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Other Invasive Procedures:

Assessment of narrowing of Coronary Arteries:

Intravascular Imaging:

Intravascular Ultrasound

Intravascular Ultrasound (or IVUS) allows us to see a coronary artery from the inside-out. This unique point-of-view picture, generated in real time, provides information that goes beyond what is possible with routine imaging methods, such as coronary angiography, performed in the cath lab, or even non-invasive Multislice CT scans.

IVUS is done in the catheterization laboratory in conjunction with angiography, using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. IVUS enables accurately visualizing not only the lumen of the coronary arteries but also the atheroma (membrane/cholesterol loaded white blood cells) "hidden" within the wall.

It can also provide more accurate stent placement, reducing complications and the incidence of stent thrombosis.

Optical Coherence Tomography or Optical Frequency Domain Imaging (OCT/OFDI)

OCT and OFDI are novel invasive imaging technique producing high resolution intracoronary images. Their general principle of operation is similar to IVUS, however OCT/OFDI use infrared light, not ultrasound.

It gives better resolution and enables detailed evaluation of coronary atherosclerotic plaques and of the vascular response to coronary interventional devices, such as new generation coronary stents. These new imaging techniques can also be used as guide for coronary intervention including stent placement and assessment of previously inserted coronary stents.

Fractional Flow Reserve:

Fractional flow reserve (FFR) is a technique used in coronary catheterization to measure pressure differences across a coronary artery stenosis (narrowing, usually due to atherosclerosis) to determine the likelihood that the stenosis impedes oxygen delivery to the heart muscle (myocardial ischemia). FFR is a novel and potentially clinically useful mathematical model for estimation of stenotic coronary artery atherosclerosis.

During coronary catheterization, a catheter is inserted into the femoral (groin) or radial arteries (wrist) using a sheath and guidewire. FFR uses a small sensor on the tip of the wire (commonly a transducer) to measure pressure, temperature and flow to determine the exact severity of the lesion. This is done during maximal blood flow (hyperemia), which can be induced by injecting products such as adenosine or papaverine. A pullback of the pressure wire is performed, and pressures are recorded across the vessel.

There is no absolute cut-off point at which FFR becomes abnormal; rather, there is a smooth transition, with a large grey zone of insecurity. In clinical trials however, a cut-off point of 0.75 to 0.80 has been used; higher values indicate a non-significant stenosis, whereas lower values indicate a significant lesion.

In addition, Professor Ahmed can also arrange the following treatments:

• Coronary bypass surgery

• Heart valve repair and surgery

• Hole closure in the heart

• Implantable loop recorder

• Pacemaker insertion

• Intracardiac Defibrillator (ICD)

• Transoesophageal echocardiogram

• MRI-Heart and Great Vessels

• Transcutaeneous Aortic Valve Implantation (TAVI)