Diagnostic and Interventional Cardiology Unit
The Diagnostic and Interventional Cardiology Unit specialises in the diagnosis and treatment of cardiological diseases. It is divided across two hospitals, Ospedale del Cuore in Massa and San Cataldo Hospital-CNR in Pisa.
It deals with the following activities:
- in the haemodynamics room, where cardiac pathologies treatable by transcatheter technique are managed: ranging from coronary artery pathology by means of angioplasty, advanced intracoronary imaging and stenting, structural pathology, i.e. involving heart valves and other cardiac structures, aortic pathology (abdominal and thoracic treated by means of stent placement), to peripheral vascular pathology (carotid and lower limbs);
- in the outpatient department: initial and follow-up visits of cardiology patients are carried out where necessary, also in the context of specific pathways, e.g. for chronic ischaemic, valvular and structural heart disease (diagnosis, surgical planning and follow-up), as well as post-infarction and chronic heart failure follow-up. There is also a cardio-oncology service, where diagnostic examinations such as exercise tests, Holter monitoring and echocardiographic examinations are carried out;
- in the clinic and in the haemodynamics room: advanced echocardiographic imaging for the diagnosis, classification and intraprocedural monitoring of ischaemic, valvular and structural heart diseases. In particular, this activity takes place in the outpatient clinic and day hospital for diagnosis and assessment by means of stress echocardiography (pharmacological or with cycloergometer), echocardiogram with contrast and transoesophageal echocardiogram, and in the haemodynamic room by means of advanced transoesophageal echocardiography techniques used for the intraprocedural monitoring of percutaneous interventions on valves and other cardiac structures. The unit’s diagnostic tools have also recently been enhanced with cardiopulmonary testing combined with stress echocardiography;
- Day Hospital-Day Service activities: evaluation and treatment of cardiac pathologies requiring one-day hospital admission (e.g. diagnostic coronarography, cardioversions, etc.);
- High complexity day service: this is a service aimed at assessing complex patients with comorbidities who are candidates for highly difficult transcatheter operations (heart valve replacements, aortic aneurysm treatment, etc).
Clinical and interventional activity is the core aspect of the unit, but both clinical and basic research is also carried out, individually (single centre) and in collaboration with other groups of researchers, as well as the training of specialists in the field.
The Unit consists of 10 doctors and 9 nurses.
With regard to coronary heart disease, the Diagnostic and Interventional Cardiology Unit is responsible for:
- diagnostic coronary angiography;
- right and left cardiac catheterisation
- coronary angioplasty with stenting;
- treatment of chronic coronary occlusions;
- use of advanced imaging methods including functional (FFR and iFR) and anatomical (IVUS and OCT) imaging;
- treatment of calcific coronary disease by advanced techniques such as rotablator and shockwave;
- positioning of a coronary sinus device for the treatment of chronic angina without further possibility of revascularisation and refractory to medical therapy (Reducer device).
With regard to structural heart disease, the Diagnostic and Interventional Cardiology Unit deals with:
- transcatheter aortic valve (TAVI) positioning via the transfemoral, transapical or trans-subclavian approach;
- transcatheter mitral annuloplasty procedure (Cardioband);
- mitral valvuloplasty procedure via the percutaneous “edge to edge” intervention (MitraClip or Pascal);
- mitral balloon valvuloplasty procedure in mitral stenosis;
- placement of transcatheter mitral valve prosthesis via the percutaneous or transapical route;
- percutaneous treatment for tricuspid valve disease;
- percutaneous exclusion procedure of the left auricle; in addition, the unit is involved in trials for the use of new devices for the treatment of the mitral valve that are not currently available on the market;
- inter-atrial defect closure procedure (IAD and PFO);
- percutaneous paravalvular leak repair procedure using a plug;
- transcatheter endomyocardial biopsy procedure.
With regard to aortic and peripheral cardiac vascular disease, the Diagnostic and Interventional Cardiology Unit deals with:
- aneurysmal disease of the abdominal aorta;
- aneurysmal disease of the ascending thoracic aorta/aortic arch;
- stenosing atherosclerotic disease of the peripheral vascular districts including carotid, subclavian, iliac, femoral and below-the-knee arterial disease.
The Unit has also developed a team dedicated to advanced echocardiographic imaging that performs the following procedures:
- First- and second-generation contrast-enhanced echocardiography for the diagnosis of atrial shunts and intracardiac masses and the assessment of left ventricular function;
- use of intracardiac echocardiography (ICE) for guiding transcatheter interventions that do not involve general anaesthesia but only local anaesthesia;
- Three-dimensional transthoracic echocardiography;
- Pharmacological stress echocardiography: dipyridamole and dobutamine with and without contrast medium to screen for ischaemia and assess valve disease;
- Physical stress echocardiography to screen for ischaemia and assess valve disease;
- Transoesophageal echocardiography with three-dimensional methods for the diagnosis and characterisation of complex valvular and structural heart diseases;
- Intraprocedural transoesophageal echocardiography for the guidance of structural interventions;
- Transoesophageal echocardiography under sedation and electrical cardioversions.
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