New Approaches in Cardiovascular Procedures
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New Approaches in Cardiovascular Procedures
Dr. Michael PlichM.D., Phd., F.C.C.P., F.S.C.A.I.Director of Invasive Cardiovascular unit, Ziv MC, Safed, Israel
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Ziv Medical Center, Safed, Israel
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Cardiology department
ICCU Intermediate care Non invasive institute : ECHO, Ergo, Holter,
Outpatients clinic Research unit Interventional cardiology unite
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Invasive procedures
Diagnostic and Therapeutic in IHD Valvular Heart Disease Congenital Heart Disease Peripherial Vascular Disease: Supra Aortic,
Renal Arteries, Lower Limbs. Pacemakers
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Cardiac Invasive diagnosis
Anatomic: ACG, I.V.U.S., Virtual Histology, Noga Map
Physiologic: Hemodynamics, Flow Assessment (Doppler wire, Thermo dilution) Pressure wire, Thermography wire.
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I.V.U.S.
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Virtual Histology
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The Unit of Invasive Cardiovascular Procedures
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The Unit of Invasive Cardiovascular Procedures
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Intensive Cardiology Care Unit
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Introducer Sheath
Introducer sheath is like a large IV which allows controlled access to the body. Dilator offers minimal trauma to the vessel. Hemostasis valve prevents of excessive blood loss.
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Diagnostic Catheters
Diagnostic catheter is a plastic tube which functions as a conduit for contrast, fluids, and pressure measurement during cardiac catheterization of coronary arteries and left ventricle
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Guide Catheter
Guide Catheter: a Larger Lumen Plastic Tube Which Functions As a Conduit for the Wire and Balloon for PTCA and/or Stent Implantation. Unlike a Diagnostic Catheter, It has a Blunt Tip.
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Angioplasty Guide Wire
A stainless steel wire with a small outer diameter (.010 –.018”) that is used to negotiate the coronary vasculature to reach and cross a lesion. It is then used to guide and support the angioplasty balloon and/or stent during advancement across the lesion.
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Inflation Device
Used to Obtain Controlled Inflation of the Balloon Catheter
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Balloon Catheter
A small diameter hollow tube with a second smaller tube attached to material at the base of the catheter (balloon). The balloon is inflated via the smaller tube once it is placed across the lesion.
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Coronary Stent
a metal tube or a coil formed as a cylinder which is designed to keep the dilated artery open.
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Catherization Methods
Femoral approach Brachial approach Radial approach
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Patient’s intake
Anamnesis Physical examination ECG Phonocardiography Rx methods Echo Doppler Nuclear cardiology CT, MRI
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Pharmacologic therapy
ACE Inhibitors, ARB, Ca Channel Blockers, β Blockers
Nitrates Cathecolamines Antiarrhytmics Statins
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Antiplatelate and Anticoagulants Therapy
Oral: – Antiplateles: Aspirin, Clopidogrel.– Anticoagulants: Warfarin
Venous:– Antiplateles: G.P.IIb-3a Blockers– Anticoagulants: Unfractioned Heparin, Low Molecular Heparin,
Bivalirudine– Fibrinolytics
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Invasive therapies
Pacemakers EPS, Ablations PCI, PTA Assist devices Experimental therapies: Myogenesis,
Angiogenesis Treatments via coronary sinus
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Invasive Unite Interactions
Hospital Community
I.C.C.U
Cath. Lab.
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Our Statistics
~ 1000 procedures 50%-60% - PCI 85%-90% - Direct Stenting (including DES) 30%-40% - Primary PCI ~ 100 Pacemakers (including ICD, Double
Chambers and CRTD)
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Cardiovascular Intervention Procedures
Double primary PCI Primary PCI to LAD Primary PCI to LAD via stent to LM Non protected LM PCI to SVG.wpl PCI using protection device.wpl Transradial approach to multivessels PCI
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Cardiovascular Intervention Procedures (continued)
Transradial approach PCI to LIMA Mitral valvuloplasty (MVP) Double protected PTA technique to Left
Subclavian Artery Double protected PTA to Left Renal Artery PTA to SFA
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Concusion
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Double primary PCI
RC1