Heart & Vascular
Cardiovascular care at AMG
Athens Medical Group is a leader in the heart & vascular care with a long history of innovations, from the first replacement of aortic valve with a human valve in Greece to new diagnostic imaging approaches and treatments for heart diseases, providing a legacy of excellence in patient care, cardiovascular research and education.
The Athens Medical Group’s doctors and surgeons work together, aiming to offer the latest treatments and interventional heart disease procedures for all heart conditions, including the most rare and complex ones.
Your personal care team
At Athens Medical Group, your care is handled by a multi-disciplinary team of world class experts and specialists covering the full spectrum of cardiac conditions.
Based on your particular condition and health status, this multidisciplinary team of experts may include physicians specialized in cardiology, cardiosurgery, nephrology, pulmonology, internal medicine, radiology and other areas, as well as other health experts, such as, dietitians, physical therapists, occupational therapists and psychotherapists.
Our holistic approach to care allows for quick and accurate test results as well as speedy and coordinated scheduling of appointments, in a matter of days and not months.
The heart is a complex organ and may require a wide-range of cardiovascular services all offered at the Cardiology Clinics of Athens Medical Group. While heart disease affects a wide range of people, many cardiovascular conditions can be successfully treated, if not easily prevented, with specialized screening and care delivered by our highly-trained and experienced specialists.
Our cardiology and cardio surgery specialists diagnose and treat heart diseases, using sophisticated equipment and the latest techniques. We aim to achieve the best possible medical result, through the collaboration of various specialties and departments.
The Cardiac Surgery Department is equal to the world’s leading medical centers.
It includes the most advanced diagnostic and interventional equipment, covering the full range of medical specialties – Heart-Thoracic-Large Vascular Surgery.
The Cardiac Surgery Department applies pioneering methods with spectacular results guaranteed by the professional and scientific excellence of our surgeons. The latter have trained and worked for more than two decades at internationally renowned university clinics, where they held management positions.
The operations carried out at AMG’s Cardiac Surgery departments include:
- Coronary artery bypass with the use of extracorporeal circulation or on a beating heart
- Replacement of heart valves
- Repair of heart valves (valvuloplasty)
- Aortic surgery (aneurysms, dissections, etc.) including aortic arch and descending aortic surgery
- Transapical implantation of bioprosthetic aortic and mitral valves in collaboration with interventional cardiologists
- Surgical ablation of chronic atrial fibrillation in collaboration with interventional electrophysiologists
- ECMO placement
The Cardiac Surgery department applies all new techniques and methods from minimally invasive robotic cardiac surgery, minimizing surgical trauma and postoperative pain, providing safety and comfort to the patients.
The Department of Interventional Cardiology is committed to perform primary angioplasty, that is the immediate opening of the occluded artery in case of acute myocardial infarction, commonly known as a heart attack, with the best results that comply with all International Standards. This method requires alertness and highly experienced personnel, while it can only be conducted in very few medical clinics in Greece, on a 24hour basis.
Angioplasty and the insertion of latest generation stents in the coronary arteries with an occasional and simultaneous use of intracoronary ultrasound takes place right after the coronary angiography, through the same incision in the leg or arm (radial access).
Diagnostic cardiac procedures include coronary angiography, that is the mapping of heart arteries to evaluate the severity of coronary heart disease. In most cases, coronary angiography is performed by hand and radial artery (minimally invasive) which achieves, without the risk of bleeding, the rapid mobilization of the patient and discharge, in a few hours.
In addition, full hemodynamic and imaging testing of right and left cavities may be performed, to accurately diagnose valvular diseases, aortic aneurysms, congenital heart disease and pulmonary hypertension.
Other procedures include the percutaneous replacement of the aortic valve (TAVI), as well as the treatment of structural congenital heart diseases with special devices, like septal defects, open foramen ovale, ductus arteriosus.
The Heart Catheterization Lab is supported by a Heart Team (Cardiac Surgeons, Cardiac Imaging Specialists), special Intensive Care Unit (Coronary Care Unit) for emergencies, and specially equipped rooms, fully alert to accept patients, on a 24hour basis.
At AMG’s Interventional Electrophysiology and Pacing Lab the whole range of electrophysiology and pacing operations is carried out with the help of the most advanced electroanatomic mapping systems. The operations include:
- Atrial fibrillation ablation procedures with the modern cryoablation method, as well as through the use of CARTO and Rhythmia electroanatomic mapping systems
- Hybrid ablation of atrial fibrillation along with left atrium appendage ligation
- Ablation of endocardial and epicardial ventricular tachycardias
- Ablation of atrial flutter and supraventricular arrhythmias
- Implants of new leadless microscopic pacemakers without cables
- Conventional Pacemaker implantations
- Defibrillators and Cardiac Resynchronization Therapy implantations.
Atrial fibrillation ablation
Ablation procedures of atrial fibrillation are being performed either by using cryoenergy or by means of the latest edition of modern electroanatomic mapping systems. The experience in cryoablation of atrial fibrillation is unique in Greece and our doctors are proctors of such procedures in Greece and Europe. Duration of the procedure is less than 2 hours and the patient is discharged the following day. Ablation of atrial flutter may be performed at the same time, if indicated. In cases of patients with bleeding disorders and increased thromboembolic risk, transcatheter left atrium appendage occlusion is performed by our certified medical team.
Hybrid ablation of atrial fibrillation
Hybrid ablation of atrial fibrillation takes place in the novel hybrid lab. Thoracoscopic pulmonary vein isolation and box lesion is performed from cardiac surgeons in the epicardium of the left atrium. Lesions are also completed and checked endocardially while left atrium appendage ligation is implemented in all patients.
Ventricular tachycardia ablation
Our medical team is also highly experienced in the management of patients with ventricular arrhythmias. Based on the use of the latest edition software of electroanatomic mapping systems (CARTO and Rhythmia), ablation procedures are performed with safety and outstanding efficacy. Our Lab is also among the few worldwide which can use CardioInsight system in specific cases.
Conventional ablation procedures
Conventional ablation procedures are also being performed, ensuring definitive treatment in cases of patients with supraventricular tachycardias and life-threatening accessory pathways, additionally avoiding unnecessary drug treatment. Increased efficacy and safety is achieved through the use of Rhythmia electroanatomic mapping systems
Pacemaker implantations
Our Electrophysiology and Pacing Labs are available 24 hours a day, 7 days a week for pacemaker implantation in emergency cases. Full body MRI compatible devices are implanted in all patients. Athens Medical Group’s Hospitals are some of the few centers worldwide that are certified for leadless pacemaker implantation by our specialized medical team. Micra pacemaker is the smallest pacemaker ever implanted in humans, 93% smaller compared to conventional devices. Starting in 2015, the largest number of leadless pacemaker implantations has been performed in Greece with great success. The procedure is performed through the right femoral vein and the microscopic device is implanted directly into the right ventricle avoiding the use of visible electrodes and a conventional pacemaker in the thorax. Duration of the procedure is around 1 hour and the patient is discharged the following day.
Defibrillators and Cardiac Resynchronisation Therapy
Defibrillator implantation is a widely established therapy that prevents sudden cardiac death in heart failure patients as well as in certain patients with diverse types of cardiomyopathies. In the Athens Medical Group Hospitals, implanted devices are fully compatible with MRI and have a prolonged duration of battery life (>10-years). In certain cases, the medical team is also skilled in implanting completely subcutaneous defibrillators. One out of three patients with heart failure is also eligible for cardiac resynchronization therapy, which significantly improves not only the quality of life but survival as well.
AMG’s Pediatric Hospital is staffed with pediatric cardiologists who have been specialized in renowned international centers of cardiology and acquire many years of experience in diagnosing and treating the most complex childhood heart diseases.
The diagnosis of a heart disease in children often has a huge impact not only on them but also on their entire families. At AMG we not only have the knowledge, the experience and the appropriate medical equipment to effectively treat even the rarest and most complex heart disease, but also we lean in with sensitivity and authentic interest over the sick child and the family.
Together with the experienced nursing staff, our pediatric cardiologists form a team that is distinguished for its ethos and care.
In the Echocardiology Laboratories, cardiological examinations are performed with the help of high-tech diagnostic tools, such as:
- Transthoracic echocardiography: It provides representation of the heart’s structures and function and recording of the Doppler flow. In addition, the partial and total strain of the myocardium, which is an early and very sensitive marker, is studied and applied to a variety of cardiomyopathies. The ascending aorta and the aortic arc are visualized and tested for their morphology and functionality.
- Transesophageal echocardiography: An examination that contributes to the investigation of cardiac causes of strokes and the imaging of clots, tumors and valvopathies.
- Stress Echo with Dobutamine (Dynamic Ultrasound Cardiac Study): A fast and effective examination which uses ultrasound to examine cardiac function in stress-fatigue conditions. It gives us important information about both the overall and partial function of the myocardium, examining both the movement and the fattening thereof.
- Bicycle Stress Echocardiogram: Anexamination for investigating Valvular Diseases and Hypertrophic Cardiomyopathy, for Myocardial Sustainability Testing as well as the prognosis of patients with heart disease.
- Three-dimensional echocardiography: An examination that offers, in certain cases, the possibility of a clearer anatomical investigation, but also an overall assessment of left ventricular function.
In the Cardiovascular Laboratory, the whole range of diagnostic tests is carried out with the help of high-tech diagnostic tools such as:
- Exercise treadmilltest with a modern machine, with manual and fatigue protocols
- Cardiopulmonary exercise test on cycle ergometer, with a modern machine for the assessment of the functional stage of patients with heart failure and cardiomyopathies, performed by specialized personnel.
- 24 hour monitoring of electrocardiogram (holter monitoring), with the possibility of estimating the risk of sudden death in cases of patients with structural heart disease
- 24-hour blood pressure monitoring, in conjunction with the Hypertension Unit
- Interrogation and optimization of pacemakerand defibrillation systems
- Tilt testing for syncopeinvestigation with modern protocols
The echocardiography department consists of three rooms, all equipped with up-to-date echo machines, meeting international standards. For routine practice and advanced echo techniques, 4 devices (2 GE VIVID E95, 1 PHILIPS IE33 and 1 GE VIVID IQ) with 3D/4D probes are available. Apart from that, all examinations are stored into Workstations for further analysis (EchoPAC Workstation and Qlab). Routine practice includes basic transthoracic echo examinations and advanced ones, covering the whole spectrum of cardiac diseases. Annually, approximately 5000 transthoracic examinations, 600 stress echoes, 700 transesophageal echoes and 1000 3D echoes are performed.
Our Echocardiography laboratory holds the EACVI laboratory Accreditation from the European Society of Cardiology (ESC) and especially the EACVI branch (European Association of Cardiovascular Imaging) (http://www.escardio.org/Education/Career-Development/Accreditation/EACVI-Laboratory-accreditation/Accredited-Laboratories), a title that is given through evaluation of quality criteria to centers of excellence. That way, European Interbalkan Medical Center can accept training grants and provide education in echocardiology to colleagues from all over the world.
MEDICAL SERVICES
Apart from transthoracic cardiac echo exam that is considered the basis of cardiovascular imaging, advanced techniques like transesophageal echo, stress echo and 3D echo are performed in our echocardiography laboratory.
Transesophageal echo (TOE) refers to a technique performed with a probe that is advanced into the esophagus. The patient is under sedation so as not to experience discomfort during the examination. With this technique we achieve better visualization of all cardiac structures and some of the usual indications for TOE are:
1) valvular heart diseases
2) cardiac sources of emboli and thrombi
3) vegetations in cases of endocarditis and 4) aortic aneurysms and dissection.
Stress echo refers to a technique used for ischemia evaluation. With the use of contrast agent and pharmacological stress (with dobutamine) we evaluate wall motion abnormalities along with the function of the coronary arteries. The accuracy of the method for detection of significant coronary stenosis is more than 90%. That way we can discriminate the patients that need to undergo coronary angiogram.
Three-dimensional (3D) echocardiography gives:
1) accurate estimation of valvular heart diseases, providing images similar to the surgical views
2) accurate evaluation of ventricular volumes and contractility in heart failure patients and
3) guides the implantation of transcatheter devices.
The echocardiography department also covers the needs of
1) the cardiac surgery department, providing intraoperative guidance for valve implantations and
2) the needs of transcatheter department providing guidance for the implantation of transcatheter devices (ASD/PFO/LAA closure devices and transcatheter repair of mitral and tricuspid valve).
CONSULTANTS – CARDIOLOGISTS OF THE DEPARTMENT
Head of 1st laboratory: Dr. Dimitrios Ketikoglou, FESC, Cardiologist
Head of 2nd laboratory: Dr Ilias Ninios -Cardiologist, Interventional Cardiologist
Head of 3rd laboratory- Director: Dr Konstantinos Papadopoulos, FESC, FEACVI, Cardiologist
Our special cardiology units aim to systematically address the whole spectrum of cardiac diseases by the more specialized cardiologists:
The Hypertension Unit performs complete diagnostic and laboratory testing (24-hour blood pressure recording, ECG, echocardiogram, albuminuria measurement, peripheral vascular assessment). Emphasis is given to the investigation of secondary hypertension and qualifying patients for renal artery angioplasty, endocrine tumor removal and treatment of sleep apnea. At the same time, the Hypertension Unit concentrates on cases of resistant hypertension and patients who are selected for renal artery denervation.
In the Arrhythmia Unit emphasis is put on the treatment of atrial fibrillation, ventricular and supraventricular arrhythmias . The aim for patients with atrial fibrillation is to evaluate the thromboembolic and bleeding risk of the disease and to select those patients that are suitable for ablation with the use of the most modern methods by our specialized group of electrophysiologists.
In the Arrhythmia Unit, patients with supraventricular and ventricular arrhythmias are monitored, patients’ prognosis is assessed and patients are selected for ablation.
In the Syncope Unit all appropriate diagnostic tests are carried out, including Holter Monitoring, Cardiac Ultrasound, Tilt Table Test and implantation of loop recorders. Patients’ prognosis is evaluated and those qualifying for the implantation of pacing and defibrillation systems are identified.
The Unit, in collaboration with the Electrophysiology Laboratory and the Group’s sports medicine physicians undertakes the preliminary testing of professional athletic teams and champions.
Some of the most frequent questions asked to our doctors include:
- What happened to me?
- What if it happens again and I’m alone?
- What can I do to help myself recover?
- How can I get back to living a normal life?
- I’m struggling emotionally. What should I do?
- What ongoing follow up do I need?
- How can I improve my exercise and eating habits?
- I’ve got more questions. Who can I ask?
