John Fawkner Cardiology The Heart Specialists
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Patient Information

Structural Heart & Coronary Intervention

Plain-language guides to the cardiac procedures performed at John Fawkner Cardiology — what each procedure involves, why it is done, and what to expect on the day and afterwards.

01

Coronary Catheterisation

Also referred to as a left heart catheterisation, left heart cath, or coronary angiogram

Overview

A coronary angiogram is an invasive procedure that allows direct visualisation of the coronary arteries — the blood vessels that supply the heart muscle with oxygen. A thin, flexible tube called a catheter is guided through an artery (usually at the wrist or groin) to the opening of the coronary arteries, where a small amount of contrast dye is injected. X-ray images are then taken to reveal the anatomy of the arteries and identify any narrowings or blockages.

Purpose of procedure

This procedure is considered the gold standard for diagnosing coronary artery disease. It is performed when there is concern about reduced blood supply to the heart — for example, after an abnormal stress test, in the setting of chest pain, or following a heart attack. In addition to diagnosing blockages, it allows the cardiologist to directly measure the pressures on the left side of the heart and assess the function of the aortic and mitral valves.

During the procedure

You will need to fast for at least six hours beforehand. The procedure is performed under local anaesthetic and light sedation, so you will be awake but relaxed and comfortable. A small nick is made in the skin at the access site — most commonly the wrist (radial artery). The catheter is then gently advanced to the heart using X-ray guidance. You may feel mild pressure but should not experience pain. The procedure typically takes 30–60 minutes. Afterward you will be monitored for a short period before going home. If the wrist is used, a compression band is applied for a few hours. You will need someone to drive you home.

02

Full Heart Study

Also referred to as a left and right heart catheterisation, or combined heart catheterisation

Overview

A full heart study combines a standard coronary angiogram (left heart catheterisation) with a right heart catheterisation, providing a comprehensive assessment of the pressures and function of both sides of the heart. In addition to imaging the coronary arteries, a separate catheter is passed through a vein — usually at the groin or neck — to measure pressures within the right heart chambers, the pulmonary arteries, and the pulmonary capillary bed.

Purpose of procedure

This combined study is used when a more complete picture of heart function is required. It is particularly important in the evaluation of heart failure, pulmonary hypertension, valvular heart disease, and in patients being assessed for advanced therapies such as heart transplantation or mechanical circulatory support. The right heart pressures measured during the study provide information that cannot be obtained from imaging alone.

During the procedure

Preparation is the same as for a standard coronary angiogram — you will need to fast for at least six hours. The procedure is performed under local anaesthetic and light sedation. Because two access sites are typically required (one arterial for the left heart component, one venous for the right heart component), the procedure takes a little longer than a standard angiogram — usually 45–75 minutes. The same post-procedure monitoring and discharge instructions apply. You will need someone to drive you home.

03

Coronary Stenting

Also referred to as percutaneous coronary intervention (PCI), coronary angioplasty, or stenting

Overview

Coronary stenting is a procedure used to open a narrowed or blocked coronary artery and restore blood flow to the heart muscle. Using the same catheter-based approach as a coronary angiogram, a small balloon is inflated at the site of the blockage to compress the plaque, and a metal mesh scaffold called a stent is then deployed to hold the artery open. Modern stents are drug-eluting, meaning they release a medication that helps prevent the artery from re-narrowing over time.

Purpose of procedure

PCI is performed to relieve symptoms of angina caused by significant coronary artery narrowings, and is also used as an emergency treatment during a heart attack to rapidly restore blood flow to the affected artery. The decision to perform stenting versus other treatments (such as bypass surgery or medication alone) is made based on the location, number, and complexity of the blockages identified at angiogram, and is discussed in detail with your cardiologist beforehand.

During the procedure

PCI is performed under local anaesthetic and sedation using the same access site as a coronary angiogram, most often the wrist. Blood-thinning medications are given through the drip during the procedure to reduce the risk of clot formation. You may experience brief chest discomfort when the balloon is inflated — this is normal and short-lived. The procedure typically takes 60–90 minutes depending on complexity. After stenting, you will be commenced on a combination of antiplatelet medications (usually aspirin and a second agent) that must be taken consistently for a period specified by your cardiologist — stopping these early significantly increases the risk of stent clotting. Most patients go home the same day or the following morning.

04

Transcatheter Aortic Valve Implantation

Also referred to as TAVI or TAVR (transcatheter aortic valve replacement)

Overview

TAVI is a minimally invasive procedure that replaces a diseased aortic valve without the need for open-heart surgery. A new biological valve — compressed onto a small delivery catheter — is guided through an artery (most commonly the femoral artery in the groin) and positioned within the existing diseased valve. Once correctly positioned, the new valve is expanded and immediately takes over the function of controlling blood flow from the heart to the body. The old diseased valve is pushed aside by the new valve and remains in place.

Purpose of procedure

TAVI is performed to treat severe aortic stenosis — a condition in which the aortic valve becomes heavily calcified and narrowed, obstructing blood flow out of the heart. Left untreated, severe aortic stenosis carries a poor prognosis. TAVI was originally developed for patients considered too high-risk for conventional open-heart surgery, but evidence now supports its use across a broad range of patients, including those at intermediate and lower surgical risk. The decision between TAVI and surgical valve replacement is made by a multidisciplinary heart team.

During the procedure

TAVI is performed in a specialised cardiac catheterisation laboratory or hybrid operating theatre. The procedure is carried out under general anaesthesia or deep sedation, and typically takes 1–2 hours. A temporary pacing wire is placed in the heart beforehand to provide electrical support if required during valve deployment. Most patients spend 2–4 days in hospital afterward. A temporary pacemaker is occasionally required permanently if the procedure affects the heart's natural electrical conduction system — this is discussed with your cardiologist in advance. Antiplatelet or anticoagulant medications are prescribed after the procedure and follow-up imaging is arranged to confirm valve function.

05

Percutaneous Mitral Valve Repair

Also referred to as MitraClip, mitral valve clipping, or transcatheter mitral valve edge-to-edge repair (TEER)

Overview

Percutaneous mitral valve repair is a catheter-based procedure used to treat a leaking mitral valve (mitral regurgitation) without open-heart surgery. Using a small clip device, the two leaflets of the mitral valve are grasped and joined at their centres, creating a double-orifice valve that reduces the amount of blood leaking backward with each heartbeat. The procedure is performed via a catheter passed through a vein in the groin, crossing into the left side of the heart through the wall between the two upper chambers (a technique called transseptal puncture).

Purpose of procedure

This procedure is used to treat significant mitral regurgitation — a condition in which the mitral valve fails to close properly, causing blood to flow back into the lungs with each heartbeat. This can result in breathlessness, fatigue, and progressive heart failure. Percutaneous mitral valve repair is typically offered to patients who are not suitable candidates for conventional open-heart mitral valve surgery due to age, frailty, or other medical conditions, or where the risks of surgery are considered too high. The decision is made by a multidisciplinary heart team following detailed imaging assessment.

During the procedure

The procedure is performed under general anaesthesia and is guided throughout by transoesophageal echocardiography (TOE), which provides real-time images to help position the clip precisely on the valve leaflets. It typically takes 2–3 hours. One or more clips may be deployed depending on the anatomy of the valve and the degree of leakage. Most patients spend 2–3 days in hospital afterward. Anticoagulant or antiplatelet therapy is prescribed following the procedure, and follow-up echocardiography is arranged to assess the result and monitor valve function over time.