Clinical Cardiology

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Interventional Cardiology
  • Heart Failure Clinic
  • Outpatient Clinic
  • Hypertrophic Cardiomyopathy Centre
  • Hypertension Centre
  • Cardiac Rehabilitation Centre
  • Echocardiography Laboratory
  • CardioOncology Centre
  • Cardiovascular Intensive Care Unit

PROCEDURES PERFORMED PER YEAR:

  • The Interventional Cardiology Clinic perform:
    • ver 600 diagnostic coronary procedures
    • ver 400 therapeutic coronary procedures
  • The Outpatient Clinic perform:
    • ver 7000 visits
    • ver 2000 exercise stress test
  • The Echocardiography Laboratory clinic perform:
    • 15,300 transthracic exams
    • 700 stress echcardiographic studies (exercise and medication-induced)
  • 4000 transoesophageal studies

The Clinical Cardiology Unit treats all the major diseases of the cardiovascular system. It provides assistance in both outpatient and inpatient treatment pathways.  Ospedale San Raffaele is recognized worldwide as a center of excellence for the treatment of ischemic heart disease. Professor Alberto Margonato, the Unit’s Head Physician, has over 30 years of experience in its diagnosis and treatment and has published more than 200 papers related to the ischemic heart disease.

Ospedale San Raffaele is also one of the first centres in the world to introduce the MitraClip procedure. This percutaneous intervention is inspired by a surgical intervention that was invented during the 1980’s by Professor Ottavio Alfieri, the famous Ospedale San Raffaele cardiac surgeon, pioneer in this field.

 

treatmentS

Interventional Cardiology Clinic

The staff of the interventional cardiology service is integrated into a clinical setting, collaborating with other speciality areas and offers treatment for several conditions, such as coronary artery disease, valvular heart disease, heart failure.

Specialists trained both in interventional and non-invasive cardiology have extensive experience and expertise in diagnosing and treating the most challenging forms of coronary artery disease and other heart conditions.

The Cardiac Catheterization Laboratory is equipped with the latest technology and offers a full spectrum of services.

The diagnostic procedures performed include:

  • Coronary, carotid, renal and other forms of angiography
  • Coronary physiology, endothelial and microcirculation assessment (coronary spasm study)
  • Endomyocardial biopsy
  • Evaluation of complex valvular disease
  • Intravascular ultrasound
  • Left and right heart hemodynamic assessment

The therapeutic procedures performed include:

  • Coronary angioplasty and stents to treat coronary artery disease
  • Nonsurgical closure of ostium secundum atrial septal defect (ASD) or patent foramen ovale
  • Total coronary occlusion
  • Bifurcation lesion
  • Prior unsuccessful angioplasty or stent procedures or prior coronary artery bypass surgery
  • Other medical conditions (multivessel disease, severe valve disease, or other medical conditions) that increase the risk of treatment complications
  • Percutaneous mitral valve repair

The staff has also expertise and experience in diagnosing and treating people with heart valve disease. Cardiologists collaborate with a multidisciplinary team of cardiac surgeons, interventional and imaging specialists in cardiology to conduct diagnostic tests, to discuss the results and to develop a treatment plan appropriate for patient’s condition.

Furthermore, our team collaborate with multidisciplinary specialists (electrophysiology, cardiac surgery, cardiac imaging) in the care of patients with atrial fibrillation and provides patients with a full range of diagnostic tests (electrocardiogram (ECG), ambulatory monitoring, echocardiogram and transoesophageal echocardiogram) and treatments aimed at rhythm control, rate control and stroke prevention strategies (Left atrial appendage closure).

Research:
Several members of our team are involved in research and development of new technologies and techniques to expand and improve cardiac catheterization treatment. They conduct research and clinical trials on possible treatments.

Heart Failure Clinic

The Heart Failure Team includes clinicians that specialise in cardiomyopathy and ischemic heart failure. The multidisciplinary team brings together experts in Cardiovascular Medicine, Cardiothoracic Surgery, Radiology, Invasive Cardiology, Immunology, Cardiac Imaging experts for patients with:

  • All types of heart failure
  • Decreased and preserved ejection fraction
  • Dilated Cardiomyopathy
  • Restrictive cardiomyopathy
  • Amyloidosis related heart failure
  • Arrhythmogenic right ventricular dysplasia (ARVD)
  • Advanced heart failure related to hypertrophic cardiomyopathy
  • Heart failure related to cancer therapies

The Heart Failure Clinic provides the most advanced technology and research to ensure the highest level of care:

  • The care is integrated, from diagnosis and treatment to follow-up
  • A full range of diagnostic testing for patients with heart failure including: Cardiac catheterization, Cardiac MRI and CT-scan, Cardiopulmonary exercise testing, Echocardiogram, Electrophysiology studies, Nuclear cardiology studies
  • The team provides outpatient care and an inpatient program if the patient requires hospitalization
  • Medical Management of Heart Failure including cardiac rehabilitation program, counselling on diet, exercise and lifestyle changes to help patients participate as much as possible in activities of daily living and to reduce their symptoms.
  • Electrical Device Management of Heart Failure:  Cardiac resynchronization therapy (CRT) with biventricular pacemakers. Implantable cardioverter defibrillators (ICDs) to prevent life-threatening heartbeats, to reduce the risk of death
  • Surgical Management of Heart Failure: Surgical management involves a wide range of procedures including:
    • High Risk Cronary artery bypass surgery
    • High Risk Valve surgery and percutaneus valve treatments
    • Ventricular Assist Device (VAD)

Research:
The Heart Failure Clinic has an active clinical research program. Particularly, the centre is dealing with a program on metabolic pathophysiology of heart failure and on the metabolic therapy of heart failure. Researchers also cooperate in multicentre trials.

Outpatient Clinic

The outpatient clinic is able to offer several services, including:

  • Heart Health Program helps the patients to optimize their heart’s health. The staff members include cardiologists and nurses. The program staff determines the heart disease risk of apparently healthy adults through a comprehensive evaluation.

The staff offers and plans for the patients a comprehensive cardiac evaluation that includes:

  • Carotid Ultrasound Examination. A noninvasive ultrasound examination of carotid arteries that measures artery thickening and detects the development of heart disease
  • Electrocardiogram
  • Exercise stress testing. This test is also called a stress test
  • Physical performance evaluation
  • Lifestyle assessment. In a lifestyle assessment, the staff evaluates your nutrition, physical activity, stress and smoking history
  • Body composition assessment. This test assesses your body composition and analyses your body fat
  • Blood tests and chemistry profile
  • Coronary computed tomography angiography (CT Angiography) method allowing to rule out significant narrowing of the major coronary arteries disease

The program staff works to develop a personalized plan to prevent heart disease and improve your heart health. Your program may include:

  • A doctor's medical recommendations about your heart health and heart disease prevention
  • Lifestyle counselling, which may include recommendations regarding lifestyle changes, such as physical activity and nutrition
  • Patient education
  • Smoking cessation counselling

Other services include a Diagnosis and Treatment Program for patients with suspected or diagnosed Coronary Artery Disease, Valvular Heart Disease and Rhythm Disorders.

Hypertrophic Cardiomyopathy Clinic

The team in Hypertrophic Cardiomyopathy Clinic have experience and expertise evaluating and treating people with hypertrophic cardiomyopathy in the Hypertrophic Cardiomyopathy. Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle becomes abnormally thick, and it is usually inherited.

In the Hypertrophic Cardiomyopathy Clinic, cardiologists trained in the diagnosis and treatment of hypertrophic cardiomyopathy will provide the patients with a comprehensive assessment and conduct diagnostic tests to determine the most appropriate therapy for each individual patient.

The clinicians work in a multidisciplinary team of specialists in cardiovascular diseases, heart surgery (cardiovascular surgery), hereditary conditions (genetics) and other areas that collaborate and coordinate the care and treatment plans. 

In addition to medical treatment, the genetic counsellors and doctors in the Hypertrophic Cardiomyopathy Clinic provide education and support. The staff talk about the importance of screening for hypertrophic cardiomyopathy in the family members and the role of genetic testing as a possible screening tool. The comprehensive care plan may involve the following services:

  • Genetic testing and counselling
  • Risk stratification
  • Exercise prescription
  • Noninvasive tests such as, echocardiography, Holter monitoring, EP testing
  • Pedigree and cascade screening of family members
  • Medical treatments
  • Advanced imaging, such as magnetic resonance imaging
  • Invasive cardiovascular tests
  • Septal ablation
  • Placement of implantable cardioverterdefibrillator (ICD)
  • Septal myectomy

Hypertension Centre

The Centre has been designed to treat patients who have high blood pressure, complex or difficult-to-treat hypertension and its co-morbidities. The Centre follows a collaborative approach to diagnosis, care and monitoring of blood pressure disorders. The clinicians work in a multidisciplinary team to develop a diagnostic and management plan that is tailored to the individual patient. The Centre supports patients with information regarding blood pressure monitoring guidelines, lifestyle changes and nutrition.

Main Pathologies Treated:

  • Resistant Hypertension
  • Secondary Hypertension
  • Primary Aldosteronism
  • Renal Artery Stenosis

Top Procedures:

  • 24hr ambulatory blood pressure monitoring (ABPM)
  • Echocardiography

Cardiac Rehabilitation Centre

The Cardiac Rehabilitation program helps the people who have a history or risk of heart disease to improve their health and reduce their risk of future cardiovascular disease and medical complications. The Cardiac Rehabilitation program provides supervised exercise directed by doctors in a clinical setting, as well as patient education and support for people with diagnosed heart conditions.

The staff in the Cardiac Rehabilitation program focus on several ways to improve the health and reduce your risk of future cardiovascular events, such as:

  • Improving physical activity habits
  • Improving diet
  • Maintaining a healthy weight
  • Taking prescribed preventive medications
  • Avoiding tobacco use or exposure

The program is available for those who have had several conditions or treatments such as:

  • Coronary artery disease
  • Coronary angioplasty and stents
  • Coronary bypass surgery
  • Heart failure
  • Heart valve repair or replacement
  • Vascular disease

The comprehensive Cardiac Rehabilitation Program offers several phases of the program, including:

  • Hospitalization. Evaluation, education and rehabilitation efforts begin while the patients are still in the hospital following a cardiac event
  • Early outpatient. In the immediate posthospitalization period, the patients will begin attending classes and participating in a regular exercise program. Registered nurses and doctors closely monitor the patients
  • Extended outpatient. This is designed for maintenance and ongoing progress of patient’s heart health

Echocardiography Laboratory

The Echocardiography Laboratory at San Raffaele Hospital is a state-of-the-art centre, with a tradition of clinical excellence, education and innovation. The teams in the Echocardiography Laboratory perform more than 20,000 outpatient and inpatient echocardiographic studies annually.

We also perform imaging tests including 2-D and 3-D echocardiography, as well as complex Doppler studies and sophisticated quantitative images such as strain and strain rate. Although stress echo is widely used to evaluate coronary artery disease, members of the team also perform stress echocardiography in evaluating heart valve disease and hypertrophic cardiomyopathy (HCM), in addition to echo imaging for structural heart disease including transcatheter aortic valve replacement, mitral clip and transcatheter mitral valve repair (Mitraclip, annuloplasty) and replacement, transcatheter tricuspid valve repair, septal ablation, and left atrial appendage closure and surgical valvular heart diseases.

The Echocardiographic Laboratory is equipped with the latest technology and offers a full spectrum of services with dedicated staff that includes Cardiologists, Registered Nurses, Clinical and Research fellows.

We store all echocardiographic studies digitally and can review them at any of our workstations.

A staff with extensive experience and expertise in diagnosing and treating structural heart disease is dedicated to echocardiographic guidance during complex interventions in the catheterization laboratory (interventional echocardiography), as well as during open-heart surgery (intraoperative echocardiography).

Research:
The Echo Lab has a dynamic research program. Several members of the Echo Lab are involved in research and development of new technologies and techniques to expand and improve the echocardiography. They conduct also research and clinical trials on transcatheter mitral valve repair and replacement, TAVI, transcatheter tricuspid valve repair, surgical mitral valve repair and on the development of interventional imaging

Cardio-Oncology Clinic

Cancer survival has improved over the years due to newer and better forms of treatment with chemotherapy and radiation. When treating cancer, some of the treatments may cause lasting damage the heart.

The goal of Cardio-Oncology clinic is to help the patients to complete the cancer treatment without developing such damage. We use state-of-the-art technology for the early identification and treatment the toxicity with the aim of not interrupting or changing the cancer therapy.

Our team includes specialists from the Oncology and Cardiovascular Departments. The team works together to provide expertise in diagnostic testing, medical management, and interventional and surgical procedures for patients.

The range of services include an evaluation and treatment of patients:

  • That will begin cancer treatment and have risk factors for heart disease
  • That will begin cancer treatment and are being treated for heart disease
  • That are undergoing chemotherapy or radiation and develop symptoms of heart failure or other
  • That have had cancer treatment in the past and develop new cardiac problems

The Unit’s team of healthcare professionals offer patients:

  • A full range of imaging techniques and diagnostic studies. These tools include cardiovascular exam, electrocardiogram (ECG), and stateof-the-art echocardiography, including 3D, contrast and strain imaging
  • Collaborative medical management. The team of cardiologists and oncologists will discuss the patient’s test results. Together, they will design the best cancer treatment plan for the patient. This includes the choice of treatment, dosage and schedule
  • Ongoing followup care during cancer treatment
  • Continued care after cancer treatment if needed

Cardiovascular Intensive Care Unit

A team of 5 Cardiologists, 1 Anaesthesiologists, and 18 Acute Care Nurse Practitioners comprise the team that provides clinical management in the Cardiovascular Intensive Care (Unit CVICU), 24-hours a day, seven days a week.

There is a total of 10 CVICU beds divided into two subunits, for a total capacity of 750 patient-days per year. Clinical management is collaborative with the Cardiologists and Anaesthesiologists. This collegial structure enables the CVICU team to participate in all clinical decisions and to direct aspects of patient management such as ventilatory and circulatory support, sedation, cardiac monitoring and more. 

The CVICUs Team cares for patients with Acute Coronary Syndromes, Acute Decompensate Heart Failure, and postoperative care of complex PCI, transcatheter valve procedures and cardiac and vascular surgical patients.

The CVICU’s team also includes clinicians specialise in the use of mechanical circulatory support (MCS) devices.

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • 12 Echocardiographic machines equipped with the most advanced technologies including:
    • 3D, Strain and Fusin Imaging technologies
    • 3 ABP recrders
    • 14 Hlter EKG recorders 
    • 3 Treadmills fr stress test 
  • 7 Treadmills in the rehabilitation centre