Cardiology in Germany's leading hospitals
The range of services offered by German cardiology hospitals covers not only the treatment of congenital and acquired heart defects, but also diseases of the circulatory system and of the vessels supplying the heart.
Cardiology deals with functional disorders of the heart and blood vessels. All conditions can be divided into the following groups:
- coronary circulation disorders: coronary artery atherosclerosis, ischaemic
- heart disease, myocardial infarction;
- rhythm disorders;
- myocardial diseases: cardiomyopathies, heart failure,
- ventricular hypertrophy, tumours;
- diseases of the outer and inner layers of the heart: pericarditis, endocarditis;
- valve diseases: insufficiency, stenosis, prolapse;
- congenital heart defects.
Conditions that are not located directly in the heart are usually treated within related medical specialties — angiology, neurology and pulmonology.
Key areas of cardiology in Germany
- cardiac arrhythmias (tachycardia, extrasystole, atrial fibrillation);
- atherosclerosis;
- inflammatory diseases of the myocardium, pericardium and endocardium;
- congenital and acquired heart conditions;
- identifying indications for investigations using nuclear medicine andsurgical methods, with subsequent assessment of the results (together with specialists from other disciplines);
- heart valve diseases correction, in particular using the MitraClip procedure);
- implantation of cardiac pacemakers and implantable cardioverter-defibrillators with
- subsequent monitoring of their function;
- intensive care;
- interventional (ablation, cardioversion) and drug treatment of rhythm disorders, high-resolution three-dimensional mapping, cryoablation, laser ablation;
- ischaemic heart disease (angina pectoris, acute myocardial infarction, acute coronary syndrome);
- pacemaker and ICD monitoring;
- treatment of circulatory disorders and aneurysms;
- coronary angiography;
- pulmonary arterial hypertension (PAH);
- minimally invasive treatment of congenital and acquired heart defects;
- drug and interventional treatment of rhythm disorders, including defibrillation and ablation;
- myocarditis;
- myocardial storage diseases;
- rhythm disorders (ablation for all types of arrhythmia using the latest high-resolution three-dimensional mapping technologies);
- monitoring and adjustment of pacemakers and defibrillators, implantation of pacemakers and defibrillators (ICD), implantation of loop recorders;
- mitral and tricuspid valve insufficiency;
- dilatation of the coronary arteries, vessel dilatation;
- conditions of the vessels supplying the heart;
- conditions of the pericardium;
- heart failure;
- condition after myocardial infarction;
- angina pectoris;
- tachycardia;
- therapeutic interventions on the coronary vessels (percutaneous transluminal coronary angioplasty (PTCA), stent implantation (stenting), atherectomy, rotablation, brachytherapy);
- catheter-based treatment of valve diseases (valve-sparing repair, valve implantation, treatment of paravalvular regurgitation);
- atrial fibrillation;
- transcatheter aortic valve implantation (TAVI);
- percutaneous transluminal coronary angioplasty, PTCA (dilatation of narrowed coronary arteries / balloon angioplasty);
- endocarditis.
The popularity of German hospitals is explained by the following factors:
- cardiology in Germany is the most rapidly developing field of medicine;
- wide use of non-invasive imaging methods: cardiac CT, cardiac MRI, myocardial scintigraphy;
- highly complex diagnostic and therapeutic minimally invasive procedures, such as coronary angiography and angioplasty, are routine practice not only in university medical centres but also in specialised hospitals;
- the risk involved in interventions in these hospitals has been reduced to a practical minimum;
- for electrophysiological studies with ablation, German hospitals use robotic systems that significantly increase the effectiveness of these procedures;
- the use of ultra-thin catheters makes it possible to perform a range of heart interventions successfully even in newborns.
The range of cardiac diagnostics in Germany includes:
- renal artery angiography;
- aortography;
- arteriography of the iliac, femoral and popliteal arteries;
- intravascular ultrasound (IVUS) of the coronary arteries;
- measurement of blood flow velocity in the coronary vessels;
- capillary microscopy;
- cardiac catheter examinations (coronary angiography, aortography and selective left ventriculography);
- laboratory blood tests;
- left and right heart catheterisation for diagnostic purposes;
- non-invasive cardiac imaging (multislice MRI, computed tomography, echocardiography, Doppler and duplex echocardiography, stress echocardiography and transoesophageal echocardiography);
- assessment of myocardial infarction risk;
- lung function testing;
- bypass graft assessment;
- PET (positron emission tomography) and single-photon emission computed tomography (SPECT);
- sonography (ultrasound) of the thyroid gland, duplex sonography of the arteries supplying the brain and of the peripheral arteries;
- stress echocardiography (stress echo);
- 24-hour ECG monitoring (Holter ECG);
- 24-hour ambulatory blood pressure monitoring (ABPM);
- myocardial scintigraphy;
- tilt table test;
- tissue Doppler echocardiography;
- whole-body plethysmography.
- transthoracic Doppler echocardiography;
- treadmill test;
- digital angiography of the extracranial cerebral arteries;
- digital subtraction angiography (DSA);
- ECG;
- exercise ECG;
- ergospirometry;
- electrophysiological study (EPS);
- endomyocardial biopsy.
The most common therapeutic procedures in cardiologyin Germany:
- balloon angioplasty (including with stenting);
- atherectomy;
- radiofrequency ablation;
- minimally invasive interventions for congenital heart defects.
Innovative techniques in cardiology:
- minimally invasive aortic valve replacement and mitral valve repair (clipping);
- left atrial appendage closure.
Interventional cardiology for coronary artery disease (CAD). Stenting in Germany
In coronary artery disease (CAD) there is a progressive tendency towards «calcification» and narrowing of the vessels that supply the heart. These narrowings cause symptoms only at very late stages and can lead to a myocardial infarction if the vessel closes completely. During coronary angiography, cardiologists widen these narrowed sections with a balloon and keep them open with a stent. German hospitals offer treatment for all forms of coronary narrowing occurring in coronary artery disease (angina pectoris, myocardial infarction), using modern stents together with innovative imaging techniques. Every year stents (support structures that keep the coronary arteries open) are implanted in approximately 2500 patients.
Cardiac catheterisation (coronary angiography) in Germany
One important area of work for German cardiologists is catheter-based examination of the heart. During coronary angiography the catheter is advanced to the heart and, once a contrast agent is injected, narrowings or other cardiac abnormalities become visible on the X-ray image.
TAVI and MitraClip — catheter-based procedures
The most common heart conditions in older age are aortic valve stenosis and mitral valve insufficiency. When these valves change, the symptoms are often very non-specific and appear only at late stages of the disease. They may present, for example, as episodes of weakness, shortness of breath or rapid fatigue
Thanks to modern procedures, cardiologists are able to treat narrowing of the aortic valve or mitral valve dysfunction — using a catheter, without major surgery. The first TAVI procedure was carried out at the CVC in 2005, and the first MitraClip implantation in 2009. Germany was the setting for one of the world's first minimally invasive tricuspid valve implantation procedures. This method delivers comparatively good long-term results, particularly in elderly patients. The TAVI or MitraClip technique is a good alternative to classical open-heart surgery, especially for patients with concomitant conditions.
Alternative treatments for arterial hypertension
Renal denervation (RDN) is a catheter-based treatment for hypertension: the catheter is introduced in the groin and advanced through the abdominal aorta into the renal arteries. The nerve fibres in the artery walls are then obliterated. This lowers high blood pressure over the long term. The procedure takes about 45 minutes, is considered safe and causes no side effects. Another highly effective method is baroreceptor stimulation.
Closure of a patent foramen ovale — minimising the risk of a recurrent stroke
It is estimated that one person in four has a patent foramen ovale, a small opening in the septum of the heart at the level of the atria. Normally the opening closes after birth, but in many people it remains open. Even though most patients do not notice the defect, a patent foramen ovale can be a cause of stroke. This defect can now be closed using a catheter. The procedure is recommended for people who have already had a stroke and in whom no other underlying conditions have been found.
Interventional closure of the left atrial appendage (LAA) in atrial fibrillation
For patients with atrial fibrillation who cannot take anticoagulants over the long term, interventional closure of the left atrial appendage (LAA) is a good option for stroke prevention. During this procedure cardiologists use a catheter to place an LAA occluder in the atrial appendage, since atrial fibrillation often leads to the formation of blood clots in this area. Closing the atrial appendage significantly reduces the risk of stroke in patients who are at risk of bleeding.
Diagnosis and treatment of arrhythmia in Germany
Arrhythmias in Germany are diagnosed and treated in specialised centres and departments of arrhythmology / electrophysiology in line with the guidelines of the German Cardiac Society Deutsche Gesellschaft für Kardiologie and the European Society of Cardiology. The main aim of German arrhythmia specialists is to determine the type of rhythm disorder, the level of risk it poses to the patient and the most appropriate treatment strategy. Clinical experience is carefully documented so that the effectiveness of treatment and the likelihood of complications can be analysed later. The advantage of Germany's specialised arrhythmia centres lies in their use of innovation and their extensive clinical experience. The high-technology equipment used in Germany includes:
- computerised electrophysiology laboratories;
- electroanatomical 3D mapping systems, telemetry and programming systems for all types of implantable pacemakers, defibrillators and rhythm devices;
- magnetic catheter navigation technology for radiofrequency ablation, which makes it possible to deliver the catheter to areas of the heart previously inaccessible for ablation, or to return it automatically to the exact spot where ablation has already been performed but proved insufficient;
- robotic systems for controlling electrophysiological studies and radiofrequency ablation (RFA).
Catheter ablation for cardiac rhythm disorders
German cardiologists have unrivalled experience in treating rhythm disorders with catheter ablation alongside drug therapy. The procedure uses the latest high-resolution three-dimensional mapping technologies as well as cryoablation and laser ablation. Every year our partner hospitals perform more than 1500 ablation procedures, including more than 1000 interventions for atrial fibrillation.
Endomyocardial biopsy
Another area of work for German cardiologists is endomyocardial biopsy. This is an important tool for the differential diagnosis of certain heart diseases. During the procedure a catheter is used to take a tissue sample from the heart muscle (myocardium), which is then examined in the laboratory.
Non-surgical treatment of congenital heart defects in Germany
Only half a century ago there was a single way to treat congenital heart defects (CHD) – surgery. In 1966 balloon atrial septostomy (percutaneous perforation of the atrial septum with a balloon catheter) was performed for the first time, marking the beginning of interventional treatment for CHD. Over the past 20 years minimally invasive methods of treating congenital heart defects have developed successfully in Germany.
Balloon dilatation of the heart valves and vessels
Narrowings (stenoses) of the heart valves or coronary vessels can be eliminated completely or partially with a special expandable balloon placed at the tip of a catheter. Today, narrowing of the pulmonary valve is treated in this way in almost 100% of cases. Repeat dilatation or surgery becomes necessary in only 5-10% of cases.
Closure of septal defects of the heart
An opening in the atrial septum allows blood to flow back from the left side of the heart into the right, placing an additional load on the right side of the heart and on the lungs. With this type of congenital heart defect, exercise tolerance decreases, cardiac rhythm disorders appear and pulmonary hypertension develops. If the opening is not too large, septal defects are closed using minimally invasive methods. European cardiologists have a wide range of treatment systems at their disposal for such procedures, differing both in the materials used and in their technical features. Within a few weeks the «umbrella» used to close the defect «becomes covered» by the body's own tissue and remains in the patient's body for life.
Enlarging the opening in the atrial septum
A special balloon catheter is used to enlarge the opening in the septum in order to improve the mixing of oxygen-poor and oxygen-rich blood in children with so-called «blue» heart defects (this treatment is performed as emergency care in newborns).
Closure of a patent ductus arteriosus (Ductus arteriosus)
The systems currently used in European hospitals for the minimally invasive closure of the connection between the aorta and the pulmonary artery (the ductus arteriosus) achieve results comparable with those of surgery.
Since 2008 our company has been arranging treatment for heart conditions in Germany for patients of all ages. We guarantee our patients a thorough work-up, precise radiological examinations, the closest possible interdisciplinary cooperation between specialists from different fields, and assistance with travelling to Germany quickly in urgent cases.
The hospitals and departments of cardiology, cardiac surgery and cardiovascular surgery that cooperate with msp group germany, offer the full range of outpatient and inpatient medical services in cardiology and electrophysiology.
All the hospitals we recommend are among the world leaders in the treatment of cardiovascular disease in adults and children and rank among the world-class specialised centres equipped with the latest technology. Their consistent and extensive use of minimally invasive techniques has significantly reduced the number of complications and the length of hospital stays.
