Coronary Angiography (CAG) is a specialized diagnostic procedure used to visualize the coronary arteries — the blood vessels that supply the heart muscle. It helps detect blockages, narrowing, or abnormalities in the arteries that may cause chest pain, heart attacks, or other cardiac conditions. What is CAG? CAG is performed using a contrast dye and X-ray imaging (fluoroscopy). A thin, flexible catheter is inserted through the wrist or groin artery and guided to the coronary arteries. Once the contrast dye is injected, X-ray images are taken to show the flow of blood through the coronary vessels. When is Coronary Angiography recommended? Chest pain (angina) or tightness Positive stress test or abnormal ECG Suspected or confirmed heart attack (MI) Coronary artery disease risk in diabetic or high-risk patients Prior to angioplasty (PCI) or cardiac surgery What does it reveal? Location and severity of arterial narrowing or blockage Condition of the heart chambers and valves Need for further intervention such as angioplasty or bypass surgery Procedure Highlights Minimally invasive, typically done under local anesthesia Takes about 20–30 minutes Most patients are discharged the same or next day Performed in a dedicated Cath Lab by expert interventional cardiologist Dr.Chetan Jain

Angioplasty and Stent Placement Angioplasty and stent placement is a minimally invasive, image-guided procedure used to treat coronary artery disease (CAD) — a condition caused by the narrowing or blockage of the heart's blood vessels due to plaque buildup. What is Angioplasty? Angioplasty, also known as Percutaneous Coronary Intervention (PCI), involves the insertion of a small balloon through a catheter into a narrowed coronary artery. The balloon is gently inflated to widen the artery and restore blood flow to the heart muscle. What is a Stent? In most cases, a stent — a small, mesh-like metallic scaffold — is placed at the site of the blockage to keep the artery open permanently. Drug-eluting stents are commonly used to reduce the risk of re-narrowing (restenosis). When is it recommended? Acute heart attack (STEMI/NSTEMI) Unstable angina or chest pain not relieved by medication Significant coronary artery narrowing found on angiography High-risk coronary lesions with compromised blood flow Benefits of Angioplasty and Stenting Rapid symptom relief (e.g., chest pain, breathlessness) Minimally invasive with faster recovery Improved heart function and reduced risk of heart attacks Short hospital stay (typically 1–2 days) Advanced Techniques Available For patients with complex or calcified lesions, we also offer: Rotational Atherectomy (ROTA) Intravascular Lithotripsy (IVL) Intravascular Ultrasound (IVUS) CHIP angioplasty for high-risk cases

CHIP Angioplasty refers to complex, high-risk coronary interventions performed in patients with severe or advanced heart disease who are not ideal candidates for routine angioplasty or surgery. What is CHIP Angioplasty? CHIP stands for Complex High-Risk Indicated Percutaneous Coronary Intervention. These procedures are done in critically ill, elderly, or high-risk patients who often have: Severely calcified arteries Multiple blockages or left main disease Poor heart function (low ejection fraction) History of failed bypass surgery (CABG) or inoperable disease Chronic total occlusion (CTO) of coronary arteries What makes it different? CHIP angioplasty goes beyond standard procedures by using advanced tools and techniques, such as: Rotational atherectomy (ROTA) Intravascular Lithotripsy (IVL) Intravascular Ultrasound (IVUS) Mechanical circulatory support (e.g., Impella, IABP) if needed Benefits: Offers life-saving treatment to patients deemed too high-risk for surgery Provides a less invasive option compared to bypass surgery Improves quality of life and heart function in patients with limited options

ROTA (Rotational Atherectomy) ROTA is a minimally invasive procedure used to break down hardened plaque (calcified deposits) in the arteries when standard angioplasty is not enough. It works by: Using a rotating diamond-tipped burr to grind the plaque into tiny particles Improving blood flow to the heart Preparing the artery for stent placement IVUS (Intravascular Ultrasound) IVUS is a high-resolution imaging technique used during angioplasty to get a detailed view of the inside of the arteries. It helps: Measure the exact size and structure of blockages Guide stent placement for better treatment outcomes Detect hidden plaque that may not be visible in traditional angiography IVL (Intravascular Lithotripsy) IVL is an advanced technique used during angioplasty to treat hard, calcified blockages in the arteries. It uses shockwave energy to break up calcium deposits, making it easier to expand the artery and place a stent. It helps: Fracture deep and resistant calcium in the artery wall Improve stent expansion and placement in calcified lesions Enhance safety by reducing the risk of vessel injury during angioplasty

1. Pacemaker A pacemaker is a small, battery-operated device implanted under the skin (usually near the collarbone) to help regulate abnormally slow heart rhythms (bradycardia). When is it needed? Sinus node dysfunction Heart block (AV block) Symptomatic bradycardia How it works: The pacemaker sends electrical impulses to the heart to maintain a normal heart rate. It monitors your heart’s rhythm and activates only when needed. Types: Single-chamber pacemaker (usually for the right atrium or right ventricle) Dual-chamber pacemaker (coordinates activity between atrium and ventricle) Leadless pacemaker (a newer, miniaturized version placed directly into the heart) 2. ICD (Implantable Cardioverter Defibrillator) An ICD is a device designed to detect and treat life-threatening fast heart rhythms, such as ventricular tachycardia or ventricular fibrillation. When is it needed? History of sudden cardiac arrest High risk of ventricular arrhythmias (e.g., post-heart attack, low ejection fraction) Certain genetic arrhythmia syndromes (e.g., Long QT syndrome) How it works: The ICD continuously monitors the heart rhythm. When a dangerously fast rhythm is detected, it delivers an electric shock to restore normal rhythm (defibrillation). It may also perform anti-tachycardia pacing (ATP) to correct rhythm without shock. 3. CRT (Cardiac Resynchronization Therapy) CRT is used to improve the efficiency of a weak or failing heart by synchronizing the contractions of the left and right ventricles. When is it needed? Heart failure with reduced ejection fraction (HFrEF) Wide QRS complex on ECG (especially LBBB pattern) Persistent symptoms despite optimal medical therapy How it works: CRT devices use three leads—in the right atrium, right ventricle, and a coronary vein over the left ventricle—to coordinate heart contractions and improve cardiac output. Types: CRT-P (CRT with pacemaker function) CRT-D (CRT with defibrillator function)

Congenital Heart Disease – Pediatric Overview Overview Congenital heart disease (CHD) refers to structural abnormalities in the heart present from birth. These defects can vary from mild (requiring only observation) to severe (requiring intervention). Treatment and follow-up depend on the specific defect and its impact on heart function. Types of Congenital Heart Defects Atrial Septal Defect (ASD) Ventricular Septal Defect (VSD) Patent Ductus Arteriosus (PDA) Pulmonary or Aortic Valve Stenosis Coarctation of the Aorta Ebstein’s Anomaly Single Ventricle Defects (e.g., Hypoplastic Left Heart Syndrome) Tetralogy of Fallot Total Anomalous Pulmonary Venous Connection (TAPVC) Transposition of the Great Arteries (TGA) Symptoms Symptoms vary by defect but may include: Breathing difficulties Poor feeding and growth Fatigue Cyanosis (bluish skin) Frequent respiratory infections Heart murmur Causes Most congenital heart defects arise from unknown causes, though genetics and environmental factors during pregnancy (e.g., infections, medication use, or maternal conditions) may play a role. Diagnosis Echocardiography (ECHO) Electrocardiogram (ECG) Chest X-ray Cardiac MRI or CT Cardiac catheterization Treatment Treatment depends on the severity and type of defect: Observation: For small, asymptomatic defects Medication: To control symptoms or stabilize the patient before surgery (e.g., diuretics, digoxin, prostaglandins) Catheter-Based Interventions: For PDA, ASD, VSD closures, and valvuloplasty Surgery: Required for more complex or severe defects Multistage Surgery: For single ventricle conditions (e.g., Norwood, Glenn, Fontan procedures) Valve Replacement: In stenotic or leaky valves, either surgically or via catheter Arterial Switch Operation: For TGA within the first month of life Complications Heart rhythm issues Heart failure Valve dysfunction Need for repeat procedures Pulmonary hypertension Endocarditis Growth and development delays Prevention While not all CHDs are preventable: Prenatal care and screening Managing maternal health conditions Avoiding teratogenic drugs Genetic counseling for high-risk families

I often meet patients — especially parents of little ones — who are told their child has a “hole in the heart.” This can sound scary, but the good news is: many of these conditions can be safely treated without open-heart surgery using a device closure procedure. 1. ASD – Atrial Septal Defect What is it? ASD is a hole in the wall (called the septum) that separates the upper two chambers of the heart (left and right atria). Why treat it? If left untreated, blood keeps flowing in the wrong direction, putting extra pressure on the lungs and heart, which can cause breathlessness, fatigue, and irregular heartbeats later in life. Closure Procedure: We use a small umbrella-like device, which is delivered to the heart through a thin tube (catheter) inserted from the groin. The device closes the hole from inside, and over time, heart tissue grows over it. 2. VSD – Ventricular Septal Defect What is it? VSD is a hole in the wall that separates the lower chambers of the heart (left and right ventricles). It is one of the most common congenital heart defects. Why treat it? It causes extra blood to flow to the lungs, leading to breathlessness, poor weight gain, and frequent infections in babies. Closure Procedure: Just like ASD, we insert a special VSD closure device through a vein. It is carefully placed over the hole in the lower heart wall, helping normalize the blood flow. 3. PDA – Patent Ductus Arteriosus What is it? PDA is a persistent blood vessel that normally closes shortly after birth, but in some babies, it remains open — allowing abnormal blood flow between the aorta and pulmonary artery. Why treat it? If left untreated, it can cause heart enlargement, lung congestion, and delay growth in infants. Closure Procedure: We use a PDA closure coil or device, delivered through a catheter from the leg, to seal the duct.

A procedure we often recommend for patients with narrowed heart valves — it’s called Valvuloplasty. Think of it as a way to gently open a “stuck” or “tight” heart valve so your heart can pump blood more efficiently. In valvuloplasty, we insert a soft balloon through a thin tube (catheter), carefully guide it to the narrowed valve, and inflate it just enough to stretch the valve open — giving your heart the breathing room it needs. There are different types of valvuloplasty depending on which valve is affected 1. BMV – Balloon Mitral Valvotomy This procedure is for those who have Mitral Valve Stenosis, which often occurs due to rheumatic fever in the past. How it works: We insert a balloon catheter through a vein in the leg and guide it to your mitral valve (between the left heart chambers). The balloon is gently inflated to open the valve, improving blood flow and easing symptoms like breathlessness and fatigue. 2. BPV – Balloon Pulmonary Valvuloplasty This is usually done for children or young adults born with Pulmonary Valve Stenosis – a narrowing in the valve that leads from the heart to the lungs. What we do: A balloon catheter is threaded through a vein and placed into the pulmonary valve. Once in position, we inflate the balloon to open the valve and allow blood to flow easily to the lungs. BAV – Balloon Aortic Valvuloplasty This is often used for elderly patients with Aortic Stenosis – a narrowing of the main valve that sends blood from the heart to the body. Here’s how it helps: The balloon catheter reaches the aortic valve through an artery. We inflate the balloon briefly to separate the stiffened valve leaflets, improving blood flow.