Coronary Stenting for Ischaemic Heart Disease

A Coronary Angiogram is needed when a detailed image of the coronary arteries is needed. Indications: 1. To Diagnose the cause of chest pain, if other tests such as ECG, Echo, stress testing, CTCA have not been conclusive 2. Prior to Valve surgery- to see if a coronary bypass is needed in addition to valve replacement Three things may be found: 1. No disease at all- that is very reassuring- Normal coronary arteries 2. Mild disease- coronary atheroma- some furring up of the pipes, but not causing any significant blockages and no need for any stents or bypass. Sometimes a "Pressure Wire" is done to see if a narrowing is truely significant or not. This is akin to seeing if there is a significant drop in coronary pressure (fllow) beyond a narrowing. 3. Significant narrowings -Coronary Artery Stenosis. depending on the site and severity, then the best treatment could be: --tablets only --tablets plus stenting --tablets plus coronary bypass surgery

If a significant narrowing is found in one or more Coronary Arteries, then Coronary Angioplasty and Stenting (Precutaneous Coronary Intervention- PCI) may be recommended. The procedure is similar to when you have a coronary angiogram, but after the images are taken, a wire is passed through the narrowing and then a balloon and stent (as scaffold) are used to widen the artery. Sometimes more imaging is done to ensure the artery is perfectly safe after the procedure- with Ultrasound (IVUS) or special light (OCT) as well as looking on X-ray. it is usually a day-case procedure, done via the wrist.

Only 5-6 days after cardiac surgery which fixed his Aortic Stenosis, Mitral Regurgitation and Tricuspid Regurgitation, he kindly chats through the high and lows. It all about getting the timing of surgery correct. Not too early and not too late.

Dr Iqbal Malik explains how the TAVI procedure works together with risks and benefits.