Cardiac Catheterization & Intervention

Structural heart diseases are conditions that affect the heart muscle, walls, chambers or valves. They may be present at birth or develop over time. Structural heart interventions are performed to improve the heart’s functions, e.g. by opening narrowed heart vessels, repairing holes in the heart or replacing damaged valves. Instead of conventional open heart surgery, a minimally invasive approach called transcatheter structural heart intervention is now commonly adopted. 

The most common structural heart intervention procedures performed by the CCIC include the following: 

Atrial fibrillation is the most common type of cardiac arrhythmia, and can possibly lead to severe complications such as ischaemic stroke, even death. While effective at preventing ischaemic stroke, the long-term use of oral anticoagulants as the standard treatment may increase the risk of severe bleeding in some patients. 

As a minimally invasive procedure, Transcatheter Implantation of Left Atrial Appendage Occluder (LAAO) offers an alternative treatment option for patients deemed not suitable for long-term use of anticoagulants after doctor’s assessment. Under local anaesthesia and 4D intra-cardiac echocardiography guidance, an occlusion device is placed inside the orifice of the left atrial appendage via a catheter to prevent blood clots from entering the bloodstream.

AF patients may consider LAAO if they have the following condition(s): 

1. Poor anticoagulation therapy compliance
2. Intolerable side effects to anticoagulation therapy
3. Chronic thrombocytopenia
4. A prior history of severe bleeding, i.e. intracranial haemorrhage, major gastrointestinal bleeding
5. A high risk of falling or a history of prior falls that resulted in injury
6. A high risk of bleeding from anticoagulation therapy

The mitral / tricuspid valve separates the atrium from the ventricle. The valves open to let blood flow into the ventricle, and close to stop blood from flowing backwards to the atrium. Regurgitation occurs when a valve fails to close fully and blood leaks back across the valve into the atrium. If the leakage is severe, there will be inadequate blood flow through the heart or to the rest of the body. The ventricle is thus under stress and the heart chambers may enlarge, leading to heart failure. Patients may experience fatigue, arrhythmia, shortness of breath, palpitations, swollen feet or ankles when heart failure develops. 

MitraClip^TM/TriClip^TM is one of the TEER devices used to repair a leaking valve and relieve symptoms of regurgitation and heart failure. During the procedure, a catheter is guided through the femoral vein to reach the heart and access the valve in question. The leaflets of the valve are held by the Clip, with with orifices (holes) on either side to allow blood flow into the ventricle. The procedure is carried out under general anaesthesia. It involves no open heart surgery or cutting the breastbone, causing only a small cut in the groin. It is suitable for patients at high risk of complications of open-heart surgery.