Heart & Vascular Institute - Texas Medical Center

Cardiology

The most modern heart facility in Texas, Memorial Hermann Heart & Vascular Institute-TMC offers leading-edge cardiovascular programs and technology, backed by a commitment to excellence in care, research and technology. Our expertise ranges from noninterventional cardiology to minimally invasive interventional techniques, to cardiac surgery, including the use of robotic-assisted procedures.

The first cardiac catheterization in Texas was performed here in 1947, and that spirit of innovation in cardiovascular care continues. Designed as the heart hospital of the future, the Institute was the first: Globally to perform robotic reconstructive aortic surgery, globally to show that heart disease can be reversed, in Texas to give patients clot-dissolving drugs to stop heart attacks, in Texas to offer cardiac risk screening designed specifically for women and in Houston to perform minimally invasive surgery to correct atrial fibrillation.

A distinguished team of cardiologists, clinicians and researchers provide a range of services to patients:

• Cardiac imaging
• Interventional cardiology
• Invasive cardiology
  

Cardiac Imaging

Our cardiac imaging team includes established clinicians and researchers in the field of cardiovascular imaging with particular expertise in the following areas:

• Diagnosis and treatment of valvular heart disease
• Diagnosis and treatment of adult congenital heart disease
• Evaluation and treatment of severe peripheral arterial disease
• Noninvasive evaluation of the extent and severity of coronary arterial disease
• Echocardiography
• Cardiac rehabilitation

• Transthoracic Echocardiogram
  This two-dimensional echocardiogram evaluates cardiac structure and function, including left ventricular systolic/diastolic function. Doppler evaluates valvular function. Tissue Doppler and strain imaging determine LV dyssynchrony and aid in optimization of chronic resynchronization therapy.
     
  
• Transesophageal Echocardiogram
  This study is complementary to the transthoracic echocardiogram in evaluating cardiac structure and function. Commonly performed before cardioversion to rule out the presence of atrial thrombus, the study also aids in the evaluation of ischemic stroke and valvular involvement in endocarditis and gives more detailed information in complex valvular heart disease. Transesophageal echocardiogram offers a detailed assessment of aortic root in dissection.
    
• Stress Echocardiogram
  Using treadmill stress testing, an echocardiogram is performed before and immediately after exercise to assess ventricular function. It is very specific for evaluation of flow-limiting for coronary artery disease.
     
  
• Dobutamine Echocardiogram
  For patients unable to exercise, dobutamine can be used as a pharmacologic agent for stress testing. An echocardiogram is performed before, during and after dobutamine infusion to assess ventricular function in response to a chronotropic agent. It is a routine modality to determine pre-op cardiac risk and provides information on myocardial viability.
     
• Nuclear Medicine
  Based on the emission of gamma rays after patients are injected with a tracer, the cardiac nuclear medicine exam is used for assessment of coronary artery disease as well as myocardial viability. This examination is usually combined with treadmill testing or a pharmacologic agent, such as dobutamine or adenosine for patients unable to exercise.
     
• PET (Positron Emission Tomography)
  Based on emission of positrons after patients are injected with a tracer, PET imaging allows for noninvasive assessment of coronary artery disease and myocardial viability.
     
• Vascular Ultrasound
  Vascular ultrasound is an accurate modality to assess the significance of carotid arterial disease, peripheral vascular disease and peripheral venous obstruction.
   
• Cardiac CT
  An advancing technology in the noninvasive assessment of coronary artery disease, CT angiography also provides information on the structure and function of the heart and great vessels. Calcium scoring provides an estimation of atherosclerotic risk.
     
• Cardiac MR
  Cardiac magnetic resonance imaging offers a detailed assessment of function and structure of the heart and great vessels. It also provides information on the extent of myocardial scarring following infarction.
    
• Holter monitoring
  This technology allows for continuous recording of the heart’s electrical activity while you go about your daily activities. It helps physicians diagnose abnormal heart rhythms and develop the most effective treatment plan.

Referrals
For more information about cardiac imaging studies or to refer a patient, call 713.7CARDIO (22-7346).

Interventional Cardiology

Cardiac interventionalists at the Heart & Vascular Institute-TMC actively pursue promising research, offering patients the opportunity to be among the first in the world to benefit from advances in interventional cardiology.

Scope of Expertise

• Coronary angiography
• Peripheral vascular angiography
• Percutaneous peripheral and coronary revascularization
• Percutaneous closure of atrial septal defects
• Percutaneous closure of patent foramen ovale (PFO)
• Percutaneous mitral, pulmonic and aortic valvuloplasty
• Percutaneous closure of patent ductus arteriosus
• Percutaneous mitral valve repair
• Percutaneous carotid stenting with distal protection
• Percutaneous abdominal aortic aneurysm repair under local anesthesia

Program Highlights

• PFO Treatment
  The Amplatzer PFO Occluder is designed for nonsurgical closure of PFO in patients with recurring cerebral vascular accident (CVA), with no apparent cause. The occluder functions as a plug to close the PFO, an abnormal opening in the wall defining the right and left atria. Made of self-expanding wire mesh with double discs, the device contains inner polyester fabric patches that, along with the mesh, cause the formation of a blood clot that blocks the opening. The occluder is guided to the heart and advanced through the defect in the heart wall via a catheter threaded into a vein in the groin. Tissue grows over the device, which becomes part of the wall of the heart. Closure prevents blood from passing through the PFO, reducing the risk of stroke.
     
• Mitral Valve Repair
  Memorial Hermann-TMC is the only hospital in Houston and one of three in Texas chosen to participate in the nationwide Endovascular Valve Edge-to-Edge Repair Study, or EVEREST II, investigating the minimally invasive Evalve® Cardiovascular Valve Repair System for the treatment of mitral regurgitation. Applying this method, cardiologists deploy a tiny clip, delivered by a catheter, into the heart to repair the malfunctioning mitral valve. Patients return to normal activity within a week. A new use of valvuloplasty – inserting a special balloon into a narrowed mitral valve – may also delay surgery in mitral stenosis patients for eight to 10 years. For patients who require open surgery for repair, minimally invasive valve surgery techniques are available. They involve approaching the mitral valve through a small incision in the right chest rather than performing a sternotomy.
    
• Tandem Heart Trial
  The Institute-TMC is one of 40 clinical sites in the United States for the Tandem Heart trial. The Tandem Heart Left Ventricle Assist Device provides circulatory support during high-risk coronary procedures, such as multivessel stenting. The heart assist device pumps approximately a gallon of blood a minute, decreasing stress on a damaged heart.
     
• Advanced Stenting Techniques
  Physicians at the Institute have a high level of expertise in carotid and multivessel stenting. Our use of drug-eluting stents helps prevent restenosis.
     
• Peripheral Artery Disease Treatment
  Cardiologists at the Institute collaborate with physicians from Memorial Hermann-TMC’s vascular lab, foot and wound service and cardiothoracic surgery department to open smaller vessels to prevent threatened limb loss. Memorial Hermann-TMC operates one of the most active limb salvage programs in the country with a success rate that exceeds the national average at 80 percent.
     
• PATCAR Study
  Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization (PATCAR) speeds up the time in which heart attack victims receive thrombolytic drugs. Under the PATCAR Trial, paramedics wirelessly send an EKG to a cardiologist to approve the immediate administration of thrombolytics. The patient is transported to Memorial Hermann-TMC for follow-up care, which includes angioplasty.

Invasive Cardiology

The Memorial Hermann Heart & Vascular Institute-TMC offers a broad range of treatment options for patients diagnosed with atrial fibrillation or ventricular tachycardia, from noninvasive interventions to device therapy to minimally invasive surgery.

• Coronary angiography
• Peripheral vascular angiography
  • Abdominal aorta
  • Carotid
  • Renal
  • Subclavian
  • Thoracic aortic
• Angioplasty
  • PTCA
  • PTA
  • Balloon angioplasty of aortic coarctation
• Stent placement
  • Coronary
  • Peripheral
  • Carotid
  • Coarctation of the aorta
• Percutaneous recanalization of lower-extremity arteries
• Atherectomy
• Brachytherapy
• Thrombolytic therapy
• Embolization
• Cardioversion
• Permanent pacemaker insertion
  • Biventricular pacemaker insertion
• Electrophysiology
  • Interventions for atrial fibrillation
  • Interventions for supraventricular arrhythmias
  • Interventions for ventricular tachycardia
  • Ablation
  • Reveal® implant
  • ICD™ insertion
• Valvuloplasty
  • Balloon aortic
  • Balloon mitral
  • Balloon pulmonary
• Percutaneous mitral valve repair (investigational)
• Transcatheter closure
  • Atrial septal defects
  • Patent ductus arteriosus
  • PFO
• Heart assist devices
  • TandemHeart™ pVAD
• IABP insertion
• IVC filter placement
• Vertebroplasty

Cardiac Catheterization Labs
The Cardiac Cath Lab provides a comprehensive array of diagnostic and interventional procedures ranging from angiography and pressure wire measurements to intravascular ultrasound, rotational atherectomy, coronary and peripheral stenting and electrophysiology procedures.