Diagnostic methods & procedures (therapeutic procedures)

CVC provides the latest in diagnostic and therapeutic procedures for heart and circulatory system. Here is a small sample of the procedures we offer.

  • electrocardiogram (ECG)

    An electrocardiogram is a measure of the heart’s electrical system to look for irregularities. We offer both resting and 24 hour electrocardiogram.

    • office based blood pressure measurement
    • 24-hour ambulatory blood pressure monitoring
    • electrocardiogramm (ECG), resting and 24 hour ECG
  • cardiac echocardiography

    A cardiac ultrasound allows a look at the structure of the heart muscle and of the four heart valves. This can be performed on the chest (also known as a transthoracic echocardiogram) and from the back of the heart by placing the echo probe in the esophagus (also known as a transesophageal echocardiogram).

    • cardiac transthoracic echocardiography (TTE) with 2D, 3D, contrast and color doppler
    • cardiac transesophageal echocardiography (TEE) with 2D, 3D
  • stress tests

    A stress test allows evaluation of the heart to look for blockage of the heart arteries. As blockages form, they are often not noticed because they do not cause symptoms. With a stress test, we can uncover the potentially life-threatening symptoms of possible coronary artery disease. We offer both exercise and pharmacologic stress tests.

    • exercise ECG
    • exercise echocardiography
    • dobutamine echocardiography
  • vascular ultrasound

    A vascular ultrasound allows a look at the blood vessels. Problems with blood vessels can lead to many symptoms all throughout the body. A vascular ultrasound can be used to evaluate many different vessels, including the carotids (vessels to the brain), subclavian (vessels to the arm), thoracic aorta (main vessel to the upper body), abdominal aorta (main vessel to the lower body), renal (vessel to the kidney), iliac (main vessel to the legs) and other leg vessel.

    • carotid ultrasound with duplex and color doppler
    • subclavian ultrasound with duplex and color doppler
    • thoracic aorta ultrasound with duplex and color doppler
    • abdominal aorta ultrasound with duplex and color doppler
    • renal ultrasound with duplex and color doppler
    • iliac ultrasound with duplex and color doppler
    • leg ultrasound (above the knee and below the knee) with duplex and color doppler
    • Transcranial Ultrasound
  • pacemaker interrogation and setting update

    For patients with pacemakers, often they need to be checked for battery life and adjustments need to be made.

diagnostic methods & procedures (interventional therapies and procedures)

There are many interventions and procedures that are performed at our center. Many of these procedures take the place of conventional surgery.

  • coronary interventions

    For coronary artery disease or heart artery blockages, there are many different possible procedures. These include looking for blockages (angiography), preparing blockages so they can be opened easier (lesion modification), opening blockages (intervention) and doing internal imaging to evaluate the vessels. In addition, the CVC specializes in complex coronary lesions.

    • coronary angiography
    • coronary intervention (balloon angioplasty and stenting)
    • coronary lesion modification (rotablator and laser therapy)
    • advanced coronary imaging (optical computerized tomography)
    • treatment of complex lesions (left main, bifurcation, chronic total occlusions)
    • coronary fistula closure
  • defects of the septa of the heart

    Patients may have holes or defects, between heart chambers. These can be between two upper chambers (atrial septal defect, patent foramen ovale) or between the two lower chambers (ventricular septal defect). Each one of these can be associated with stroke and other neurological symptoms. Evaluation of these begins with ultrasound. The flow through the hole can be measured and evaluated. These holes can be then closed. We also specialize in closure of shunts left over after closure.

    atrial septal defect (ASD) and patent foramen ovale (PFO) closure

    • measurement with transcranial doppler
    • shunt measurement and calculation
    • closure of ASD and PFO
    • closure of residual shunt after prior ASD and PFO device

    ventricular septal Defect (VSD) closure

    • measurement with echocardiography (transthoracic and transesophageal)
    • measurement with magnetic resonance imaging
    • shunt measurement and calculation
    • closure of VSD (perimembranous, muscular, post-infarct)
    • closure of residual shunt after prior VSD device
  • valve diseases of the heart

    There are four main valves in the heart (aortic, mitral, pulmonary and tricuspid). Each of these valves can be too tight (stenosis) or leaky (regurgitation). We measure the pressure difference across the valve (gradient), open up too tight valves (angioplasty), implant percutaneous valves (TAVI, TAVR) and can in the case of leaky mitral valves, perform minimally invasive mitral valve repair (MitraClip, annuloplasty procedure). For patients with prior surgical valves with leakage around the valve, we can perform procedure to close the leak (paravalvular leak closure). For patients with prior surgical valves with leakage in the valve, we can perform minimally invasive valve replacement (valve-in-valve procedure).

    aortic valve disease

    • invasive pressure gradient measurement
    • balloon angioplasty
    • transcatheter aortic valve implantation (TAVI)
    • valve-in-valve procedure
    • coronary intervention after TAVI
    • paravalvular leak closure after aortic valve replacement

    mitral Vvalve disease

    • transseptal puncture
    • mitral stenosis: invasive pressure gradient measurement
    • mitral stenosis: balloon angioplasty
    • mitral regurgitation: percutaneous mitral valve repair (MitraClip)
    • mitral regurgitation: percutaneous mitral valve repair (annuloplasty)
    • valve-in-valve procedure for mitral valve
    • paravalvular leak closure after mitral valve replacement
  • left atrial appendage closure

    In case of an electrical disturbance of the heart such as atrial fibrillation, blood stays in one of the heart chambers (left atrium) for a long time, leading to clots. These clots can cause stroke. Therefore many patients take warfarin or other blood thinning medications. Research has shown that many of these clots tend to form in the left atrial appendage, a structure within the left atrium. To prevent clots, we specialize in a new procedure known as left atrial appendage occlusion. By closing the left atrial appendage, we can stop blood from staying in the appendage, decreasing the risk of stroke without the patient having to take lifelong blood thinning medications. Prof. Dr. Sievert was the first physician in the world to perform percutaneous left atrial appendage closure.

    • transseptal puncture
    • closure of left atrial appendage for atrial fibrillation
    • closure of leak after prior left atrial appendage device
  • myocardial biopsy

    For patients with unknown heart disease, infiltrative heart disease (sarcoid or amyloid), often samples of heart tissue are needed to find the cause of the problem or to monitor therapy. Heart biopsies can be taken to better understand the problem.

    • myocardial biobsy
  • resistant hypertension therapy

    Many patients have high blood pressure, which can lead to heart disease, stroke and other issues. Thankfully patients can take medications to control their blood pressure. In some patients, medications are not enough or patients are unable to take their medications. In these cases, recent research has shown that the nerves around the kidneys and in the carotid arteries contribute significantly to high blood pressure. Renal denervation allows lowering of blood pressure in patients with resistant high blood pressure. In some cases, this has even helped with sleep apnea, atrial fibrillation, heart failure and diabetes.

    • renal denervation therapy
    • carotid sinus Denervation therapy
  • hypertrophic cardiomyopathy alcohol septal ablation

    For patients with hypertrophic cardiomyopathy, there are few treatments available. One tested and valuable procedure is alcohol septal ablation. In selected patients, this relieves symptoms and can allow a better quality of life.

    • hypertrophic cardiomyopathy alcohol septal ablation
  • peripheral vessel intervention, therapy of aortic aneurysm and stenosis

    Once blood leaves the heart, it travels in various vessels to different parts of the body. The vessels can either be too large (aneurysm) or have blockages (stenosis), leading to symptoms in all major body parts. The main vessel from the body is the aorta, which can have problems by being too tight (coarctation) or large (aneurysm) – this can happen in the chest (thoracic aorta) or abdomen (abdominal aorta). From the aorta come branch vessels to the arm (subclavian), belly (mesenteric), kidneys (renal), whole legs (iliac) and parts of the leg (above the knee and below the knee). In some cases, patients may have extensive disease or infection in their hands or feet that may put them at risk of amputation or surgery to remove the hands or feet. By opening up vessels leading to the hands and feet, we can help provide blood flow and prevent amputation (critical limb ischemia/limb salvage therapy).

    • thoracic aortic aneurysm stenting
    • abdominal aortic aneurysm stenting
  • peripheral vascular intervention
    • subclavian balloon angioplasty and stenting
    • mesenteric vessel balloon angioplasty and stenting
    • renal balloon angioplasty and stenting
    • iliac balloon angioplasty and stenting
    • leg above the knee angioplasty and stenting
    • leg below the knee angioplasty
    • critical limb ischemia/limb salvage therapy
  • cerebrovascular intervention, stroke intervention, CCSVI

    Many brain and neurological symptoms (passing out, dizziness, problems with senses and movement) can be due to reversible problems with the brain blood vessels. These include problems in the main arteries that lead to the brain (carotid and vertebral arteries). In the case of multiple sclerosis, these problems are believed to be caused by the veins leading from the brain (cerebrospinal venous system). In addition, the CVC has successfully treated multiple cases of stroke, which is a life-threatening emergency.

    • carotid artery stenting
    • vertebral artery angioplasty and stenting
    • multiple sclerosis chronic cerebrospinal venous insufficiency therapy (CCSVI)
    • acute stroke intervention