Interventional Cardiology

Atherosclerosis, a build-up of plaque along the walls of arteries, can form anywhere in the body. When it affects the blood vessels of the heart, it’s known as Coronary Artery Disease (CAD) and it forces your heart to work harder and makes it more difficult for blood to flow.

If left untreated, the narrowing or blockage of arteries can weaken the vessels and can lead to more complex forms of disease affecting the structure and systems of the heart. Overtime, it can also increase the likelihood of stroke or heart attack.

Atherosclerosis, and coronary artery disease specifically, is by far the most common form of heart disease. In fact, it’s estimated that at least 50 percent of individuals aged 60 and older have some degree of atherosclerosis.

Read more about atherosclerosis.

In the early stages of atherosclerosis, there are often no symptoms and it may be manageable with lifestyle changes and medications. However, as plaque build-up becomes more severe and extensive, it can become more symptomatic and take a bigger toll on heart health. A few common signs of atherosclerosis include:

• Chest pain (angina)
• Shortness of breath
• Chronic fatigue
• Signs of peripheral artery disease (PAD)

When you receive an interventional cardiology procedure at Georgia Heart Institute, every facet of care is customized to meet your unique needs. When you’re undergoing any type of procedure, it’s natural to have questions and concerns – that’s why we work to ensure your comfort and understanding at every step.

As our dedicated team works to ensure a compassionate experience, our extremely skilled interventional cardiologists pull from the most up-to-date approaches, advanced technology and proven treatments to provide the highest-level of care that’s uniquely yours.

Centered around the expertise of our highly-skilled interventional cardiologists, Georgia Heart Institute’s Interventional Cardiology Program brings together specialty-trained nurses, technologists and medical assistants – all collaborating to ensure the best care outcomes.

This impressive team of experts performs thousands of interventional procedures each year in the state-of-the-art catheterization labs located at both NGMC Gainesville and NGMC Braselton. These labs boast the latest and most advanced technologies available, to perform interventional procedures with more precision and control, proven to result in improved patient outcomes.

Plus, by utilizing proven and leading techniques, including a radial-first approach, our interventional cardiologists can overcome the most advanced and complex conditions to ensure the best outcomes and keep your heart at its healthiest.

As a part of Georgia Heart Institute, our interventional cardiology team is actively collaborating in nationally-funded research that focuses on better understanding and predicting heart attacks, as well as providing the right treatment even sooner. This dedication to continuous improvement and discovery means that our experts are always finding new and better ways to care for patients through interventional cardiology and beyond.

Learn more about ongoing research initiatives at Georgia Heart Institute.

In the event of a cardiovascular emergency, we are proud to offer patients care at the state’s first Emergency Cardiac Care Center. All four NGMC hospitals have been accredited. This certifies that we have the necessary experts, equipment and processes in place to provide life-saving heart care in the most efficient and effective way possible.

Learn more about Emergency Cardiac Care at Georgia Heart Institute.

When there is plaque build-up along the walls of an artery, also known as atherosclerosis, it causes the vessels to become narrowed and stiffened, while also affecting blood flow. When this occurs in the arteries that directly supply the heart with blood and oxygen, it’s called Coronary Artery Disease. Overtime, plaque build-up can become more extensive and severe, impacting the overall health and function of the heart.

Learn more.

This life-threatening condition occurs when one or more of the coronary arteries becomes blocked or severely obstructed. This is often the result of atherosclerosis, or a build-up of fatty plaque along the walls of the coronary arteries. When this plaque becomes extensive or severe, it can rupture, which causes a blood clot to form, partially or completely cutting off blood flow to the heart.

When there is a condition that affects the structure of the heart, the valves, the walls or the muscle, rather than the arteries, it’s known as structural heart disease. This group of diseases can be especially complex and can drastically affect the strength and health of heart and it’s ability to function long term.

Learn more about care through the Structural Heart Program at Georgia Heart Institute.

Atherectomy is a procedure used to open arteries that have become blocked with plaque, which is made up of fatty substances such as cholesterol topped with a calcified layer. Removing the plaque reopens the artery, which restores normal blood flow. During the procedure, the plaque is either shaved or vaporized away. There are four types of atherectomy:

• Directional, which uses a cutting tip attached to a catheter to shave off plaque
• Laser, which uses a laser device to vaporize plaque
• Orbital, which uses a high-speed rotational device that orbits around the inner layer of the vessel to shave off calcified plaque to make it more compliant to balloons and stents.
• Rotational, which uses a cutting tip that spins at a high speed to grind off calcified plaque

• Angiogram: This imaging procedure is used to provide in-depth images of the coronary arteries using x-ray technology. With a specialized catheter, contrast dye is released directly into the blood stream to make blood vessels visible on x-ray. These highly-detailed images of the coronary arteries can help pinpoint disease in the arteries, locate blockages and confirm diagnoses made from other, non-invasive tests.
• Coronary Intravascular Ultrasound (IVUS): A type of diagnostic test that uses sound waves to provide high-definition views of the inside cross section of a coronary artery. During this procedure, a small ultrasound device mounted on a catheter is inserted into an artery in the groin or wrist and is advanced up to the heart. A computer measures how sound waves bounce off your blood vessels and then translates that information into images, allowing doctors a view of the coronary artery. It allows very accurate sizing of stents we deploy and results in better outcomes.
• Optical Coherence Tomography (OCT): Another advanced, high resolution imaging technology from within the heart blood vessels that can visualize not only how much plaque resides in a blood vessel, what type of tissue the plaque is made of, and used to optimize stent deployment.

Diagnostic catheterization is a minimally invasive procedure that helps your doctor diagnose and sometimes treat heart health issues. During the procedure, a catheter is woven into an artery and up to the heart to allow your doctor to examine the area and perform diagnostic tests, as needed.

• A left heart catheterization is often used to look for coronary artery disease, valve disease, and blood flow issues.
• A right heart catheterization may be used to check your left ventricle filling pressure and how much blood is pumping from your heart. Right heart catheterization is also used to detect the presence of pulmonary hypertension, which is high blood pressure affecting the arteries in the lungs and on the right side of the heart.

Using catheter-based diagnostic and imaging technology, interventional cardiologists are able to investigate and assess functional effect of blockages in patients with coronary artery disease. There are several different studies your doctor may use to fully assess the extent of disease and determine the best and most effective course of treatment. This may use include:

• Fractional flow reserve (FFR): Analyzing the current blood flow in a specific diseased segment of an artery in comparison to maximum blood flow in a healthy segment of same artery. 
• Microvascular Function Testing: Used to detect microvascular dysfunction, which is a type of coronary artery disease that impacts the small blood vessels feeding the heart. These are the small vessels that are not visible on coronary angiography. Because heart health issues in women often manifest differently than in men, tests such as the coronary reactivity test are used to carefully examine the blood vessels in the heart and how they’re functioning. This helps identify causes of chest pain or shortness of breath that are not evident on the basic angiogram.

The removal of a small piece of heart muscle for biopsy, which is an examination of the tissue. During the procedure, a catheter is inserted into a vein in the neck, then threaded down to the heart, using imaging to help correctly guide it into place. Once in place, a specialized device with jaws at the tip is used to remove small pieces of the heart muscle for analysis.

• Cardio MEMs implantation: This advanced monitoring device is used to help heart failure patients prevent hospitalizations and improve quality of life. Once it’s implanted, this device helps to track and manage pulmonary artery pressure. If there are sudden changes, the patient and their providers can identify worsening symptoms in the earliest possible stages and preventative measures can be taken. This device is implanted using a catheter and is guided through the femoral artery to the right side of the heart where it is carefully placed and secured.
• Intra-Aortic Balloon Pump (IABP): A therapeutic device used to help the heart pump more blood. During a procedure to implant this device, a balloon-tipped catheter called an intra-aortic balloon is inserted through the upper leg and guided to the aorta. The device provides short-term treatment, and while in place, the balloon will inflate when the heart relaxes, pushing blood to the coronary arteries. When the heart contracts, the balloon deflates, helping the heart pump more blood.
• Impella Heart Pump: A tiny heart pump used to help maintain blood flow during percutaneous coronary interventions in patients at high risk of complications. During placement of the pump, a catheter which has the pump at its tip is inserted through the femoral artery and guided to the left ventricle of the heart. Once in place, the pump moves blood from the ventricle to the aorta, performing this essential function while the heart rests during PCI. Once PCI is complete, the Impella is removed.
• ECMO: Helps facilitate extracorporeal membrane oxygenation in a critical care situation. During this procedure, a tube known as a cannula is inserted into a vein to draw out blood and a second tube is placed into either a vein or an artery to return warm oxygenated blood to the body. This allows blood to be pumped outside the body to a heart-lung machine that removes carbon dioxide from the blood and sends back oxygen-filled blood to the body. This allows the heart and lungs time to rest and heal.
• Pacemaker Insertion (Emergent and Temporary): A pacemaker is a device placed under the skin to help control your heart rhythm. During the procedure, a small incision will be made under the collarbone, and a sheath will be inserted into a blood vessel there. What’s known as a “lead wire” (and sometimes more than one) will be guided through the sheath into the blood vessel and on to the heart. Imaging scans will verify the lead wire is in the proper position, and then the pacemaker generator will be placed on the nondominant side of your body.

Learn more about heart support devices and emergency cardiac care.

• Coronary Angioplasty (Balloon Angioplasty): A catheter is inserted into a blood vessel and guided until it reaches the artery that has narrowed or been blocked by plaque. Once it’s in place, the balloon is inflated, which pushes plaque to the sides and opens the artery, restoring blood flow.
• Coronary Angioplasty & Stenting: This involves the same angioplasty procedure outlined above, but also includes the placement of a stent. Once the balloon has been inflated, reducing the blockage, a small mesh tube called a stent is placed inside the artery to keep it open and maintain healthy blood flow.
• Complex Percutaneous Intervention (PCI)

This procedure is used when the peripheral arteries in the pelvis or legs are narrowed or blocked. During a peripheral arterial angioplasty, a balloon-tipped catheter is woven to the artery that is blocked, then the balloon is inflated. This pushes the plaque in the artery to the sides, opening up room for blood to flow. A stent may be placed to keep the peripheral artery open.

• Alcohol Septal Ablation: A procedure used to treat a condition called hypertrophic cardiomyopathy, which causes the heart muscle to be unusually thick. During the procedure, a catheter is inserted through the groin and woven to the artery that carries blood to the septum. Once it’s in place, alcohol is injected through the catheter into the thickened area of the heart. The alcohol causes heart muscle cells to die off, thinning out the heart.
• PFO/ASD Closures: These procedures are used to close defects in the heart called patent foramen ovales or atrial septal defects. A catheter is inserted through the groin and guided to the heart. Once it reaches the heart, a small device shaped like a tiny umbrella is released through the catheter and positioned as to effectively close the hole.
• MitraClip: A procedure used to fix a mitral valve defect. During the procedure, a catheter is guided through a vein in the leg up to your heart. Once it reaches the heart, a small clip known as a MitraClip is attached to the mitral valve to help it close, which restores normal blood flow.
• Transcatheter Aortic Valve Replacement: Also known as a TAVR, this procedure is used to replace an aortic valve that is narrowed and fails to open properly. This treats a condition known as aortic valve stenosis. During the procedure, a balloon-tipped catheter with a replacement valve is inserted into the body and guided through the blood vessels to the aortic valve in the heart. Once the catheter is in place, the balloon is inflated, which moves the replacement valve into position.
• Transcutaeous Mitral Valve Replacement (TMVR): TMVR is a minimally-invasive procedure where a replacement mitral valve is inserted to correct mitral valve dysfunction or regurgitation. This procedure is typically offered for patients who have developed complications after mitral valve repair with a mitral annuloplasty ring and are considered high risk for repeat mitral valve surgery.
• Ventricular Septal Device (VSD) Closure
• Closure of paravalvular leak: For patients with significant paravalvular leaks following a TAVR or TMVR procedure or valve surgery, we offer minimally invasive transcatheter paravalvular leak repair, a procedure with superior outcomes for patients where even the most complex leaks can be closed successfully. With the most advanced cardiovascular imaging technology and coordination through a multi-disciplinary panel of physicians, our team will determine the best and most effective treatment plan for long-term wellness.
• Valvuloplasty: A procedure used to increase the opening of a heart valve that has a severely narrowed opening. This narrowing is due to what’s known as stenosis, which causes the valve leaflets to thicken or stiffen, reducing blood flow. During a valvuloplasty, a balloon-tipped catheter is inserted through the groin and moved upward through the aorta into the heart. Once the catheter is in place, the balloon is inflated, which pushes the valve leaflets open.
• Watchman: A procedure to correct a defect in the left atrial appendage which can significantly reduce risk of stroke secondary to atrial fibrillation in those who can not tolerate blood thinners typically due to bleeding issues. During the procedure, a tiny device known as the WATCHMAN is implanted into the heart to close off the left atrial appendage, preventing blood clots to exit the appendage and potentially cause a stroke. A catheter is inserted into the leg and woven up to the heart, and the WATCHMAN is guided into place through the catheter.

An interventional cardiologist is a type of doctor that specializes in the diagnosis and treatment of conditions that affect the coronary arteries by utilizing catheter-based procedures. Interventional cardiologists go through additional training to further understand the physiology of the coronary arteries, how atherosclerosis and other conditions present in the coronary arteries and how to utilize catheter-based techniques to treat coronary artery disease or structural heart diseases. Combining all this knowledge and training, interventional cardiologists are uniquely qualified to provide the full spectrum of catheter-based cardiac care.

Rather than an open procedure, interventional procedures utilize a small incision – only a few millimeters in length – to insert a thin tube, or catheter, into one of the arteries in the groin, neck or wrist and then onto your heart.

Every portion of the procedure will utilize specialized catheters, some with devices or a camera on the end, inserted through this one port so there are no other incisions. Once complete, the small incision is carefully closed and will fully heal in just a few days.

Following a catheter-based procedure, patients will be kept in a recovery unit while their small incision stops bleeding completely and starts to heal. This is done to ensure patients are as comfortable and safe as possible before heading home.

Once released to go home, it is recommended that patients avoid strenuous activity for several days, ensuring the artery and skin have both fully healed. Outside of the small incision, there is no other recovery that is required.

While you can see one of our interventional cardiologists at many of our convenient locations throughout the region, receiving a procedure does require a referral. This process may be coordinated by one of the non-invasive cardiologists of Georgia Heart Institute, or by your primary care provider. Our interventional cardiology team stands ready to provide the comprehensive diagnostic or treatment services you need to support your personalized care plan.

Your cardiologist will help you and your family determine the best treatment option for your unique condition and your life goals. At Georgia Heart Institute, our work closely together with the cardiothoracic surgeons of Northeast Georgia Physicians Group to find the option that will provide the best outcomes for you.

Our primary goal is just for you to live longer, feel better and keep your heart healthy. Because we have a comprehensive, collaborative program, including the latest techniques in interventional cardiology and the least invasive approaches for heart surgery, patients at Georgia Heart Institute have options that are unique across the region. So you can feel confident that you are getting the best care from a collaborative team who will help navigate your heart health journey with you.