FREQUENTLY ASKED QUESTIONS


Since 1982, The Shawl Interventional Cardiology Research Institute continues to enrich interventional cardiology by way of new developments, field advancements and education, and has remained an instrumental force in the field of Interventional Cardiology.

Dr. Shawl has authored over 150 leading articles, abstracts, editorials and book chapters. He has also published a book entitled, Supported Complex and High Risk Coronary Angioplasty (1990).

Summary of Topics

     
 

Q: What is Interventional Cardiology?
A: Interventional Cardiology has emerged more than a decade ago as an alternative to traditional cardiac surgery. Through the use of minimally invasive catherter-based techniques and innovative drug therapies and devices, many conditions can now be treated without surgery or lengthy hospital stays.

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Q: What are Interventional Procedures?
A: Depending on the patient's specific condition, an inteventional procedure can involve several techniques and devices including the following:

Angioplasty - a 40-minute procedure in which a small balloon is inserted in an artery via a catheter and inflated to open an area of blockage.
Atherectomy - a procedure involving a catheter with a rotating tip that either breaks up calcified plaque into very small particles or removes the plaque.
Stent - a small mesh sleeve, used over an angioplasty balloon an left in place as a framework to keep an area of blockage open. Recent developments of new stents that are coated with drugs to help prevent recurrence of blockage due to formation of scar tissue (restenosis) are revolutionary techniques.
Radiation Therapy - also known as bracytherapy, is used as an adjunct to other treatments to help prevent restenosis or its recurrence following stent implantation.

Drug therapies are also used to enhance the patient's recovery and recuperation while minimizing the chance of the condition's recurrence.

Recent advances in medical imaging, such as MRI (magnetic resonance imaging) and IVIS (intravascualr ultrasound), allow for highly precise views of the interior of the heart and of the blood vessels.

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Q: What is Coronary Artery Disease?
A: Coronary artery disease also known as atherosclerosis is a disease of the heart arteries. This is a build up of plaque or fatty deposits inside the artery. This build up of plaque can block the flow of blood to the heart causing chest pain, heart attack, or other symptoms of heart disease. Coronary artery disease can be reduced by changes in diet and lifestyle as well as with some medications.

To diagnose coronary artery disease you may be asked to undergo an angiography procedure (heart catheterization). The angiography is done in the catheterization laboratory at the hospital. During this procedure the patient is sedated and a small sheath (short hollow tube) is inserted through a puncture site in the groin area (femoral artery). Through this sheath a catheter is maneuvered to the heart arteries where a special dye is injected and x-ray pictures can be taken of the heart arteries. If treatment is needed, the interventional or non-surgical procedures can be done through this sheath.

Treatment for coronary artery disease can be done surgically by coronary artery bypass graft surgery (CABGS) or non-surgically by percutaneous coronary intervention (PCI). These non-surgical procedures, which can be done in the catheterization laboratory, are listed in Procedures.

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Q: What is Peripheral Vascular Disease?
A: Like the heart arteries plaque can build up in any artery of the body. PVD is plaque build up in the arteries supplying blood to the arms, leg and brain. Risk factors that contribute to PVD are smoking, high blood pressure, family history, high cholesterol, and diabetes. Symptoms of PVD to the legs are claudication (pain in the legs especially when walking that is relieved when resting), numbness or tingling in the legs or feet, coldness in the legs or feet, and/or ulcers of the legs or feet that do not heal. The non-surgical treatment for peripheral vascular disease is balloon angioplasty and stenting.

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Q. What do I do before a scheduled procedure?
A: Review the Pre-Procedural Information. If you need further clarification, or if any of the information is unclear, contact us or your doctor before the scheduled procedure is to take place.

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Q: What are the "do's and dont's" after a procedure?
A: Review the Post-Procedural Information. If you need further clarification, or if any of the information is unclear, contact us or your doctor before the scheduled procedure is to take place.

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Q: What are Drug Coated Stents?
A: Drug coated stents, also called medicated stents can be used to treat Coronary Artery Blockages. These stents are coated with a time-released medication which can prevent the occurance of restenosis (development of scar tissue that re-blocks the artery at the original site. These medicated stents are particularly useful for small to medium size arteries. In larger arteries, a non-medicated stent is as beneficial as a medicated stent.

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Q: Are there any special precautions with medicated stents?
A: Yes. There is a higher risk for a clot formation following the implantation of these stents. Drugs such as Plavix (along with aspirin) can reduce the risk of complications. These drugs are to be continued for at least 4 to 6 months. DO NOT STOP TAKING THESE MEDICATIONS, unless directed by your physician.

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Q: What is High Risk Angioplasty & Cardiopulmonary Support (CPS)?
A: High-risk angioplasty means angioplasty in patients who have poor LV function alone or with other medical conditions that make them a high risk candidate for angioplasty or even bypass surgery. We mean people who have had previous multiple myocardial infarctions with multiple coronary stenoses. Or they have only one open artery which is also threatening to close. In these high risk patients, one cannot perform angioplasty or any other intervention because their heart will not tolerate the procedure. But with the support of the Percutaneous Cardiopulmonary Bypass Support (PCPS), the procedure can be performed very safely, even in patients in ventricular fibrillation.

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Q: What is Percutaneous Transmyocardial Revascularization (PTMR)?
A: There are many patients who because of small size vessels or diffuse disease are not good candidates for percutaneous interventions or bypass surgery. These patients become severely limited because of incapacitating angina. Percutaneous Transluminal Myocardial Revascularization (PTMR) can provide these with symptomatic relief of angina. In some animals, like crocodiles and alligators, the blood flow to the heart muscle is directly from the LV chamber via small channels. Based on this knowledge, Dr. Mirhoseini created channels in human hearts using laser energy. Over the last few years other surgeons have created similar laser channels directly into the heart muscle with objectively evident beneficial effects. However, the surgical method is more invasive and is associated with 10-19% mortality. Now, using catheter-based technology, Dr. Shawl is able to create channels from inside the chamber of the human heart into the LV muscles and performed the first few cases in India without any complications. Today, Dr. Shawl and his team performs PTMR in the U.S. with FDA IDE approval and has performed a number of cases with great success and promising results. Dr. Shawl also presented the results of these early experiences at the ACC meeting in Atlanta. At six months, 9 out of 12 patients showed objective improvement.

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Q: What is Carotid Stenting?
A: Carotid Stenting basically involves the same technique as for coronary angioplasty. Initially, we dilate the lesion with balloon angioplasty and then place a stent across the blockage. The whole procedure takes only half an hour to 45 minutes and the risks are considerably less than carotid surgery, even though carotid stenting is just evolving. Further refinement in equipment and technique greatly reduces the risks. Carotid artery stenting is done to prevent future strokes in people with a blockage in the carotid artery. See New Stroke Treatment to learn more.

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Q: What is Hybrid MIDCAB/PTCA?
A: This is an "integrated minimally invasive approach" or "hybrid procedure". The only advantage of conventional bypass surgery is excellent outcome with arterial conduits like LIMA, RIMA, radial or gastroepiploic vessels. Dr. Shawl uses these conduits by minimally invasive (MIDCAB) surgery. In patients with multiple vessel disease, instead of conventional CABG, Dr. Shawl combines the use of MIDCAB and percutaneous intervention.


In the last 30 cases+ at Washington Adventist Hospital, Dr. Shawl and his team have performed MIDCAB initially and then percutaneous interventions to the remaining vessel the next day. In the new operating room and cath lab, the MIDCAB and percutaneous interventions can be performed at the same sitting. This is revolutionary and the leading model for bypass and interventions in which occur at the same place and the same day.

There are also new introductions of Robotic Technology. This method uses robotic arms that are inserted into the chest in four small holes about the size of a pencil. The surgeon "operates" from a comfortable console about ten feet away from the patient by viewing a 3-D image of the operational field through a tiny camera in the patients body. This new technology allows the surgeon to perform minimally invasive surgery and angioplasty at the same time.

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