Cardiology

The Heart Institutes in Israel are tertiary referral centers, serving the entire country as well as patients from abroad.
We provide a complete range of cardiovascular services, from outpatient cardiac diagnosis and follow-up to the most advanced diagnostic and interventional procedures, for adults, children and infants, including pre & post transplant assessment & follow-up.

Interventional Cardiology

Different from cardio surgeons, cardiologists are experts in all forms of catheterization, using laboratories furnished with the newest state-of-the-art digital equipment. Cardiac catheterization serves for both diagnostic and treatment purposes.
Patients undergoing the procedure have a catheter inserted through a small incision in the groin or forearm, which is subsequently advanced through the arteries until it reaches the heart. The catheter can then be used to diagnose heart conditions including coronary artery disease and defective heart valves, the size and function of the heart. The assessment is done by injecting a small amount of radiographic dye, to perform a coronary angiogram determining blockages in the coronary arteries. Anatomic and physiologic information of the coronary arteries are obtained by intravascular Doppler and ultrasound (IVUS) examinations.
Cardiac catheterization is also used to treat coronary heart disease by the following interventional procedures.

Balloon Angioplasty

Is carried out for the dilatation of narrowed vessels, even those with the most difficult and complex lesions.

Implantation of stainless steel and nitinol stents

• Metal mesh inserted to support the dilated vessel from within.
• Stents coated with different drugs.
• And stents covered with biocompatible plastic sheets.

Radioactive Brachytherapy

An intravascular radiation preventing recurrent narrowing of previously treated and dilated vessels.

Directional Atherectomy and Rotablation

This special technique drills to open complex and calcified lesions.

Balloon Valvuloplasty

The balloon used for dilatation of narrowed calcified valves.

Endomyocardial Biopsies

Tissue samples are obtained to diagnose heart muscles' diseases and to conduct a post heart transplant follow-up.
All these procedures are performed both on elective patients and those with acute coronary syndromes. Some patients with acute myocardial infarction undergo opening of their occluded arteries during the acute phase, depending on many factors.
Over 20,000 interventional cardiologic procedures of all different kinds are carried out in Israel each year, half of which are interventional therapeutic procedures. All procedures are performed by a highly trained staff consisting of cardiologists, nurses and technicians, who maintain a high level of academic expertise and consistently continue their clinical training, in order to stay at the forefront of the field.

Pediatric Interventions

Heart conditions' diagnosis at any age might need catheterization, but obviously young people seldom suffer from blockage of arteries by plaques of all kinds. Yet a hole between the right and left atria is not uncommon at birth. In cases that it does not close by itself, an operation is needed, since the defect impairs the heart function. Nowadays most infants can enjoy Closure of atrial-septal defects by up-to-date devices, being a much less invasive procedure than open heart surgery.

Heart Failure and Heart Transplantation

Several Heart Failure Units were established throughout the country in order to provide the basis for the National Heart Transplant Program. These are active centers that offer comprehensive medical care to heart failure patients. Multidisciplinary teams of expert physicians, nurses, dieticians and social workers provide the patients with extensive coverage.

Most programs are primarily based on a very active out-patient clinic and a day-care facility operating throughout the week. In addition, patients can be hospitalized in regular medical ward beds, monitored beds and in the intensive cardiac care unit that is fully equipped for hemo-dynamic monitoring. This infrastructure has proven to be excellent for treating patient's symptoms and improving their functional capacity and quality of life, prolonging survival and keeping them as much as possible out of the hospital. The active heart transplant program combined with the fully equipped modern cardiology facilities, including state-of-the-art Echocardiography, and Electrophysiology laboratories, provide solutions and support to thousands of patients with moderate to advanced heart failure.
Patients who eventually deteriorate into a truly life-endangering heart failure and are otherwise free of contra indications, are automatically listed for transplantation. The sickest patients, those requiring mechanical support (defined as status I patients by UNOS classification), are hospitalized until transplant. Due to the shortage of organ donors and the constantly increasing waiting time for transplant, several cardiology units have recently introduced into their program a mechanical "artificial heart" as a "bridge to transplantation". This left ventricular assist device (LVAD) can be implanted in critically ill patients to keep them alive until a donor heart becomes available.
Hundreds of patients have been followed-up all over Israel after heart transplantation. Ten percent of the patients were under the age of 21 at the time of transplantation. Our medium and long-term survival rates are comparable to those of the International Society for Heart and Lung Transplantation (ISHLT). Many of our patients enjoy decent health over 10 years after transplant, regaining normal quality of life and physical capabilities, in parallel with normalization of their left ventricular ejection fraction (LVEF).

Echo-Cardiography

Non-invasive imaging of the heart is obtained by using different state-of-the-art instruments and innovative ultra-sound techniques.

Echocardiographic examinations are performed for the evaluation of both the structure, shape and the function of the heart muscle, as well as the heart valve and large vessels.

In urgent cases, e.g., tamponade (blood effusion of the cardiac sack), trauma to the aorta and or aortic dissection, this type of diagnosis can save lives.

Trans-esophageal echocardiography permits high-resolution images of specific areas of the heart such as the mitral and aortic valve, left atrial appendage, both atria, the interatrial septum and large vessels. It supplies a better understanding and improved diagnosis enabling a more accurate treatment.

Most studies are carried out in the echocardiography clinical laboratories. Over 50,000 procedures are performed each year, approximately 60% of which are for ambulatory patients, 10% of trans-esophageal diagnostics in adults.

Some 10,000 are for pediatric patients and over one thousand examinations are performed on fetal hearts in pregnant women.

In emergency cases, the echocardiographic examination is carried out in the emergency room, the trauma unit, or the operating theatre, in order to assess the necessity and probability of success of valve repair, to diagnose pathological events causing hemodynamic instability etc.

The service is also available in internal medicine departments, oncology and hematology departments, as much as in different intensive care units, e.g. cardiac intensive care, respiratory, surgical and neuro-surgical units.

Echocardiography allows an assessment of fluid around the heart (pericardial effusion), evaluation of valve replacement and ventricular function in the acute setting. Different types of echocardiographic studies include regular trans-thoracic, trans-esophageal and stress dobutamine echocardiography, as well as echocardiography in children and of fetal hearts. The medical staff consists of experienced sonographers and highly trained physicians. The entire medical staff maintains a high level of clinical and academic expertise.

We are involved in international clinical trials, ascertaining a high quality clinical and research performance. Our echocardiography units are internationally respected in the field of cardiac function assessment, valvular function and pathology of the thoracic aorta.

Electrophysiology

Several electro-physiological units function in Israel, accepting referrals from all hospitals, from neighboring and overseas countries.
Electrophysiological tests determine the nature of the arrhythmia.
The units carry out electrophysiological studies of complex arrhythmias, and perform ablations of abnormal pathways. Our results have been very successful, and in most cases a complete cure has been achieved. In addition, the units implant state-of-the-art pacemakers into patients who faint or have slow heart rates, and defibrillators in patients who have been resuscitated.

ICCU - Intensive Coronary Care Units

When choosing a medical facility, one needs to be sure that even if one's condition is worsen an intensive care unit is available to see him/her through the difficult period.

All the Intensive Coronary Care Units in Israeli hospitals employ well experienced medical staffs, consisting of highly trained cardiologists and technicians who are supported by experienced nurses, who have been specially trained in the treatment of urgent heart problems.
All units are equipped with the most advanced monitoring devices available today, treating thousands of patients suffering from various acute and complex heart conditions, such as heart attack or acute coronary syndrome. For these patients major concerns are the prevention of further heart muscle damage and prompt treatment of life-threatening arrhythmias. Patients in the ICCU are therefore continuously monitored by ECG, and if needed, any adverse problem is attended immediately. The patients are treated by the most advanced therapies available including primary angioplasty, intra aortic balloon counter-pulsation, and cardio-version defibrillator implantation. Patients with severe heart failure undergo strict hemo-dynamic monitoring which allows optimal treatment. Following stabilization, patients are either sent home or, after optimizing their medical therapy in the ICCU, are transferred to the internal medicine ward.
Education and rehabilitation of heart attack and acute coronary syndrome patients begins in the ICCU, continues during the hospital stay and after the patient is discharged. Patients receive instructions on preventive medicine, i.e., how to avoid future events by adhering to a healthy diet, exercise and refrain from smoking.