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Accredited chest pain center
Our medical facility offers a range of procedures to address structural heart disease, which refers to defects in the heart’s valves, walls, or chambers that can be present at birth or develop over time. Patients are referred to us by general cardiologists, interventional cardiologists, or cardiovascular surgeons, and our team conducts a thorough investigation to diagnose and treat any issues.
In addition to a comprehensive physical examination, our additional tests may include echocardiograms, computed tomography (CT) scans, and cardiac magnetic resonance imaging (MRI) scans. In the past, structural heart diseases required open-heart surgery, but advancements in technology now allow for less invasive approaches.
At Cookeville Regional’s structural heart program, we have a team of interventional cardiologists, cardiothoracic surgeons, and dedicated clinical support staff who specialize in the diagnosis and treatment of conditions affecting the heart’s valves and other vital structures. Our program is the only one of its kind in the Upper Cumberland, enabling residents of the region to receive specialized care close to home. We provide advanced treatment options that are tailored to each patient’s individual needs, including minimally invasive procedures, and strive to deliver the best possible outcomes for our patients.
Treatment Options
WATCHMAN
In non-valvular atrial fibrillation (AFib), more than 90% of stroke-causing clots that come from the left atrium are formed in the left atrial appendage. The Watchman implant is a minimally invasive, one-time procedure that aims to reduce the risk of strokes that originate in the left atrial appendage.
The procedure involves an interventional cardiologist making a small incision in the patient's upper leg and inserting a narrow tube, similar to a standard stent procedure. The doctor then guides the Watchman device into the left atrial appendage of the heart.
This treatment is offered to patients with non-valvular AFib as an alternative to long-term warfarin (Coumadin) medication to reduce the risk of AF-related stroke. By closing off the LAA, the risk of stroke may be reduced, and over time, patients may be able to stop taking their blood thinner.
The Watchman implant is a one-time procedure that is designed to prevent blood clots from entering the bloodstream and causing a stroke. The device remains permanently implanted in the heart and can be an effective alternative to long-term blood thinning medication. The procedure has a high success rate and can help patients with AFib manage their condition and reduce the risk of stroke.
MitraClip
Mitral valve regurgitation is a common valve disorder where blood leaks backward through the mitral valve and into the left atrium when the heart muscle contracts.
Functional mitral regurgitation can occur due to coronary artery disease, heart attacks, or changes in the size and shape of the heart muscle that prevent the mitral valve from opening and closing properly. Structural defects, infections, aging, or congenital anomalies can also cause this condition.
In the past, open-heart surgery was the primary treatment option. However, there is now a non-surgical option available called the MitraClip. This procedure is suitable for high-risk patients who need medical attention for either type of mitral regurgitation.
During the procedure, a thin tube called a catheter is inserted through a vein in the leg and guided to the heart to access the mitral valve. A small implanted clip is attached to the mitral valve to help it close more completely, restoring normal blood flow through the heart. The MitraClip procedure is minimally invasive and provides a simple option for treating mitral regurgitation without requiring open-heart surgery.
This is a minimally invasive option for patients with cryptogenic cerebral vascular accidents and/or embolic events thought secondary to this defect. This therapy has been shown in several recent trials to be superior to medical therapy (antiplatelet or anticoagulation). In this procedure, a small disk is placed on each side of the defect in the intra-atrial septum and will be endothelialized, or adhered, into the tissue over time.
Patent foramen ovale (PFO) closure
Percutaneous closure of an atrial septal defect (ASD), ventricular septal defect (VSD), or a patent ductus arteriosus (PDA) are also offered. These congenital heart conditions can be corrected on an outpatient basis via a catheter-based approach similar to PFO closure.
Transcatheter mitral valve replacement (TMVR)
Transcatheter mitral valve replacement is a minimally invasive procedure used to treat severe mitral regurgitation or mitral stenosis without the need for surgery.
During the procedure, a catheter is inserted into a vein in the groin, and expert imaging is used to guide a new valve to the heart. The new valve is then placed in the existing mitral valve, effectively replacing it.
This type of procedure is less invasive than traditional mitral valve replacement surgery, and patients typically experience a shorter recovery time. Transcatheter mitral valve replacement is an effective treatment option for those who may not be good candidates for surgery due to their age or underlying medical conditions. It has shown to be safe and can significantly improve the quality of life for patients with mitral valve disease
Pulmonic valvuloplasty
Congenital pulmonary stenosis is a health condition that is present from birth. It occurs when the pulmonary valve in the heart fails to open fully, leading to an obstruction in the blood flow from the right ventricle to the lungs.
The right ventricle pumps low-oxygen blood to the lungs via the pulmonary artery, which is connected to the pulmonary valve. This valve helps the blood flow through the heart's four chambers and out to the body.
Typically, the pulmonary valve opens completely when the right ventricle contracts, allowing the blood to flow without obstruction. However, in pulmonary stenosis, the valve fails to open completely, causing blood flow to slow down or even block.
A pulmonic valvuloplasty is a procedure that can correct this issue without the need for open-heart surgery. The procedure involves using a catheter with an inflatable balloon at the tip. The catheter is inserted into a blood vessel in the groin and then guided to the pulmonary valve. The balloon is inflated, stretching the valve and helping to open it up. As a result, blood can flow through the pulmonary valve and into the pulmonary artery without obstruction. Pulmonic valvuloplasty is a minimally invasive procedure that can be highly effective in correcting congenital pulmonary stenosis.
Alcohol septal ablation
Alcohol septal ablation is a non-surgical alternative for patients with hypertrophic obstructive cardiomyopathy who are not suitable candidates for corrective surgery, or for those who may benefit from a catheter-based approach. This procedure is performed similarly to a heart catheterization and involves the use of a small balloon to deliver alcohol directly into the hypertrophied tissue, resulting in a reduction in the size of the abnormally thickened myocardium.
Patients typically return home the day after the procedure. HOCM is a genetic condition that usually manifests in the second or third decade of life and can cause symptoms such as exertional chest pain, shortness of breath, fatigue, fainting, and palpitations, and in rare cases, sudden death.
Medical management of the condition involves the use of medications such as beta blockers and calcium channel blockers to slow the heart rate and improve the filling of the heart. However, persistent symptoms may require open-heart surgery and surgical removal of the overgrown heart muscle to improve blood flow from the left ventricle.
Alcohol septal ablation is a minimally invasive procedure that can be performed under local anesthesia, and involves injecting highly-concentrated alcohol via catheter into a carefully selected artery that supplies blood to the overgrown tissue in the enlarged septum. The targeted cells experience controlled cell death, reducing the obstructive muscle mass by no more than two grams, to avoid complications such as an irregular heartbeat that may require a permanent pacemaker.
After the procedure, patients are closely monitored for two days in the Cardiovascular Intensive Care Unit, with a temporary pacemaker inserted via the jugular vein to monitor heart rhythm and changes in blood chemistry. Over the next several weeks, a thin layer of scar tissue forms and left ventricular diastolic function improves as the ablative process completes.
Mitral valvuloplasty
Mitral valvuloplasty is a catheter-based procedure used to treat mitral valve stenosis, a condition where the mitral valve opening is narrowed, leading to a reduced blood flow through the heart. The procedure involves inserting a catheter with a balloon tip into a blood vessel, typically in the groin, and guiding it to the narrowed valve in the heart.
Once in position, the balloon is inflated, which compresses the valve leaflets and stretches the valve opening, resulting in an increase in the width of the valve and an improvement in blood flow. After the balloon is deflated, the catheter is removed, and the patient is monitored for a short period.
The procedure is less invasive than traditional open-heart surgery and is associated with a shorter recovery time.
Mitral valvuloplasty is most effective in patients with certain characteristics, such as a favorable valve anatomy and mild to moderate stenosis. The procedure may not be appropriate for all patients and other treatment options, such as medication or surgical repair, may be recommended instead.
Balloon aortic valvuloplasty
The aortic valve is responsible for regulating the flow of oxygen-rich blood from the left ventricle to the aorta, which delivers blood to the entire body. The valve is situated within the aortic root, the structural support for the aortic valve and the initial portion of the aorta.
There are two primary malfunctions of the aortic valve: aortic valve insufficiency/regurgitation and aortic valve stenosis. Balloon aortic valvuloplasty is a non-surgical procedure that is performed to treat aortic valve stenosis, a condition in which the valve opening becomes narrowed.
The procedure involves a catheterization, where a cardiologist inserts a catheter with a balloon tip into a blood vessel, typically in the groin. The catheter is guided to the narrowed aortic valve in the heart, and once in position, the balloon is inflated to widen the valve, improving blood flow. The balloon is then deflated, and the catheter with balloon is removed.
Balloon aortic valvuloplasty is a minimally invasive alternative to traditional open-heart surgery and may be an appropriate treatment option for some patients with aortic valve stenosis. However, the procedure may not be appropriate for all patients, and other treatment options, such as medication or surgical repair or replacement of the aortic valve, may be recommended instead.
Coronary artery chronic total occlusion (CTO) intervention
Chronic total occlusions are blockages that have persisted for more than three months and are typically caused by the buildup of fatty deposits or plaque in the arteries. They are a complication of coronary artery disease, which occurs when the arteries supplying blood to the heart become narrowed or blocked due to atherosclerosis. When the heart doesn't receive enough blood, the patient may experience chest pain, shortness of breath, or a heart attack.
Interventional cardiologists perform a procedure to treat chronic total occlusions by entering the patient's body through a blood vessel in the groin or wrist. They use tiny wires (catheters) and other minimally invasive tools to approach the blockages and pass the wire through each blockage.
After placing the wires and devices in position, the healthcare provider will inflate a balloon to push the plaque aside, creating more space in the artery. They will then insert a stent, which is a small metal mesh tube, to help keep the artery open and allow blood to flow freely. The stent will remain in place permanently, and the patient will be closely monitored for a short period after the procedure.
Chronic total occlusion treatment is an effective treatment option for patients with advanced coronary artery disease who may not be candidates for traditional open-heart surgery. However, the procedure is not appropriate for all patients, and other treatment options, such as medication or surgery, may be recommended instead.
Coronary atherectomy
This is a catheter based endovascular surgery used to remove plaque buildup in blood vessels to restore normal blood flow.
In an atherectomy, the plaque is shaved or vaporized away with tiny rotating blades or a laser on the end of a catheter.
Transcatheter Aortic Valve Replacement (TAVR)
This is a catheter-based procedure for treatment of severe aortic stenosis and allows patients to have a minimally invasive option that has been shown to be superior to the traditional surgical approaches. Patients are evaluated by a multidisciplinary team of interventional and imaging cardiologists along with cardiovascular surgeons to determine what method is best for the patient. During the procedure, the doctor accesses the heart with a catheter through an artery in the groin, and the replacement valve is then placed in the native aortic valve. Most patients can be discharged home one to two days after their procedure with no incisions.
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