Structural Heart and Valve Disease Program

The Structural Heart and Valve Program brings cutting-edge therapies to patients with valve and congenital heart diseases.
Below is a diagram of procedures currently being done at our center as the standard of care or clinical trial.


Contact the Structural Heart and Valve Disease Program at:

202-877-5975

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Heart Transplants

In some cases, heart failure progresses to the point where the heart is no longer able to pump an adequate amount of blood, and heart transplantation may prove the best treatment option.

At MedStar’s Advanced Heart Failure Program, our expert heart transplant team offers you comprehensive care and support throughout the entire heart transplant journey. Our program features:

  • Experience: Our center performed the first heart transplant in the region in 1987. We have since performed more than 250 heart transplants.
  • Expert doctors: Our cardiologists are board-certified in heart transplantation. Our surgeons have years of experience performing heart transplants.
  • Multidisciplinary team: Our large team includes many dedicated clinicians and health care workers who have particular expertise in the specialized needs of transplant patients, such as coordinators, infectious disease specialists, pharmacists, social workers, physical therapists, occupational therapists, etc.
  • Quality of life: Our experienced transplant coordinators work with you and your family ever step of the way to help prepare you for a heart transplant. Our goal is to allow you to get back to the kid of life that you want to live, where you can return to work, spend quality time with your family and friends, resume the activities that you enjoy, etc.

Heart Transplant: Steps

Receiving a donor heart to replace your own requires many steps. Your heart transplant journey begins with expert doctors and a multidisciplinary team to support you through each stage of the process. In general, you can expect the process to unfold like this:

Step 1: Pre-Surgery

  • Initial evaluation: To help make sure you will benefit from a heart transplant, we perform a thorough medical and psychosocial evaluation, including blood tests and imaging studies, and we arrange for you to meet with several members of the transplant team.
  • Pre-surgical consultations: Before receiving a heart, you will meet with a transplant coordinator who will educate you about a heart transplant. You also will meet with a social worker to help you identify your social support systems and discuss what it is like to live with a transplanted heart. A financial counselor will meet with you to coordinate your insurance benefits and ensure you have adequate coverage for the special medications needed to live with a transplanted heart.
  • Transplant list: If the evaluation suggests that heart transplantation is a good option for you, your name will be placed on the national waiting list for a suitable donor heart. The wait time to receive a heart can be lengthy. When a suitable heart becomes available, a heart transplant coordinator will notify you and you will be asked to come to the hospital right away.
  • Clinical management: Patients may require a combination of therapies to support them while waiting for a new heart. These may include inotrope medications or LVADs. Some patients wait at home for their transplant, while others may require admission to the hospital. Learn more about left ventricular assist devices (LVADs).

 Surgery

  • Surgery day: The heart transplant surgery requires 4-8 hours. The transplant team will keep your family members informed of your progress.
  • Post-surgery: After surgery, you will wake up in a special cardiac intensive care unit. Our nurses have special training and expertise in caring for heart transplant patients. Our expert cardiac intensivist physicians and their team will closely monitor you and oversee your care in close collaboration with the transplant surgeons and cardiologists.
  • Progressive Care Unit: When you no longer need intensive care, you will be transferred to a specialized unit. During the course of your recovery, you will receive information about your transplant medications from a transplant pharmacist, physical therapy services, nutrition consultation and specialized education from one of the transplant coordinators. Your entire team will help prepare you and your loved ones for life after discharge.

After discharge:

  • Follow-up: We follow all of our heart transplant patients very closely. We will ask you to come in for follow-up visits after you receive your new heart, initially at least once a week. These checkups will be gradually spread out so that by year three you will only need to make annual visits. Testing to accompany these visits may include heart biopsies, echocardiograms and lab tests. Your Transplant Coordinator will help you arrange all of these visits.
  • Living with a donor heart: Life after a heart transplant can be an adjustment. For some it is a very emotional experience. That is why we offer a unique Patient Support Program that can assist you and your family in a number of ways, including an on-call nurse coordinator, patient support groups and referral to therapists if necessary. There is also a pharmacist and registered dietician to help answer any questions you may have at any time about medications and diet.

 

For information or appointments,
please call 855-463-3320.

Left Ventricular Assist Devices (LVAD)

Heart failure can progress to a point where it becomes end-stage heart failure. At this time, your heart becomes so weak it needs mechanical assistance to help do its job.

Our expert surgeons can give your heart a boost by implanting a pump called a left ventricular assist device, or LVAD. This device helps your heart pump blood to the rest of the body.

Why Choose MedStar Heart & Vascular Institute for LVAD Treatment

At the MedStar Advanced Heart Failure Program, our doctors are world-renowned for pioneering left ventricular assist device (LVAD) technology. Our expertise includes:

  • Pioneers: One of our heart surgeons, Steven M. Boyce, MD, helped design one of the first third-generation, continuous flow LVADs, and is pioneering novel surgical techniques for implanting LVADs.
  • Excellent outcomes: We currently care for more than 100 people with LVADs, many of whom have been living successfully with this technology for many years.
  • Highly specialized care: Our team includes experienced LVAD coordinators, along with dedicated pharmacists, physical therapists, nutritionists and others with special training and expertise in working with advanced heart failure patients.
  • Dedication to quality of life: Many of our patients return to work full-time and maintain active lifestyles.
  • High patient volume: We are among the busiest sites in the U.S. for LVAD surgeries.
  • Deep experience: The very first implantation of an LVAD pump took place at a MedStar hospital in 1988. At that time, we were one of just four hospitals in the world to perform this pioneering surgery.
  • Expert surgeons: Our highly experienced doctors have been involved with the development of LVAD technology since its beginning. Newer programs seek them out for assistance and advice, both nationally and internationally.
  • Patient support: Our patients receive the benefit and counseling of a number of team members who are experts at managing their care. Team members include nutritionists, social workers and transplant coordinators. Learn more about patient support.

What is a Left Ventricular Assist Device (LVAD)?

A left ventricular assist device is a small pump that helps circulate your blood when your heart becomes too weak to do its job effectively. The pump enables your heart to pump more blood with less work. An LVAD does not replace your heart and is not an artificial heart.

An LVAD is surgically attached to your left ventricle, your heart’s bottom left chamber. The pump continuously moves oxygen-rich blood from the left ventricle into the aorta, where it is delivered to the rest of your organs.

 A left ventricular assist device consists of several parts:

  • Pump: Resides inside or near your chest, and is attached to your heart.
  • Driveline: A small cable that attaches the pump to an external controller. The driveline exits your body through the skin.
  • Controller: A small computer, this machine alerts you when batteries need to be changed or if your device requires other attention. The controller usually is worn in a pack around the waist.
  • Batteries: Your LVAD needs an electrical source at all times, so it is usually attached to rechargeable batteries.
  • Power plug: You usually connect to an electrical source to recharge batteries.

When will your doctor recommend a LVAD?

Your doctor may recommend a left ventricular assist device when medications are no longer enough to help your heart pump adequate amounts of blood to the rest of your body.

LVADs can be used in two different situations:

  • Bridge-to-transplant: For patients who are awaiting a heart transplant, an LVAD can serve as a temporary assistive therapy until a suitable donor heart becomes available.
  • Destination therapy: For patients who do not qualify for a heart transplant, or simply do not want one, an LVAD can be implanted as a long-lasting treatment. The pumps are designed to last for many years.

Left Ventricular Assist Device Surgery: Steps

LVADs are implanted through open-heart surgery. Your LVAD journey begins with expert doctors and a multidisciplinary team to support you through each stage of the process. There are several possible steps:

  1. Initial evaluation: To help make sure you will benefit from receiving an LVAD, we perform a thorough medical and psychosocial evaluation, including blood tests, imaging studies and meetings with several members of the team.
  2. Pre-surgical consultations: Before receiving a pump, you will meet with an LVAD coordinator who will educate you about how your LVAD works and answer your questions about the technology. You also will meet with a social worker to help you identify your social support systems and discuss what it is like to live with an LVAD. A financial counselor will meet with you to coordinate your insurance benefits and talk about the ongoing expenses of maintaining a left ventricular assist device.
  3. Surgery day: The open-heart surgery performed to implant an LVAD takes about four to six hours.
  4. Post-surgical recovery: After surgery, you will wake up in a cardiac intensive care unit. Our nurses have special training and expertise in caring for LVAD patients. Our expert cardiac intensivist physicians and their team will closely monitor you and oversee your care, in close collaboration with the surgeon and advanced heart failure cardiologist.
  5. Progressive Care unit: When you no longer need intensive care, you will be transferred to a specialized heart failure unit. As you continue to recover from surgery, you will learn how to get around with your LVAD and take care of it before being discharged.
  6. Going home: You may have many questions about living with your new left ventricular assist device. Your personal LVAD coordinator can talk you through these issues.
  7. Follow-up: We will follow you closely after surgery to help you stay safe and healthy. At first, you will see our team in clinic on a weekly basis. These visits will gradually become less frequent as you continue to improve.

Life with a Left Ventricular Assist Device (LVAD)

After the LVAD is implanted, it is our hope that patients resume an active lifestyle. 

Receiving an LVAD may make you feel more energetic because your body is receiving an adequate amount of oxygen-rich blood again. You should be able to enjoy:

  • Moderate exercise
  • Intimacy with your partner
  • Returning to work or school

Activities you may need to avoid include:

  • Bathing in a tub or swimming: Your LVAD controller cannot be submerged in water. Your LVAD coordinator will help teach you how to adjust your personal hygiene.
  • Contact sports: These activities could damage your device.
  • Sleeping on your stomach: You will need to sleep on your back or side to avoid damaging any of the lines attached to the pump.
  • Having an MRI scan: It is safe to undergo a CT scan or X-ray, but not an MRI. 

Learn more about:

For information or appointments,
please call 855-463-3320.

Patient Support

Our unique Patient Support Program for advanced heart failure patients offers the resources you need to optimize your medical care and improve your quality of life.

The initiative is offered through our Advanced Heart Failure Program, where we bring together a large multidisciplinary team of experts to help you cope with this complex condition:

  • Expert clinicians: Our experienced, board-certified cardiologists and surgeons specialize in treating advanced heart failure patients. Your support care team may also include coordinators for left ventricular assist devices (LVAD) and heart transplants, specially trained nurses, physical therapists and many others.
  • Dedicated social workers: Our social workers specialize in working with advanced heart failure patients. They can help you access community resources, support groups and more.
  • Nutritionists: Diet plays a key role in managing heart failure. You can work with a nutritionist to reduce salt in your diet or make other healthy eating changes.
  • Financial counselor: For patients under consideration for left ventricular assist devices (LVAD) or heart transplants, our dedicated financial counselor will help you explore all the insurance and funding options available.

Why Patient Support for Advanced Heart Failure?

Patients with advanced heart failure have complex medical, social and emotional needs. Our multidisciplinary team of various specialists helps you enhance your quality of life while living with advanced heart failure. We offer:

  • Individualized support: We bring you the resources you need at the time you need them. From crisis management to physical therapy, we will help you obtain the right support.
  • Symptom management: We have a team of clinicians who are experts at managing uncomfortable symptoms such as pain, nausea, etc.
  • Family support: Advanced heart failure can affect your spouse, your children, your family or your caregivers. We offer support groups and education for family members and caregivers so they in turn can give you the support you need to enjoy life.
  • Education: We understand you want to know everything you can about your condition. Members of our patient support team will answer all your questions and provide you with the information you need to live well.

 Learn more about:

For information or appointments,
please call 855-463-3320.

Advanced Heart Failure Program

When it comes to heart failure, the doctors at our MedStar Heart & Vascular Institute are known for their innovation. They performed D.C.’s first heart transplant and implanted the country’s first HeartWare left ventricular assist device (LVAD).

We continue to improve these surgeries, and our Advanced Heart Failure Program remains one of the nation’s busiest for LVAD — giving our surgeons unmatched experience. We also offer medications not widely available, leading clinical trials and a unique team effort that provides the support you and your family need.

Why Choose MedStar Heart & Vascular Institute for Advanced Heart Failure Treatment

More serious cases of heart failure call for special treatment. Our Advanced Heart Failure Program at the MedStar Heart & Vascular Institute offers you:

  • Ventricular assist devices: Our program implants both short-term ventricular assist devices (VADs) and long-term, durable VADs. We are among the busiest centers in the United States for this procedure. Learn more about our left ventricular assist devices (LVAD).
  • Heart transplants: Our dedicated transplant team brings together specialists to direct and coordinate your care throughout the transplant journey. We performed the area’s first heart transplant, in 1987. Learn more about our heart transplants.
  • Specialized medications: Inotropes are strong medications designed to treat advanced heart failure. Sending patients home on these medications is only done at select programs like ours. Such programs have expert doctors specializing in treating advanced heart failure.
  • Clinical research: We pioneered many advanced heart failure treatments, including the use of VADs. We continue to take part in state-of-the-art clinical studies to improve heart failure care. Our doctors often design and lead these trials, giving our patients potential early access to emerging, promising therapies. Learn more about our leading research. 

Advanced Heart Failure Care at MedStar Heart & Vascular Institute 

Our advanced heart failure care stands apart for several reasons:

  • Leading doctors: The success of our advanced heart failure program hinges on top cardiologists and the expertise and experience of our surgeons. One of our cardiac surgeons, Steven Boyce, MD, helped design one of the first third-generation, continuous-flow LVAD devices and is pioneering new surgical techniques to implant them. All of our cardiologists are board-certified in Advanced Heart Failure and Transplant Cardiology, a new subspecialty of the American Board of Internal Medicine.
  • Team approach: Drawing on the resources of our extensive medical system, we bring together clinical and non-clinical experts to deliver the care you need.
  • Clinical teaching: We are among the select group of U.S. programs officially accredited to train the next generation of cardiologists who want to specialize in advanced heart failure and transplantation.
  • Patient support program: Our unique program brings together a large group of experts from many disciplines to participate in your medical care and help you maximize your quality of life. These include a variety of doctors, care coordinators, social workers, financial counselors, physical therapists and other specialists who collaborate on your care. Learn more about our Patient Support Program.
  • Other services: In addition to all aspects of advanced heart failure care, MedStar’s Heart & Vascular Institute provides state-of-the-art surgical intensive care and other crucial services. Learn more about our:
  • Diagnosis and diagnostic procedures, including sophisticated heart imaging such as cardiac MRI and high-resolution cardiac CT
  • Electrophysiology lab, for implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT)
  • Cardiac catheterization lab, for minimally invasive percutaneous valve repair or replacement
  • Cardiac rehabilitation

 Advanced heart failure requires careful monitoring and close follow-up. Our team partners with you and your regular cardiologist to manage and treat your heart failure while helping you maximize your quality of life.

 Learn more about:

Advanced Heart Failure Treatment in D.C. and Baltimore

The MedStar Heart & Vascular Institute is the largest heart care system in the mid-Atlantic, with acute care hospitals, clinics and cardiology practices throughout D.C., Maryland and Northern Virginia. Find one of our locations.

Inpatient services are currently available at:

  • MedStar Washington Hospital Center, 110 Irving Street NW, Washington, D.C.

For information or appointments,
please call 855-463-3320.

WATCHMAN Device

For people who have atrial fibrillation, or A-fib, blood clots that cause strokes are a danger. The WATCHMAN™ device permanently seals off the left atrial appendage, a section of the heart that is the site of almost all stroke-causing blood clots in people who have A-fib.

It’s the only FDA-approved device of its kind designed to prevent blood clots that form in the left atrial area from entering the bloodstream and causing strokes.

 Our heart rhythm experts (electrophysiologists) and cardiologists at MedStar Heart & Vascular Institute were the first in the Washington metropolitan region to successfully use the WATCHMAN™ device to treat patients with atrial fibrillation (A-fib).

Facts at a glance: The WATCHMAN™

Here’s a look at important facts about the WATCHMAN™:WATCHMAN_ProductShot_with_Access_Sheath

  • The device has a mesh membrane that is spring-loaded to expand to about the size of a quarter once a doctor places it in the left atrial area.
  • This meshing acts as a filter: It allows blood to pass through while stopping clots.
  • The WATCHMAN™ is permanent. Heart tissue eventually grows over the device.
  • The device has no batteries or wires.
  • Most patients who get the WATCHMAN™ can stop taking blood-thinning medications within 45 days.

When will your doctor recommend the WATCHMAN™?

People who have A-fib often must take blood-thinning medication to prevent clots and strokes from happening. If you cannot take blood thinners due to side effects or bleeding problems, your doctor may recommend the WATCHMAN™ device.

Why choose MedStar for the WATCHMAN™?

Our heart specialists spent eight years testing the WATCHMAN™ device in clinical trials before it received FDA approval. While the procedure is new to others, it’s not new to us. Our doctors have more experience with the WATCHMAN™ device than anyone else in the Washington metropolitan region. 

We’re experts at performing medical procedures within the delicate structure of the left atrium. We’ve been performing complex ablation procedures within this fragile heart chamber for decades. Our doctors have the expertise and confidence you want when undergoing a heart procedure.

What is the WATCHMAN™?

The WATCHMAN™ is a self-expanding device that seals off the left atrial appendage, which is located at the top left chamber of your heart. In a normally-functioning heart, blood fills and then leaves the left atrial area with each heartbeat.

If you have an arrhythmia like A-fib, blood can remain in this area. This increases your risk for blood clots and strokes. The WATCHMAN™ creates a permanent barrier that prevents blood clots that may form in the left atrial area from entering the bloodstream and causing a stroke.

The WATCHMAN™ procedure: Steps

Our team of cardiologists and electrophysiologists implant the WATCHMAN™ device using a nonsurgical procedure performed in our specialized electrophysiology (EP) or cardiac catheterization labs. EP labs feature special equipment that allow our doctors to test the electrical activity of your heart.

The nonsurgical procedure lasts about an hour and involves several steps:

  1. You will receive anesthesia.
  2. Your doctor inserts a catheter (plastic tube) into a vein in your groin area.
  3. Your doctor guides the WATCHMAN™ device through the catheter to the opening of your left atrial area.
  4. Once the device is in place, it expands to create a mesh barrier of the left atrial area.
  5. You will most likely stay overnight in the hospital following the procedure.
  6. You should be able to discontinue the use of blood thinners after 45 days.
  7. The WATCHMAN™ is intended to be left in place permanently. Heart tissue eventually grows over the device.

Learn more about:

 

For information or appointments,
please call 855-463-3320.

AFib Treatment

Atrial fibrillation, or AFib, is the most common type of cardiac arrhythmia. It causes your heart to beat irregularly and increases your risk of blood clots, stroke and other heart-related complications. Learn more about atrial fibrillation.

Heart Rhythm Treatment

Our heart rhythm experts (electrophysiologists) at MedStar Heart & Vascular Institute’s Center for Comprehensive Atrial Fibrillation Management are nationally sought after to treat all forms of AFib—from routine cases to the most complex. Meet our doctors.

Some of our team’s pioneering achievements include being the first in the Washington metropolitan region to apply cutting-edge technologies to patients with AFib. These include:

Why Choose MedStar for A-fib Management

Our doctors are leading the way in researching and implementing new treatments for A-fib. At the Center for Comprehensive Atrial Fibrillation Management you benefit from:

  • Unsurpassed expertise: Our doctors have pioneered many heart treatments. We were the first in the region to offer new A-fib treatments, such as the WATCHMAN™ Device.
  • Comprehensive care: We provide a full spectrum of A-fib management—from diagnosis to individualized treatment plans. We also provide ongoing stroke prevention support and follow-up care for implantable devices like pacemakers.
  • Team approach: Our heart rhythm experts and cardiac surgeons work collaboratively to tailor individualized treatment plans that take into account your unique conditions and needs.
  • Clinical Research: Our team leads the way in clinical research to remedy heart arrhythmias like A-fib. Our doctors design and lead multiple research trials, giving patients early access to cutting-edge therapies.
  • Convenience: Our electrophysiology (EP) program is the largest in the Washington metropolitan region. We make it easy to get the care you need with 10 outpatient clinics located throughout the mid-Atlantic region.

Diagnosis and Treatment of A-fib

Our experts test the electrical activity of your heart in our dedicated EP labs. Highly-specialized equipment enables our team of experts to accurately diagnose your condition. Learn more about A-fib treatment options at MedStar Heart & Vascular Institute. 

Comprehensive A-fib Management

The Institute is part of large network. Many of our services can be obtained at our locations throughout the mid-Atlantic region. Inpatient services are currently available at:

For information or appointments,
please call 855-463-3320.

Aneurysm Repair

If our doctors find a dangerous aneurysm in time, they can save your life with urgent aortic repair. For cases that are less urgent, but still troubling, we work with you to find the best treatment plan, whether that is careful monitoring, medication or a procedure that reinforces the aorta. 

At the MedStar Heart & Vascular Institute, our world-renowned team offers the approaches you need for successful aortic care:

  • Open Surgery
  • Complex Repairs: Doctors around the region often refer patients to us.
  • Minimally Invasive Endovascular Repair: Other programs use stent-grafts in the descending aorta, but we also place them in the ascending aorta.
  • Hybrid Repairs Combining Surgery and Endovascular Techniques: We take this specialized approach more than any other heart and vascular program in the D.C. area.

 Complex Aortic Aneurysms

While our team members provide top care for all types of aneurysms, they offer particular expertise for challenging cases. Our expertise with complex procedures leads many outside doctors to refer these patients to us — sometimes from more than a hundred miles away. 

Complex cases can involve aneurysms that:

  • Run across both the chest and abdomen (thoracoabdominal) and can interfere with blood vessels branching off the aorta
  • Involve the aortic root, ascending aorta and/or aortic arch
  • Involve other areas of the body and require a careful watch over blood supply
  • Require multiple steps to fix

Aneurysms: Surveillance and Medical Therapy

Smaller aneurysms that do not cause pain may not need treatment. Instead, your doctor may recommend that you avoid heavy lifting, intense exercise and emotional stress and come in for regular monitoring. 

Other aneurysm may pose somewhat greater risk but are manageable with medications that:

  • Lower blood pressure
  • Relax blood vessels
  • Reduce the potential for rupturing 

Traditional Aneurysm Surgery

Surgical repair is often the best treatment for aneurysms that are causing symptoms or have grown larger, generally 2 inches across or greater. There are two categories of surgery, though our doctors perform both similarly:

  • Emergency Surgery: The aneurysm has already ruptured, or could soon, as indicated by symptoms like abdominal, chest or back pain.
  • Elective Surgery: While there is more time to plan, the aneurysm’s size, rate of growth or interference with blood flow makes a repair necessary. 

Aneurysm Surgery: Steps

Traditional aneurysm surgery replaces the damaged aorta and takes out at least part of the bulge, though complete removal is often unnecessary. Our doctors perform several steps:

  1. Some aneurysm repairs require cardiopulmonary bypass. Our surgical team uses a heart-lung machine to slow the heart and access the aorta, while still providing blood and oxygen to the brain and body. The body is cooled so it consumes less oxygen. Bypass is needed for:
    • Aneurysms in the aortic root and ascending aorta
    • Aneurysms in the aortic arch, unless a hybrid approach is taken (learn more about hybrid aneurysm repair)
    • Some aneurysms that traverse the chest and abdomen (thoracoabdominal aortic aneurysms)

Other aneurysms do not require this step — the enlarged section is simply clamped while maintaining the most critical blood flow.

  1. After anesthesia, surgeons make an incision above the aneurysm and open the aorta.
  2. At least part of the aneurysm is removed and a long-lasting synthetic graft is placed to reinforce the damaged aorta.
  3. Bypass is ended, if it was needed. Otherwise, the clamps are removed and incision is closed.
  4. Hospital recovery typically takes 7 to 10 days. 

Endovascular Aneurysm Repair

We also offer an alternative to surgery — a minimally invasive approach called thoracic endovascular aortic repair (TEVAR or EVAR) that uses a metallic scaffold and a synthetic fabric (stent-graft) to reinforce the aorta and avoid a rupture. While an endovascular approach is not appropriate for every patient, it can provide benefits over surgery, especially since it is minimally invasive. 

We are one of the few heart and vascular centers in the greater D.C. area using stent-grafts throughout the aorta, helping to refine and expand their use. We are also one of the few programs in the area combining endovascular repair with open surgery to help patients with particular aneurysms. Learn more about our hybrid aneurysm repair. 

Minimally Invasive Aneurysm Repair: Benefits and Challenges

Endovascular aneurysm repair can provide several advantages over traditional, open surgery:

  • Provides an option for patients too frail or sick for surgery
  • Smaller incision(s)
  • Less pain
  • Shorter hospital stay and recovery
  • Less chance of complications 

Endovascular Aneurysm Repair: Steps

Successful endovascular aneurysm repair requires several steps:

  1. Our team runs additional tests to make sure you are a good candidate for this type of repair, as well as to choose the best stent-graft.
  2. A team member administers local anesthesia and a sedative, or general anesthesia.
  3. Using X-rays and special dye for guidance, a guide wire and then a catheter are threaded through the arteries to the aneurysm.
  4. The collapsible stent-graft is put into the catheter and positioned over the aneurysm. It is then fixed in place and opened to reinforce the aorta’s wall.
  5. Hospital recovery typically takes 2 to 3 days. 

Aneurysm Follow-Up Care

Following discharge from the hospital, you are asked to come back within a certain amount of time for a checkup and ultrasound or CT scan. We are also likely to recommend some lifestyle changes:

  • Watch your blood pressure and weight
  • Eat foods lower in fat, cholesterol and calories
  • Exercise
  • Quit smoking (if applicable)

Transradial Catheterization

For many patients, cardiac catheterization can be performed through the radial artery in the wrist, instead of using an artery in the groin. The femoral artery in the groin has been traditionally used because it is a larger artery that allows for a larger, more easily maneuvered catheter.

Your physician will conduct a non-invasive test in the catheterization lab to be sure that there is sufficient collateral blood flow to the hand. If this test is normal, the physician can then access the same coronary arteries through the wrist as during a femoral catheterization procedure. If the patient's condition indicates a need for a stent, this can be done through the wrist as well.

A transradial catheterization has several advantages, including:

  • It is a more comfortable procedure for patients.
  • There is virtually no risk of bleeding complications where the catheter is inserted. This is especially important for patients who have other medical conditions, such as bleeding disorders, obesity or peripheral arterial disease.
  • Recovery time is much faster. Following the procedure, a simple wristband is used to compress the artery. The patient can sit up and walk around immediately, as compared to a patient undergoing a femoral artery procedure who must lie flat for four to six hours following the procedure.
  • Patients can often eat within an hour of their procedure.

 

Patient Steve Sindler’s Story

Hear from grateful patient and successful Annapolis attorney Steve Sindler about how the transradial approach to cardiac catheterization—and the experts at MedStar Heart & Vascular Institute at MedStar Union Memorial Hospital made a difference in his recovery.

The Transradial Approach to Cardiac Catheterization

Interventional cardiologist Dr. John Wang, chief of the Cardiac Catheterization Lab at MedStar Union Memorial Hospital, performs a transradial cardiac catheterization. This newer approach to catheterization, performed through the wrist instead of the groin, can mean less pain and a faster recovery for patients.

Dr. John Wang Discusses the Benefits of Transradial Cardiac Catheterization

“We’ve done thousands of procedures safely through the transradial approach.” Dr. John Wang, chief of the Cardiac Catheterization Lab at MedStar Union Memorial Hospital, describes the benefits of a newer approach to cardiac catheterization, performed through the patient’s wrist. The transradial approach is much more comfortable for patients and allows for faster healing and recovery.

Find out more about Transradial Cardiac Catheterization at MedStar Union Memorial Hospital.

Complex Aortic Center

Your aorta is the largest blood vessel and is responsible for carrying oxygen-rich blood to the rest of the body. The aorta receives all of the heart’s output under high pressure, making repairs to this crucial artery challenging. That is why our Complex Aortic Center brings together two specialties that traditionally have worked apart — the doctors who operate on the heart and its major arteries (cardiac surgeons) and those who operate on the other veins and arteries (vascular surgeons). Their combined skill and close partnership provides top care for the aortic tears known as dissections and the bulges called aneurysms. The aortic program at our MedStar Heart & Vascular Institute is one of the select few in the Greater D.C. area offering:
  • Complex Procedures: While our experienced team treats all types of aneurysms and dissections, they offer special expertise for complex repairs. Often, these are cases other doctors refer to us, sometimes from more than a hundred miles away. Our doctors treat several of these patients each week.
  • Minimally Invasive Aneurysm Repair throughout the Aorta: We can often find a minimally invasive, endovascular alternative for aortic repair, even when patients are told by other doctors that they cannot have surgery. We make small incisions and use special tools to reach the aorta. We can repair aneurysms throughout the aorta this way.
  • Hybrid Techniques: Certain patients benefit from procedures that combine traditional, open surgery with an endovascular repair, providing optimal treatment for you or your loved one. We perform more of these procedures than any other heart and vascular program in the area.
We design a treatment plan just for you, with the most advanced imaging and the latest stents and stent-grafts — the materials used to make successful repairs. Learn more about:

Top Aortic Care at MedStar

Aortic care at our Heart & Vascular Institute stands apart for several reasons:
  • Leading Doctors: The success of our aortic center hinges on top cardiologists and the expertise and experience of our surgeons:
    • Vascular: Board-certified in general and vascular surgery, Tareq Massimi, MD, leads a team that treats aortic disease. He is recognized around the world for complex, minimally invasive procedures to treat dissections and aneurysms. Dr. Woo is particularly acclaimed for combining this endovascular approach with traditional surgery, a hybrid technique he has performed hundreds of times and taught to other doctors around the globe. Learn more about hybrid aneurysm repair, or about the aortic center’s vascular team.
    • Cardiac: Well-versed in aneurysm and dissection repair, Christian Shults, MD, is our attending cardiac surgeon, is co-director of the Complex Aortic Center and leads its cardiac team. In addition to being fellowship-trained and board-certified in both surgery and thoracic/cardiac surgery, Dr. Shults has extensive domestic and international training in complex open and endovascular aortic surgery. Learn more about the aortic center’s cardiac team.
  • Team Approach: The vascular and cardiac teams often take a joint approach to challenging cases. They also consult closely beforehand on every patient, reviewing diagnoses and combining their knowledge and judgment to come up with the best recommendation.
  • Clinical Trials and Research: We take part in clinical trials to improve aortic care. Our doctors often create and lead these trials, giving patients even earlier access.
  • Support Services: In addition to all aspects of vascular and cardiac surgical care, MedStar’s Heart and Vascular Institute provides genetic testing, state-of-the-art surgical intensive care (if needed), access to additional specialists and other crucial services. Learn more about our:

Aortic Center Vascular Team

Read the profiles of our vascular team members:

Aortic Center Cardiac Team

Read the profiles of our cardiac team members:

For information or appointments,
please call 855-463-3320.

Aortic Dissection Treatment

While aortic dissections are a serious and sometimes fatal condition, more patients than ever are living long and healthy lives after undergoing a repair or using medication to manage the problem. 

At the MedStar Heart & Vascular Institute, our surgeons have the experience and skill to perform the challenging surgeries needed to repair aortic dissections. They specialize in complex cases, with other doctors often referring patients to them. And they have specialized expertise in a minimally invasive approach called endovascular repair. 

Learn more about aortic dissections or the team at our Complex Aortic Center

Complex Dissection Cases

We specialize in complex dissection repairs, thanks to the combined skills and partnership of our vascular and cardiac surgeons. Other doctors often refer challenging cases to us — sometimes from more than a hundred miles away. 

Complex dissections often require repair and are frequently marked by:

  • Patients who are especially ill
  • Multiple tears, and several new blood passageways (lumens)
  • Particular challenges in using equipment for repair
  • Skill needed to determine when the dissection is properly repaired and the surgery or procedure is finished
  • An even greater need for precision and accuracy 

Aortic Dissections and Medications

Medications are important for treating dissections, to lower blood pressure and relieve strain on the damaged aorta. We prescribe medication to all our dissection patients, and also recommend repair for many of them. Learn more about the types of aortic dissections

We start most patients with a beta-blocker such as metoprolol or labetalol, which:

  • Blocks adrenaline
  • Widens arteries
  • Decreases the force of the heart’s contraction 

We may also use:

  • Nitroprusside (to relax blood vessels)
  • ACE inhibitors
  • Calcium channel blockers 

Aortic Dissection Surgery

Surgery is the standard treatment for Type A dissections (ascending aorta), though some patients are too sick to undergo an operation and may rely on medication. Patients with Type B dissections (descending aorta) may also need surgery if:

  • The dissection is interfering with the major arteries branching off the aorta, with problems in the limbs or organs
  • The aorta has expanded too much or is at risk of rupturing
  • Medication cannot relieve the pain
  • Internal bleeding is causing problems
  • A large aneurysm has formed (learn more about aortic aneurysms

Learn more about the types of aortic dissections

Dissection Surgery: Steps

Surgically repairing an aortic dissection involves a number of steps:

  1. Patients with Type A dissections are placed on a heart-lung machine (cardiopulmonary bypass). This allows the surgical team to slow the heart and clear the aorta of blood, while still providing blood and oxygen to the brain and body. The brain and body are also cooled so they consume less oxygen.
  2. After a team member administers general anesthesia, and the patient has been placed on the heart lung machine, surgeons make an incision into the aorta to inspect the extent of the tear. They also determine if other vessels or body parts also require repair.
  3. The damaged aorta is replaced with a long-lasting synthetic graft and reconnected.
  4. A Type A dissection may also damage the aortic root. In most cases, this damage can be repaired, but at other times the aortic root may need to be replaced. This involves removing the aortic tissue and replacing it with a long-lasting synthetic graft, reattaching the coronary arteries and either repairing or replacing the aortic valve. Learn more about our heart valve surgery.
  5. The body is re-warmed, bypass is ended and the incision is closed.
  6. Hospital recovery typically takes 7 to 10 days. 

Learn more about the types of aortic dissections.

Endovascular Dissection Repair

While surgery remains an important tool for treating ascending aortic dissections (Type A), our team is among those advancing minimally invasive repair for patients with descending aortic dissections (Type B). 

Called endovascular repair, these procedures involve threading catheters through the femoral artery to your aorta. A stent-graft is sent through one of the catheters, then positioned to reinforce your aorta. An endovascular approach requires a high degree of expertise but offers several advantages:

  • Minimally invasive
  • Faster recovery
  • Fewer complications — less chance of rupturing, better blood flow to organs and less pain 

Learn more about the types of aortic dissections.

Aortic Dissection Follow-Up Care

Many patients follow a post-treatment plan, particularly if they are managing their dissection with medication. Your doctor may ask you to maintain a certain weight or limit yourself to light or moderate exercise.

For information or appointments,
please call 855-463-3320.

Hybrid Aneurysm Repair

Our aortic team is unique in treating aneurysms with a hybrid procedure when necessary: making part of the aortic repair with conventional open surgery and the rest with an endovascular approach. The minimally endovascular approach uses small incisions and special tools to reach the aorta. 

Not every patient needs a hybrid procedure, but it can provide a less-invasive solution for more complex cases. At the MedStar Heart & Vascular Institute, we complete more of these procedures than any other program in the D.C. area. 

Learn more about:

Hybrid Aneurysm Repair for Aortic Arch

After your aorta leaves your heart, it curves back toward your chest and abdomen — an area called the aortic arch. This area is challenging to repair because of the crucial arteries that branch off it to supply the brain and arms with blood. 

In the past, open surgery represented the only option for repairing aneurysms in the arch. This involved putting the patient on a heart-lung machine, cooling the body and stopping the normal circulation. But, a hybrid approach offers an alternative, with two main steps:

  1. Surgery: Our doctors perform open surgery to graft new blood-supplying arteries to the brain and arms, closer to where the aorta leaves the heart.
  2. Endovascular: A catheter is threaded toward the aneurysm and a stent-graft is positioned over the aneurysm, then released to treat the aneurysm. 

Learn more about aortic aneurysms and the parts of the aorta. 

Hybrid Aneurysm Repair Benefits

Using a hybrid approach to repair aortic arch aneurysms offers several benefits:

  • No heart-lung machine used
  • No need to cut into the sensitive aortic arch, resulting in less intense treatment with fewer complications 

While we may also use a hybrid approach for aneurysms that cross both the chest and abdomen (thoracoabdominal aneurysms), we can often treat these with a purely endovascular repair. Learn more about the types of aortic aneurysms

Hybrid Elephant Trunk Procedure

A hybrid procedure can often help patients with extensive aneurysms that involve both the ascending aorta (including the aortic arch) and the descending aorta. The procedure is performed in two stages, usually staggered so the patient can recover in between:

  1. Surgery: The ascending aorta and arch are replaced with a long-lasting synthetic graft. A second graft is left in the descending aorta but not attached at its far end, leaving it looking like an elephant’s trunk and giving the procedure its name.
  2. Endovascular: Using a catheter, a stent-graft is placed in the descending aorta, where it joins the earlier elephant trunk graft and completes the repair. 

By using an endovascular approach in the second step, the patient avoids a second surgery and a second large incision. Learn more about aortic aneurysms and the parts of the aorta. 

Cardiac Surgery at MedStar Heart Institute

For Patients: 202-877-DOCS (3627) | For Physicians: 202-877-7777

Our cardiac surgeons have a reputation as the best in the region and among the finest in the nation.

Team approach to cardiac care

There are many different aspects to consider when treating patients with cardiac disease. Our cardiac surgeons work in teams with other cardiac experts, including cardiac imaging specialists, interventional cardiologists, pulmonologists, radiologists and nurses to complete the entire picture for each patient. We are committed to a team approach to care.

The advantage of experience in cardiac surgery

We are one of the highest volume cardiac surgery centers in the Washington metropolitan area. Volume and experience also translate into best practices based on outcomes. Our entire team sees a large number of patients per year. We continually refine surgical techniques, so you receive the least invasive surgical option that will also bring the best long-term results.

Cardiac surgery database for better patient care

We have compiled a cardiac surgery database containing data on more than 60,000 cases from the past 30 years. This unique resource helps us continually improve patient care. It gives our physicians a direct window on the practices and approaches that produce the most successful outcomes for our patients. Few cardiac centers have anything like it.

Sophisticated communication and electronic medical records

Our sophisticated information management and communications capabilities are powerful resources for integrating MedStar Heart Institute services and locations, from enabling real-time sharing of patient images and data to supporting electronic medical records. This means you can receive advanced cardiac care no matter your location-at one of our sister hospitals, or at one of our satellite locations. If you are looking for experienced heart surgeons with advanced surgical expertise, who treat large numbers of patients every year, you have come to the right place. Our heart surgeons treat complex heart conditions using a variety of techniques—including minimally invasive surgery—with outstanding outcomes. They also work as part of a larger team of heart specialists to provide patient-focused care both before and after surgery.

Advanced heart surgical care in Washington, D.C.

Our history of innovation and research is not the only reason you should choose us for your heart surgery. Consider these facts:
  • The Society for Thoracic Surgeons awarded us three stars, its highest rating, based on quality and outcomes.
  • Nearly half of our CABG (Coronary Artery Bypass Graft) procedures are performed off-pump (without using a heart and lung machine), which speeds recovery and reduces bleeding, neurologic impairment and other complications.
  • We are the only hospital in the Washington, D.C., region to offer the Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive procedure performed for severe aortic stenosis.
  • Our doctors and researchers have a database of more than 60,000 cardiac surgical cases from the past 30 years. This rich data helps us continually improve patient care.
  • Our patients have access to clinical trials in better methods to prevent and treat cardiac and vascular disease.

Cardiac surgical services

We offer the following surgical services for the treatment of heart conditions:

Heart conditions we treat

We offer the above heart surgeries for treatment of:
If you are a patient, call our referral and appointment line: 202-877-DOCS (3627)
If you are a physician, call our consultation line: 202-877-7777

Make a Gift to MedStar Washington’s Vascular Surgery Program

Some 15 million Americans have vascular disorders, which affect the arteries and veins throughout the body. Vascular disorders are often thought of as “hardening of the arteries” or “poor circulation.” At least half of those with vascular disorders have no symptoms.

Quick and Effective Diagnosis Leads to Better Outcomes

However, it is important to diagnose these conditions accurately and early, because they can lead to progressive discomfort, long-term disability or even sudden death. Vascular disease can reduce your life expectancy by causing heart attacks, strokes, ruptured blood vessels, blood clots or kidney failure. Blood vessel disease in your legs can lead to amputation if left untreated; in fact, it leads to about 100,000 amputations each year. Also, if you have vascular disease, your risk for developing heart disease is six times greater. Our vascular surgery team can determine the nature and extent of your condition by performing a complete range of diagnostic tests, and then implement the most sophisticated treatment strategies to return you to good health. As a Level I trauma center and an advanced surgical center staffed by board-certified surgeons, the Hospital Center serves more than 300,000 patients a year in the Washington metropolitan area.

We Depend on the Support of Our Generous Donors

We are a not-for-profit organization, and depend on the support of our generous donors. Since 2000, we have provided more than $220 million in charity care to our community. Please help us as we work to effectively treat and cure vascular disease.

Vascular Health Quiz

  1. Do you feel pain, tightness, tiredness or weakness in your legs when you walk?
  2. Do your legs feel better when you stop walking?
  3. Has a physician ever told you that your have poor circulation in your legs?
  4. Have you ever been told that you have blockage in your carotid arteries?
  5. Have you recently experienced TEMPORARY:
    1. Loss of vision in one eye?
    2. Slurred speech?
    3. Difficulty understanding what is being said to you?
    4. Weakness or numbness of an arm or leg on one side of your body?
  6. Do you have high blood pressure?
    1. If yes, for how long? ___Years
    2. Has it been difficult to get your blood pressure under control?
    3. Are you taking more than two blood pressure medications now?
  7. Do your legs swell?
  8. Have you had problems with blood clotting or phlebitis?
  9. Have you had or do you have an open sore on your legs, feet or toes that doesn't heal?
  10. Do you have a family history for enlarged arteries or aneurysms?

If you answered "Yes" to any of the questions above, you should consider seeing your doctor or a vascular specialist for further evaluation.

 

MedStar Washington Hospital Center offers the most comprehensive service in diagnosing and treating vascular disorders. A team of specialists thoroughly reviews each case to determine the best treatment for each patient. MedStar Washington Hospital Center has a complete range of diagnostic tests to determine the nature and extent of vascular conditions and implement the most sophisticated treatment strategies to return patients to good health.

 

Minimally Invasive Vascular Surgery Suite

vascularsurgerysuite

The Lawrence B. Taishoff Center for Endovascular Surgery

Vascular surgeons at the Hospital Center perform approximately 1,800 operations every year, nearly four times more than any other hospital in the area. The Taishoff Center was made possible through a $1 million gift from the Taishoff Family Foundation, in appreciation of the care given to Lawrence Taishoff by Dr. Cameron Akbari, senior vascular surgeon at the MedStar Washington Hospital Center.

About the hybrid suite: the only one of its kind in the Washington, D.C. area

A hybrid suite has all the functional capabilities of the most advanced, state of the art traditional operating room. Vascular surgeons can perform open surgery and endovascular surgery, which uses small tubes and wires to treat disease from within the blood vessels.

Most operating rooms in the country will have a portable radiologic (imaging) unit to use during vascular operations; however, the imaging and processing and capabilities are vastly inferior to one in which the imaging equipment is built into the operating room.

 

Take a virtual tour of the minimally invasive surgery suite. 

 

Benefits of the hybrid suite

As a result of this advanced technology, our vascular surgeons are able to perform the most advanced endovascular and hybrid procedures, incorporating the latest technology, such as three-dimensional imaging and rotational imaging. This allows precise and accurate endovascular treatment with faster recovery for complicated diseases, which in the past had required extensive invasive operations with prolonged recovery.

Another added benefit of the hybrid suite is that post processing is more advanced, compared to a portable vascular surgery unit. Surgeons can get better visualization and more accurate measurements for the conditions they treat. For example, our surgeons can now incorporate intravascular ultrasound directly in the endovascular suite without any added machinery. They can place an ultrasound probe inside a blood vessel, and look inside any blood vessel prior to delivery of a stent. In the case of hybrid procedures, all of these advanced techniques can be performed at the same time as traditional, open surgery, if necessary, due to the advantages of having all the technology in one operating suite.

About vascular surgery at the Hospital Center

Our board-certified vascular surgeons have the most experience in the Washington metropolitan area in treating complex vascular problems. The wide variety of surgical cases evaluated and treated by our surgeons provides them with a depth of experience unparalleled by other physicians in the area.

What is a Vascular Surgeon?

A vascular surgeon is a specialist who evaluates and treats diseases of the blood vessels. Treatment can include traditional open surgery and endovascular approaches. Some of these surgeries may include:

  • Removing the plaque from an artery
  • Bypassing the area of obstruction with a graft
  • Performing endovascular procedures

Because of their training, vascular surgeons are uniquely qualified to diagnose all vascular diseases and interpret a wide variety of diagnostic tests.

Vascular Surgery Locations

Our expert vascular surgeons are available at the following locations:

MedStar Washington Hospital Center
106 Irving Street, POB North 3150
Washington, DC 20010
202-877-0275
www.medstarwashington.org/maps
www.medstarwashington.org/parking

MedStar Georgetown University Hospital
3800 Reservoir Road NW
Washington, DC 20007
202-444-2255

MedStar Good Samaritan Hospital
5601 Loch Raven Blvd.
Smyth Building, Suite 303
Baltimore, MD 21239
443-444-3434

MedStar Harbor Hospital
3001 S. Hanover Street
Outpatient Center, Suite 216
Baltimore, MD 21225
410-350-2106

MedStar Montgomery Medical Center
18109 Prince Philip Dr. Suite B-100
Olney, MD 20832
301-774-8962

MedStar Southern Maryland Hospital Center
7501 Surratts Rd.
Clinton, MD 20735
301-877-7353

MedStar St. Mary’s Hospital
25500 Point Lookout Rd.
Leonardtown, MD 20650
240-434-4072

MedStar Union Memorial Hospital
Johnston Professional Buidling
3333 N. Calvert Street, Suite 325
Baltimore, MD 21218
410-554-2950

MedStar Health at Lafayette Centre
Building 2
1133 21st St., NW
Washington, DC
202-416-2000

MedStar Health at Chevy Chase
Barlow Building
5454 Wisconsin Avenue, 11th Floor
Chevy Chase, MD 20815
301-215-9420

MedStar Health at McLean
6862 Elm St  Suite 800A
McLean VA 22101
(703) 288-7070

Medstar Health Bel Air Medical Campus 
12 Medstar Blvd
Bel Air, MD 21015
(410) 877-8088

Medstar Franklin Square Medical Center 
9101 Franklin Square Drive, Suite 210
Baltimore, MD 21237
(443) 444-3431

For more information or to make an appointment, call 202-877-DOCS (3627)

Why Choose Us

 vascular-surgery-team-mwhc

Our vascular surgery program was established in order to provide the region with a service dedicated to the thorough evaluation and treatment of vascular disorders. Our physicians work together to offer patients the most sophisticated diagnostic and treatment options. 

Team of Specialists

Our team of specialists includes:

  • Vascular medicine specialists
  • Vascular surgeons

These specialists work together to ensure a well-rounded approach to your care. When their expertise is needed, the team also has access to other specialists throughout the MedStar network, including:

  • Heart specialists
  • Diabetes specialists
  • Kidney specialists

Comprehensive Services

The program offers the most advanced evaluation options to achieve a precise diagnosis of your condition. Whenever possible our physicians use noninvasive diagnostic testing and treatments. The program also has access to the most sophisticated forms of treatments and procedures, including new catheter-based and surgical approaches.

Convenient Access

Usually, you will see one doctor during your initial evaluation. This physician will then discuss your case with our other specialists, to confirm a diagnosis and decide on the best treatment plan. The team works closely with your primary care physician to manage your care.

We offer the most comprehensive approach to your health care. We strive to combine the finest clinical capabilities with compassionate care and an unyielding commitment to our "Patient First" philosophy.

Vascular Surgery

WOO-SHULTS-IN-SURGERY-Feature-vascular-surgery

MedStar Heart & Vascular Institute's vascular surgery program is the largest, most experienced diagnostic and treatment center for vascular problems in the metropolitan area. Our specialists treat the most critical vascular patients, resulting in excellent outcomes. Our team includes vascular medicine specialists, vascular surgeons, interventional cardiologists and radiologists who work together to ensure a well-rounded approach to your care.

Experience and Expertise

Our vascular medicine specialists and vascular surgeons evaluate and treat the widest spectrum of vascular disease. Our vascular lab is accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories, and members of our staff are registered vascular technologists, ensuring the highest quality of care and sophisticated diagnostic testing available. Learn more about one of our vascular surgeons, Frederick Beavers, MD.

Referrals from Vascular Specialists

As home base for the most complex helicopter system in the area—patients are flown here from hundreds of miles away—our physicians are among the most experienced at quickly and effectively evaluating and treating the signs and symptoms of vascular disease. Our physicians are so widely respected, other vascular surgeons refer to our center.

Think You Have Symptoms of Vascular Disease?

Take our quiz to find out if you need to see one of our experienced vascular specialists.

Vascular Conditions Treated

Vascular Diagnosis

  • Abdominal aortic ultrasound
  • Angiography
  • Ankle-brachial Index
  • Arterial duplex scan
  • Arteriogram
  • Computerized tomographic angiography (CTA)
  • Doppler
  • Ultrasound
  • Magnetic Resonance Angiography (MRA)
  • Pulse Volume Recordings

Vascular Treatments

Electrophysiology Lab

Electrophysiology Lab at MedStar Heart & Vascular Institute

Our electrophysiologists manage one of the largest and busiest electrophysiology (EP) labs in the country. This is a major referral center for the entire mid-Atlantic region, and our physicians perform more than 5,000 EP procedures each year. 

About the electrophysiology lab

EPlab2MedStar Washington Hospital Center opened the area's first Cardiac Arrhythmia Center in 1985 and since then has remained in the forefront of new techniques to evaluate and manage patients with a wide variety of arrhythmias. A recent major renovation and expansion has created an eight-laboratory EP suite. It features state-of-the-art equipment and technology as well as a dedicated EP patient care suite that is unique and unrivaled in the region. Together with the adjoining outpatient Cardiac Arrhythmia Center, this facility is a fully integrated arrhythmia care center for patients.

Their clinical scope of work encompasses all areas of arrhythmia management, including:

  • Pacemakers
  • Implantable cardioverter defibrillators (ICDs)
  • Biventricular pacing
  • All types of ablation, including ablation for:
    • Supraventricular tachycardia (SVT)
    • Ventricular tachycardia
    • Atrial fibrillation

Cardiac Catheterization Research & Clinical Trials

From the most effective new cardiac treatments to staying ahead of the latest scientific advances, innovation is at the heart of MedStar Heart & Vascular Institute. The Heart Institute is a pipeline to the most important new research and developments for its physicians, which translates into state-of-the-art care for patients.

Through our Cardiovascular Research Institute, we bring the benefits of pioneering research and clinical trials to patients from throughout the region. At any time, we are involved in 30 to 50 investigational trials for the treatment of heart disease, and our cardiologists and cardiac surgeons publish their findings widely.

Here are just a few of the highlights from our research and clinical trials:

  • The TAVR procedure (transcutaneous aortic valve replacement) is a clinical trial, examining a minimally invasive procedure to treat patients with aortic stenosis who are too ill to undergo traditional surgery. We added more than 200 patients into the national clinical trial, and we are considered one of the international leaders in this area. TAVR is not offered anywhere else in our region.
  • Our interventional cardiologists have pioneered the testing and development of ventricular assist devices (VADs) since 1988. Today, VADs are routinely used as bridges to transplantation and, for some patients, a long-term solution for advanced heart failure.
  • We are assessing the MitraClip—a catheter-based therapy—for percutaneous repair of mitral valve regurgitation. We are the only center in the region to do this.
  • We are assessing a treatment for coronary arteries that uses completely biodegradable stents that dissolve once treatment is complete. 

Cardiac Catheterization Treatments

You may have heard the term “cardiac cath,” but may not know exactly what it means. Cardiac catheterization is a minimally invasive diagnostic and treatment option that involves passing a catheter (a thin, flexible tube) through the vessels supplying blood to the heart. Your doctor uses this procedure to tell how well your heart is functioning, and to diagnose any possible cardiac disease.

Cardiac Cath Care in Washington, D.C.

The Cardiac Catheterization Lab at MedStar Heart & Vascular Institute has 11 labs dedicated to interventional procedures, so treating patients is fast, leading to the best possible outcomes. All of our catheterization labs use the latest digital technology, which offers highly detailed images.

Interventional cardiologists perform cardiac catheterizations. These physicians have up to eight years of clinical training following medical school. 

Cardiac catheterization allows our cardiologists to treat certain types of heart conditions. For example, they can:

  • Open up a narrowed or blocked blood vessel in the heart or elsewhere in the body
  • Open a blocked heart valve
  • Dilate obstructed arteries in the heart
  • Repair holes in a blood vessel or other types of heart defects

Other diagnostic tests and procedures performed at the Heart & Vascular Institute:

Minimally Invasive Heart Procedures

Cardiac catheterization is a minimally invasive diagnostic and treatment option. Because it doesn't require surgery, you recover faster, with less pain and fewer complications. Patients who have an interventional treatment, such as placement of a stent, can usually go home the next day.

About 10 percent of patients who undergo cardiac catheterization need open heart surgery. At MedStar Heart & Vascular Institute, we have world renowned surgeons able to manage even the most complex cases.  Our cath labs are fully equipped operating rooms, so if cardiac surgery is necessary, we never have to move patients in the middle of a procedure. 

Learn more about cardiac catheterization and the many other diagnostic tests and procedures we perform for:

Radial Approach for Cardiac Catheterization

Based on the needs of each individual patient, our physicians assess each situation and may opt to perform angioplasty and cardiac catheterization procedures through the wrist instead of the groin. Traditionally, doctors performed cardiac catheterizations by threading a catheter through the groin.

Coronary Artery Disease

Valvular Heart Disease

Structural Heart Problems

Cardiac Electrophysiology Treatments

Restoring the Rhythm of Life:

Advanced AFIB Treatment

Welcome to the Section of Cardiac Electrophysiology at MedStar Heart & Vascular Institute—one of the nation’s most advanced programs for the treatment of heart rhythm disorders.

We offer:

  • The most sophisticated diagnostic tools and advanced treatment options—with more in our research pipeline.
  • A team of 16-board-certified, nationally recognized arrhythmia specialists.
  • Locations throughout the region.
  • A state-of-the-art patient care and procedure suite as its centerpiece.
  • And a new heart alliance with Cleveland Clinic – the nation’s #1 heart program.

We balance the best of technological expertise with the compassion of patient-centered care for all types of cardiac arrhythmias.  Our experts are leaders in developing and testing the most advanced medical, surgical and minimally invasive treatment techniques available today.  And they are caregivers who share a philosophy of medicine that puts patient comfort, privacy and individual attention first.

MedStar Heart & Vascular Institute is headquartered at MedStar Washington Hospital Center and is consistently recognized by U.S.News & World Report and The Society of Thoracic Surgeons for preeminent cardiac care.  MedStar Heart Institute is comprised of more than 100 cardiac physician specialists throughout the Washington region, as well as the nationally recognized expertise of the Hospital Center, the academic depth of MedStar Georgetown University Hospital, and the cardiac services of MedStar Montgomery Medical Center, MedStar Southern Maryland Hospital Center and MedStar St. Mary’s Hospital.

The Section of Cardiac Electrophysiology offers services in nine convenient locations:

Washington, D.C.

Maryland

Virginia

Take a Virtual Tour

Cardiac Electrophysiology Suite at MedStar Heart & Vascular Institute

afib-virtual-tour

New Imaging Technologies

The doctors at the MedStar Heart & Vascular Institute are leaders in state-of-the-art cardiac care and innovation. We offer the most advanced imaging technologies which include:

Optical coherence tomography (OCT)

This new imaging technology is a lot like an ultrasound, but it uses fast-traveling light waves instead of sound waves to produce detailed pictures of your organs. It helps your doctors evaluate the health of your coronary artery and can clearly show the positioning and state of your coronary stents. OCT can also provide doctors with highly detailed information about the plaque in your arteries.

Fractional flow reserve (FFR)

This technology uses a thin wire to measure the blood pressure and blood flow through particular areas in your coronary artery. The wire helps doctors locate blockages even in the tightest areas in your artery.

Intravascular ultrasound (IVUS)

Ultrasound uses sound waves to create detailed pictures of your organs. In IVUS technology, your doctor threads a tiny ultrasound camera into the coronary arteries. This allows doctors to see the inside of blood vessels and arteries. It helps your doctors determine what size stent or balloon you may need. It also helps them make sure your stents are working properly. Some doctors may refer to it as the physiological analysis of lesions.

Learn more about IVUS.

For information or appointments,
please call 855-463-3320.

Heart Biopsies

Heart biopsies help your doctors determine how well you are adjusting to a heart transplant. They can also show if you suffer from certain heart conditions.

What are heart biopsies?

In a heart biopsy, doctors remove a small sample of heart muscle and send it to a lab for analysis.

We perform a cardiac catheterization procedure to access the tissue needed for the biopsy. We guide a catheter through your groin to one side of your heart and remove three heart muscle tissue samples. Then, we send them to the lab for examination.

Why do I need a heart biopsy?

Generally, we perform a heart biopsy to make sure your body is not rejecting a newly transplanted heart. We also perform a heart biopsy if we suspect you may have cardiac carcinoma or signs of other heart conditions, such as:

  • Cardiomyopathy
  • Myocarditis

Learn more about the diagnostic procedures we perform at the MedStar Heart & Vascular Institute.

For information or appointments,
please call 855-463-3320.

Diagnostic Procedures

Diagnosing the trouble with your heart is the first step to getting you better. The MedStar Heart & Vascular Institute uses state-of-the-art technology to give your expert physicians the information they need to create a personalized treatment plan right for you.

Common Heart Tests

There are some common tests your doctor can use to assess the health of your heart. These include:

  •         Cardiac Angiograph
  •         Electrocardiogram (EKG)
  •         Cardiac Echocardiogram (ECHO)

Interventional Cardiac Procedures

Interventional heart procedures involve using small incisions and wires so your doctors can get a better picture of how your heart is working. These may include:

Cardiac Imaging Studies

Your doctor may want to perform an imaging study on your heart to diagnose any conditions or possible disease. We offer some of the most advanced cardiac imaging in the region, including cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI). These sophisticated tests provide valuable information about your cardiac health.

  • Cardiac Computed Tomography
  • Cardiac MRI
  • Intravascular Ultrasound (IVUS)
  • New Imaging Technologies 

 

For information or appointments,
please call 855-463-3320.

Laser Lead Extractions

The leads (wires) that lead from the implantable device to the heart may become fractured or infected.  

Your electrophysiologists can replace or remove these leads by using an extraction device wrapped in laser fiberoptics. 

By guiding the device, your doctor can deliver a controlled dose of laser energy to remove any scar tissue and free the lead.  The lead is then pulled out.  

This procedure can be performed on an outpatient basis.

Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.

 

For information or appointments,
please call 855-463-3320.

Pacemakers

Pacemakers are small—weighing about an ounce—sources of electrical stimulation implanted in the heart to maintain a healthy rhythm.  

Pacemakers are used to treat bradycardia; when the heart rate is slow, as well as atrial fibrillation, heart failure and syncope.  They work by delivering an electrical shock to the heart to retrigger a healthy rhythm.  Pacemakers rest just under the collarbone and are implanted during an outpatient procedure.


Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.

For information or appointments,
please call 855-463-3320.

Implantable cardioverter defibrillators (ICDs)

Implantable cardioverter defibrillators (ICDs) are invaluable for protecting a patient from sudden cardiac arrest.  

How does an ICD work?

These small devices, about the size of a pager, are implanted below the collarbone.  Wires from the device are led to the heart to continuously monitor the heart’s rhythm.  If a dangerous arrhythmia begins, the heart is shocked back into the correct rhythm.  These devices also keep a record of the heart’s rhythms which can be wirelessly transmitted for analysis by the cardiologist.

Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.

For information or appointments,
please call 855-463-3320.

Center for Complex Arrhythmias

The Center for Complex Arrhythmias is a specialized center for arrhythmias that are challenging to treat, such as:

The MedStar Heart and Vascular Institute physicians who staff our Center for Complex Arrhythmia Therapy have proven expertise in tough arrhythmias. They routinely receive cases transferred from other physicians and healthcare facilities.Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.

 

For information or appointments,
please call 855-463-3320.

Transcatheter Aortic Valve Replacement (TAVR)

TAVR is a treatment procedure for patients with aortic stenosis who are too ill to undergo traditional open-heart aortic valve replacement surgery. During a TAVR procedure, your doctor replaces your diseased aortic valve with a new valve. Instead of opening your chest, your doctor uses a catheter (small tube) to thread the valve through a small incision in the groin or the chest wall. During this procedure, your heart remains beating the entire time. Studies have shown that patients achieve better outcomes when they undergo a TAVR procedure than they do with medication alone.

Evaluation for TAVR

The first step is to complete a TAVR Assessment, so we can gather information about your heart health. Once the TAVR Assessment is complete, the TAVR team will be able to review your case and make a recommendation. You will not receive a new valve during the TAVR assessment. We will call to schedule you for either an office visit or a cardiac catheterization. During this visit, you should bring a list of your medications. Your assessment will include:
  • Questions for you about your everyday life, what you can and cannot do for yourself, your living situation, and your heart symptoms.
  • Medical checkup during which a doctor or nurse practitioner will ask you questions about your heart and your health.
  • Cardiac surgeon consultation to review your chart and examine you to determine a best recommendation for conventional aortic valve replacement, TAVR or medications.
  • Questions from you and your family about your treatment options.

Making a decision

Once your TAVR Assessment is complete, the team will discuss all the information we have about you, your heart and your general health, to make a recommendation about the best treatment option for your severe aortic stenosis. If you and your physician decide you will have a TAVR procedure, you will need the following tests:
  • Cardiac Echocardiogram (Echo): This ultrasound of your heart provides information about your heart valves and how well your heart functions.
  • Cardiac Catheterization (Angiogram): A cardiologist will perform this test to study the function of your heart and heart valves and to measure pressures within the chambers of the heart.
  • Transesophageal Echocardiogram (TEE): If the doctors need more information after your cardiac echocardiogram, you will be scheduled for a TEE, a more detailed echocardiogram that uses the esophagus to look at your heart.
  • Computed Tomography (CT) Scan: This painless 30-minute test uses X-ray technology and computers to give your doctors information they need about your heart and/or your leg arteries.

The TAVR Team

If you are considering a TAVR procedure, be assured you are in the best possible hands. The MedStar Heart & Vascular Institute was the fourth cardiac center in the country to perform clinical trials on the TAVR procedure. We perform 70 TAVR procedures each year, making us one of the top five cardiac centers in the nation for this procedure. Our TAVR team—including cardiologists, cardiac surgeons and interventional cardiologists—have worked closely together to improve our overall heart valve program, based on what we've learned from the TAVR clinical trials. The principal investigators in our TAVR trials include: Request an evaluation for the TAVR procedure. If you have any questions about TAVR, or if your heart condition changes a lot while you are waiting for the procedure, please call MedStar Heart & Vascular Institute's TAVR Team at 202-877-5975.

Minimally Invasive Heart Surgery

Traditional heart surgery requires the surgeon to cut open the patient’s chest and cut through the breastbone. Minimally invasive heart surgery allows our cardiac surgeons to work through small incisions only three to four inches long, using elongated instruments and scopes.

What are the benefits of minimally invasive heart surgery?

  • Less pain
  • Shorter recovery time
  • Smaller scars
  • Shorter hospital stay
  • Lower risk of infection
  • Lower risk of bleeding and blood transfusion

What minimally invasive heart procedures do our surgeons perform?

Our heart surgeons treat complex heart conditions using a variety of techniques—including minimally invasive surgery—with outstanding outcomes. They also work as part of a larger team of heart specialists to provide patient-focused care both before and after surgery. Our specialists are trained in a full range of minimally invasive procedures, for the safety, healing and comfort of our patients.

At MedStar Heart & Vascular Institute, we offer the following procedures for the treatment of heart conditions:

ANEURYSM REPAIR

The aorta, the body’s largest artery, delivers blood from the heart to the rest of the body. When disease is present, the aorta can tear (dissect) or dilate to form an abnormal widening or ballooning called an aneurysm.

LEARN MORE

BEATING HEART BYPASS

During beating heart bypass surgery, the heart is able to continue beating naturally, eliminating the need for a heart/lung machine, or pump.

LEARN MORE

CORONARY ARTERY BYPASS

Coronary artery bypass graft surgery (CABG, or bypass surgery) is one of the most common heart surgeries our cardiac surgeons perform.

LEARN MORE

HEART VALVE SURGERY

During heart valve surgery, one or more unhealthy valves are repaired or replaced, to help reduce the strain on the heart and restore a healthy blood flow throughout the body.

LEARN MORE

TRANSCATHETER AORTIC VALVE REPLACEMENT

A transcatheter aortic valve replacement (TAVR) procedure is an advanced treatment option for patients with severe aortic stenosis, or abnormal narrowing of the aortic valve.

LEARN MORE

MINIMALLY INVASIVE SURGICAL ABLATION

Most patients with atrial fibrillation are candidates for minimally invasive surgical ablation. 

Leadless Defibrillator: Subcutaneous Implantable Defibrillator

Approximately 450,000 people in the U.S. succumb to sudden cardiac arrest (SCA)—an abrupt loss of heart function—each year. Most episodes are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia or ventricular fibrillation.

For patients who are at risk of SCA, MedStar Heart & Vascular Institute now offers a new, innovative, leadless defibrillator—the world’s first and only subcutaneous implantable defibrillator (S-ICD).

In cases of life-threatening arrhythmias, a leadless defibrillator shocks the heart to restore normal rhythm. The S-ICD is the first heart defibrillator implanted beneath the skin that does not require wires placed within the heart. It provides reliable defibrillation while leaving the heart’s blood vessels untouched. Since leads (wires) do not have to be inserted into the heart, the S-ICD procedure is much simpler. In addition, the removal or replacement of the device is much easier, and reduces the potential risk for vascular injury and infection.

Patients who might be good candidates for the new leadless defibrillator include:

  • Young patients who want to preserve their blood vessels (or vasculature) for future procedures
  • Patients who are very overweight and will have better outcomes with a defibrillator that sits right below the skin
  • Those patients who have already had prior vascular procedures, making their blood vessels no longer suitable to place leads within them.
  • Patients who are at particularly high risk for blood infections (for example, patients on dialysis or who have indwelling catheters)

Heart Valve Surgery

Your cardiologist may refer you to a MedStar Health cardiac surgeon to repair or replace your heart valve if medication has failed to reduce the strain on your heart and has not alleviated symptoms.

Your cardiac surgeon may recommend one of the following surgeries, depending on your pathology and what is causing the problem:

  • Heart valve repair is the preferred treatment option, because using your own tissue is better than replacing a heart valve.
  • Heart valve replacement can be performed using a variety of valves, including mechanical and biological tissue valves (those from pig or cow tissue). Mechanical valves require the use of blood thinners but have good long-term durability. Biological valves do not require use of long-term blood thinner.
  • Valve sparing is a relatively new technique used to treat aortic disease. Your heart surgeon can preserve your own valve while repairing the aorta.

Heart valve surgery (whether valves are repaired or replaced) is open-heart surgery that is done while you are under general anesthesia. A cut is made through the breastbone (sternum). Your blood is routed away from your heart to a heart/lung bypass machine. This machine keeps the blood circulating during your heart surgery.


Meet Heart Valve Patient Joanna Zimmerman

“To have a heart that allows me to live my life in all the ways I wanted to live my life…that feels like a tremendous blessing.” - photo caption

Joanna Zimmerman and her husband wanted to start a family, but Joanna was born with a heart valve problem and was told by multiple doctors that she should not have a child before the valve was fixed. Eager to start her family sooner rather than later, she sought out the experts at MedStar Heart & Vascular Institute. After evaluating Joanna, the current state of her valve, reviewing the literature on similar cases and in consultation with her high risk obstetrician, it was determined that Joanna could proceed with a pregnancy. They were thrilled to welcome a healthy daughter.

A happy ending indeed, but there’s more. Wanting a big family, Joanna and her husband once again sought the advice of Dr. Ruiz and Dr. Corso at MedStar Heart & Vascular Institute. At this point, though, her valve had narrowed to the point where having more children without intervention was not advised. Joanna had a successful surgery to replace her aortic valve and grew her family by two more!

Endarterectomy

Although it may be performed on any artery, this procedure most commonly treats carotid artery disease (carotid endarterectomy). In an endarterectomy, the surgeon opens the artery and removes the blockage. This type of open surgery is best for short blockages.

Coronary Artery Bypass Surgery

Coronary artery bypass graft surgery (CABG surgery) is one of the most common heart surgeries MedStar Heart & Vascular cardiac surgeons perform. You may have heard people call this bypass surgery. Your doctor will recommend a CABG (pronounced like the vegetable cabbage) when blood does not flow easily through the arteries of the heart and/or blood vessels narrow, reducing the flow of blood to the heart. Coronary artery bypass surgery creates alternate routes for blood to flow to the heart, bypassing the natural arteries. Instead of removing the blockages in the coronary arteries, your heart surgeon will use a vein from your chest or leg to construct detours around the blockages and into the heart. These grafts allow the flow of oxygen-rich blood to the heart muscle. At MedStar Health hospitals, our heart surgeons perform half of these surgeries as beating-heart surgeries, meaning they do not need to use the heart/lung bypass machine.  

Beating Heart Bypass

In beating-heart bypass surgery, the heart continues to beat naturally, eliminating the need for a heart/lung machine or pump. Prongs are placed on a specific area of the heart, stabilizing that area while allowing the heart to continue beating.

This process avoids many of the complications that can arise from the use of the heart/lung machine, such as stroke, increased need for blood transfusions, kidney and lung complications, and lengthy hospital stays. Also, stopping the heart is too traumatic and dangerous for some patients to endure. The beating-heart procedure enables a larger, more diverse population to undergo bypass surgery.

Recovery from this procedure is also faster and most patients return to normal activities sooner.

At MedStar Health, anyone requiring heart bypass surgery is a candidate for beating-heart surgery. You and your doctor will discuss whether beating-heart surgery is appropriate for you. The decision depends on your overall health, the severity of your coronary artery disease, the number of arteries requiring bypass and other factors.

Cardiac Surgery

MedStar Heart & Vascular Institute’s cardiac surgery team is the best in the region and among the finest in the nation—that has a lot to do with our commitment to a team approach to care. Our cardiac surgeons work in teams with other cardiac experts, including cardiac imaging specialists, interventional cardiologists, pulmonologists, radiologists, and nurses to complete the entire picture for each patient.

The advantage of experience

We are one of the highest volume cardiac surgery centers in the central Maryland and Washington regions. Our entire team sees a large number of patients per year; volume and experience also translate into best practices based on outcomes. We continually refine surgical techniques, so you receive the least invasive surgical option that will also bring the best long-term results. Learn more about cardiac surgery at MedStar Washington Hospital Center.

Better patient care

We have compiled a cardiac surgery database containing data on more than 60,000 cases from the past 30 years. This unique resource helps us continually improve patient care. It gives our physicians a direct window on the practices and approaches that produce the most successful outcomes for our patients. Few cardiac centers have anything like it.

Sophisticated communication

Our information management and communications capabilities are powerful resources for integrating MedStar Heart & Vascular Institute services and locations, from enabling real-time sharing of patient images and data to supporting electronic medical records. This means you can receive advanced cardiac care no matter your location-at one of our sister hospitals, or at one of our satellite locations.

Advanced heart surgical care

Consider these facts:

  • The Society of Thoracic Surgeons awarded us three stars, its highest rating, based on quality and outcomes.
  • Nearly half of our CABG (Coronary Artery Bypass Graft) procedures are performed off-pump (without using a heart and lung machine), which speeds recovery and reduces bleeding, neurologic impairment and other complications.
  • We are the only hospital in the region to offer the Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive procedure performed for severe aortic stenosis.
  • Our patients have access to clinical trials in better methods to prevent and treat cardiac and vascular disease.
     

Stenting

A stent is a small metal wire tube used to prop up weak arteries. A doctor may also insert a stent to improve blood flow or prevent an artery from bursting.

  • Carotid stents treat arteries delivering blood to the brain.
  • Coronary stents treat the arteries of the heart.
  • Drug-eluting stents release medication over time to prevent further blockages.

For information or appointments,
please call 855-463-3320.

Septal Alcohol Ablation

This surgical procedure is less invasive than traditional open heart surgery. Doctors apply a little bit of alcohol to the problematic muscle tissue. The alcohol burns away the tissue, removes the obstruction and eases blood flow.

Septal alcohol ablation includes several steps:

  • Sedation keeps you comfortable during the procedure.
  • Cardiac catheterization creates a detailed picture of your heart.
  • Transesophageal echocardiogram insertion by probe creates a sonogram, or picture, of your heart and allows doctors to secure a catheter in place.
  • Alcohol infusion causes the tissue to shrink over time.
  • Temporary pacemaker insertion to regulate a slowed heartbeat for the first few days after the procedure.

For information or appointments,
please call 855-463-3320.

Rheolytic Thrombectomy

A rheolytic thrombectomy is a procedure designed to remove clots. A special pump delivers high-pressure saline to the tip of the catheter. This creates a vacuum that breaks the clot into fragments and suctions the fragments out of the artery. Your doctor may recommend the procedure if you have extensive clots, such as in the case of a heart attack or have vein graft disease.

For information or appointments,
please call 855-463-3320.

Percutaneous Valves

Generally, open heart surgery can repair or replace a damaged heart valve. Percutaneous valve replacement is a nonsurgical approach designed for people who are very weak and may not be able to tolerate open-heart surgery.

During this procedure, the physician will secure a catheter in your groin and direct it into the chambers of your heart. A new valve is inserted through a tube (through the groin and into the heart) and secured.

For information or appointments,
please call 855-463-3320.

Patent Foramen Ovales and Atrial Septal Defects

While most congenital defects of the heart require surgery, our doctors perform some procedures in the catheterization lab. These include patent foramen ovales and atrial septal defects.

Patent Foramen Ovales (PFO)

A (PFO) is a small opening in the dividing wall between the heart's upper two chambers. To close this hole, our cardiologists use a special PFO closure device, which opens like an umbrella to permanently close the hole in the heart. Once your doctor inserts the balloon-tipped catheter into an artery and places it at the defect, the catheter is inflated. The inflation produces an indent, which measures the size and shape of the defect. The umbrella device tightly seals the surrounding normal septal tissue to create a permanent closure of the defect.

Atrial Septal Defects (ASD)

In a patient with an ASD the atrial septum—the wall between the left and right atria (upper chambers of the heart)—fails to close. To repair it, our cardiologists use two small umbrella-shaped clamshell devices placed on the right and left side of the septum. The two devices, once attached, close the hole in the heart.

Medications

Because most vascular disease is associated with atherosclerosis, medications may be prescribed to reduce the overall risks of atherosclerosis, such as heart attack or stroke. These might include medications to

  • Lower cholesterol
  • Lower blood pressure
  • Control diabetes
  • Prevent blood clots

Other medications may be specifically for the vascular disease for which you are being treated. These might include symptom-relief medications or stronger medications for blood clots.

If a blood clot is blocking an artery, your doctor can administer thrombolytic therapy in which a clot-dissolving drug is injected into the artery at the point of the clot.

For information or appointments,
please call 855-463-3320.

Intracoronary Radiation Therapy

Intracoronary radiation therapy prevents the arteries from re-narrowing. Physicians use it to treat certain types of blockages in the coronary arteries, which may have narrowed due to an overgrowth of scar tissue at an angioplasty site.

Small doses of radiation therapy are directly applied to the angioplasty site to slow down or stop rapid scar tissue growth. Your doctor may deliver radiation treatment to the angioplasty site using a wire, balloon, or catheter. He or she inserts one of those devices into the newly opened artery for five to 25 minutes to administer the radiation therapy. You may be eligible for the radiation therapy procedure if a re-narrowing has occurred within a previously implanted stent.

Cutting Balloon

A cutting balloon is similar to the device used in conventional balloon angioplasty. The cutting device activates when the balloon inflates. The blades cut through plaque to open up blockages. The cutting balloon is particularly useful in hardened blockages that have narrowed. Your doctor may use this procedure with stents to open the blockage.

For information or appointments,
please call 855-463-3320.

Cardiac Rehabilitation

Cardiac rehabilitation is an important step in your recovery from heart disease. Our programs—monitored by exercise physiologist, physical therapists, and a physician—ensure that you exercise safely, without placing too much stress on your heart.

All MedStar Health Cardiac Rehabilitation programs are certified by the American Association of Cardiovascular & Pulmonary Rehabilitation.

Getting Started

To join MedStar Health’s Cardiac Rehabilitation program, you must:

  • Get a referral from your doctor
  • Undergo a post-event/procedure exercise stress test (unless your doctor indicates otherwise)

Once you begin the program, you will:

  • Talk to the physician, who will ask you about your medical history and review the results of your stress tests
  • Complete a six-minute walk test around a track, while your cardiac rehabilitation team monitors your heart rate and electrocardiogram (ECG)
  • Receive your individual exercise prescription, which our team develops for you

We use the information obtained at the start of the program to create a personalized exercise program for you. We will evaluate your prescription throughout the program, so you can continue to progress appropriately toward recovery and independent fitness activities.

Sessions

Our staff will teach you how the machines work and how to use them. We encourage you to attend the program for one hour of exercise training three times per week. The exact number of supervised exercise sessions depends on your individual needs as well as your insurance coverage. We will help you determine your benefits before you begin the program.

Communication with Your Cardiologist

Our physician and staff communicate closely with your cardiologist and your referring physician while you are a part of our program. We will notify them if there are any concerns about your heart rate and blood pressure, and if there is a reason to adjust your medication or if there are any other medical concerns.

Heart Health Education

In addition to exercise training, our program staff will provide you with educational information about various risk factors and lifestyle issues related to heart disease.

Wellness Program

You may want to attend MedStar Washington Hospital Center's Wellness Program because you:

  • Want to exercise in a medically supervised environment due to uncontrolled blood pressure or other medical conditions
  • Have recently completed our cardiac rehabilitation program
  • Want to be active, but feel more comfortable with a supervised program

We will create a personalized exercise program that is right for you. Our staff includes an exercise physiologist and physical therapists who will supervise you while you exercise and check your blood pressure and heart rate. They will also guide you while you work out on the various machines.

Please note: The Wellness Program is a self-pay program, and is not covered by health insurance.

Location

Cardiac Rehabilitation Program
125 Michigan Avenue, NE
Washington, D.C.
7:30 – 11:30 a.m., Monday, Tuesday, Thursday

Wellness Program
125 Michigan Avenue, NE
Washington, D.C.
7:30 – 10:30 a.m., Wednesday and Friday

Inpatient Rehabilitation

In addition to any cardiac services, your heart may require inpatient rehabilitation. MedStar National Rehabilitation Network's cardiac rehabilitation program is designed for patients who need assistance in getting back to their former level of physical endurance and self-sufficiency after an acute care stay for medical and/or surgical treatment of cardiac disease.

Program Highlights

  • Therapy in our cardiac gym five days a week
  • Specialized ECG-monitored exercise therapy under the supervision of doctors, nurses, and an exercise physiologist
  • Heart function and rhythm monitoring as patient’s move through a series of progressively more-intense activities
  • Therapy sessions that address bathing, dressing, walking, using stairs, and getting out of bed
  • Education on ways to prevent the progression of heart disease and manage the psychological impact on health
  • Weekly cardiac support group

Specialists

  • Sandeep Simlote, MD, clinical director, Cardiac Rehabilitation Program
  • Cynthia McDonald, RN, co-clinical director, Cardiac Rehabilitation Program

Before discharging a patient, our team will recommend services that will ease a patient’s transition to the next level of care. This might include outpatient services, skilled nursing facilities, or home care through the MedStar Visiting Nurse Association. Our job is to build a roadmap for your recovery — and to support you along the journey as you rebuild your life.

Location

MedStar National Rehabilitation Hospital
102 Irving Street, NW
Washington, DC 20010

For more information about Cardiac Rehabilitation at MedStar National Rehabilitation Hospital, please call 202-877-1152.

Cardiac Catheterization Lab

800xtechnology_Satler at monitor

MedStar Heart & Vascular Institute's Cardiac Catheterization (Cath) Lab features 11 individual labs with 24/7 staffing. The cath lab uses sophisticated imaging technology and implements best practices for patient care before, during and after procedures.

We Put Patients First

Patients are our first priority in everything we do. You can expect the best medical treatment delivered with care, compassion, clear communication and responsive service. Every member of our cardiovascular team treats each patient with the understanding and support we would give to our own families.

The Heart Team Approach

As part of our ongoing commitment to patient care quality and safety, we use an advanced “Heart Team” approach which brings together cardiology, cardiac surgery, intensive care medicine, nursing, ancillary care and administration in a collaborative patient care model based on diagnostic and therapeutic guidelines. Focusing on the total patient’s needs in a collaborative way has led to significant improvement in patient satisfaction as well as outcomes.

Our unique alliance with Cleveland Clinic Heart and Vascular Institute has further enhanced our focus on quality and safety across all cardiovascular services, and is reflected in the national and international recognition of many of our highly-trained cardiovascular specialists.

State-of-the-Art Facilities

Innovation is at the heart of the Heart & Vascular Institute's cath lab, which uses leading-edge imaging technology and implements the best practices in patient care. We also participate in nationally-recognized clinical trials not available at other facilities.

Dedicated Cath Labs

We have 11 dedicated catheterization labs, more than any other hospital in the Washington, D.C., area. We manage our patients with the most technologically advanced diagnostic tests and treatments, including angioplasty, stents, lasers, intravascular ultrasound (IVUS), brachytherapy, angiogenesis and other novel medical therapies. We also offer three state-of-the-art cardiac computed tomography (CT) scanners.

Our catheterization labs offer every cardiac service, including open heart surgery and heart transplantation. However, if interventional therapies are not appropriate for a particular patient, advanced options to help support the heart’s function can be pursued.

New Hybrid Labs

Hybrid labs are operating rooms that support complex procedures involving both cardiac catheterization and cardiac surgery. These specialized labs enable our heart teams, including anesthesiologists, interventional cardiologists, cardiovascular surgeons, and cardiac imaging specialists to work as together to perform complex valvular procedures in a minimally invasive fashion to improve patient outcomes and quality of life.

The Latest Technology

The latest technology is incorporated to help our physicians rapidly evaluate patient information, whether from the Emergency Department or referring physicians to help establish the best course of therapy for our patients. This helps coordinate real-time patient care.

Cath lab physicians use this technology to work in close coordination with other Heart & Vascular Institute facilities, physician and emergency transport teams. Our labs allow for the transmission of real-time data from the field to the doctors, so they are prepared to make treatment decisions before the patient even enters the facility. This technology helps coordinate rapid transfer to our institution from anywhere in the region.

Emergency Transport Available

We planned our facilities around patient needs, so you don't need to wait for care and treatment. We can admit patients to our cath lab from the Emergency Department in fewer than 60 minutes. We have four helicopter transport teams available to move patients around the region.

Balloon Valvuloplasty

Valvuloplasty is a procedure that uses a large balloon catheter to stretch open scarred valves that are blocking blood flow to the lungs, chambers of the heart or the body.

During this procedure, your doctor inserts a small catheter into the blood vessel and uses it to guide a wire to the problem valve. Leaving the wire in place, he or she then removes the smaller catheter and guides a larger one with a balloon attached. Your doctor may inject a contrast dye into the balloon so that it shows up on X-rays. This may be necessary to make sure the balloon is in the right place. Once in position, the doctor inflates the balloon, which stretches and widens the valve.

For information or appointments,
please call 855-463-3320.

Atherectomy

An atherectomy cuts away the plaque responsible for blocking or narrowing an artery. Your doctor can use a few different devices depending on the location and severity of the blockage.

  • Directional atherectomy uses a catheter with a small, mechanically driven cutter that shaves the plaque and stores it in a collection chamber. This device is effective in large arteries with soft blockages.
  • Extraction atherectomy uses a special catheter, called a transluminal extraction catheter (TEC), which has a rotating cutter. The device removes plaque particles through a vacuum suction system while it cuts.
  • Rotational atherectomy uses a high-speed rotating diamond chip burr, called a Rotablator®, which mashes plaque into very small particles. These particles can usually pass harmlessly through the coronary arteries. This device works best on hardened calcified blockages.

For information or appointments,
please call 855-463-3320.

Arrhythmia Treatment

Depending on your diagnosis, your cardiologist will create a comprehensive treatment program to treat your arrhythmia. Treatment for arrhythmias may include:

  • Ablation
    In some cases, when the electrical flow of the heart gets blocked or experiences a short circuit disturbs normal heart rhythms, the most effective treatment is to destroy the tissue housing the short circuit. This procedure is called cardiac ablation. It is a relatively non-invasive procedure that involves inserting catheters—narrow, flexible wires—into a blood vessel to locate the site of damage and restore electrical flow. For many types of arrhythmias, catheter ablation is successful in 90-98 percent of cases—eliminating the need for open-heart surgeries or long-term drug therapies.
  • Implantable Cardioverter Defibrillators (ICDs)
    ICDs are invaluable for protecting a patient from sudden cardiac arrest. These small devices, about the size of a pager, are implanted below the collarbone. Wires from the device are led to the heart to continuously monitor the heart's rhythm. If a dangerous arrhythmia begins, the heart is shocked back into the correct rhythm. These devices also keep a record of the heart's rhythms which can be wirelessly transmitted for analysis by the cardiologist.
  • Medical Management
    Depending on the nature and severity of your arrhythmias, your physicians may prescribe medicine to help regulate your heart. Or, they may use medicine in combination with one of these other treatments.
  • Pacemakers
    Pacemakers are small sources of electrical stimulation implanted in the heart to maintain a healthy rhythm. Pacemakers are used to treat bradycardia (slow heart rate), as well as atrial fibrillation, heart failure, and syncope. They work by delivering an electrical shock to the heart to retrigger a healthy rhythm.
  • Implantable Loop Recorders
    Sometimes, a patient's arrhythmia may not show up while the ECG is being recorded. Your physician may suggest loop recording. A small recordable device is placed underneath the skin, close to the heart, and records the heart's rhythms during a period of time. The test results are sent to the cardiologist, so he or she can analyze the patterns for cardiac arrhythmias.
  • Laser Lead Extractions
    The leads (wires) that lead from the implantable device to the heart may become fractured or infected. Your electrophysiologists can replace or remove these leads by using an extraction device wrapped in laser fiberoptics.

For information or appointments,
please call 855-463-3320.

Angiogenesis

Angiogenesis, a form of gene therapy, helps heart patients grow, repair, and restore new blood vessels.

Angiogenesis grows new blood vessels using substances called growth factors, which deliver instructions to the patient's affected cells so they grow. This type of gene therapy allows the body to heal itself.

Your doctor injects the growth factors directly into the heart or leg muscles. Or, he or she can administer them intravenously through catheters into the arteries of the heart.

Angiogenesis is ideal for patients who have a blockage in a major coronary artery and have developed collaterals. Collaterals are smaller blood vessels the body grows over time to help compensate for the loss of circulation.

For information or appointments,
please call 855-463-3320.

Angioplasty

Angioplasty is a procedure to improve blood flow through narrowed or blocked arteries of the heart. If tests show that you have narrowed arteries, angioplasty can relieve your chest pain and keep your arteries from narrowing further. It also can help prevent heart attack and improve your overall quality of life. Sometimes, doctors use angioplasty as an emergency treatment for heart attack. This procedure can, in some cases, restore blood flow better than clot-busting drugs. An angioplasty also can limit damage to the heart muscle and improve survival after a heart attack.

Your doctor has two options for this procedure:

Balloon Angioplasty

Using a catheter with a balloon attached, your doctor threads it to where the coronary arteries branch off to the heart. Once the catheter is positioned over the blockage, your interventional cardiologist inflates the tiny balloon. The pressure causes the plaque blocking the artery to split and compress, molding it against the artery wall and restoring blood flow. Once the blockage is cleared, the physician deflates the balloon and removes the catheter.
Often, a mesh tube called a stent is placed in the artery during the procedure. When the balloon inflates, the stent expands, supporting the artery wall and reducing the chances of the artery becoming blocked again. Sometimes a drug-eluting stent is used to release medications into your artery and prevent your artery from becoming blocked with scar tissue.

Laser Angioplasty

Some blockages are too long or too complicated for the balloon technique to be effective. In this case, your doctor may opt to use laser angioplasty. The laser directs a cool beam toward the blockage through a catheter in the coronary artery. The laser beam vaporizes the plaque causing the blockage, changing it to gases and water. A balloon angioplasty may follow laser angioplasty.

For information or appointments,
please call 855-463-3320.

Diagnosis

Many times, cardiac and vascular symptoms are misdiagnosed, or thought to point to other health conditions. When this happens, the disease progresses, putting patients at risk. It is critical to diagnose cardiac and vascular disease accurately to lead to the most effective and swiftest treatment.

Diagnostic tests like the following help your doctor identify any condition you may have and determine the best treatment plan and course of action for your particular situation:

Arteriogram

In this test, dye is injected into the arteries while X-rays are taken. The dye highlights the arteries, allowing the area of blockage to be accurately pinpointed.

Cardiac Catheterization

Cardiac catheterization is a minimally invasive diagnostic and treatment option that involves passing a catheter (a thin, flexible tube) through the vessels supplying blood to the heart. Interventional cardiologists use this procedure to tell how well your heart is functioning, and to diagnose any possible cardiac disease. With catheterization, MedStar Health cardiologists can:

  • Determine the pressure and blood flow in the heart's chambers
  • Collect blood samples from the heart
  • Examine the valves and arteries of the heart
  • Identify heart abnormalities

The procedure is performed in a catheterization laboratory (also called a cath lab).

Cardiovascular Imaging

MedStar Heart & Vascular Institute has one of the most advanced imaging programs in the region, including state-of-the-art equipment and expert staff to interpret these complex tests. We are one of the busiest imaging labs in the country—in 2012, we performed close to 25,000 cath lab procedures. Many of our cardiac imaging experts are internationally known for their research and contributions to the field of cardiac imaging.

MedStar Health hospitals offer advanced imaging technologies, including:

  • Optical Coherence Tomography (OCT) uses fast-traveling light waves instead of sound waves to produce detailed pictures of your organs.
  • Fractional Flow Reserve (FFR) uses a thin wire to measure the blood pressure and blood flow through particular areas in your coronary arteries. The wire helps doctors locate blockages even in the tightest areas in your arteries.
  • Intravascular Ultrasound (IVUS) lets your doctor thread a tiny ultrasound camera into the coronary arteries. This allows doctors to see the inside of blood vessels and arteries.

Computed Tomography (CT) Scan

A CT scan is a non-surgical procedure that provides physicians with detailed three-dimensional views of the heart and blood vessels. For patients, the experience is similar to having an X-ray; however, for physicians, this procedure provides detailed information about the inner workings of the heart and can be used in diagnosing abdominal and thoracic aneurismal disease.

Coronary Calcium Scanning

This test provides a measurement of arterial buildups (atherosclerosis) in the arteries of the heart.

Calcium scoring is a safe and simple test that takes only 15 minutes to complete and uses only a small amount of radiation (similar to the amount in two or three mammogram tests). Your doctor will receive a detailed report, including your calcium score and a comparison of your score to normal values, and will discuss the results with you.

Duplex Scan

A duplex scan is an ultrasound study used to assess blockages, narrowing, or other abnormalities in the abdominal vessels, the veins and arteries of the legs and arms, and the carotid arteries of the neck.

Electrocardiogram (ECG)

Electrocardiogram (ECG) records the electrical activity of the heart. The test measures damage to your heart, determines if your heart is beating normally, and checks the size and position of your heart chambers. It is useful in determining whether someone has heart disease. An ECG can be done as part of a routine health examination, or your doctor may order it if you exhibit symptoms of heart problem, such as chest pain or breathing problems.

Electrophysiology Studies

An electrophysiology study, or EPS, is a diagnostic procedure to look more closely at the electrical function of your heart. It is the most accurate and reliable method of evaluating your heart rhythms and will help your physician determine the treatment option that is most appropriate for you.

Certain conditions can cause the electrical system to make the heart beat too slowly, too fast or in an uncoordinated manner. These irregular patterns are called arrhythmias and they can occur in any of the four chambers of the heart. An electrophysiology study will help your physician determine the best treatment for you by showing where the arrhythmias are occurring.

Genetic Testing

There are certain conditions that are known to run in families. Genetic counselors are available to explain genetic testing for your family. By identifying an inherited genetic trait, individuals can take preventative steps to protect their heart health.

Heart Biopsy

At MedStar, our team generally performs heart biopsies to ensure your body is not rejecting a newly transplanted heart. We also perform a heart biopsy if we suspect you may have cardiac carcinoma (cancer) or signs of other heart conditions, such as cardiomyopathy or myocarditis.

During a heart biopsy, your physician performs a cardiac catheterization to access the heart muscle and remove three tissue samples to be sent to a lab for analysis.

Heart Scan Screenings

Each year, more than 500,000 Americans have a fatal heart attack and almost 300,000 of them have no prior warning. The good news is that 85 percent of heart disease can be halted or prevented if your risk is identified early enough. Even if you have no symptoms of heart disease, you should consider a heart scan if you are a man over age 40, or a woman over age 45, and:

  • Have a family history of heart disease
  • Have high cholesterol
  • Have high blood pressure
  • Are overweight
  • Are physically inactive
  • Are a smoker
  • Have a high level of stress

A heart scan uses an ultrafast spiral computed tomography (CT) scanner to detect the presence of calcified (hard) plaque in your coronary arteries. When calcified plaque builds up in your arteries, they narrow, reducing the flow of blood and oxygen to your heart. This is known as coronary artery disease or hardening of the arteries. When a coronary artery becomes completely blocked, a heart attack occurs. Knowing the amount of calcified plaque in your arteries will help you make the right decisions about your health care.

Holter/Event Monitor

Event and Holter monitors are worn for a period of several months or 24-72 hours, respectively. They measure and record the heart's rhythms and send a these signals by phone so the results can be interpreted.

Intravascular Ultrasound (IVUS)

A small catheter with an ultrasound transducer at the tip is inserted into a vessel to get a scan from inside the vessel.

Loop Recording

Sometimes, a patient's arrhythmia may not show up while the ECG is being recorded. Your physician may suggest loop recording. A small recordable device is placed underneath the skin close to the heart and records the heart's rhythms during a period of time. The test results are sent to the cardiologist so he or she can analyze the patterns for cardiac arrhythmias.

Magnetic Resonance Imaging (Cardiovascular MRI)

A Cardiovascular MRI is a sophisticated technique for the assessment of cardiac and vascular disease. This technique allows physicians to visualize cardiac and vascular structure and function and aid understanding of complex valve disease.

Nuclear Cardiology

Nuclear Cardiology uses nuclear medicine technology to study the heart. By using a tiny amount of radioactive material (radioactive tracer), pictures of the heart are taken with a special camera that shows both blood flow to the heart muscle and pumping function of the heart.

Positron Emission Tomography (PET) Scan

PET imaging is a very advanced, non-invasive test that allows your cardiologist gain more information about the function of the heart.

Stress Test

Stress testing includes a variety of diagnostic exercise tests to evaluate patients for coronary artery disease, congestive heart failure, and cardiac arrhythmias. MedStar Health performs standard and thallium tests and echocardiography exercise tests (either treadmill or bicycle exercise). We use state-of-the-art oxygen consumption techniques to determine how much exercise your heart can safely handle.

Tilt Table Test

During this test, you will lie on a table that moves from side to side. Your blood pressure and pulse will be recorded as the table is tilted. This test will sometimes show an arrhythmia that contributes to the syncope.

T Wave Alternans

This is a test used to discover if a patient has a risk of having ventricular tachyarrhythmias. By reading your ECG, your cardiologist can determine if you are at risk for cardiac arrhythmias by analyzing this pattern in your heart's rhythm.

Venous/Arterial Doppler

This sound-wave test measures blood pressure and blood flow in the arms and legs.

Information on other imaging technologies is available through the Radiology pages.

For information or appointments,
please call 855-463-3320.