The decision to perform a balloon angioplasty is taken after you have been to the cardiac catheterisation laboratory and the narrowing in your arteries has been carefully assessed. If the narrowing is reasonably accessible, and provided only one or two vessels are involved, the cardiologist may recommend PTCA (coronary angioplasty).
This procedure is an extension of coronary arteriography and involves the dilation of the effected vessel or vessels by means of a balloon. This is usually performed at the initial cardiac catheterisation or a few days later.
The risk of bleeding from the puncture site is much greater than with a simple arteriogram, and it is therefore advisable to remain immobile in bed for 24 hours after the procedure.
The long-term success of this procedure depends upon keeping the recently-dilated narrowing in the artery open and clot-free. The taking of anti-platelet drugs such as aspirin (Disprin), etc. assist greatly. Most patients will also be kept on medication for six to twelve weeks to prevent the coronary artery going into spasm.
On discharge if you experience any chest discomfort, pain or bleeding from your groin, you should contact your doctor immediately. Your doctor may ask you to visit him after four to six weeks for a follow-up stress test. Long-term medication may include cholesterol-lowering drugs.
It is extremely important to follow your medication regimen.
Cardiac catheterisation procedures
Cardiac catheterisation - also known as an angiogram - is performed to evaluate the functioning of the heart muscle and valves, and to take photographs of the coronary arteries to see whether there is any serious narrowing or obstructions present in the arteries.
If narrowing has occurred the position, severity and number of instances of narrowing can be determined. This information is used to decide, together with you, what the best treatment would be for your particular case.
The examination takes place in the cardiac catheterisation laboratory which is equipped with the necessary X-ray equipment. A technologist and radiographer, who are in private practice, will be in attendance throughout the procedure.
The procedure is usually performed in the right hand side groin area. This area is cleansed and draped, and the skin is anaesthetised with a local anaesthetic injection - similar to that used by a dentist. You will experience a burning sensation for a few seconds, after which you should feel no pain.
A thin needle is then placed in the artery, after which a catheter (a thin plastic tube) is inserted. You will not be aware of the catheter inside the blood vessels or heart, and will only feel manipulation in the groin.
The catheter is inserted into the left main artery. Photos are then taken in different positions to examine all the branches of the artery. Whilst the photos are being taken we shall ask you to hold your breath for a short period. Pressure will again be placed on the groin as the catheter is changed and another is put in position to take photos of the right coronary artery.
To judge the movement of the heart muscle, a ventriculogram is done. Dye is injected into the left ventricle through a catheter while the photos are taken. During this procedure you will feel a warm flush which is caused by the dye. This feeling does not last very long and the whole procedure lasts approximately 45 minutes.
You may be told the preliminary findings immediately and the final results and the recommended treatment will be discussed with you later in the day or the following morning.
You may have a plastic sheath in your groin which will be removed by the nursing staff once you are back in the ward. A sandbag will then be placed on your groin for approximately two hours after the angiogram to prevent any bleeding. It is important to lie flat on your back and not flex your leg during this time.
You will not be allowed to eat or drink for one hour after the procedure.
If you are sensitive to iodine notify your doctor immediately.