• Treatments for Heart Conditions

  

  The heart is a very complex organ, and targeted procedures are needed to treat specific heart problems. See below for a list of treatments for some of the most common heart conditions we treat.

  • Catheter ablation for atrial fibrillation
  • Coronary artery bypass grafting (CABG)
  • Heart valve repair/replacement surgery
  • Left ventricular assist device (LVAD)
  • Percutaneous transluminal coronary angioplasty
  • Transcatheter aortic valve implantation (TAVI)
  • Other treatments

• Catheter Ablation for Atrial Fibrillation

  

  Atrial fibrillation (AF) is the most common heart rhythm disorder, and is usually detected when an irregular pulse occurs. Your doctor will then perform an electrocardiogram (ECG) to confirm the irregular heart rhythm.

  Mount Elizabeth is one of the first hospitals in Singapore to offer AF ablation procedures for patients suffering from this heart rhythm disorder.

  Patients with AF may be at a higher risk of developing a stroke due to the increased possibility of a blood clot forming inside their heart chambers. They are also at risk of developing weakened heart muscles and suffering from heart failure, because AF can compromise the heart muscle's efficiency at pumping blood around the body.

  Many factors, including age and overall heart health, play a part in determining appropriate treatment for AF.

  Catheter ablation is a non-surgical procedure where a thin catheter with electrodes is carefully inserted into the blood vessels and directed into the abnormal site of the heart that is causing the irregular beats. The exact site is then localised and radiofrequency energy is used to ablate (remove) the affected area.

  This technique utilises a 3D mapping system that allows our specialists to combine electrical information from inside your heart with the heart's anatomy.

  Studies show that the condition of patients improve greatly after undergoing catheter AF ablation, with success rates of up to 95 – 98%. Clinical studies have also demonstrated that catheter AF ablation is more effective at restoring and maintaining a normal heart rhythm compared to medication. This may reduce the need for lifelong treatment and also the side effects associated with medication. There is also evidence that catheter ablation can improve heart function.

• Coronary Artery Bypass Grafting (CABG)

  

  Coronary artery bypass grafting is a surgical procedure performed to bypass (go around) blocked coronary (heart) arteries to restore blood flow to the heart. During the procedure, healthy blood vessels from another part of the body, such as leg veins or the internal mammary artery, are surgically removed and sewn around the blocked part of the affected artery. This creates an alternative route for oxygen-rich blood to bypass the blocked part of the coronary artery and restore blood flow to the heart.

  Surgeons commonly perform this procedure to treat cases of severe coronary heart disease, which is characterised by the hardening of the heart arteries due to the build-up of fatty deposits, called plaque, in the walls of the arteries. Plaque can accumulate and eventually clog the arteries, restricting blood flow to the heart. Coronary artery bypass grafting is used to treat severe blockages that greatly reduce the ability of the heart to effectively pump blood throughout the body. This treatment restores normal blood flow to the heart and alleviates the symptoms associated with coronary heart disease including angina (chest pain).

  If the bypass is performed using the great saphenous vein from the leg, or the radial artery from the arm, they are harvested traditionally using open surgery, requiring a long incision down the forearm, or from the knee to the calf or hip. A newer, minimally invasive procedure known as endoveinous (for the leg) or endoradial (farm) harvesting uses a special flexible tube to harvest the blood vessels. This method only requires a single incision of around 1 inch or less instead of a long incision down the limb. Using this method of minimally invasive harvesting lowers the risk of infection and avoids the unsightly long scars of the traditional method. In the context of the hot Singaporean weather, patients will not need to hide their long scars by wearing long sleeved shirts and long pants.

  This procedure can also lower the risk of a heart attack, especially if you have diabetes. It also improves your chance of survival and may improve your quality of life.

• Heart Valve Repair/Replacement Surgery

  

  There are 4 valves in your heart which act like doors to control the blood flow between different parts of the heart. Valve problems can occur due to congenital abnormalities (present at birth), or can be acquired later in life as a result of infection and degeneration. The affected valves can be repaired or replaced through heart valve surgery.

  Valve repair consists of fixing the damaged valve as much as possible, usually without the use of artificial parts. If all efforts to repair the malfunctioning valve fail, your surgeon will replace the valve during the same procedure.

  The valve can be replaced using artificial valves (made of plastic or metal), or bioprosthetic valves (made of biological material from animal tissue), or an allograft valve (human valve tissue).

  During heart valve surgery, an incision down the middle of the chest is made and the breastbone is separated. Your surgeon will assess whether this procedure or a less invasive key-hole surgery is more suitable for you.

  Heart valve repair/replacement surgery is used to treat patients of valvular heart disease. Your doctor will evaluate the condition of your heart valves, and the decision for heart valve surgery will be based on your symptoms and test results. For example, the repair of the aortic valve (the valve between the aorta and the left ventricle) is crucial if it is narrowed or leaking. Abnormal functioning of the aortic valve can lead to heart failure due to insufficient blood supply to the heart.

  If the damaged valve is successfully repaired through the heart valve surgery, you will benefit from:

  • Reduced risk of infection
  • Reduced need for long-term blood thinners
  • Reduced risk of stroke
  • Better preservation of your heart function
  • Increased chance of long-term survival

  If damaged valves are not repaired, other heart diseases or even death may result.

• Percutaneous Transluminal Coronary Angioplasty

  

  Percutaneous transluminal coronary angioplasty, also known as balloon angioplasty, is a non-surgical procedure used to re-open the coronary (heart) arteries that have been narrowed or blocked due to the accumulation of plaque (fatty deposits). This allows blood flow to the heart to be restored.

  During the procedure, a flexible catheter with a deflated balloon at the tip is introduced into an artery in your wrist, arm or groin. The catheter is then slowly guided towards the affected part of the coronary artery, and the balloon inflated and deflated several times to compress plaque against the walls of the coronary arteries. This will result in the widening of the artery and the restoration of normal blood flow to the part of the heart fed by this artery. A stent (a tiny expandable metal coil) may also be implanted to help keep the artery open and decrease the risk of re-blockage.

  The current golden standard treatment for coronary artery disease are drug-eluting stents, delivered to the blocked artery to keep it open and allow the blood to flow smoothly. Drugs that help prevent clogging may be inserted into the artery at the same time as the stent. This procedure will restore the blood flow through the artery and improve the symptoms of heart disease.

  Bioresorbable scaffolds (BRS) or “dissolvable stents” heralds a new concept in the treatment of coronary artery disease. This implanted stents are unique in that they gradually dissolve and disappear after 2 – 3 years. They have the potential advantages of reducing the risk of very late stent clotting, restoring coronary artery function and tone and not leaving behind a permanent implant.

  The doctor may recommend percutaneous transluminal coronary angioplasty if prescribed medications and lifestyle changes have not been sufficient to reduce the effect of the blocked arteries. The doctor may also recommend this procedure if your symptoms, including chest pain and shortness of breath, are getting worse.

  The success rate of this procedure is often very high (around 90%) and the risk of complications is very low. Percutaneous transluminal coronary angioplasty is a minimally invasive procedure that does not require the use of general anaesthesia. A successful angioplasty can relieve your symptoms (chest pain), allow you to resume normal activity and increase your chance of long-term survival.

• Left Ventricular Assist Device (LVAD)

  

  The left ventricular assist device, or LVAD, is a device which supports the left heart ventricle’s pumping action.

  Mount Elizabeth hospitals offer LVAD implantation as well as destination therapy (an alternative to heart transplant) for patients suffering from chronic heart failure.

  The thickest of all the heart’s chambers, the left heart ventricle pumps oxygenated blood to tissues in the body in order to maintain healthy blood circulation. LVAD is normally used for patients with a severely weakened heart despite medication, particularly in cases where the patient has end-stage congestive heart failure. In heart failure, the heart's muscles weaken and over time, loses the ability to pump enough blood to support the body's functions.

  Patients suffering from end-stage congestive heart failure may experience:

  • Breathlessness
  • Swelling of the body
  • Difficulty in sleeping, eating, walking
  • Persistent low blood pressure
  • Disruption of organ functions such as in the kidney and liver

  During LVAD implantation, the doctor will connect one end of the pump to your left ventricle and the other to your aorta, the biggest artery in the body. The LVAD is then joined via a special cable to a computer controller and a battery that remain outside of your body.

  For patients with heart failure, the LVAD can help restore normal blood flow, thereby relieving symptoms of heart failure such as persistent tiredness and shortness of breath.

  An LVAD can also be used to stabilise a patient’s medical condition before a heart transplant.

  However, if a patient is not a suitable candidate for a heart transplant, the LVAD can still be used an option to restore normal blood circulation. Called destination therapy, studies have shown that this may double the 1-year survival rate of patients with end-stage heart failure, as compared to treatment with medication alone.

• Transcatheter Aortic Valve Replacement/ Implantation (TAVR/ TAVI)

  Transcatheter aortic valve replacement/ implantation (TAVR/ TAVI) is a minimally invasive treatment option for severe aortic valve stenosis (severe AS).

  In our team of healthcare professionals are specialists involved in one of the first TAVR procedures in Asia as well as one of the proctors for a global TAVR programme.

  The aortic valve in the heart allows blood to be pumped out to the rest of the body. With ageing, the aortic valve may become narrowed. In severe AS, the valve narrowing becomes severe and patients usually develop breathlessness, fainting spells and chest discomfort. Left untreated, up to 50% of patients may die from the condition within 2 years.

  Open heart surgery to replace the aortic valve is conventionally used to treat severe AS. However, the surgical risks are often high for many elderly patients and those suffering from debilitating diseases, like poor heart function, severe lung disease and end stage renal failure. Some patients are even considered inoperable.

  TAVR/TAVI is now an alternative treatment option for elderly patients suffering from severe AS. This minimally invasive method is usually performed via a small puncture in the groin and occasionally, via a small cut in the side or front of the chest. A guiding catheter, a thin and flexible tube, is used to implant an aortic valve onto a beating heart.

  Unlike open heart surgery to replace the aortic valve, with TAVR/TAVI, the patient's chest is not cut open and the heart is not stopped. The procedure can also be done under local anaesthesia.

  Step 1: Balloon Valvuloplasty

  

  Guided by a catheter, an inflatable balloon is first inserted into the aorta to open up the heart valve.

  Step 2: Aortic Arch Navigation

  

  The transcatheter heart valve is navigated through the artery into the heart.

  Step 3: Native Valve Crossing

  

  The artificial valve is placed in position in preparation for deployment.

  Step 4: Deployment

  

  The inflatable balloon is used to deploy and lock the valve in place. There are also other TAVR/TAVI valves that are self-expanding and do not require a balloon for deployment.

  Step 5: Final Assessment

  

  The catheter is removed and the new valve is now functioning in place of the original diseased valve.

  TAVR/TAVI may be an option for people who have severe AS and at increased risk for surgery, or who are not suitable for open heart surgery. The procedure aims to alleviate the symptoms associated with AS and improve life span.

  Following the procedure, you may have to spend 3 to 5 days recovering in the hospital, which may include a period of observation at the intensive care unit, before you can be discharged.

  There are potential risks for the TAVR/TAVI procedure, including:

  • Risk of bleeding
  • Infection
  • Heart attack
  • Stroke
  • Death
  • Abnormalities in heart rhythms

  Our specialists will be able to provide advice on your suitability for TAVR/TAVI and answer your questions about the procedure.

• Other Treatments We Perform

  • Automatic Implantable Cardioverter-Defibrillator (AICD) Implantation
  • Pacemaker Implantation
  • Paediatric/Congenital Heart Repair Surgery
  • Surgery for Heart Failure
  • Thoracic Aortic Vascular Surgery and Endovascular Aneurysm Repair

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