Angiography (Coronary)
Coronary angiography is a procedure in which a contrast material that can be seen using x-ray equipment is injected into one of the arteries of the heart. This helps to view the flow of blood through heart. Coronary angiography is performed to detect obstruction in the coronary arteries. Coronary angiography is usually performed in conjunction with cardiac catheterization. A catheter is inserted through a blood vessel. The catheter is carefully threaded into the heart using an x-ray machine that produces real-time pictures (fluoroscopy). Once the catheter is in place, contrast material is injected and pictures are taken.

Angioplasty
Angioplasty is a medical procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart (coronary arteries). Coronary arteries can narrow down due to deposition of fact and cholesterol, and the process is called atherosclerosis. If the blockage is not too severe, a balloon catheter may be used to open the heart artery as an alternative to open heart surgery. The catheter is a small, hollow, flexible tube that has a balloon near the end of it. The catheters are inserted in an artery (usually near the groin). The heart and heart arteries are then visualized by using X-rays and dye, and blockages in the heart vessels are identified. A balloon catheter is inserted in or near the blockage and inflated, thus widening or opening the blocked vessel and restoring adequate blood flow to the heart muscle. Occasionally, blood thinning medicines are also given to prevent formation of a blood clot. In almost all cases, a device called a stent is also placed at the site of narrowing or blockage in order to keep the artery open.

This procedure greatly improves blood flow through the coronary arteries and to the heart tissue in about 90% of patients and may eliminate the need for coronary artery bypass surgery (CABG). The result is relief from chest pain, and improved exercise capacity. In 2 out of 3 cases, the procedure is considered successful with complete elimination of the narrowing or blockage.

Arrhythmias
An arrhythmia is any disorder of heart rate or rhythm. It means that heart beats too fast, too slow, or with an irregular pattern. When the heart beats faster than normal, it is called tachycardia. When the heart beats too slow, it is called bradycardia. Normally, the 4 chambers of the heart (2 atria and 2 ventricles) contract in a very specific, coordinated manner. Problems can occur anywhere along heart’s conduction system, causing various arrhythmias. Examples include:

The tests that may be performed to identify arrhythmias include, ECG, Holter monitor, Echocardiogram, Electrophysiology study, or Coronary angiography.

When an arrhythmia is serious, urgent treatment may be required to restore a normal rhythm. This may include intravenous medications, electrical "shock" therapy (defibrillation or cardioversion), or implanting a temporary pacemaker to interrupt the arrhythmia.

Supraventricular arrhythmias may be treated with anti-arrhythmic drugs. However, most supraventricular arrhythmias can be treated and cured with radiofrequency ablation, eliminating the need for lifelong drug therapy. Increasingly, most ventricular tachycardias are treated with an implantable cardioverter-defibrillator (ICD). As soon as arrhythmia begins, the ICD sends a shock to terminate it, or a burst of pacing activity to override it. Bradycardias that cause symptoms can be treated by implanting a permanent pacemaker.


Congenital Heart Defect Corrective Surgery
Surgery to correct or treat birth defects of the heart (congenital heart disease) is required if the defects threaten the child's well-being or life. Heart defects come in all types, from minor to major. Defects can occur inside the heart or in the large blood vessels outside the heart. The heart defect may need immediate surgery or may be able to safely wait for months or years. In most cases, the timing of the surgery will depend on how sick the baby is. The heart defect may be repaired in a single surgical procedure or may require a series of procedures. Surgery may involve opening the heart to repair defects or repairing defects of the blood vessels.

An incision may be made through the breastbone (sternum) and between the lungs (mediastinum) while the child is under general anesthesia. For some heart defect repairs, the incision is made on the side of the chest, between the ribs (thoracotomy) instead of through the breastbone (sternotomy). It is sometimes necessary to use tubes to re-route the blood through a special pump (heart-lung bypass machine) that adds oxygen to the blood and keeps it warm and moving through the rest of the body while the repair is being done. This machine does the work of the heart and lungs during the operation. Heart surgery for children requires a specialized team of health care providers. Heart surgery requires intensive and extensive monitoring, treatment and coordination by the entire team. Heart surgery for children may take as many as 12 hours in the operating room. After heart surgery, the child will be moved to the intensive care unit (ICU) to be constantly and closely monitored and treated for several days.


SPECIFIC HEART DEFECT SURGERIES INCLUDE:

Patent ductus arteriosus (PDA) ligation

Coronary Heart Disease
Coronary heart disease (or coronary artery disease) is a narrowing of the small blood vessels that supply blood and oxygen to the heart (coronary arteries). Coronary disease usually results from the build-up of fatty material and plaque (atherosclerosis). As the coronary arteries narrow, the flow of blood to the heart can slow or stop, causing chest pain (stable angina), shortness of breath, heart attack, or other symptoms. Chest pain (angina) is the most common symptom, and it results from the heart not getting enough blood or oxygen. Other symptoms include, shortness of breath (usually a symptom of congestive heart failure), Heart attack (usually severe and longer lasting pain not relieved by resting or nitroglycerin).

The treatment for CHD varies depending on the symptoms and how much the disease has progressed. The general treatments include lifestyle changes, medications, and sometimes surgery. The outcome is variable. Some people can maintain a healthy life by changing their diet, stopping smoking, and taking medications as long as they are closely monitored. Others may require more definitive interventions, such as PTCA or surgery. Although everyone is different, it is always essential to detect CHD early for the best outcome.

ECG (EKG)
An electrocardiogram (ECG) is a test that records the electrical activity of the heart. ECG is used to measure the rate and regularity of heartbeats as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart (such as a pacemaker). Sometimes stress test is used to diagnose problems after controlled physical activity. Holter monitor is used for measuring heart’s electrical activity over a period of time (generally 24 hours).

Echocardiogram
Echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than x-ray image and involves no radiation exposure. A trained sonographer performs the test, then a physician interprets the results. An instrument that transmits high-frequency sound waves called a transducer is placed on ribs near the breast bone and directed toward the heart. The transducer picks up the echoes of the sound waves and transmits them as electrical impulses. The echocardiography machine converts these impulses into moving pictures of the heart. Echocardiogram works well for most patients and allows doctors to see the heart beating and to visualize many of the structures of the heart. Sometimes, the sonographer may administer a small amount of a dye through an IV to better see the inside of the heart. Very rarely, more invasive testing using special echocardiography probes may be necessary.

Heart bypass surgery
This surgery is done to bypass clogged arteries supplying the heart. Coronary arteries are the small blood vessels that supply the heart muscle with oxygen and nutrients. Fats and cholesterol can accumulate inside these small arteries, and the arteries can gradually become clogged. When one or more of the coronary arteries becomes partially or totally blocked, the heart does not get an adequate blood supply. This is called ischemic heart disease or coronary artery disease (CAD). It can cause chest pain (angina). If blood supply to heart becomes critically low, and the muscle begins to die, it may result in potentially deadly heart attack. Symptomless CAD is especially common in diabetics.

Heart bypass surgery creates a detour or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. The surgery is commonly called Coronary Artery Bypass Graft, or CABG (pronounced "cabbage"). A vein from the leg, called the saphenous vein, or some arteries can be used for bypass. In the traditional surgery, the patient is connected to the heart-lung machine, or bypass pump, which adds oxygen to the blood and circulates blood to other parts of the body during the surgery. One end of the graft is stitched to an opening below the blockage in the coronary artery. If the grafted vessel is the saphenous vein or the radial artery, its other end is stitched to an opening made in the aorta. If the grafted vessel is the mammary artery, its other end is already connected to the aorta.
Other surgical techniques for this procedure are being used more frequently. One popular method is to avoid the use of the heart-lung machine. This is called off-pump coronary artery bypass or OPCAB. This operation allows the bypass to be created while the heart is still beating. Another alternative is the use of smaller incisions that avoid splitting the breastbone. This is referred to as Minimally Invasive Direct Coronary Artery Bypass or MIDCAB.

Heart Palpitations
Palpitations are heartbeat sensations that feel like pounding or racing. One may only have an unpleasant awareness of heartbeat or may feel skipped or stopped beats. The heart's rhythm may be normal or abnormal. Palpitations can be felt in chest, throat, or neck. Normally heart beats between 60-100 times per minute. If heart rate is over 100 beats per minute, this is called tachycardia. An unusually slow heart rate is called bradycardia, and an occasional extra heart beat is known as extrasystole.

Heart valve surgery
Heart valve surgery is used to repair or replace diseased heart valves. There are four valves in heart: (1)Aortic valve; (2) Mitral valve; (3) Tricuspid valve; and (4) Pulmonary valve. The valves control the direction of blood flow through your heart. The opening and closing of the heart valves produce the sound of the heartbeat.

Heart valve surgery is open-heart surgery that is done under general anesthesia. A cut is made through the breast bone (sternum). Blood is routed away from heart to a heart-lung bypass machine. This machine keeps the blood circulating while heart is being operated on. Valves may be repaired or replaced. Replacement heart valves are either natural (biologic) or artificial (mechanical). If you receive an artificial valve, you will need to take life-long medication to prevent blood clots. Natural valves rarely require life-long medication. Heart valve surgery may be recommended for narrowing of the heart valve (stenosis) or leaking of the heart valve (regurgitation).

Intracardiac Electrophysiology Study (EPS)
Intracardiac electrophysiology study (EPS) involves placing wire electrodes within the heart to determine the characteristics of heart arrhythmias. The study is performed in a hospital laboratory by trained staff. The cardiologist inserts a catheter through a small incision in a groin vein. This catheter is equipped with an electrode connected to electrocardiographic monitors. The catheter is then carefully threaded into the heart using an x-ray imaging technique called fluoroscopy to guide the insertion. Electrodes are placed in the heart to measure electrical activity along the heart's conduction system and within heart muscle cells themselves. EPS is an invasive test. If ablation is thought to be the appropriate therapy, it is performed at the time of EPS.