Insertion of tiny heart pump without surgery

Cardiologists at the University of Illinois Medical Center at Chicago are leading the Midwest in offering improved treatment options to patients, from the most advanced techniques in angioplasty, to lowering the amount of radiation exposure during heart scans, to opening an innovative clinic that treats heart disease and depression together.

For patients needing cardiac catheterization for angiograms or angioplasty, Dr. Adhir Shroff and Dr. Mladen Vidovich, assistant professors of cardiology at the UIC College of Medicine, are routinely threading the catheter through the small radial artery of the wrist rather than the large femoral artery in the groin. This simple change can reduce complications and recovery time and decrease hospital costs. It has been introduced with great success at UIC and the Jesse Brown VA.

Although the technique is widely used in Europe and India, physicians in the U.S. have been slow to adopt it. "The issue is really just the learning curve," said Shroff. "The change requires dozens of small changes."

"Repairing the Heart Through the Wrist"

These same physicians are also the first in the region to use a tiny heart pump that can be inserted without the need for surgery. Patients with the worst blockages are often the sickest, making it too dangerous to treat their coronary artery blockages with standard angioplasty or even with a bypass operation, says Shroff. The Impella heart pump makes it possible to offer less invasive procedures to high-risk patients.

"Our ability to continuously maintain blood flow will decrease complications during these high-risk cases where the patient had no other options to fix their heart arteries," Shroff said.

Smaller than a pencil eraser, the Impella is implanted through a catheter threaded into the left ventricle. From this position, it pumps blood from within the heart into the aorta, supplementing the weakened pumping of the heart.
"Tiny Heart Pump Helps Treat the Sickest Patients"

Vidovich has introduced a new way of timing heart scans that can reduce the radiation dose by 70 to 80 percent. A computational innovation called prospective gating controls the scan by determining the moment during the heartbeat that the heart is still, and only exposing the patient to radiation at this optimal instant for a clear picture. Although heart scans are safe, over a lifetime people are exposed to more radiation than they realize, said Vidovich, and reducing cumulative radiation exposure is an important consideration, especially for women and young patients.

UIC cardiologists have created a unique service, the Heart and Mind Clinic, based on evidence of a biological link between heart disease and depression.

"We have really known for centuries that there is a link between mental states and the heart -- for example, every language has an expression that translates to 'dying of a broken heart,'" said Dr. Radmila Manev, associate professor of psychiatry at UIC and co-director of the clinic.

Patients at the clinic are screened and treated for depression and heart disease at the same time. Although studies have established that 30 percent to 40 percent of people with heart disease have depression, little had been done to link the treatment of the two, said Vidovich, co-director of the clinic. "Studies have shown that heart patients who are screened and treated for depression survive longer and suffer fewer subsequent cardiac events, such as another heart attack."

The clinic will also be a resource for research, says Dr. Hari Manev, professor of pharmacology in psychiatry and scientific director of the clinic, "helping us understand the biological basis for depression, and even the possibility that there are different types of depressions with different biological bases."

"New Heart and Mind Clinic Studies Depression in Heart Patients"