As we all know calcium is an essential mineral needed for human body. With ageing, calcium starts to deposit in various parts of the body. Deposition of calcium in the blood vessels of the heart known as coronary calcification is associated with damage to the blood vessels that can result in heart attack. Coronary calcification is seen in 97% of men and 67% of women above the age of 70 yrs. The other common place in heart for the calcium to deposit is the valves, particularly aortic valve. This leads to narrowing of the aortic valve, called as degenerative/calcific aortic stenosis, which happens mostly in older age group.
ARE THERE ANY HIGH-RISK GROUPS IN WHICH CALCIFICATION IS PREDOMINANTLY SEEN?
The following are considered to have higher chance of calcification in blood vessels- Advanced age, tobacco use, hypertension, kidney disease, dyslipidemia. According to a research by American college of cardiology, sitting for longer time during day is associated with increased coronary artery calcification, a marker of subclinical heart disease that can increase the risk of a heart attack.
HOW DO I KNOW IF I HAVE CALCIFICATION IN THE HEART?
Coronary artery calcification can be detected using CT scan, which is quantified as coronary artery calcium (CAC) score. This score gives us an idea about the burden of calcification.
One needs to know that the calcific burden does not reflect the degree/percentage of narrowing (stenosis) in the arteries. It only gives us an idea of extent of cholesterol deposition in the blood vessels (atherosclerosis). CAC of more than 400 is associated with worse outcomes. However, severe narrowing with calcium deposition is considered as a challenging subset of patients.
Aortic valve calcification can be identified in echocardiogram and if needed a CT of the aortic valve can give a clear idea of calcific burden in the valve.
IS OPEN HEART SURGERY THE ONLY OPTION IN CORONARY AND AORTIC CALCIFICATION?
No. There is a wrong perception that patients with significant coronary calcification with narrowing should only undergo bypass surgery. That does not apply anymore. Though treatment of coronary calcium with angioplasty still remains challenging even now, lot of innovative techniques have evolved to treat it without needing open heart surgery. These procedures are done in the cardiac catheterisation lab either through the wrist/groin and the patients are discharged usually in 2 to 3 days and get back to their routine activity.
Similarly, in calcific aortic stenosis (narrowing), a procedure called TAVI (Transcatheter aortic valve implantation) can be performed via a pinhole procedure in the groin. This also avoids opening the chest for valve replacement and the patient can be discharged within a day or two.
WHAT ARE THE VARIOUS INNOVATIVE TECHNIQUES AVAILABLE TO TREAT CORONARY CALCIFICATION?
This includes use of various types of balloons such as cutting balloon, high pressure OPN balloons, atherectomy procedures such as rotational atherectomy or rotablation (small diamond tipped burr used to drill the calcium), Laser atherectomy, Orbital atherectomy and Intravascular lithotripsy (through sonic waves creates cracks in the calcium). All these techniques safely and selectively break the calcium deposits with minimal damage and ease the stent delivery and expansion. With these techniques, even calcification in large coronary arteries such as Left main artery can be treated successfully with stent angioplasty. They are performed routinely these days across all age groups with high success rate by experienced interventional cardiologists in specialized centres.
WHAT CAN I DO TO PREVENT CORONARY CALCIFICATION?
Lifestyle and risk factor modification that includes moderate to vigorous physical activity, strict diabetic control, treating hypertension, dyslipidemia as well as preventing advanced kidney disease are considered important to prevent coronary calcification.
UNIQUENESS OF THE PROCEDURE AND ITS ADVANTAGES
These procedures are complex procedures which demand skills and expertise. Identifying the extent and severity of calcification inside the coronary artery with novel 3 D imaging techniques such as intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT) helps to plan the procedure early on and also improvises the final outcome.
These are pin-hole procedures done mostly via wrist without the need for any incision or scar in the chest . Patients can walk in and walk out of the cardiac catheter lab. Patients will be discharged within 24-48 hrs and they can go back to normal life within few days. It improves the quality of life dramatically.
BENEFIT TO THE PATIENT
In this era of modern medicine, the three important factors most patients prefer are early mobilization, early discharge, and quick recovery. Patients would like to go back to their normal life as soon as possible after any treatment and by doing treatment through this pin-hole procedures for heart ailment, this can be achieved.