Cardiovascular Integrated Physicians (CVIP) provides the following invasive, interventional cardiology services.

Cardiac Catherization

To properly examine a patient’s heart function so that appropriate diagnoses and treatments can be delivered, doctors perform cardiac catherization. Also known as an angiogram, a cardiac catherization is an invasive imaging procedure that allows doctors to view heart structures and activity to evaluate various heart conditions. A catheter is placed into the groin (femoral artery) or wrist (radial artery) and guided all the way to the heart using an x-ray machine. Once the catheter is placed, visual imaging of the heart can be viewed to observe things like the heart’s pumping function or locations of artery blockage. Pressure in various chambers of the heart can also be recorded; this imaging and data recording may help in the diagnosis and treatment of various heart conditions including valve heart disease, cardiomyopathy, and coronary artery disease.

A coronary angiogram is an X-ray image of the coronary arteries of the heart. To produce an angiogram, a contrasting material, usually a liquid dye, is injected into a catheter that is inserted into a patient’s femoral or radial artery and leads to the heart. This material makes blood flowing through the coronary arteries visible on an X-ray through color contrast. The contrasting material subsequently gets eliminated from the body via the kidneys and urine. Once visibility is attained, doctors can identify signs of heart conditions, such as any plaque formation, obstruction, or narrowing in the arteries, allowing doctors to identify the presence and extent of coronary artery disease. Other techniques for evaluation of coronary artery disease include intra-vascular ultrasound (IVUS). A moderate or indeterminate coronary blockage is further evaluated with measurement of pressures inside the coronary arteries using intra-vascular pressure sensors. If significant blockage is diagnosed within the coronary arteries, a stent may be placed at that time. Other methods used to treat coronary artery disease include atherectomy (use of mechanical devices or laser techniques), balloon angioplasty, and thrombectomy. Patients may be considered for coronary bypass surgery instead of stents depending on findings from the coronary angiogram.


Coronary Stent

During a cardiac catheterization, a coronary stent may be placed in the coronary arteries of a patient if an angiogram indicates the presence of artery narrowing or obstruction. A stent is a wire mesh tube that props open a blocked coronary artery. Stent placement is permanent and restores blood flow through the artery. Coronary stents can be placed during an elective procedure or during emergency treatments in cases such as heart attacks. 


Left Atrial Appendage Closure (Watchman, Amulet)

Patients with atrial fibrillation (AFIB) have higher risks for stroke. This is because in AFIB, the atria cannot contract properly and therefore cannot pump blood sufficiently; blood then starts to pool within them, enabling formation of blood clots within the left atrial appendage, a small sac in the top left atrium of the heart. If resulting clots travel through the coronary arteries, they can cause strokes, so AFIB raises the patient’s risk of stroke. Accordingly, AFIB patients can benefit from taking blood thinners to lower their stroke risks. Blood thinners can cause side of effects such as bleeding. Some patients cannot tolerate blood thinners if they are predisposed to bleeding or had a bleeding event. Patients with poor balance or those with active lifestyle or high-risk occupations may be at risk of injury and serious bleeding with blood thinners. Some patients also experience side effects with various blood thinners.

Thus, a patient who has a contraindication to blood thinners may be a candidate for a left atrial appendage closure (LAAC) procedure. A left atrial appendage closure procedure is an alternative to blood thinners such as Warfarin (Coumadin), Xarelto, Eliquis, and Pradaxa to prevent stroke associated with atrial fibrillation. It is a minimally invasive procedure in which a permanent, plug-like implant is placed in the left atrium to close off the left atrial appendage, thereby reducing the chance of stroke by preventing accumulation of blood in a location where blood clots are likely to develop. This procedure requires catheter insertion in the groin vein, general anesthesia, and a one-night stay in the hospital. An example of an LAAC-sealing devices is the Watchman FLX Device, or Amulet devices.


Aortic Valve Stenosis

The aortic valve is the valve which allows blood flow from the heart to the aorta, the body’s main artery that supplies the rest of the body with blood, oxygen, and nutrients. When the valve becomes too narrowed, which is a condition called aortic valve stenosis, it prevents blood from flowing out of the heart to the aorta. Severe aortic valve stenosis is a serious condition that can lead to shortness of breath, dizziness, passing out, heart failure, and sudden death. Treatment options include surgical aortic valve replacement (SAVR)in an open-heart surgery performed by a cardiothoracic surgeon, or the minimally invasive transcatheter aortic valve replacement (TAVR), which is performed by a structural interventional cardiologist such as Dr. Daniel as a member of a heart valve team.


Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure which places an artificial aortic valve within a diseased, narrowed valve through a catheter (most commonly inserted through the femoral artery in the leg). A doctor guides the artificial valve to the heart, where a valve is positioned on the tip of the catheter that the is expanded, which presses the valve in place within the diseased valve. The new valve starts functioning immediately upon implantation. Also known as a transcatheter aortic valve implantation (TAVI), TAVR is a less invasive approach to aortic valve replacement compared to open-heart surgical valve replacement. After the procedure, a patient may stay one to two nights in the hospital.


Mitral Valve Regurgitation

The mitral valve is a heart valve located on the left side of the heart and has two leaflets (flaps), which is why it is also called the bicuspid valve. The mitral valve sits between the left atrium and left ventricle. Normally, blood flow returns from the lungs to the left atrium through the mitral valve; the blood then flows to the left ventricle to be pumped out to the aorta for transport to the entire body. A normal mitral valve functions by preventing blood from flowing backwards into the left atrium. In mitral valve regurgitation, however, leakage of the mitral valve results when the two leaflets do not close properly, causing some of the blood to flow backwards into the left atrium. Mitral valve regurgitation may be associated with various conditions including mitral valve prolapse, rheumatic heart disease, and cardiomyopathy. This condition may lead to symptoms of heart failure such as fatigue, shortness of breath, coughing, and swelling of the feet. Treatments for mitral valve regurgitation include mitral valve repair or replacement. Patients who may not be candidates for surgery are offered an alternative option: a minimally invasive transcatheter mitral valve repair (TMVr) procedure called MitraClip™, the attachment of an implanted clip to the mitral valve to facilitate valve closure and restore proper blood flow in the heart.



In cases of severe mitral valve regurgitation, patients may be a candidate for a minimally invasive transcatheter mitral valve repair (TMVr) procedure called MitraClip™. Unlike with surgery, this procedure does not require opening the chest and stopping the heart temporarily. With MitraClip, a catheter is inserted in the femoral vein in the groin to guide an implanted clip smaller than a dime to the mitral valve, to which the clip is attached. The clip improves the valve’s ability to close by grasping the tips of the leaflets (flaps) of the mitral valve to reduce regurgitation, or backflow blood leakage into the left atrium. The valve will continue to open and close on either side of the clip, allowing blood to flow through. Patients typically stay for one or two nights in the hospital after the procedure before going home.