Cardiology and Angiology Duisburg (NRW): Prof Jánosi

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Prof Dr Alexander Jánosi is a specialist in cardiology and angiology and head physician at the Clinic for Cardiology, Angiology, and Electrophysiology at the Duisburg Heart Center of the Evangelisches Klinikum Niederrhein.

Prof Janósi and his team offer patients state-of-the-art catheter-based interventional procedures on the heart and peripheral vessels – from advanced coronary intervention with imaging (IVUS/OCT) and pressure measurement (iFR/FFR) to complex PCI of severely calcified stenoses and recanalization of chronic occlusions to structural heart valve therapies. Interdisciplinary cardiac teams decide on the optimal course of treatment.

Invasive Cardiology and Angiology: State-of-the-Art Minimally Invasive Examinations by Renowned Cardiologists

The field of invasive cardiology focuses on diagnostic and interventional procedures on the human heart. These procedures are performed in the cardiac catheterization laboratory using contrast agents and X-rays, not only on the heart and its major vessels, but also on the carotid arteries, renal arteries, and peripheral vessels (invasive angiology).

Catheters are thin, flexible plastic tubes through which contrast agents can be injected, and balloon catheters with and without pre-mounted vascular supports (stents) can be advanced. Access to the heart is gained via the groin or wrist artery against the blood flow.

Thanks to local anesthesia, the vascular puncture is relatively painless. The absence of sensitive nerve fibers inside the vessels and the heart makes general anesthesia unnecessary, allowing the patient to remain awake and engage in conversation with the treating physician during the examination of their heart. As a result, many examinations and procedures can be done in outpatient settings.

All standard procedures for invasive diagnostics (intravascular flow measurement, intravascular ultrasound, optical coherence tomography) and therapy (balloon dilatation, stenting, rotablation, shock wave therapy) of narrowed coronary arteries and peripheral vessels are available.

Transcatheter Aortic Valve Implantation (TAVI): Gentle Treatment of Aortic Valve Stenosis

Even a healthy lifestyle cannot reliably prevent aortic valve narrowing. The aortic valve acts as a check valve and prevents the blood that has been ejected from the aorta from flowing back into the left ventricle during the filling phase of the heart. If the aortic valve narrows over time, for example, due to calcium deposits, the heart must constantly exert enormous force to pump against the increased resistance.

In advanced stages, this can lead to shortness of breath, dizziness, and chest tightness. In this case, the rigid, inflexible valve should be replaced to restore blood flow and relieve the heavily strained heart. The narrowed aortic valve can be replaced either by major surgery or – in a particularly gentle procedure – with a catheter (TAVI procedure). In this procedure, the new valve is placed in the heart via a small incision, usually in the groin. For many patients, this procedure is less stressful and allows for a faster recovery.

This option was initially developed for patients with excessive surgical and anesthesia risks. TAVI therapy is far less invasive than conventional heart valve surgery. Since the chest is not opened and the use of a heart-lung machine under anesthesia is not necessary, the patient can be mobilized from bed on the day of treatment and leave the clinic after a few days of observation.

Due to these advantages, the TAVI procedure is now considered the standard procedure for most patients with aortic valve stenosis. Prof Dr Alexander Jánosi is an experienced cardiologist who routinely carries out this treatment.

Anatomic conditions and comorbidities play a decisive role in treatment planning. Detailed preliminary examinations and thorough imaging are therefore essential to recommend the optimal treatment for each patient, including the selection of the access route, valve type, and appropriate size.

MitraClip: Interventional Treatment for Mitral Valve Insufficiency

Mitral valve insufficiency refers to leakage of the mitral valve. This is the second most common acquired valvular defect after aortic valve stenosis described above.

If there is a leak in the mitral valve, part of the blood flows back into the left atrium during the heart's action, causing backflow into the pulmonary circulation. Patients experience this as oppressive shortness of breath, suffer from water retention, and have a significant decrease in their ability to cope with everyday life.

If this pathological stress persists over a more extended period, it is accompanied by chronic damage to the heart muscle. Open surgery was the only possible corrective measure for this clinical picture for a long time. Such surgery, however, is not an option for many patients due to severe concomitant diseases, advanced age, or a severe restriction of the heart's pumping function.

Therefore, a catheter-based mitral valve repair procedure using MitraClip has been developed to reduce mitral valve leakage without surgery. A small metal clip is advanced through the inguinal vein to the mitral valve via a controllable catheter. It connects the two leaflets of the mitral valve, allowing the defective valve to close more tightly as a result. Opening of the chest is not required for this procedure.

Experienced Center for Closing Defects in the Atrial Septum

Congenital defects (“holes”) in the atrial septum are usually detected early and then treated by a pediatric cardiologist. In adult patients, catheter-assisted closure is rarely considered, but when it is, it can usually be performed without complications.

The so-called patent foramen ovale is more common, a malformation that can be associated with cerebral embolisms in particular. This is a slit-shaped opening in the overlap area of the two leaves of the atrial septum, which only becomes visible when the pressure in the right atrium exceeds that in the left atrium.

This connection is essential for the unborn child in the womb, but in most people, it “grows together” after birth. The foramen ovale does not close in approximately 20% of adults. If an open foramen ovale is found in younger patients (< 60 years) with a cerebral infarction of unclear cause, it is presumed to be significant as a passageway for blood clots and should be closed.

This type of closure can be carried out quite easily using a catheter with a specially designed “occluder.” The Duisburg Heart Center also has extensive experience in this area—patients benefit from close cooperation with colleagues in pediatric cardiology.

Please, visit the website of the Department of Cardiology, Angiology, and Electrophysiology for more information.