize the inside of blood vessels and organs of the body such as the arteries, veins, and the heart chambers. The study is performed using equipment such as catheters (thin, flexible tubes) and a radio-opaque contrast agent (X-ray dye) to highlight the blood vessels as the dye passes through them.

The angiography procedures we perform include:

Types of Angiograms

Cardiac catheterisation

Cardiac catheterisation is a procedure used to examine the blood flow within the heart arteries (coronary arteries) using a technique called coronary angiography. It is performed for both diagnostic and interventional (treatment) purposes. The test is useful for identifying the anatomy of the coronary arteries, narrowing, occlusion (blocked) and valve disease.

Pressure Wire Study

A Pressure Wire Study (PWS) is a coronary catheterisation procedure in which a thin tube called a catheter is threaded through an artery up towards the heart. The catheter is attached to a sensor that measures blood pressure in the artery before and after the narrowed area. The study is useful in determining whether the narrowed section of a coronary artery is likely to cause problems in the future.

Intravascular Ultrasound (IVUS)

Intravascular Ultrasound (IVUS) uses high frequency sound waves (silent waves), called ultrasound, to visualize the coronary arteries from the inside-out. The ultrasound images are generated in real time and can be used as an aid in coronary stent sizing, and in confirmation that the stent has been placed optimally, is fully expanded and hugging the vessel wall.

Optical Coherence Tomography (OCT)

Optical Coherence Tomography (OCT) is a high-resolution catheter imaging technique performed using a catheter emitting near-infrared light that offers microscopic visualization of the coronary arteries. OCT may be used to assess narrowing in the coronary arteries and to image the result of stent deployment during Percutaneous Coronary Interventions (PCI).

Coronary angioplasty and stent

Coronary angioplasty is a procedure used to widen blocked or narrowed coronary arteries. The term angioplasty means using a balloon to stretch open the narrowed or blocked portion of the artery. A short wire-mesh tube called a stent, is then left into the artery permanently to allow blood to flow more freely. Coronary angioplasty is sometimes known as Percutaneous Transluminal Coronary Angioplasty (PTCA). The combination of coronary angioplasty with stenting is usually referred to as Percutaneous Coronary Intervention (PCI).

Chronic Total Occlusion

Coronary artery Chronic Total Occlusion (CTO) is a complete or almost complete blockage of a coronary artery for three months or more. CTO is caused by a heavy build-up of plaque (fatty deposits) within the artery. Traditionally, most patients with CTO who have symptoms would undergo Coronary Artery Bypass Graft surgery (CABG (, open heart surgery) to clear the blockage. With current technology, CTO can now be performed percutaneously through the through the groin or wrist using catheters and various adjuncts (wires, balloons and stents) by Percutaneous Coronary Intervention (PCI).

Transcatheter Aortic Valve Implantation (TAVI) or Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter Aortic Valve Implantation (TAVI) also known as Transcatheter Aortic Valve Replacement (TAVR), is a procedure used to treat aortic stenosis (narrowing of the aortic valve). The aim of this procedure is to avoid the risks of open-heart surgery and prolonged deep anaesthesia. TAVI procedure involves the replacement of the heart’s natural aortic valve by inserting a new artificial heart valve inside the old narrowed valve using a balloon catheter. The new valve is made up of a metal frame (stent-a stainless steel tube) and biological material taken from cows.

Patent Foramen Ovale Closure

Patent Foramen Ovale (PFO) is a hole between the left and right atria (upper chambers) of the heart. This hole exists in everyone before birth, but most often closes shortly after being born. PFO is what the hole is called when it fails to close naturally after a baby is born. To correct this abnormality, a Patent Foramen Ovale Closure (PFOC) is performed by inserting a catheter into a vein in the groin and passing an ultrasound probe down the throat (Transoesophageal Echo, or TOE), to allow the doctor to see the heart structures and blood flow across the hole. A balloon is moved to the area of the hole and inflated across the hole in order to measure the size of the hole when it is gently stretched. A small device made up of two ‘umbrellas’ joined at the centre is put into the hole to close it up.

Left Atrial Appendage Closure (LAAC)

The Left Atrial Appendage (LAA) is a small pouch connected to the left atrium of the heart (one of the top chambers of the heart). The LAA is a normal part of the heart anatomy and causes no problems in the general population. When the Left Atrial Appendage does not squeeze consistently the blood inside the pouch becomes stagnant and may form clots. These clots may be ejected into the left atrium, and travel to the brain causing a stroke. In patients with atrial fibrillation (an irregular heart rhythm), blood clots can form increasing the risk of stroke. Left Atrial Appendage Closure (LAAC) is a procedure performed to reduce the risk of this happening.

LAAC is an alternative treatment for patients who find blood-thinning medications , difficult to tolerate or are unable to take due to bleeding problems. LAAC, is performed by inserting a catheter into a vein in the groin and passing an ultrasound probe down the throat (Transoesophageal echo, or TOE). A Nitinol metal shape device is then implanted to close the opening of the LAA in order to close off the entrance to the appendage.

Trans-oesophageal Echocardiography

Transoesophageal Echocardiography (TOE) is used to assess the overall health of the heart, including assessing the heart valves and degree of heart muscle contraction. TOE uses ultrasound technology to visualise still or moving images of the heart. To perform this test a thin probe (or ultrasonic transducer) is passed through the mouth, down the throat and into your oesophagus (gullet). Because the oesophagus is so close to the upper chambers of the heart, very clear images of the heart structures and valves can be obtained.

Electrophysiology Study

Electrophysiology Studies (EPS) are performed to identify and understand the nature of abnormal heart rhythms (arrhythmias) and to decide what will be the most effective treatment to manage or terminate these rhythms. Treatment options are performed using ablation for a variety of arrhythmias, as listed below.

Ablation

We perform ablation of Supra-Ventricular Tachycardia (SVT), Atrial Flutter, Atrial Fibrillation and ventricular Tachycardia. Ablation is performed using radiofrequency or cryo (freezing) therapy and with advanced mapping systems and robotic approaches (Hansen Sensei) if required. For more information see our Arrhythmia dedicated website

Cardioversion

A cardioversion is a brief electrical shock delivered to the heart either externally or internally using a catheter placed within the heart. Cardioversion is used to treat arrhythmias such as Atrial Fibrillation (abnormal heart rhythm involving the top chambers of the heart). Cardioversion can be performed by passing a catheter through the groin and up to the heart or externally using electrode pads attached to the chest.

Temporary Pacing

Temporary cardiac pacing provides electrical stimulation to a heart if it is compromised by disturbances in the heart’s rhythm or inserted as an emergency procedure or electively to cover during surgery. Temporary pacing is performed by, inserting a temporary pacing wire into the heart, or externally using defibrillator pads attached to the chest and operated through a defibrillator monitor.

Permanent Pacemaker

A Permanent Pacemaker (PPM) is an electronic, battery-powered device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate. Pacemakers can be used to treat abnormal heart rhythms, fainting spells (syncope), congestive heart failure and hypertrophic cardiomyopathy. Single chamber pacemaker uses a lead into the upper or lower chamber of the heart. Dual chamber pacemaker uses two leads; one in the upper chamber and one in the lower chamber of the heart.

Pacemaker generator change

A pacemaker generator change (often referred to as a box change), is the replacement of the pacemaker electronic-powered battery. The battery in a pacemaker can last up to 10 years and does not stop suddenly but rather loses its charge slowly dependent on usage. The remaining lifespan of a pacemaker is determined during follow up visits to the Pacemaker Clinic. The battery will eventually require replacement.

Implantable Cardioverter Defibrillator

An Implantable Cardioverter Defibrillator (ICD) is an electronic, battery-powered device that is in placed in the chest or abdomen to constantly monitor the heart’s rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy (a shock) to the heart muscle. This causes the heart to beat in a normal rhythm again.

Lead extraction

A lead is a special wire that delivers energy from a pacemaker or Implantable Cardioverter Defibrillator (ICD) to the heart muscle. A lead extraction is the removal of one or more leads from inside the heart.

Implantable Loop Recorder

An Implantable Loop Recorder (ILR), is a small thin device that is implanted under the skin of the chest to record the heart’s electrical activity (heart rhythm). ILR is used for diagnosis in patients who experience symptoms such as syncope (fainting), seizures, recurrent palpitations, lightheadedness, or dizziness regularly but not often enough to be captured by a 24-hour heart monitor. The ILR device can be left in place for up to 4 years, enabling the heart to be monitored for an extended period of time.

Pericardiocentesis

Pericardiocentesis is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart), to restore normal heart function and peripheral perfusion (delivery of arterial blood full of oxygen and nutrients to the tissues via the blood vessels).

Arrhythmia (disturbance in heart rhythm) management and treatment

For more information see our Arrhythmia dedicated website

Meet the Team

Team

Blood Management

Our blood management services apply across all aspects of cardiac and thoracic care

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Counselling Services

Our psychosexual clinical nurse specialist is available to support all our cardiac and thoracic patients

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Symptom Control

Our symptom control team are here to help you manage symptoms, especially if you have heart failure or lung disease

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Dietetic Support

Our dieticians play a crucial role in the care of all cardiac and thoracic patients

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Contact Us

London Bridge Hospital

Tel: 020 7407 3100

Tax: 020 7234 2019

[email protected]

27, Tooley Street
London SE1 2PR

International Department

Tel: 020 7234 2009

Tax: 020 7234 2019

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