Hemodynamics, Invasive Cardiology and Coronary Care Unit
The Hemodynamic and Invasive Cariology Unit treats mainly patients with myocardial ischemia in its various forms: angina pectoris, myocardial infarction. Patients undergo coronography, left ventriculography and left cardiac catheterisation to assess the possibility of a myocardial revascularisation, angioplasty or by-pass. Coronary angioplasty (PTCA) is carried out following coronography, if possible in the same sitting. In addition to balloon angioplasty, the unit has all the most modern equipment (Rotablator, Directional atheroctomy, intracoronary ultrasound, OCT, Optical coherence tomograghy) and a wide range of coronary prostheses (stent) to treat any coronary pathology. The latest arrivals are reabsorbable stents that keep vessels as open as possible following angioplasty but are completely reabsorbed a year leaving the vessel pervious and without metal prosthesis. The Unit is able to guarantee emergency and/or urgent tests for all pathologies. In particular in acute infarct the team is able to remove any obstructions from occluded arteries within 30 minutes of reaching Accident and Emergency not only with the traditional balloon but also with other modern systems such as microaspiration devices (that suck up thrombi that are always present in occluded coronary veins) or filters (that are placed distally to the occlusion to prevent thrombi from going into circulation when the vessel is reopened). The unit also deals with patients with valvular and congenital disorders. Replacing aortic valves percutaneously (TAVI) in aortic stenoses with a high surgical risk, replacing aortic, mitral and tricuspid valves percutaneously with a new digenerate surgical prosthesis valve and replacing pulmonary valves following Fallot Tetralogy or pulmonary atresia with duct. Patients with serious mitral insufficiency resulting from the dilation of the left hypokinetic ventricle due to the presence of primary or ischemic cardiomyopathy can be treated percutaneously inserting one or more clips between the two valvular strips that limit or in most cases eliminate regurgitation. In patients with interatrial and interventricular septum defects, generally congenital, the continuity solution is generally closed percutaneously with various "umbrella" devices depending on the type and anatomy of the defect that is assessed before with cardiac MRI and trans esophageal tridimensional echo. The pulmonary arteries and aorta can also be dilated (in the event of aortic coarctation) with various types of stents even covered to cope with a possible rupture of the vessels. Moreover, interventional cardiology contributes to ischemic stroke prevention in collaroation with Neurologists closing the pervious foramen ovale percutaneously in the event of cryptogenic ischemic stroke (absence of any other causes) with important left/right shunt. The left auricle, area where thrombi form and collect during atrial fibrillation, is closed percutaneously with a plug device that closes off the auricle preventing thrombi from getting out in patients that have problems with chronic anticoagulant treatment . And lastly treating carotid stenosis with sophisticated cerebral emboli prevention systems during procedures both with filters and endovascular anterograde flow clamping system (balloon) (MOMA) is available even as an emergency. Interventional cardiology contributes to treating serious arterial hypertension that is resistant to pharmacological treatment both with angioplasty and stenting renal arteries in the event of renal stenosis both with radiofrequency ablation of the renal artery (simpathyecectomy) that, blocking the nerve ends, prevents those nervous reflexes that cause resistant hypertension.