Heart Care

The increasing number of cardiovascular diseases is among the top causes of death and their diagnosis and treatment should be performed by experienced physicians in fully equipped hospitals with advanced medical technologies.

The Heart Care Centers of the ACIBADEM Healthcare Group compete on a world class level to provide the most modern heart care in Turkey. ACIBADEM uses state-of-the-art technological equipment for the early diagnosis and treatment of cardiovascular diseases.

With an emphasis on the life-saving aspect of early diagnosis, ACIBADEM Heart Care Centers put specific emphasis on the use of advanced technology in diagnostic instruments Among the diagnostic instruments used are the 2×64 Cross-Section Dual Source Computerized Tomography capable of performing cardiac angioplasty in six seconds, the PET CT enabling detailed imaging of the heart, and the Flash CT. The Flash CT is the fastest tomography instrument in the world and is able to perform cardiac angioplasty in 0.25 seconds, while also emitting the lowest level of radiation in the world.

Medical Performance Indicators

Since 2002, the ACIBADEM Healthcare Group has been inspecting its medical and administrative performance through performance indicators. Patient safety and satisfaction as its top priority, ACIBADEM views the scores it obtains in heart care -and all other branches- as a guide in providing better patient care.

– The “Euroscore” criteria states expected mortality rate in open heart surgery as 3.8%, while the percentage at ACIBADEM is 1.6%.

– The “Euroscore” criteria states the expected mortality rate in coronary bypass as 2.7%, while the percentage at ACIBADEM is 1.0%.

What is Euroscore?

Operations on seniors, diabetics, or patients with a history of heart attack, heart surgery, contraction and expansion disorders of the heart, and malfunctioning of the kidneys, liver, and lungs face higher risks in operations. Various risk scores exist for an objective evaluation of the patient taking such factors into account. In these scorings, weighted risk numbers are calculated. “Euroscore” is the most commonly used scoring system,

Comprehensive Cardiac Care at ACIBADEM Health Care Centers

ACIBADEM provides a high standard of modern diagnosis, treatment, and support services for adult and pediatric cardiovascular diseases.

Coronary Artery Disease

Coronary artery disease is among the most frequently encountered heart diseases. Blood can travel freely through a healthy coronary artery, making it possible to supply the heart with the oxygen rich blood that it needs.

High levels of cholesterol and blood pressure or smoking can damage the interior of the arteries, resulting in a buildup of plaque inside the arterial walls and preventing the flow of blood. This situation signals the beginning of coronary heart disease.

The more plaque builds up in the artery, the narrower the artery becomes, further reducing the amount of blood flowing into the heart. This starves the heart of oxygen, causing chest pains.

A narrowed artery blocked entirely by blood clots results in a heart attack (myocardial infarction). The lack of oxygen-rich blood leads to permanent damage in the heart muscle.

Heart Attack

A heart attack begins when the coronary arteries feeding the heart or any of their branches get blocked. This results in irreversible damage to the heart muscle or a fatal heart attack. Heart attacks are the most serious of all coronary heart diseases.

Two leading risk factors increase the risk of heart attack: “unchangeable risks” and “changeable risks”. Unchangeable risks include genetic factors, age, and being a male. Men and people with family members with a history of early heart attacks are at greater risk. Risks also increase with age.

The second group is “changeable risks”. The reduction of these risk factors is entirely dependent upon the efforts of the individual. Smoking, high blood pressure (hypertension), diabetes, high levels of blood fats, and obesity are all included in this group.

The primary symptom of a heart attack is a pain in the chest. In classic cases of heart attacks, this pain is severe and crushing. Early intervention is of extreme importance in heart attacks and being aware of the symptoms enables the individual to seek medical assistance without wasting time.

Cardiac Valve Diseases

The heart has four valves that open and close continuously, always. The inadequate opening and closing of the valves can result in cardiac valve diseases.

Valve diseases can be congenital or developed after rheumatism in childhood, or calcification in old age.

Complaints can vary depending on which valve is diseased. Symptoms begin to emerge as complaints increase. These are generally fatigue, becoming quick to tire, palpitations, feeling blocked, a shortage of breath, and swollen feet signaling an edema in the body.

Prior to any complaints, valve diseases can get diagnosed by chance during routine check-ups, when the doctor hears a murmur in the heart. As complaints increase, a diagnosis can be made using special diagnostic techniques; electrocardiography, chest X-ray, echocardiography and heart catheterization.

Arrhythmias

In arrhythmia, problems arise as a result of heart beat rate. Although arrhythmias are generally seen in patients with already existing cardiac conditions, they can also develop in people who have no health problems.

Some sufferers are unaware of these problems and will only get diagnosed during a routine checkup, or following an electrocardiography taken for another reason. Yet, a significant number of patients consult their doctors with complaints of palpitations, irregular heartbeats, feeling an irregular sensation in the chest, a feeling of emptiness, dizziness, fainting, a reduction in the capacity for exertion, and shortness of breath.

Endocarditis

Endocarditis is the microbial inflammation of the inner layer of the heart, called the endocardium which also involves the heart valves. Symptoms vary depending on the part of the heart that is infected and the type of bacteria causing the infection.

Patients are given antibiotics intravenously for at least 4-6 weeks. Surgery is an option in heart failure caused by endocarditis or upon the expulsion of blood clots.

It is imperative that endocarditis receives treatment. Heart patients in particular need careful protection.

Cardiomyopathies (Heart Muscle Diseases)

Defined by the World Health Organization (WHO) in 1995, cardiomyopathies are diseases of the heart muscle that result in the dysfunction of the heart. The four groups of cardiomyopathies are as follows:

  1. Dilated Cardiomyopathy
  2. Hypertrophic Cardiomyopathy
  3. Restrictive Cardiomyopathy
  4. Arrhythmogenic Right Ventricular Cardiomyopathy

There are many factors that cause cardiomyopathies including coronary artery disease, heart valve disease, hypertension, systemic infections, diseases of the metabolic system, genetic reasons, and a variation of poisoning.

Surgery can be carried out under circumstances where medication or interventions cannot be implemented.

Major Vascular Diseases

Abdominal Aortic Aneurysms:Damage to the aortic wall causes the largest artery exiting the heart to expand to 1.5 times its original size in the abdominal area. It is more frequently observed in older men. There are generally 2-3 cases in every 10 thousand people.

People who smoke, have familial aneurysms, are older or tall, or have blocked arteries, high levels of cholesterol, or chronic lung disease and hypertension, are at risk of developing abdominal aortic aneurysms.

More often than not, abdominal aortic aneurysms do not display any symptoms. The disease is usually identified when the patient consults the doctor for another medical complaint. Approximately 25 percent of patients can suffer continuous or temporary stomach aches.

Thoracic Aortic Aneurysm: These are aneurysms that form in the aorta in the chest area. A localized expansion of approximately 4 cm is called an aneurysm. 1-1.5 percent of patients with thoracic aneurysms are aged 65 and over.

Patients aged 65 and over are more prone to the disease in later years. Thoracic aneurysms can be triggered by aortic dissections, familial aneurysm, connective tissue disease (Marfan Syndrome), trauma, and infectious diseases.

Thoracic aortic aneurysms generally do not display any symptoms. Wide aneurysms can cause pain in the chest, back and abdomen. Complaints are similar to a heart attack. However, other symptoms can also include dysphonia, difficulty in swallowing, coughing or vomiting, and bleeding. The sudden onset of these symptoms can signal the presence of an emergency situation such as the aorta rupturing.

Dissection: Aortic dissection is a tear in the wall of the aorta. Clinical progress may vary depending on the location of the aortic tear.

In most patients, the condition is caused by hypertension. It may also develop as a result of various diseases such as aortic aneurysm, collagen tissue diseases, aortic stenosis, aortic coarctation and other medical procedures related to the aorta. Symptoms frequently begin with a sudden, severe chest and back pain described as being similar to stabbing. It may also be accompanied by complaints such as perspiration, coldness, nausea and vomiting.

Peripheral Embolisms: Peripheral vascular disease (PVD) is narrowness or the constriction of veins other than the coronary veins that supply the heart. The constriction is so advanced that not enough blood is supplied to the organs.

Diabetes, long-term hypertension, long term lipid metabolism disorder, history of atherosclerosis (vessel stiffness) in the family, gout, insufficient exercise, and nicotine addiction are among the risk factors.

The most common complaint is pain. However, characteristics of the pain differ: People with constriction suffer from pain after walking a certain distance. As the constriction increases, walking distance decreases. It is usually felt as cramps. However, the pain disappears after resting for 2-5 minutes.

Vena Constrictions (Venous Thrombosis): Vena constrictions caused by a small clot in the vena may sometimes never have any symptoms. However, the tiniest of clot can be life threatening depending on its location. Surgical methods are implemented on patients who do not respond to medical treatment, who suffer a risk of gangrene, and who have intensive pulmonary embolisms.

Varicose Veins

Varicose veins are defined as expanding, elongating, and the twisting of vena in the leg. They are observed in 10-20% of the Western population. The likelihood of varicose veins is proportional to age. Every other person over 50 suffers from varicose veins.


There are 4 types of varicose veins:

Spider web: These veins settle superficially on the skin. They have a diameter of 1 mm or less, cannot be felt to the touch, and are usually red in color. They are widespread linear forms in the shape of a star or a spider web and may spread to the whole leg.

Reticular varicose: It is difficult to feel this type of varicose vein that is slightly swollen on the skin, has a diameter of less than 4 mm, and is blue in color.

Great vena varicose veins (Saphena varicose vein): These are varicose veins that are easily felt and seen, and which form large twists along the large and small saphena. They have diameters of less than 3 mm. As they run under the skin, they do not usually change the color of the skin, with only the greenish reflection of the vein visible. The swellings become pronounced when standing and disappear when feet are raised while lying down.

Deep great vein varicose: These are in the deep layer of the leg. Varicose veins cannot be observed on the skin, yet cause edema and circulation disorder in the leg.

They are more common in women than men, and in people with a history of varicose veins in the family. Varicose veins may also occur as a result of obesity, aging, pregnancy, menopause, prolonged standing, and constriction and valve disorders in the deep vena.

The exact cause of varicose veins is unknown. The primary cause is the enlargement of the vein due to a structural deformation on the vena wall. This leads to a reverse flow of blood due to a malfunctioning valve in the vein. This reverse flow makes it more difficult for blood to return to the heart, gradually increasing the pressure in the vena. The increase in the pressure further enlarges the veins, creating a vicious cycle.

Varicose veins also have less common causes. In individuals who have a constricted deep vena, the superficial vena that carries 10 percent of the blood in the leg assumes the whole return of the venous blood in the leg. Therefore the diameter increases and forms varicose veins.

Congenital cardiac diseases are the most common of anomalies developed in the womb. Congenital cardiac diseases account for fifteen percent of infant deaths in the first 30 days of the neonatal period.

Eight babies out of one thousand are born with congenital heart disease. This is equivalent to 1 percent of live births.

There exist a wide variety of pediatric cardiac diseases. Specialists categorize pre-natal cardiac diseases into three:

Congenital cardiac diseases
Rheumatic cardiac diseases
Rhythm-conduction disorders

Congenital Cardiac Diseases

Congenital cardiac diseases are among the most common cardiac diseases seen in infants. Disorders in this category include anomalies that emerge during fetus development. Hundreds of variations exist, some of which are mild, with others causing severe and complicated problems.

Rhythm Conduction Disorders

These are irregularities in the electrical system of the heart as made apparent by abnormally slow, paused or accelerated rhythms. Although mostly observed in adults, they can also inflict infants with congenital cardiac diseases, following cardiac surgery or without an apparent reason. Although with a lower rate of occurrence than the more common cardiac illnesses, cardiac muscle or cardiac membrane diseases such as cardiomyopathy, myocarditis and pericarditis do occur.

Rheumatic Cardiac Diseases

Rheumatism is a disease that causes problems in the organs of origin. Throat infections are one among its most common causes. Viruses called “hemolytic streptococcus” settle in the throat and infect the area. They may also settle in the heart and cause deformation, constriction, or inadequacies in the cardiac valves.

Diagnosis And Treatment of The Most Common Congenital Cardiac Diseases

Anomalies in the hearts of infants born with congenital cardiac disease may sometimes be mild enough to make treatment unnecessary, while at other times they may progress to life-threatening levels. Severe congenital cardiac diseases are usually diagnosed in infancy. However, surgical intervention has a high rate of correction even in severe cases of anomaly.

Diagnostic Methods

Severe congenital cardiac diseases are usually diagnosed in infancy as babies with such anomalies show severe symptoms from birth. However, sometimes the diagnosis does not take place until childhood or as late as adulthood. This happens when the congenital anomaly is very small. In some cases, the person can go through his/her entire life without showing any symptoms and problems.

A pediatric cardiologist follows a physical examination with various analyses in order to be able to diagnose.

Electrocardiography (ECG) is a device that senses weak electrical currents in the heart of the child and records heartbeats onto ECG paper. As no electrical current is applied, the child does not feel any pain.

The cardiologist obtains information about the size and shape of the child’s heart and lungs by performing a chest X-ray. The level of radiation used in chest X-rays is very low and has no side effects.

The echocardiograph examination makes it possible to monitor live images through the use of sound waves outside the chest. Blood streams in the heart and veins are measured using sound waves with the Doppler technique. These two techniques provide the cardiologist with information about the structure and function of the heart. Most cardiac anomalies are diagnosed using this method of examination.

Fetal echocardiography is a method similar to ultrasonography that can be used after the 16th week of pregnancy. It does not harm the mother or the baby. It makes it possible to examine the condition and function of the heart and cardiac veins of the fetus and to identify any cardiac anomalies before birth.

Cardiac catheterization – angiography is an advanced examination method used with the help of a highly developed X-ray machine. It is usually performed with the help of a thin tube (catheter) inserted into the aorta or vena through the inguinal area and guided to the heart.

The Effort test is performed by continuously taking the heart’s electrocardiography while the child walks on a treadmill at a fast pace.

Cardiac electrophysiology: Congenital disorders or cardiac surgery may sometimes cause cardiac rhythm disorders. The cause and type of cthe disorder can be determined by a special test similar to cardiac catheterization called cardiac electrophysiology. This enables the cause of arrhythmia and abnormal conduction paths to be treated using a method called ablation (cauterization with radiofrequency waves) upon necessity.

Cardiac MRI: In some infants, it may not be possible to completely diagnose a cardiac disease despite all tests. In such cases, certain advanced techniques like the MRI (Magnetic Resonance Imaging) or MRI angiography might become necessary to enable accurate diagnosis. These tests provide the physician with valuable information related to the structure of major veins entering and exiting the heart and the pulmonary veins.

Treatment

How are congenital cardiac diseases treated?

Medically treated Cardiac Diseases

Congestive Heart Failure

WHAT IS IT? When the heart pump does not work sufficiently, fluid accumulates in the lungs and other organs causing edema (swelling). This condition is found quite frequently in a number of cardiac anomalies.

TREATMENT: The cardiac muscle is strengthened by using drugs including digoxin. Diuretic medication can also be administered to help discharge the excess fluid accumulated in the body.

Cardiac Rhythm Disorders

There are three different types of cardiac rhythm disorders:

Tachycardia: This is the very fast beating of a child’s heart. In children, the heart beats 60 to 150 times a minute depending on age. Excessive beating can cause fatigue in the heart. However, tachycardia is not always a sign of congenital cardiac disease. Drug therapy can be used to lower the heart rate to a normal level.
Bradycardia: This is the very slow beating of a child’s heart. It may deteriorate the blood-pumping function of the heart. Although it is usual congenital, on rare occasions, it may also develop after surgery. In some children, it may be necessary to implant a device (pacemaker) that enables the heart to beat normally.
Arrhythmia: This is irregularity of the heartbeat. It may be congenital and develop after surgery, and should be treated according to the type of irregularity of the cardiac rhythm.

Cardiac Diseases Treated Using Catheterization

Balloon Septostomy

This is a procedure used in the treatment of certain cardiac anomalies, such as the transposition of great arteries (TGA) to prolong the life of an infant until surgical intervention.

Valvotomy, Balloon Angioplasty

Some of the narrow cardiac valves and coronary veins are expanded using a balloon during catheterization. Although re-narrowing may take place, this procedure provides the baby with time to grow.

Coil Embolization and the Umbrella Device

Certain atrial septal defects (ASD) and patent ductus arteriosus can be treated with catheterization. However, implementation of these procedures require suitability of both the size of the patient and the location and width of the defect.

Electrophysiology and Ablation

In certain pediatric patients, rhythm problems can be treated with cauterization using a method called “ablation”. In such cases, the cause of the problem should be found using cardiac catheterization (an electrophysiological study).

Surgically Treated Cardiac Diseases

  1. Cardiac Diseases without Cyanosis
    These patients usually have a septal defect, constriction, or disorder in the veins or valves. There is no cyanosis as venous blood does not circulate in the body. Generally, symptoms of heart failure are observed.
    Patent Ductus Arteriosus (PDA)
    Atrial Septal Defect (ASD)
    Ventricular Septal Defect (VSD)
    Atrioventricular Septal Defect (AVSD)
    Aortic Stenosis (AS)
    Aortic Coarctation (AoCoA)
  2. Cardiac Diseases That Develop with Cyanosis
    Under normal conditions, blood pumped from the heart to the body is oxygen-enriched and light red in color. However, in cardiac diseases characterized with cyanosis, blood pumped to the body is oxygen-deprived and darker. In such cases, the infant’s skin appears purplish. The degree of this condition, also called cyanosis can vary depending on the patient’s pathology, age and activities.
    Tetralogy of Fallot (TOF)
    Pulmonary Stenosis (PS)
    Transposition of Great Arteries (TGA)
    Tricuspid Atresia (TA)
    Pulmonary Atresia (PA)
    Truncus Arteriosus
    Total Anomalous Pulmonary Venous Drainage (TAPVD)
    Hypoplastic Left-Heart Syndrome (HLHS)

ACIBADEM Cardiac Care Services Include:

Cardiovascular Embolism
Effort Test
Coronary CT Angiography
Myocardium Perfusion Scintigraphy
Positron Emission Tomography
Coronary Angiography
Coronary Stent and Balloon Angioplasty Applications
Coronary Bypass
Robotic Coronary Bypass
Small Incision Coronary Bypass

Cardiac Valve Diseases
Echocardiography
Angiography and Catheterization
Percutaneous Valvuloplasty
The Catheter Method and Aortic Valve Implantation (TAVI)
Robotic Valve Surgery
Valve Surgery with Small Incision

Arrhythmias
Holter Monitorization
Diagnostic Electrophysiology Study (EPS)
Catheter Ablation
Implanting Permanent and Temporary Pacemaker
AICD Implantation
Pacemaker Implantion with three chambers

Aorta Vascular Diseases
Endovascular Aneurysm Repair (EVAR)
Thoracic Endovascular Aneurysm Repair (TEVAR)
Hybrid Treatment
Surgical Repair
TAVI

Peripheral Embolisms
Doppler Ultrasound
BT Angiography
Magnetic Resonance Imaging (MRI)
Digital Subtraction Angiography (DSA)
Stent Application in Carotid Aorta (CAS)
Endarterectomy in Carotid Aorta (CEA)
Peripheral Surgical Bypass
Peripheral Endoluminal Bypass

Varicose
Transdermal Laser
Sclerotherapy
Varicose Surgery
Endovenous Varicose Surgery

Cardiomyopathies
Interventional Treatment (Ablation)
Surgical Treatment

Congenital Heart Diseases
Pediatric Cardiology
Pediatric Heart Surgery
Treatment of congenital cardiac diseases with catheterTreatment of congenital cardiac diseases

Cardiac Rehabilitation

Robotic and Minimally Invasive Cardiac Surgery

Robotic cardiac surgery, requiring advanced techniques and substructure, is used in only limited number of centers in the world including the US. ACIBADEM Maslak Hospital has been a pioneer in robotic cardiac surgery. Firsts are realized in the world and in Turkey via operations with robotic surgery:

Performances of da Vinci robot in ACIBADEM Maslak Hospital:

– Aneurism (ballooning) of the left ventricle of the heart for the first time in the world

– First complicated mitral valve repair in Turkey

– First mitral valve replacements.

Coronary artery patients without vascular disease are operated via robotic method routinely if their anatomical structures are fit. Furthermore, mitral valve repair, mitral valve replacement and tricuspid valve intervention can also be performed on patients with suitable anatomical structure. Technical rate of success in robotic cardiac surgery is 90%.

Why Robotic – Minimally Invasive Cardiac Surgery?

• Less Bleeding

• Less need for blood transfusion

• Less pain

• Lower infection risks

• Faster discharge from hospital

• Faster recovery

• More aesthetic

Advantages of Robotic and Minimally Invasive Surgery

  • The success rate of the operation rises: Thanks to the three-dimensional camera, it allows an easy view of the locations that are hardest to observe. Furthermore, the arms of the robot are capable to turn 540 degrees and move in 6 directions. Because the devices used are very tiny, they can reach locations that a human hand cannot extend to. For example, the success rate of fixing the cardiac valve increases using this method.The patient incurs less pain: Because the operation is realized with tiny sections, the patients feel less pain compared to an open operation.The skin does not have major surgery scars: Because the procedures are realized from 3 or 4 holes of 8 millimeter each, there is no aesthetically bothering scar left on the skin.Hospitalization period is shorter: Thanks to a minor operation section and less blood loss, patients can be discharged within 1-2 weeks even in the most complicated surgeries.Faster return to work and social life: Minimal damage occurs at surgery sites. So it is much easier and faster for the patient to leave the bed and join usual physical activities again.Decreased hemorrhage rate: Zones of hemorrhage can be clearly seen thanks to three dimensional, high-resolution cameras that can magnify the operation site. So the blood loss is minimal, even not requiring any blood transfusion to the patient.
  • No breast bone problem: Because cutting through the breastbone is not necessary, no risk is encountered like displaced or infectious breastbone.Maslak Hospital has been a pioneer center in robotic cardiac surgery. Firsts are realized in the world and in Turkey via operations with robotic surgery.

Coronary Angiography: This is the most reliable method used to test the anatomical structure of arterial constriction, and to provide functional assessment with supplementary techniques.

The method is used in patients whose results from other tests suggest coronary constriction, patients who are scheduled for stent or balloon angioplasty, or in the diagnosis and treatment of emergency heart attacks.

The procedure is performed in the catheter laboratory, making hospitalization necessary. The patient does not feel any pain during the procedure, but only a warm sensation spreading across the entire body during the few seconds of the injection of a radio-opaque substance. Under normal circumstances the procedure is short, lasting only 5 to 10 minutes.

It has an extremely low mortality rate when conducted by experienced personnel in experienced centers (< 0.1%).

After the procedure, the patient needs to be monitored for 2 to 6 hours in the hospital.

Wrist Angiography: Angiography plays a key role in the diagnosis of cardiovascular diseases. With the help of recent developed technologies, it can be done from the wrist instead of the inguinal region. If constriction exists in the veins in the inguinal region or if the inguinal region is not suitable due to excessive weight, wrist angiography is preferred.

It can be used in 99 percent of patients. Vein complications in the patient are observed only very rarely. Following the procedure, the patient is able to sit, walk around and eat. The patient can return to his/her daily life within the same day.

Treatment

Coronary Angioplasty And Stent Applications: Coronary angioplasty (balloon endarterectomy) is the widening of local constrictions in coronary arteries using non-surgical methods. A “wire of guidance” is inserted and pushed from the inguinal aorta to the coronary veins. A deflated balloon slides through this wire until it reaches the constricted area. When the balloon is inflated from outside (approximately 3 cm in length and 3-4 cm in width), the constriction in the coronary veins is removed.

Yet, not every coronary constriction is suitable for this method. For some patients, bypass surgery might be necessary, while for others heart medication can be an effective and safe form of treatment. Such decisions should only be made by relevant specialists.

Bypass Surgery: Depending on the degree of arterial constrictions, the doctor may recommend coronary artery bypass intervention. This intervention corrects the blood flow that supplies the heart, thus restoring health. Coronary bypass surgery may provide a second chance for your heart and for life.

Coronary artery bypass surgery re-supplies blood to the heart through the formation of a different path, other than the constricted or narrowed artery. In the event of more than one constricted artery, more than one bypass is required.

The artery to be used for the bypass, also known as a graft, is taken from the chest, arm or leg and attached to the constricted coronary artery. The most commonly used grafts are internal thoracic arteries, aorta from the arms, and vena from the legs. Since the areas of origin of these veins have additional veins, their removal does not affect the blood circulation of the body.

Small Incision Surgery: Endoscopic surgery is a minimally invasive method in which open heart surgery is done using special endoscopic devices through a small incision made in the chest region. During the operation, all surgical instruments are under the control of the surgeon. In the meantime, the endoscopic camera can be used to view the surgery area.

Coronary bypass using the endoscopic method can be used for valve repair, valve implant, and the repair of ventricular septal defects and ablation for rhythm treatment.

Compared with open surgery, mobility is higher and scar healing is much faster. Following surgery, patients return to work and resume active life much earlier. However, the structure of the sternum wall and the anatomy of the heart must be suitable for this method.

TAVI: Transcatheter Aortic Valve Implantation (TAVI) involves the implantation of an aortic valve to the heart using the catheter method without open surgery. Biological cardiac valves are used in valve implant surgeries around the world and in Turkey. In the TAVI method, this biological valve is placed in a stent jacket, when opened, is firmly placed on the valve implant area.

Two different techniques can be used in this method. In the first technique, similar to a valve angiography, the valve is pushed from the inguinal area to the heart with the help of a catheter. When in place, the stent mechanism is opened. The second technique is used when there is a constriction in the inguinal region or the abdominal region that will be used to access the heart. Then a small incision of 4 to 5 cm is made in the front wall of the sternum to access the end point of the heart. The valve is placed with the help of a catheter pushed to the heart. In both methods, there is no need to stop the heart and perform open surgery. The procedure can be completed under local anesthesia.

Patients are taken to their rooms after the TAVI procedure. During this time, the patient is given anticoagulants and monitored under normal conditions for 4-5 days and discharged. Following several days of rest, the patient returns for a follow-up exam and resumes daily life. The TAVI method is primarily recommended for high risk patients who would otherwise not be able to endure valve implant open surgery. Additionally, it can be used on patients who have other obstacles against open surgery. The TAVI method is proven to be effective on such patients and to prolong their lives and improve their clinical condition.

Although TAVI is a recently developed method, technological developments, application experiences, and scientific results indicate that it will become much more common.

TAVI AT ACIBADEM: TAVI valve procedures have been performed in experimental environments since 2002 and on humans since 2004 around the world. The operation has been successfully implemented in a number of prominent centers both in the USA and Europe as of 2010. It was first used in Turkey in 2009. The ACIBADEM Cardiology and Cardiovascular Surgery team have at their disposal the necessary equipment to perform this new and successful treatment method and are able to successfully implement the TAVI procedure.

The procedure is organized and completed by a team composed of many specialists from different disciplines, including cardiovascular surgery, cardiology, anesthesiology, and reanimation and radiology.

As with all other diseases, early diagnosis of cardiac diseases is vitally important for successful treatment. Regular check-ups and close monitoring of your heart’s health is the first condition of early diagnosis. ACIBADEM Heart Care Centers provide diagnostics and treatment using state-of-the-art equipment.

ECG: Electrocardiography (ECG) is a device that records the electrical activity of the heart to examine the cardiac muscle and its functioning. It is used for fast assessments, especially in emergencies.

ECG is an important tool in the diagnosis of cardiovascular diseases, structural anomalies, and arrhythmias. ECG monitoring and interpretation can be performed quickly.

The Effort ECG Test: This is an exercise test performed on a treadmill following a systematic, specific protocol. It is based on the interpretation of ECG recordings received via electrodes placed on the chest while exercising. The test usually lasts 5 to 10 minutes, but varies based on the patient’s age and condition..

It is a test that monitors the functioning pattern of the heart under effort and is used to identify embolisms that normally do not display symptoms in daily life.

Interpretation of the Effort EKG test for diagnosis should be done by experienced doctors to avoid misinterpretations about some other diseases with similar findings.

Echocardiography: Echocardiography is a diagnostic and investigative tool that allows examining the structure, pathology and functions of the heart by using ultrasonic sound waves.

It is possible to examine the movements and cavity of the ventricle wall, the growth of the cardiac muscle, and cardiac valves using echocardiography. It also makes it possible to observe the structure and functionality of implanted artificial valves. Virtually all congenital cardiac diseases are diagnosed using this method.

It has no harmful side effects on the patients and can be used easily. The patient feels no pain during the procedure.

Holter Monitorization: A Holter monitor is used to monitor the cardiac rhythm or blood pressure of the patient. Separate devices the size of cell phones are used for EKG records and blood pressure measurements. The devices are fixed to the body of the patient for usually 24 hours or more. The devices measure cardiac rhythm and blood pressure continuously.

It is usually used to monitor the cardiac rhythm and blood pressure of the patient in daily life. Physicians use this test upon suspicion of an abnormal cardiac rhythm or an imbalance in blood pressure.

Trans-Telephonic Monitor: A recording device, similar to the Holter device, is attached to the patient to monitor cardiac functions.

Under normal circumstances, Holter devices can remain on the patient for two to three days. However, in patients who only rarely feel any discomfort, symptoms may not occur during the time the Holter device is carried. In such cases, a telemedicine device that operates trans-telephonically can be used.

Stress Echocardiography: Echocardiography taken during periods of rest determines the width of the cardiac cavity, malfunctions in the movement of the wall, and contraction functions of the heart. It can help to indirectly diagnose coronary artery disease. It also helps to identify other conditions such as cardiomyopathy that compliment other valve diseases, cardiac membrane infections, a tear in the aorta, and excessive thickening of the heart that could cause chest pains and difficulty in breathing.

Stress echocardiography can be used in conjunction with the effort ECG to identify the location of vascular disease.

Myocardium Perfusion Scintigraphy: Myocardium perfusion scintigraphy is used mainly to identify any problems in blood accumulation in the cardiac muscle. It provides information about the blood build-up of the heart under two different conditions, one under stress (for instance, during exercise) and the other, in rest.

Myocardium scintigraphy can be used to identify serious coronary artery diseases. Its diagnostic sensitivity and precision in the diagnosis of severe vascular diseases is around 90 percent. Findings obtained during the test also provide information on the mortality risk, cardiac functions, and advanced cardiac failure of the patient, and data vital in making a decision about the correct course of treatment.

Flash CT: Flash CT is a radiological method of diagnosis that creates a cross-section image of the examined area using X-rays.

As a radiological method of diagnosis, the Flash CT is able to provide images of all the parts of the body, particularly cardiac and pulmonary scans.

The heart can be scanned in 250 milliseconds. When compared with single tube and single detector systems, it provides images in half the time. It allows the heart to be scanned in 250 milliseconds, with a 99% accuracy rate. (a quarter of the time of a heartbeat). Thus, although even in cases in which the heart rate of the patient is over 100 beats per minute, there arises no need to slow the heart down with medication. Flash CT is a scanning tool that emits the lowest level of radiation in the market. Cardiac scanning can be completed with 80 percent less radiation. It can be used in routine procedures as a non-invasive cardiologic diagnostic method.

Cardiac MRI Test: The MRI Test provides valuable information on congenital cardiac diseases and cardiac cavities and enables detailed assessments of structures of the main arteries entering and exiting the heart. It supplements echocardiography findings without adversely affecting the patient.It provides detailed information in the assessment of cardiovascular constrictions, the extent of the effect of a heart attack on cardiac muscles, and the condition of the heart in preserving its vitality and functionality. The MRI test has the highest level of diagnostic sensitivity in the assessment of cardiac muscle diseases and masses in the heart.

Contrary to traditional imaging methods, the MRI does not contain radiation and ultrasound waves. The accurate images of the organs are displayed using physiological parameters.

PET CT: The PET CT is a cardiac examination based on scintigraphy. This method is utilized to observe vitality retention of the heart. It is used mainly to obtain detailed information on the function and vitality of cardiac cells, giving accurate results on the vitality of cardiac tissue. It provides guidance in determining whether bypass surgery would be beneficial for a high risk patient.