Hi-tech Cath Lab & Cardiology Service
Our Department of Cardiology is pioneer in region and recently completed 25 glorious years. We have dedicated Team of Cardiologist with Internationally renowned Dr. Ajit Bhagwat heading the Department.
Our team consists of Adult and paediatric Interventional Cardiologist, Electrophysiologist, as well adult and paediatric cardiovascular surgeons. We can proudly say that we have advanced Cath lab with IVUS, OCT imaging facilities as well as rich experience in doing complex PCI using Rotablation, IVL etc. Our Institute was first in Marathwada region to perform Transcatheter Aortic Valve Implantation (TAVI) and have successfully completed 5 TAVI recently. Our centre also provides training in Interventional Cardiology being accredited by national board of education for DNB Cardiology.
Stenting of the renal artery ostium of the transplanted kidney:
A 38Y M had undergone kidney transplant 4 months ago. He presented with headache and vomiting. BP was found to be 200/120mm which couldn’t be controlled with 5 drugs. His serum Creatinine had jumped from 0.8 to 1.3 mg%. Abdominal duplex ultrasound revealed presence of severe renal artery stenosis (RAS) of the transplanted kidney that was transplanted in the right iliac fossa. Renal artery was anastomosed end to side with the external iliac artery.
His CT angiography was performed that revealed a critical 90% ostial stenosis of the renal artery supplying the transplanted kidney and it was confirmed on catheter angiogram (Fig1,vid. 1).
Percutaneous revascularization was plannted Renal artery ostium was engaged with IMA guide catheter and the lesion was crossed with 0.014″ run-through floppy coronary guide wire. The lesion was dilated with 3.5 mm X 12 mm non-compliant ballon (Fig 2) followed by stenting with a 3.5 mm X 18 DES (video 2) resulting in excellent final angiographic result. (Fig 3, video 3) There was a remarkable improvement in patient’s BP over next one week and presently he is on a single drug (5 mg of Amlodipine) with well controlled BP. Serum Creatinine came down to 1.0 mg%.
Take Home Points:
- RAS of transplanted kidney is rare & related to technical issues during surgery.
- Hypertension and worsening renal function are the usual manifestations.
- It is important to understand the anatomical details of surgery from the surgeon before PCI
- Pre-PCI CT angiogram is useful to understand the anatomy.
- Minimal diluted contrast should be used as it is a precious single kidney.
- Choice of guide catheter depends on the angle of anastomosis. RJ, IMA or hockey stick catheter ususally work.
- The ostial stenosis in such cases may be difficult to dilate in presence of suture material and hence cutting balloon may come handy.
- It is better to leave a strut or two of the stent in the external iliac artery rather than cut it too close to nail the ostium and ultimately miss it.
- BMS and DES work equally well in RAS.
- 20-20 deg LAO-caudal opens up the right iliac fossa well and delineates the anastomotic site. However fine tuning the angle may be necessary.
Procedure Details:
- Fetal, Paediatric and Adult transthoracic and transesophageal Echocardiography
- Dobutamine stress Echocardiography,
Transradial and Transfemoral Angiography and Angioplasty - Complex PCI-with Rotablation, IVL
- Bifurcation PCI, Imaging PCI with IVUS and OCT
- Pacemaker Implementation- Single and Dual
- Automated Cardiac Implantable Defibrillator Implementation
- CRT-P and CRT-D implementation Balloon Mitral Valvotomy
- Transcatheter Aortic Valve Implantation (TAVI)
- Electrophysiology Study and Radio frequency ablation
- ASD, VSD, PDA and Post MI VSR device closure
- Right heart Cath
Procedure Statistics:
- More than 35000 Interventions in last 25 years.
- More than 2000 interventions yearly including LM PCI, bifurcation PCI, TAVI, post MI VSR device closures.
Equipment Details:
- Philips Azurion Cath lab GE Vivid Echocardiography Machine
- Treadmill Machine
- 24hrs and Extended Holter Monitor
- IVUS and OCT imaging
- Rotablator
