E. Murat Tuzcu, MD
Biography

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Cardiovascular disease is the leading cause of death for both men and women in the United States. Doctors are working to find new techniques to diagnose and treat without invasive surgeries. We discussed the latest nonsurgical treatments for heart disease with cardiologist E. Murat Tuzcu, MD, from The Cleveland Clinic Heart Center on July 26, 2005.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live. Our guest today is E. Murat Tuzcu, MD, a Cleveland Clinic Heart Center interventional cardiologist. He is here to discuss the latest nonsurgical advancements in heart care.

Dr. Tuzcu, can you explain your work in the catheter lab and how it is helping you and your colleagues care for patients with heart disease?

TUZCU:
More than half a century ago, doctors and cardiologists started to diagnose heart disease through catheterization: they put long, tiny tubes, called catheters, through the blood vessels of the leg, up to the heart. There they injected special dyes, and took pictures of the heart and the blood vessels. That was called angiography.

Over the years this basic technique allowed cardiologists to expand their diagnostic abilities and also do some treatments. For example:

• They started using balloons to open blocked arteries which bring blood to the heart (balloon angioplasty).
• Larger balloons were used to open narrowed heart valves (balloon valvioplasty). In the near future, we'll be able to put in artificial heart valves to repair some narrow valves.
• More recently, we thread devices through catheters and into the heart to repair congenital heart defects (such as holes in the heart).

As you see, the profession called interventional cardiology has a very large scope and in a nutshell, it means to treat many, many heart diseases through tiny tubes inserted through the leg or the arm -- diseases that used to be in the domain of heart surgery. So that's what I do.

MODERATOR:
What are the advantages to working via catheter rather than simply opening the heart?

TUZCU:
The major advantages are avoiding the problems associated with open heart surgery, the generally long hospital stays (anywhere from 5 to 8 days), and the weeks needed to recuperate from open heart surgery.

Moreover, many patients, particularly those with other issues, or elderly patients, may have serious complications or die after surgery. Treatments done through catheters generally require only an overnight hospital stay, have much shorter recovery times, are generally less uncomfortable, and in many cases, may have less risk of complications and death.

Having said this, it is very important to understand that a cardiologist should always keep in mind the available treatment options, be it from surgery or through the catheter or by medications, and choose the one or the ones that suit that particular patient best.

"The World Health Organization declared that coronary artery disease will be the No. 1 killer of the world in the year 2020."

So I would not present the interventional cardiologist's work as a competitor to the surgeon's work, but I rather like to think these are all complementary tools in our toolbox when we help our patients.

MODERATOR:
What types of heart disease can be treated through catheterization?

TUZCU:
The oldest and most widely used catheter treatment is treating blockages of the blood vessels that take blood to the heart. These blood vessels are called coronary arteries, and the blockages of these coronary arteries is called coronary artery disease.

This is the No. 1 killer in our country, as well as most of the world. The World Health Organization declared that coronary artery disease will be the No. 1 killer of the world in the year 2020.

This is an immense health care problem. For the last 20 years we've made tremendous advances in the treatment of coronary artery disease using catheter techniques.

Nowadays, most of the patients that come to us with chest pain or heart attacks are diagnosed by coronary angiography -- that is, taking pictures of the blood vessels supplying the heart. Most of the time, the narrowing that causes heart attack or chest pain is treated by using special devices called stents. Let me explain what a stent is.

If we go back to early '80s, when we were doing treatments using just balloons, we were able to open a blocked artery by stretching the blood vessel and by compressing the plaque that was narrowing the opening of the blood vessel. Unfortunately, three to five patients out of ten on whom we used technique, were coming back to our offices with recurrent chest pain within six months. We called this restenosis, meaning "narrowing again."

The way to solve this problem took more than a decade -- that's when we came up with devices called stents. Stents are tiny, miniaturized mesh cylinders that act as a scaffolding device within the blood vessel.

Think of the blood vessel as a three-lane highway going through a tunnel. The tunnel wall can get an accumulation on it which encroaches on the lanes, occupying two of the three lanes. What we do is put a mesh tube in there, and, with a balloon, expand it, forcing the accumulation back to the tunnel wall. We create a new opening and keep it intact because this little mesh cylinder doesn't allow the tunnel to be narrowed again.

The 1990s is the time of stents, but we also saw some renarrowing after stents, with about 15% of patients requiring repeat procedures. Nowadays we have new stents that are treated with special medications. They are called drug-eluding stents, which not only prevent the blood vessel compression, but also prevent scar tissue formation within the stent.

Nowadays patients who receive a drug-eluding stent have a 5% or less risk of renarrowing. This new technology, which can be applied with very small risk and offers an excellent long-term outcome, increased the number of patients treated by catheter rather than surgery.

So, this is the most common catheter application for heart disease. There are others I would be happy to talk about when other questions come up.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician.