Diagnostics and Procedures

Diagnosis

To effectively treat structural heart problems, our multidisciplinary team of physicians must have a clear picture – literally – of the anatomy of each patient’s heart. Fortunately, Mount Sinai utilizes the most advanced cardiac imaging technology available to visualize and diagnose structural heart problems. In fact, our leading-edge echocardiography laboratory at the Columbia University Division of Cardiology at Mount Sinai is accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) and is recognized as one of the best in the region. Our technology includes the following:

Cardiac MRI (CMR)

Mount Sinai structural heart specialists utilize cardiovascular magnetic resonance imaging (CMR), also known as a cardiac MRI, a medical imaging technology for the non-invasive assessment of the function and structure of the cardiovascular system. It uses the same basic principles as Magnetic Resonance Imaging (MRI), but we optimize the imaging to better evaluate the cardiovascular system.

CT Scans

At Mount Sinai Medical Center, we utilize low-dose CT scans for cardiovascular-related diagnoses. More detailed than a regular X-ray, a CT scan uses computers and a rotating machine to take X-ray images of the body from different angles to create a three-dimensional view of your heart and the arteries within the heart. This allows your Mount Sinai doctors to diagnose certain conditions that might only be seen in cross-sections of the body.

Diagnostic Cardiac Catheterization

Mount Sinai’s team performs cardiac catheterization for diagnostic purposes to evaluate blood flow to the heart and within the heart, as well as to evaluate the heart’s ability to function properly. Cardiac catheterizations are a group of procedures performed in Mount Sinai’s state-of-the-art cath lab. During these procedures, your Mount Sinai cardiovascular care team inserts a thin, hollow tube (called a catheter) into arteries or veins in your leg or arm and threads it into the heart. At Mount Sinai, we utilize the radial artery in the arm whenever possible, reducing our patients’ recovery times.

Echocardiogram

Echocardiography uses ultrasound to “see” the heart and evaluate its function and structures. This process creates an image of a heart so your Mount Sinai physicians can non-invasively view patients’ hearts, looking for any problems or abnormalities. Echocardiograms produce these images by sending sound waves to the heart.

Procedures

Left Atrial Appendage Occlusion

Atrial fibrillation is a heart condition where the upper chambers of the heart (atria) beat too fast and with a chaotic rhythm (atrial fibrillation). This condition can cause blood to pool and form clots in an area of the heart called the left atrial appendage. If a blood clot forms, it can travel through an artery to the brain and cause a stroke. Blood thinners, or anticoagulants, are very effective at reducing the risk of stroke in people with atrial fibrillation, and most people can take them for years without serious side effects. However, because blood thinners help prevent clots by thinning the blood, they also increase the risk of bleeding. For those patients that have reason to seek an alternative to blood thinners due to a high risk of bleeding or due to life-style that makes being on life-long blood thinners less attractive, the WATCHMAN Left Atrial Appendage Closure Implant is a one-time procedure alternative to blood thinners that can help reduce stroke risk and bleeding worry for life. The WATCHMAN device is implanted in the left atrial appendage of the heart to permanently close off this small pouch and keep harmful blood clots from entering the bloodstream. The device is inserted through the vein of the leg using a minimally invasive small incision and a catheter, which then comes out. By closing off the left atrial appendage, the source of more than 90% of stroke-causing blood clots that come from the heart in people with non-valvular atrial fibrillation, the risk of stroke may be reduced and, over time, patients are able to stop taking blood thinners. In a clinical trial with WATCHMAN, 96% of people were able to stop using blood thinners after 45 days.

Left atrial appendage occlusion (WATCHMAN device)

Atrial fibrillation is a heart condition where the upper chambers of the heart (atria) beat too fast and with a chaotic rhythm (atrial fibrillation). This condition can cause blood to pool and form clots in an area of the heart called the left atrial appendage. If a blood clot forms, it can travel through an artery to the brain and cause a stroke. Blood thinners, or anticoagulants, are very effective at reducing the risk of stroke in people with atrial fibrillation, and most people can take them for years without serious side effects. However, because blood thinners help prevent clots by thinning the blood, they also increase the risk of bleeding. For those patients that have reason to seek an alternative to blood thinners due to a high risk of bleeding or or due to a lifestyle that makes being on lifelong blood thinners less attractive, the WATCHMAN Left Atrial Appendage Closure Implant is a one-time procedure alternative to blood thinners that can help reduce stroke risk and bleeding worry for life. The WATCHMAN device is implanted in the left atrial appendage of the heart to permanently close off this small pouch and keep harmful blood clots from entering the bloodstream. The device is inserted through the vein of the leg using a minimally invasive small incision and a catheter, which then comes out. By closing off the left atrial appendage, the source of more than 90% of stroke-causing blood clots that come from the heart in people with non-valvular atrial fibrillation, the risk of stroke may be reduced and, over time, patients are able to stop taking blood thinners. In a clinical trial with WATCHMAN, 96% of people were able to stop using blood thinners after 45 days.

Mitral Valve Repair and MitraClip Implantation

The mitral valve controls blood flow to the left side of the heart. However, blood can regurgitate or flow backward when the mitral valve doesn’t work properly. Mitral valve problems, which are quite common, can be congenital (from birth) or result from infections and diseases. They can also happen with age due to «wear and tear» on the heart valve. At Mount Sinai, our cardiac surgeons use minimally invasive techniques whenever possible to repair or replace the mitral valve for patients requiring this intervention. In fact, Mount Sinai has performed more valve surgeries than any hospital in South Florida, and our cardiac surgeons have far-reaching expertise with complex cases, using the most advanced surgical techniques available. Our experts often perform mitral valve repair (used to treat mitral valve disease) using catheter-based techniques rather than heart surgery. During this process, one of our doctors inserts a catheter into a blood vessel, to the heart, to then fix the abnormal valve. MitraClip implantation uses a catheter to insert a clip into the leaky valve to ensure the valve closes correctly. Inserting the catheter into the groin area, your Mount Sinai physician will guide the tube into the heart, crossing the septum to access the left chambers. The MitraClip is attached to the valve and protects the heart from further leakage of blood.

Septal Ablation (with alcohol)

For patients with hypertrophic cardiomyopathy, a thickening of the wall between the heart chambers called the septum, Mount Sinai physicians may recommend septal ablation. To reduce this thickening, your doctor will insert a catheter into a blood vessel, find the septum between the heart’s ventricles, and release alcohol into the wall. This alcohol causes some of the cells in the septum to die or reduce in size, relieving stress on the heart muscle.

Septal Occluder Implantation

In this process, your Mount Sinai physician will use a catheter to insert an occluder (a mesh and polyester disc) into the atrial septum, which is the wall separating the heart’s upper chambers. The occluder closes, or blocks, the hole in the septum to prevent blood from flowing between the two chambers.

Transcatheter Aortic Valve Replacement (TAVR)/Transcatheter Aortic Valve Implantation (TAVI)

For patients with aortic valve disease, such as stenosis, or failed previously placed bio-prosthetic aortic or mitral valves, transcatheter aortic valve replacement/implantation offers a less invasive approach than open heart surgery to replace the aortic valve or failing bioprosthetic aortic/mitral valves. During this procedure, your physician will insert a replacement valve through a catheter, or thin hollow tube, by making an incision in your groin. Then the physician will thread the catheter to the heart and “pop” a new valve into place. The new valve pushes the old valve away as it expands.