Left Main Percutaneous Coronary Intervention (PCI) is a minimally invasive procedure used to treat a blockage or narrowing in the left main coronary artery. On an average, the left main coronary artery provides blood flow to approximately 60-75% of the left ventricle and as much as 85-100% in case of a left dominant circulation. 

         Left Main PCI is considered a complex procedure and requires the expertise of a specialized interventional cardiologist.It is typically recommended for patients who are not suitable candidates for coronary artery bypass surgery, which is a more invasive procedure.

          Bifurcation Percutaneous Coronary Intervention (PCI) is a specialized procedure performed to treat blockages or narrowings in the point where a coronary artery branches into two smaller vessels, known as a bifurcation. 

          It is a complex & technically challenging procedure that requires the expertise of an interventional cardiologist with experience in treating these types of lesions. It requires careful consideration and classification of the coronary artery anatomy, bifurcation angle, side branch size, extent of disease as well as the patient’s clinical status (stable vs unstable) to decide on appropriate treatment strategy CABG vs PCI. There are several specialized techniques as well as bail-out techniques for bifurcation PCI which the interventional cardiologist needs to be well versed with for optimal results in these complex cases.

      Optical Coherence Tomography, is a diagnostic imaging technique used in cardiology to visualize and assess the coronary arteries and intracoronary structures with high resolution.

      A probe emits near-infrared light, which is reflected back by the tissues, creating detailed images of the vessel walls and structures. These images provide information about the composition of plaques, the degree of blockage, and the presence of any abnormalities like dissections, intramural hematoma, thrombus and its types and precise stent assessment like apposition, expansion etc. and even identification of subtle abnormalities.

      The images generated by OCT assist cardiologists in making accurate diagnoses, guiding interventions, and assessing the effectiveness of the treatment. It has become an essential tool in interventional cardiology for optimizing outcomes and improving patient care.

      FFR (Fractional Flow Reserve) is a measurement obtained during cardiac catheterization, where a thin wire with a pressure sensor is threaded through the blood vessels to the site of the blockage. A value of less than 0.80 indicates significant narrowing and suggests the need for intervention, such as stenting or bypass surgery, to improve blood flow and reduce the risk of adverse cardiac events.

      RFR, on the other hand, is a newer technique that uses the same pressure wire but provides a measurement without the need for the administration of hyperemia-inducing medications. It provides a ratio similar to FFR, with values less than 0.89 indicating significant stenosis.

      Both FFR and RFR help guide decision-making in determining whether a blockage is causing a significant reduction in blood flow and whether intervention is necessary. These measurements assist cardiologists in identifying which lesions require treatment, optimizing patient care, and reducing the number of unnecessary interventions.

      IVUS, or Intravascular Ultrasound, is a medical imaging technique used in cardiology to visualize and assess the coronary arteries from within.

      The IVUS probe emits sound waves that bounce off the surrounding tissues and structures, creating detailed cross-sectional images of the blood vessel walls. These images provide cardiologists with information about the vessel’s size, determination of the plaque composition, and measurement of the degree of stenosis or narrowing. IVUS is particularly useful in complex lesions, such as those with Left Main Coronary Artery disease, diffuse disease, calcification or eccentric plaques.

      IVUS assists cardiologists in making accurate diagnoses, guiding treatment decisions, and optimizing stent placement during interventions by facilitating proper stent sizing and post stenting assessment.

      IVL or Intravascular Lithotripsy, is a minimally invasive technique used in cardiology to treat calcified coronary artery lesions. A special catheter with an integrated balloon and lithotripsy emitter is inserted into the blocked artery, typically through the groin or wrist. Once positioned at the site of the calcification, the balloon is inflated, and low-energy sonic pressure waves are delivered to the plaque. These pressure waves create microfractures in the calcified plaque, allowing for better expansion of the artery and improved blood flow.

      By safely modifying the calcified plaque, IVL helps to optimize stent delivery and expansion, reducing the risk of complications such as vessel dissection or perforation or  inadequate stent deployment.

      Rotablation is a specialized technique used in cardiology to treat severely calcified coronary artery lesions. It involves the use of a tiny, diamond-tipped burr mounted on a high-speed rotational device to gently remove the hardened plaque from the inner lining of the blood vessels.

      Rotablation allows for precise and controlled removal of the calcified plaque, improving the vessel’s ability to expand and restore proper blood flow. After rotablation, additional treatments such as balloon angioplasty or stent placement may be performed to further optimize the blood flow in the treated artery.

       Percutaneous balloon mitral valvotomy (PBMV) is a minimally invasive procedure used to treat mitral valve stenosis, a condition where the mitral valve in the heart is narrowed, impairing blood flow between the left atrium and the left ventricle.

      During a PBMV procedure, a thin catheter with a deflated balloon at its tip is inserted into a blood vessel, typically through the groin. The catheter is guided to the site of the mitral valve using X-ray imaging and advanced imaging techniques. Once in position, the balloon is inflated, which helps to widen the narrowed valve opening. It stretches the rigid valve leaflets, separating them and improving blood flow through the valve.

      It can provide immediate relief of symptoms such as fatigue, shortness of breath, and fluid retention. Additionally, PBMV can improve heart function and reduce the risk of complications associated with severe mitral valve stenosis.

      Device closure is a minimally invasive procedure used to treat certain types of heart defects, including Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), and Patent Ductus Arteriosus (PDA).

      During the procedure, a catheter with a closure device attached to it is inserted into a blood vessel, typically in the groin. The catheter is carefully guided to the heart, where the defect is located. The closure device is then positioned and released to close the hole or opening in the heart.

      For ASD closure, the device seals the abnormal opening between the two upper chambers of the heart (atria). Similarly, for VSD closure, the device closes the abnormal hole between the two lower chambers (ventricles). In the case of PDA closure, the device is used to block the persistent connection between the aorta and the pulmonary artery.

      The closure device is designed to promote tissue growth over time, eventually permanently closing the defect. This eliminates the need for open-heart surgery, resulting in faster recovery and fewer complications improving the quality of life for many patients .

      Transcatheter Aortic Valve Implantation, is a minimally invasive procedure used to treat aortic valve stenosis, a condition where the aortic valve becomes narrowed, impairing blood flow from the heart to the rest of the body.

      During a TAVI procedure, a catheter with a collapsible replacement valve is inserted into a blood vessel, typically in the groin or chest. The catheter is guided to the site of the diseased aortic valve using advanced imaging techniques such as X-ray or echocardiography. Once in position, the replacement valve is expanded, pushing aside the diseased valve leaflets and assuming the function of a normal valve.

      TAVI is an alternative to open-heart surgery for patients who are at high risk or deemed unsuitable for surgery. It can be performed under local anesthesia, and the recovery time is typically shorter compared to traditional open-heart surgery. TAVI is particularly beneficial for elderly patients or those with multiple comorbidities.

      Cardiac Resynchronization Therapy, is a treatment approach used in cardiology to improve the heart’s pumping efficiency in patients with heart failure and abnormal electrical conduction.

      During a CRT procedure, a specialized device, known as a biventricular pacemaker or cardiac resynchronization therapy device, is implanted under the skin of the chest. The purpose of CRT is to coordinate the contractions of the heart’s chambers and restore synchronous pumping. The device delivers small electrical impulses to the heart, stimulating the ventricles to contract simultaneously, thereby improving the heart’s efficiency and blood flow.

      CRT is typically recommended for patients with heart failure who have a reduced ejection fraction (a measure of the heart’s pumping capability) and have shown evidence of electrical dyssynchrony.