Work at the Department
The Department of Interventional Cardiology conducts the latest and most complex invasive diagnostics of the cardiovascular system, i.e. interventional treatment of the widest range of cardiovascular diseases. According to the dominant presence and increasing trend of coronary artery pathology (both in the form of chronic conditions and as acute coronary syndromes), most of the work is dedicated to patients with this symptomatology. The state-of-the-art imaging technologies are used in diagnostics and the assessment of the significance of coronary lesions is additionally confirmed by applying intravascular imaging, i.e. by measuring the physiological parameters of coronary flow. In addition, the above-mentioned methods are also used for planning coronary interventions, i.e. for the optimization thereof. In the process of dealing with acute coronary syndromes, where time means life, we are connected (through the so-called STEMI network) with SHP as well as with all coronary units in the region. In case of patients in the most severe condition with concomitant cardiac insufficiency, including cardiogenic shock, we are equipped with devices for mechanical circulatory support which improves both immediate and long-term results of coronary interventions in patients with this pathology. In addition to coronary pathology, this department is dedicated to solving structural heart diseases (communication between heart chambers, i.e. large blood vessels), diagnostics and treatment of heart muscle and pericardial diseases, including hypertrophic cardiomyopathy, as well as pulmonary circulation pathology, i.e. preparation of patients for heart transplantation or implantation of mechanical circulatory support devices. The experience of this department in percutaneous aortic valve implantation as an alternative to valvular surgery in patients at increased operative risk is of particular importance. We have established a close cooperation with the Department of Electrophysiology and Cardiac Electrostimulation.
Departments, divisions, offices and centers:
The Department of Interventional Cardiology is a part of the Institute’s Cardiology Clinic. The department gathers interventional cardiologists, nurses (perioperative nurses) and X-ray technicians. Procedures are performed primarily in three X-ray angiography rooms of the institute with the addition of the Catheterization Laboratory.
The outpatient unit for interventional cardiology is a part of the outpatient-polyclinic service of the Cardiology Clinic, and all interventional cardiologists employed at the department also work here. If necessary, the department uses all other resources of the institute (from the echocardiography office, stress tests, X-ray service).
We cooperate with the Technical Service of the Institute for the purpose of equipment maintenance, training and periodic inspection.
The Department of Interventional Cardiology is involved in subspecialist teaching of cardiology at the Faculty of Medicine in Belgrade, and resident doctors attending subspecialist programs participate in regular operation of the department through their planned and structured training following the principle of mentorship.
List of procedures
- Coronary angiography, diagnostic coronary artery angiography. The procedure is predominantly performed radially (puncture of the arm artery) which enables fast mobilization of the patient with the possibility of the same procedure being performed in a day hospital.
- Determining the physiological significance of coronary stenosis (FFR, iFR) to assess the need for interventional treatment by measuring the pressure and flow at the site of stenosis. It is performed in the same manner as coronary angiography, i.e. during that procedure.
- Intravascular (intracoronary) ultrasound (IVUS) and Optical Coherence Tomography (OCT): measuring the anatomical and topographic characteristics of coronary stenosis necessary to assess borderline, i.e. complex coronary lesions, to select the most optimal procedure to treat the condition as well as to optimize it.
- Percutaneous coronary interventions (PCI), Stenting of coronary arteries (stenting), i.e. balloon dilatation (PTCA) of stenotic coronary arteries. Coronary artery stenosis diagnosed by these methods can in most cases be resolved by percutaneous interventions, avoiding coronary surgery. An optimal decision when selecting between stenting and surgery (bypass) in complex cases is made by the multidisciplinary Heart Team (cardio-surgical medical advisory board). Stenting is usually performed by hand (radial approach). The latest drug-eluted stents (DES stents) are used for stenting, which minimize the possibility of coronary stenosis recurrence (restenosis) at the site of their implantation during the follow-up period.
- Resolving Acute Coronary Syndromes (acute myocardial infarction, unstable angina). Acute heart attack is one of the most significant causes of sudden cardiac death, i.e. permanent disability. The organization of the Institute staff and its interconnection through the STEMI network with other city and regional services enable clearing the clogged heart artery and its stenting in the so-called golden time interval for all potential patients from Belgrade and the surrounding area.
- Mechanical circulatory support in case of heart pump failure. Interventional cardiology staff has the ability to provide mechanical circulatory support to all patients who require it, most often in the most severe cases of cardiogenic shock. In these cases, the intra- aortic balloon pump is used in the catheterization room, i.e. the devices for external extracorporeal membrane oxygenation and assisted circulation.
- Structural heart diseases: in all patients with pathological communications between heart chambers (usually congenital, as well as acquired), i.e. between large blood vessel at the heart base, in most cases it is possible to provide their interventional closure using specially designed implants while avoiding surgery.
- Implantation of left trial appendage occluders (pocket at the atrial basis with a tendency to develop thrombi in patients with absolute arrhythmia) in patients who must not receive oral anticoagulant therapy. Absolute arrhythmia is the most common cause of cerebrovascular accidents (strokes). Therefore, relevant patients must be on continuous anticoagulant therapy. In case of contraindications with respect to these drugs, the only safe solution is this procedure, which can be successfully performed in our country.
- Alcohol septal ablation in patients with hypertrophic cardiomyopathy. Patients with significant septal thickening and a significant intraventricular pressure gradient are prone to sudden death and malignant arrhythmias. At our institute, we successfully apply alcohol septal ablation, which is performed based on the same principles as coronary angiography, and which enables non-surgical treatment for these patients.
- Percutaneous, transcatheter aortic valve implantation (TAVI). The institute is a leader in the region when it comes to percutaneous aortic valve implantation in patients with hemodynamically significant aortic stenosis and high operative risk. The Institute monitors the development of this method, which currently enables application in patients with medium operative risk and older age.
- Endomyocardial biopsy (cardiac biopsy) is an important method of heart muscle disease diagnostics (inflammatory and infiltrative diseases) and allows the selection and management of optimal therapy. This procedure is also a part of the regular monitoring program for heart transplant patients.
- Catheterization of the right heart and hemodynamic assessment of pulmonary circulation. This technique is routinely performed at the Institute with the approach through the vein which allows for easy and quick performance. It is necessary in the assessment of complex congenital heart defects, as well as acquired heart diseases that cause an additional load on the pulmonary circulation, especially for the assessment of operability, i.e. the effectiveness of drug therapy.
- Patients suffering from so-called primary pulmonary hypertension, who require proper therapy and monitoring, represent a special group. Similar methods can be used in cases of pulmonary embolism, for diagnostic purposes, and especially for emergency treatment of this urgent and life-threatening condition.
- Pericardial puncture (pericardiocentesis) and pericardial drainage. This procedure is necessary in case of fluid build-up in the heart sac, which leads to compromised circulation. These conditions can appear either as acute or chronic, in case of inflammatory diseases, after heart surgery, in case of autoimmune diseases, as well as in case of malignancies. It is performed quickly and efficiently, with ultrasound or X-ray control (or both at the same time) and enables not only the treatment of these most urgent conditions, but also the necessary diagnostic procedure.
Instructions for patients
The department works in the shift mode implemented by the Institute, where two shifts cover every weekday from 08 a.m. to 08 p.m. Outside these working hours, as well as on Sundays, active readiness is provided with the possibility of gathering the whole team in the shortest period possible.
Regardless of the above, the presence of the necessary staff is organized every weekday from 7:00 a.m. to take care of patients admitted within the STEMI network, and before the start of the regular shift from 8:00 a.m.
Furthermore, according to the regular schedule within the STEMI network (acute heart attacks), the department covers 24 hour-shifts over the weekend (weekend days are determined on a monthly basis), i.e. 07:00 p.m. to 07:00 a.m. on weekdays (also determined on a monthly basis). The SHP operator is also familiar with this schedule. During the on-call duty for the STEMI program, the presence of the entire team at the institute is mandatory during the entire on-call duty shift.
Angio room (catheterization laboratory):
- on weekdays 08 a.m. – 08 p.m.
- for the STEMI program according to the above mentioned schedule
- 24/7 stand-by
The Institute for Cardiovascular Diseases Dedinje, as well as its Department of Interventional Cardiology belong to the tertiary health care level. Therefore, it is necessary to have all medical documentation from previous health care levels, preceding the admission. If the patient was previously subjected to coronary angiography, i.e. percutaneous intervention, performed in another center, it is necessary (except in the case of objective lack of possible delivery) to have a CD (DVD) with recordings of the said procedure. Necessary analyses are listed in detail on the Institute’s website, i.e. the patient receives the list upon scheduling the hospital admission if it is made through the outpatient-polyclinic service of the Institute. In general, it is mandatory to have complete hematological and biochemical test results, teleradiography of the heart and lungs, echocardiographic examination. An immunological/serological report on the presence of infectious, hematogenously communicable infectious diseases (hepatitis, lues, HIV) is also required. The epidemiological situation may require reports (antigens/antibodies) for the presence of other infectious diseases (e.g. SARS-COV2). If percutaneous intervention is foreseen, it is mandatory to have original data on the blood type (ABO/Rh).
Outpatient unit activities are an important segment of the department’s work. The outpatient unit provides examinations of patients referred by their physicians (cardiologists) from other centers for additional diagnostics, i.e. consultative expertise. Special attention is paid to patients who are foreseen for invasive diagnostics (coronary angiography), i.e. percutaneous coronary intervention (PCI). The urgency level and admission schedule are determined accordingly. Patients referred for PCI are transferred to the Heart Team (Cardiac Surgery medical advisory board), for verification and possible superanalysis with the opinion and conclusion of the medical doctor working in the outpatient unit.
Another aspect of outpatient unit work is the follow-up examination after percutaneous intervention. During the follow-up examination, compliance with drug therapy is monitored, corrected if necessary, and the possible occurrence of adverse coronary events after stenting is monitored. All data are entered into the electronic database for further analysis and processing. Upon that occasion additional follow-up examination are also scheduled, if necessary.
For all follow-up examinations, it is necessary to have recent laboratory analyses in order to assess residual risk factors, compliance with therapy, as well as monitoring comorbidities. In patients receiving oral anticoagulant therapy, it is especially necessary to have up-to-date data on INR values, a record of changes in values and doses of relevant medications.
Working hours:on weekdays 12 – 08 p.m.
Contact telephone: 011-3601-664
Procedure for scheduling outpatient unit examination:
Outpatient unit examinations are scheduled through the Integrated Health Information System of the Republic of Serbia (IHIS). All specialists in regional centers with access to the system are able to schedule an appointment. Scheduling the first, follow-up examinations is done through internal IHIS referrals at the time of patient discharge from the hospital he/she was previously admitted to. Emergency patients are admitted without an appointment.