Catheter Interventions

Balloon Valvuloplasty

Balloon valvuloplasty is a surgical procedure used to open a narrow heart valve. During balloon valvuloplasty at Mount Sinai, we use a thin tube, or catheter, and insert the catheter through a vein in your groin or at your wrist. Then, your Mount Sinai cardiovascular care team threads the catheter to the affected valve in your heart. Once the catheter is positioned into the narrowed valve opening, your interventional cardiologist inflates the balloon to separate the valve leaflets. After the balloon has opened the heart’s valve, the catheter and balloon are removed. This procedure is also known as percutaneous balloon valvuloplasty, or a balloon enlargement of a narrowed heart valve.

Coronary Angioplasty

When plaque builds up inside the arteries of the heart, the artery can become partially or completely blocked. And if those blockages prevent blood from flowing to the heart, a heart attack can happen. Coronary angioplasty can open the blocked arteries before a heart attack can happen and before the need for more serious procedures like coronary bypass surgery. During coronary angioplasty at Mount Sinai, we use a thin tube or catheter and insert the catheter through a vein in your groin or at your wrist. Then, your Mount Sinai cardiovascular care team threads the catheter to the affected artery in your heart. Once the catheter is positioned inside the artery at the blocked part, we inflate a tiny balloon at the end of the catheter. The balloon spreads open, or dilates, the artery and compresses the blockage – comprised of plaque – to increase blood flow. Finally, your Mount Sinai physician inserts a stent, which is a small rigid tube, to prevent the artery from becoming blocked again. At Mount Sinai, we use coronary angioplasty to reduce chest pain due to a lack of sufficient blood flow to the heart. A coronary angioplasty can also reduce potential damage to the heart muscle after someone suffers a heart attack.

Coronary Atherectomy

Coronary atherectomy, or rotablation, is a type of angioplasty that we perform at the Mount Sinai Heart Institute to remove plaque inside the arteries of the heart. We insert a thin tube, or catheter, through a vein in your groin or at your wrist. Then, your Mount Sinai cardiovascular care team threads the catheter to the part of the artery in the heart where the blockage is located. Once the catheter is positioned inside the heart at the point of the blockage, we use a tiny drill or blade positioned at the tip of the catheter to break up the plaque. In some cases, we let the broken pieces of plaque flow through the bloodstream, and in other cases, we use suction to pull the plaque into the catheter. At Mount Sinai, we also use a laser option to vaporize the plaque and smooth the lining of the vessel.

MitraClip and Edwards PASCAL Therapy

MitraClip and Edwards PASCAL Therapy are nonsurgical treatments for mitral regurgitation. This is a condition where blood flows backward into the heart because the heart’s mitral valve does not close tightly. MitraClip repairs the heart’s mitral valve without the need for an invasive surgical procedure. The device is delivered to the heart using a catheter, or a small tube, through the femoral vein, which is a blood vessel in the leg. The heart beats normally during the procedure, and a heart-lung bypass machine is not required. The treatment works by clipping together a portion of the leaflets, or tissue flaps, of the mitral valve to reduce the backflow of blood. Like MitraClip Therapy, Edwards PASCAL Therapy is a nonsurgical treatment for mitral regurgitation. This system uses paddles and a spacer to clip together the leaflets. Patients who have the MitraClip or Edwards PASCAL Therapy treatment typically experience short recovery times and short hospital stays, an average of 2-3 days.

Percutaneous Heart Valve Replacement (Edwards or CoreValve® Systems)

Some patients with diseased valves in their heart can have their heart valves replaced without surgery, using an artificial valve and special devices made by Edwards or CoreValve®. These non-surgical approaches are especially helpful for patients who may not be good candidates for heart surgery – either because of their age or other health conditions. Percutaneous heart valve replacement uses a special type of catheter equipped with an artificial valve, called a transcatheter valve, inserted through an artery in your groin or under the collarbone. Once inserted, your Mount Sinai cardiovascular care team threads the catheter to the heart and positions it where the new valve is needed. Once in place, the transcatheter valve expands into the place of the original valve and takes over its function. For patients who have had prior valve replacement surgery, they can have a transcatheter valve placed into the failing surgical valve to fix narrowing or valve leaks. Patients who replace diseased valves in their heart using this non-surgical approach often see significant improvements in their quality of life. In addition, they have fewer complications, shorter hospital stays, and quicker recoveries than patients who have valve replacement surgery. Mount Sinai was one of the first hospitals to perform heart valve replacement without surgery and is among the most experienced hospitals using this technique.

Structural Heart Disease Treatments

Structural heart disease includes congenital heart defects, which are defects present at birth. In addition to congenital heart defects, structural heart disease includes abnormalities of the valves and vessels of the heart wall. These may develop through wear and tear, or through disease progression. Common structural heart defects include “holes” between the chambers of the heart, a pinched or constricted aorta (the main artery that carries blood from the heart), abnormal connections in the heart, or leaky or narrowed valves. Other issues include an atrial septal defect (ASD), which is a hole in the wall, or septum, that separates the top two chambers of the heart. A patent foramen ovale (PFO) is a flap-like hole in the wall that separates the upper two chambers of the heart. Cardiac catheterization techniques for these include procedures that focus on closing the holes.