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At Your Heart’s Service: The Heart & Vascular Center at SUNY Upstate Medical University




A treasured book is one in which the pages lead a reader through an endless series of intertwined events, never dropping the narrative’s connective thread. The same valued engagement can be seen as paramount in patient care. At the Heart & Vascular Center at SUNY Upstate Medical University, specialists guide patients through numerous integrated, advanced therapies from diagnosis to recovery while never allowing the thread of patient support to fall slack.

A part of the Division of Cardiology, the Heart & Vascular Center serves as a hub of cardiovascular services unique to the Central New York area, including cardiac magnetic resonance imaging (MRI), a digital cardiac catheterization laboratory, three- and four-dimensonal echocardiography, and a Stereotaxis magnetic navigation system. Each technology is not only utilized in the diagnosis and treatment of specific cardiovascular diseases, but also in combination to provide hybrid solutions to complex cases.

Similarly, the physicians who make up the Heart & Vascular Center team collaborate across disciplines. Physicians use the physical proximity of their colleagues to their advantage, pulling an expert aside for a quick question about a patient’s procedure or an opinion about the best approach for an unexpected complication. In addition, formal collaboration takes place during daily conferences with Upstate Medical University fellows. As much as physicians within the Heart & Vascular Center are considered resources to each other, they serve as resources for physicians within the community, enabling the practice to merge with the private sector through shared technology and patient care.

“One of the major reasons for the Heart & Vascular Center was the integration of disciplines within cardiovascular medicine, which is facilitated with the enhancement of images and data for review and discussion,” says Daniel Villarreal, M.D., FACC, FAHA, FACP, Chief of the Division of Cardiology and professor of medicine at SUNY Upstate Medical University. “All of the elements are integrated to produce very sophisticated, advanced cardiac services that can support advanced treatment of patients with cardiac disease.”

The Heart in Trouble

The cardiac catheterization laboratory is dedicated to the diagnosis and treatment of coronary artery disease and operates on both an inpatient and outpatient basis. Many patients with chest pain, a positive stress test or symptoms of coronary artery disease are referred by their primary care physician or cardiologist. While the Heart & Vascular Center can provide interventions including coronary angioplasty, endovascular thrombectomy, intra-aortic balloon pumps and stents, diagnostic procedures such as intravascular ultrasound for fractional flow comparisons can be employed first.

The ultrasound technology allows Hani Kozman, M.D., FACC, Director of the Cardiac Catheterization Laboratory and assistant professor of medicine at SUNY Upstate Medical University, and his colleagues to pass a pressure wire across a patient’s coronary lesions. The wire measures the pressure difference between blood flow above and below the blockage and compares the resulting ratio to the pressure in the aorta. Knowing the ratio of the pressure measurements allows Dr. Kozman to determine whether the lesions are causing the patient’s chest pain. The procedure can be performed through the femoral artery or the arm on an outpatient basis.

The Cardiac Catheterization Laboratory is also equipped to provide quick and effective care for patients presenting with emergency chest pain and myocardial infarction.

“We are comfortable with very sick patients. On average, 40% of our total procedures are primary angioplasty when the patient is brought in with a heart attack,” says Dr. Kozman. “We were ranked as the highest acute catheterization laboratory in the state from 2003 to 2005.”

The Heart in Pictures

Building on the center’s expertise and familiarity with cardiac imaging technologies, the Echocardiography Laboratory at the Heart & Vascular Center serves as a multidimensional diagnostic and treatment site. Echocardiography provides vital information for cardiothoracic surgeons about function and motion conditions and assists with tissue synchronization technology in the placement of pacemakers and cardioverter-defibrillators.

The laboratory is also helping pioneer newly developed equipment not yet in wide use, such as that used for three- and four-dimensional echocardiography that is applied to both transthoracic and transesophageal imaging. In combination with tissue Doppler technology, this advanced echocardiogram is able to evaluate the cardiac motion through measurements of the heart’s velocity rather than the blood flow gauged by previous generations of echocardiography technology. This development allows for the detection of subclinical defects and provides improved views of the heart’s pathology and structure.

“Cardiac imaging is the most rapid development in the cardiology field. Imaging has the potential to impact treatment because the modalities are noninvasive and often real-time,” says Kan Liu, M.D., Ph.D., noninvasive cardiologist, Director of the Echocardiography Laboratory at SUNY Upstate Medical University. “These tools could improve the specificity and sensitivity of diagnoses in the future for many cardiac diseases.”

Cardiac MRI has also evolved significantly from the 1980s, when the technology could not capture views of the entire heart and the surrounding vasculature. At the Heart & Vascular Center, the cardiac MRI is utilized to evaluate the cause and prognosis of heart failure, congenital heart disease and life-threatening arrhythmias, as well as to determine the viability of the myocardium before a patient experiences a revascularization.

Without exposing patients to any harmful radiation, the technology gathers images in such detail that physicians are able to pinpoint cardiovascular diseases in earlier stages than were possible to see before by measuring muscle function, blood flow and damaged tissue.

“There is no cardiac imaging modality that can examine the heart muscle and its function in as much detail as cardiac MRI. It is the most advanced and most powerful tool used in the management of patients with a variety of heart diseases,” says Ali Salah, M.D., FACC, Director of Cardiac Imaging and assistant professor of medicine at SUNY Upstate Medical University. “Our imaging tests are performed at the highest standard of care and with state-of-the-art technology to obtain the best results and maximize patient safety, comfort and convenience.”

The Heart in Flutter

Should a cardiac MRI identify a cardiac arrhythmia in a patient, the Heart & Vascular Center can also employ magnetic technology for a further evaluation and treatment of the abnormality. The Electrophysiology Section, under the leadership of Luna Bhatta, M.D., FACC, and Tamas Szombathy, M.D., FACC, has recently acquired a cutting-edge Stereotaxis magnetic navigation system that allows physicians to perform radiofrequency ablation with the assistance of computerized catheter positioning. The system consists of a patient bed, a network of computer-controlled magnets and several monitor screens connected to an overarching computer navigation and treatment platform. The system’s critical advantage lies in its unique ability to guide soft, flexible catheters to delicate, out-of-reach regions of the heart through minimal incisions in the chest.

The network of magnets, which adjusts in a 360º range around the patient bed, connects to the central computer platform to position the catheters. Once the catheters are in place, physicians deliver a dose of radiofrequency ablation to immobilize the arrhythmia’s abnormal electrical signals and allow the heart to return to a normal rhythm pattern. The Stereotaxis magnetic navigation system provides patients with a safer, less-invasive treatment option that has proven to more effectively and definitively treat common and complex arrhythmias. The system is the only one of its kind in the Central New York region.

For more information about the Heart & Vascular Center and the Department of Cardiology at SUNY Upstate Medical University, visit www.upstate.edu/cardiology or call (315) 464-2680.

 


 

 

 

MD News January/February 2012, Central New York


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