Cardiology outpatient clinics and specialised clinics – Herz- und Kreislauferkrankungen

Specialised clinic for percutaneous heart valve interventions and structural heart disease

Management
Prof. Michael Joner

In recent years, modern interventional techniques for the treatment of valvular heart disease have been introduced at the Department of Cardiovascular Diseases. These new, minimally invasive procedures include:

Transcatheter aortic valveHeart valve between the left ventricle and the aorta. It prevents the blood from flowing back into the left ventricle during the relaxation phase. implantation (TAVI): a severe narrowing of the aortic valveValve. is dilated via the groin or via the apex of the heart and a new heart valveIn the inflow and outflow area of the heart chambers there are valves which prevent the blood from flowing back in the wrong direction. Each heart half has a sail valve and a pocket valve: 1. Tricuspid valve (between the right atrium and right ventricle) 2. Pulmonary valve (between the right ventricle and pulmonary artery) 3. Mitral valve (between the left atrium and left ventricle) 4. Aortic valve (between the left ventricle and the aorta). is inserted.
MitraClip procedure: a high-grade leak in the mitral valveHeart valve between the left atrium and left ventricle. It got its name because of its shape, which has a strong resemblance to a bishop’s mitre. is sealed with one or more clips (MitralClips).
Atrial appendage closure: a new therapy to reduce the risk of stroke for patients with atrial fibrillation and severe side effects (bleeding) on blood thinning drug therapy (e.g. Marcumar) is the closure of the left atrial appendage using an Amplatzer™ Cardiac Plug (ACP).

An essential task of the special outpatient clinic is the assessment of patients who are to receive a TAVI, a MitraClip or an atrial appendage closure as well as their professional follow-up care. In many cases, a preliminary assessment of the underlying valve disease, an evaluation of the severity and the overall condition and concomitant diseases of the patient as well as an individual planning of the further procedure is possible right from the first examination, as well as the provision of a second opinion for referring doctors or patients.

Among the outstanding advantages for the treatment of severe heart valve defects at the German Heart Centre Munich are the

very close cooperation between cardiologists and cardiac surgeons,
joint staffing of the clinics,
interdisciplinary heart valve conference held at least once a week.

When determining the indication, we follow the guidelines of the European and German Society of Cardiology.

In patients with atrial fibrillation, systemic and especially cerebrovascular embolismSmall particles washed away with the bloodstream (= embolus, usually parts of blood clots from another part of the circulatory system) can cause blood vessels to close. As a result, the cells supplied by the blood vessel in question die. Air, fat and foreign bodies that get into the vessels can also cause an embolism. with insult is the most serious complication. If bleeding occurs on standard oral anticoagulationInhibition of blood clotting by means of medication (e.g. Marcumar, Heparin). Colloquially also incorrectly referred to as “blood thinning”. therapy, it is possible to close the left atrial appendage, where more than 90 per cent of the thrombi in atrial fibrillation originate, with an Amplatzer Cardiac Plug (St. Jude Medical). This treatment method has been carried out at the German Heart Centre Munich since 2011 and is an alternative to long-term oral anticoagulation for these patients.

Specialised outpatient clinic for severe hypertension

Management

Dr Teresa Trenkwalder

High blood pressure (arterial hypertension) is a common condition that can usually be successfully treated with:

regular physical exercise
low-salt diet
weight loss
taking medicationAdministration and dosage of a medicine.

However, in about 10 per cent of hypertensionHigh blood pressure. Increased pressure within the arterial system. Normal value: 120/80 mmHg. A blood pressure above 140/90 mmHg is an increased health risk. patients, only an inadequate control can be achieved despite taking several blood pressure tablets. These patients have a significantly increased risk of secondary diseases such as heart attack, heart muscle weakness and strokeOcclusion of a cerebral artery or rupture of a vessel with subsequent cerebral haemorrhage. The affected nerve cells die due to lack of oxygen, leading to permanent loss and paralysis.. If a combination of three different blood pressure medications cannot achieve sufficient blood pressure control, this is called therapy-resistant hypertension. Our specialised outpatient clinic for severe hypertension is aimed precisely at these patients with therapy-resistant hypertension. We specifically look for possible (and easily treatable) causes of high blood pressure. In addition to clinical and laboratory examinations, this also includes imaging of the kidneys and renal vessels using ultrasound as well as the investigation of breathing disorders during sleep.

We then make an individual, medication-based therapy proposals, and the blood pressure control is monitored by means of long-term blood pressure examinations. Our doctors are certified as hypertensiologists by the German Hypertension League.

Outpatient clinic for lipid metabolism disorders

Head
Prof. Wolfgang Koenig

Among the main risk factorsCollective term for factors that can pose a health risk. These include alcohol and nicotine consumption, obesity, high blood pressure, sugar and fat metabolism disorders, high cholesterol levels, stress, lack of exercise, etc. for cardiovascular diseases are lipometabolic disorders. These are usually elevated cholesterolFat-like substance formed in the liver, which is the basic substance of various hormones. Every cell in the body contains cholesterol, which is mainly stored in the cell membranes. Cholesterol is partly taken from food, partly synthesised by the body. Pathological proliferation, e.g. in the case of cholesterol metabolism disorders, leads to arteriosclerosis, among other things. and/or triglyceride levels, which can lead to atherosclerotic vascularConcerning the blood vessels. deposits. In our lipid outpatient clinic, we assess and differentiate acquired or congenitalCongenital. metabolic defects on the basis of the medical history, physical examination, special laboratory analysis and, if necessary, with the help of additional genetic tests. A central component here is the recording of the individual cardiovascular risk profile in order to be able to give a coordinated therapy recommendation. Our outpatient focus is on the individual care and therapy adjustment of patients with lipometabolic disorders in order to prevent atherosclerotic diseases in primary and secondary preventionAll measures to prevent a recurrence of the acute disease.. In selected cases of Lp(a) hyperlipidaemia or in patients who cannot reach LDL cholesterol target levels on maximum drug therapy, we offer lipid apheresis treatment. The Apheresis Competence Centre run by Dr Heigl and Dr Hettich carries out these treatments at the German Heart Centre in Munich.

Dear Colleagues,

You are welcome to refer patients with lipometabolic disorders from your practice to our lipid outpatient clinic.

Please provide your patient with a referral for the lipid outpatient clinic, the current laboratory values and the completed questionnaire for their first visit. If you have any questions about drug therapy for lipometabolic disorders or lipid apheresis, you can find out more by calling our outpatient clinic on +49 (0) 89 1218-4005.

Outpatient clinic for angiology and peripheralBeing far at the edge, not at the centre of the body, far from the heart, e.g. hands and feet, fingers, etc. arterial disease

Interventional angiology:
Dr Salvatore Cassese
Dr Sebastian Kufner

Angiology outpatient clinic:
Prof. Birgit Steppich
Dr Olga Bruskina

Our angiology department serves as an expert contact for all diseases affecting the venous and arterial vascular system, especially peripheral arterial disease and venous thromboembolism. All modern procedures for non-invasive and invasive vascular diagnostics are available in the department. In accordance with current guidelines, we create comprehensive therapy concepts that include optimised drug therapy according to the latest study results as well as catheter-based, minimally invasive interventional revascularisation using state-of-the-art instruments.

The range of services of the angiology outpatient clinic

Colour-coded Doppler duplex sonographyUltrasound procedure in which, in addition to the two-dimensional image, the blood flow within the vessel is also displayed. This allows diseased vessel areas to be detected because of the changes in blood flow. with high-end ultrasound equipment
Vasolab 320, vascular diagnostics with:
- Acral pulse oscillography
- Acral blood pressure measurement (fingers/toes)
- Segmental pulse oscillography
- Digital photophlethysmography (DPPG)
Peripheral Doppler pressure measurement (ABI)
Transcutaneous oxygen partial pressure measurement (TcPO2)
Treadmill ergometrySee exercise ECG.
Professional care by a trained wound nurse
Non-invasiveExamination that does not require penetration of the body. (ECG, CT) imaging using MR and CT angiography

The service spectrum of interventional angiology

Peripheral angiographyImaging of blood vessels using contrast medium and X-ray examination. of the aortaThe main major artery in the body. Leads from the left ventricle via an arch in the thoracic cavity to the abdominal cavity. There it splits into two large iliac arteries., pelvic, leg, arm, brain-supplying, renal and visceral arteries
Vascular recanalisations, vessel dilatations (PTA), stentSpiral-shaped, lattice-like vessel supports, usually made of a precious metal. Used when balloon dilatation has not produced the desired results or to close off aneurysms of the great vessels. implantations, thrombus aspiration, vessel preparation with atherectomy, etc.

Contacts