Heart disease: Intervention in treatment for a long healthy life

Worldwide heart disease is demanding growing attention due to rising morbidity and mortality, imposing a significant challenge for healthcare. Treatment of heart disease needs a holistic approach along with life-long follow up. Emergence of interventional cardiology has practically revolutionised diagnosis and treatment of cardiovascular diseases. It is often more effective than surgery in some cases, and a good alternative in many cases for frail and high-risk subgroups.

In the treatment of coronary artery disease, coronary angiogram is now the gold standard test and sometimes the only test to correctly diagnose coronary artery disease and direct planning of treatment. Angioplasty with or without stent placement is the prime arena of interventional cardiology.

Coronary angiogram and angioplasty use special contrast agent to visualize the coronary obstructive lesion. During angioplasty, a balloon tipped catheter is used to widen narrowed arteries to restore blood circulation to the heart muscle and stents are deployed when necessary. Modern facilities like intravascular imaging, and physiological assessment act as adjunctive diagnostic and monitoring tools.

For calcified lesion, special devices like atherectomy device, laser, intravascular lithotripsy balloon etc. are pivotal for successful outcome. Special devices like mechanical thrombectomy device, thrombo-suction catheter, rotational angio-jet device, embolic protection device etc. have evolved for the treatment of heart attack.

Angioplasty has reached a state of the art owing to the diversification of catheters, wires, balloon, stents and what not! Dr. F. Mason Sones, Jr. did the first coronary angiogram in 1958 and Andreas Grüntzig introduced percutaneous transluminal coronary angioplasty in 1977. The development in the same field today is magnificent in terms of device, technological aspects and efficiency. From balloon to bare metal stent to drug eluting stent, bioabsorbable scaffold, recently drug eluting balloons! - the technological progress is breathtaking.

A very promising sector of intervention is treatment of heart rhythm disorder. Pacemaker, Implantable cardioverter defibrillator reduces mortality and improves quality of life. Electrophysiological study is necessary to diagnose the origin of abnormal beat, helps in mapping and planning for radio frequency catheter ablation of the abnormal focus. Leadless pacemaker is a new technology which abates the risks of leads, vascular access complications and leaves no incision and thus devoid of resultant scar and chance of infection. This device is self contained and much smaller in size.

Structural heart disease is gaining more and more importance as suitors for interventional corrections. Cardiac resynchronization therapy with or without defibrillator is a modality for heart failure patients with poor cardiac activity. For hypertrophic cardiomyopathy, alcohol septal ablation is sometimes curative in selective cases. Left atrial appendage occlusion, soon to be available in Bangladesh, promises stroke free survival in a specific group of atrial fibrillation patients with high bleeding risk for anticoagulation use. For treatment of congenital heart defect like ASD, VSD, PDA, PFO etc. we use percutaneous closure devices.

Percutaneous intervention of valvular heart disease has brought revolution and deferred, sometimes made, surgery unnecessary. From the mitral valvuloplasy (PTMC) to pulmonary valvuloplasy, transcatheter edge to edge repair (TEER) for mitral and tricuspid valve, transcatheter aortic valve replacement (TAVR) opened new horizons for the treatment of valvular heart disease.

Percutaneous intervention needs skill, training, dedication and policy, specialized laboratories, equipment for maintaining proper treatment flow. The procedures demand exposure to dangerous radiation and contrast induced hazards. In some instances, it is more costly in comparison to surgery. From the perspective of our country, the field of cardiology has advanced because of the endless efforts from the pioneers and cardiologists on boarding, in most of the cases personal pursuit for training at home and abroad prevails.

Government should come forward to help the sector reach the zenith by providing proper training opportunities, equipment, guidance, making policy for better service. The whole world is now exploring the fields of robotics assisted and AI guided intervention, stem cell therapy for treatment of heart diseases. We dream for superior genre therapy by intervention in future within this country as a progressive one. And sky is the limit.

Interventional cardiology has transformed the landscape of heart disease treatment, offering effective, minimally invasive solutions for conditions once requiring open-heart surgery. By improving survival, reducing recovery time, invasiveness, hospital stay and enhancing quality of life, it plays a vital role in modern cardiovascular care. However, challenges such as cost, accessibility remain, and long-term follow-up is a must without which the benefit is questionable. With continuous advancements in technology and techniques, interventional cardiology will continue to expand its role in combating the global burden of heart disease.

* Dr Tunaggina Afrin Khan is a consultant of Clinical & Interventional Cardiology at Unico Hospitals PLC