The cardiac catheterization laboratory at TMH under the direction of Dr. Kenneth Korr performs approximately 4,500 cases annually including 1,500 interventional cases. The laboratory facilities include three fully digitized suites capable of both diagnostic and interventional procedures.

Procedures performed in both labs include diagnostic catheterization with retrograde and transeptal techniques, percutaneous coronary interventions including balloon angioplasty, stenting (coated and uncoated), intracoronary brachytherapy, rotational and directional atherectomy, closure of patent foramen ovale, alcohol septal ablation and intracardiac and intravascular ultrasound. The clinical laboratories are also supported by a separate Angiographic Core Laboratory at RIH capable of quantitative coronary angiography.

Cardiac Electrophysiology and Arrhythmia Service
Director: Alfred E. Buxton, MD
Two state of the art clinical EP laboratories serve as the focal point for the service. One has biplane fluoroscopy, the other has single plane fluoroscopy. Both laboratories are fully equipped to perform catheter ablations and pacemaker/defibrillator implantation. Both are fully computerized, with multi-channel physiologic recording and stimulating systems. Two animal laboratory facilities are available, and utilized. These are state of the art facilities, with multi-channel recording and fluoroscopy.

A full range of laboratory based and clinical multicenter research studies are performed. The main emphasis of the laboratory is understanding mechanisms underlying supraventricular and ventricular arrhythmias, risk prediction of sudden death, and marrying new technologies to solve clinical problems.

Coronary Care Unit and Intermediate Coronary Care Unit, RIH
Director: George R. McKendall, MD
The Coronary Care Unit at RIH is comprised of 16 state-of-the-art acute intensive care beds with an adjacent 20-bed step-down unit. Approximately 120 patients per month are admitted to the CCU with acute coronary syndromes or cardiac disorders. An adjacent fluoroscopy equipped procedure room is available for insertion of temporary pacemakers, Swan-Ganz catheters, and intra-aortic balloon pumps. There are approximately 1650 admissions annually to the RIH CCU and 2200 to the intermediate coronary care unit. There are telemetry units on most of the general medical floors for less acute or "stepdown" patients.

Coronary Care Unit and Cardiac Telemetry Units, TMH
Director: Paul C. Gordon, MD
The Coronary Care Unit at TMH is comprised of 9 state-of-the-art acute intensive care beds with 5 additional "swing" beds shared with the ICU/Critical Care service. Approximately 125 patients per month are admitted to the CCU with acute coronary syndromes or cardiac disorders. An adjacent fluoroscopy equipped procedure room is available for insertion of temporary pacemakers, Swan-Ganz catheters, and intra-aortic balloon pumps.

There are 2 step-down units with 60 beds and 48 telemeters, with a cardiac service staffed by experienced and skilled nurse practitioners.

Risk Factor Management Program
Director: Raymon Riley, MD
Staff: Janet Long, NP
The Risk Factor Reduction Program takes a comprehensive approach to evaluation and treatment of established and "emerging" atherosclerosis risk factors. An extensive initial evaluation is performed on each patient referred to the Program with particular attention paid to lifestyle issues such as smoking, diet and exercise; coexisting medical problems and medications; and presence or potential for development of vascular disease. A specific plan is formulated for risk reduction, incorporating relevant laboratory findings. Patients seen in follow-up are monitored closely to optimize adherence to treatment plans, in conjunction with referring physicians. The Program emphasizes defining the type of lipid disorder and aggressively achieving therapeutic lifestyle changes and implementing appropriate pharmacologic therapy. Emerging lipid and non-lipid risk factors are considered in the evaluation. Evidence of subclinical atherosclerosis is persued.

Cardiac Research Laboratory
Director: Lynne L. Johnson, MD
The research laboratory is a fully equipped animal research laboratory that has over 20 years of experience in measuring regional coronary blood flow in a swine model. The laboratory is equipped with a gamma scintillation camera, HP5500 echocardiography machine, and cineangiographic fluoroscopy unit. The staff is fully trained to perform coronary angiography, place coronary stenoses using catheter techniques and place intracoronary stents. A major focus of research has been the evaluation of uptake and distribution of new radiopharmaceutical agents which evaluate myocardial blood flow, ischemia, metabolism, and more recently atherosclerotic plaque activity. Tracers evaluated include a hypoxia avid agent, infarct avid agent, and novel tracers targeting proliferating smooth muscle cells and apoptosis. A swine model of multivessel disease with hibernating myocardium has been developed and is used to assess methods to image angiogenesis with VEGF. The laboratory presently receives funding from the NIH, industry, and internal sources.

Nuclear Cardiology
Directors: James A. Arrighi, MD, and Peter Tilkemeier, MD
The Nuclear Cardiology laboratory at RIH is part of the Nuclear Medicine Department. Two cameras are dedicated to performing cardiac imaging and include two digital dual head right angle mounted tomographic camera (Vertex, ADAC) with attenuation correction. The volume of nuclear cardiology studies performed at RIH is in the range of 60-80 studies weekly. Both thallium and Tc-99m sestamibi are used as well as a variety of imaging protocols. State-of-the-art computers and software are available for scan processing and viewing.

The Nuclear Cardiology Laboratory at TMH is also part of Nuclear Medicine. Two identical cameras to those at RIH are housed here and the two departments are fully networked. Similar volume of patients are performed by an all RN staff.

A nuclear cardiology database was begun at RIH in 1994 and now has 16,000 patients. Follow-up is routinely performed and with help of a research nurse approaches 90%. This database has afforded material for outcomes research projects performed by fellows leading to publications.

Echocardiography
Director: Athena Poppas, MD, RIH
The Echocardiography Laboratory at RIH performs over 5,800 transthoracic, 400 transesophageal and 500 stress studies each year. The laboratory includes four full-time echo rooms as well as a dedicated transesophageal echo suite, and a stress echo laboratory. A separate reading room for fellows and attendings allows real-time viewing of studies in progress, and reading of completed studies. The lab is equipped with six state-of-the art echo-Doppler machines, one of which is dedicated to research, transesophageal probes (including biplane and multiplane instruments), and a digital stress echo acquisition and reading system.

Director: Gary Katzman, MD, TMH
The echocardiography laboratory at The Miriam Hospital performs 4,000 transthoracic, 250 transesophageal, and 250 stress studies each year. The laboratory includes 3 full-time echo rooms as well as a dedicated transesophageal echo suite, and a stress echo laboratory. Echocardiograms are also done at bedside in emergency and critical care areas. A separate reading room for fellows and attendings allows real-time viewing of studies in progress, reading of completed studies and viewing of digital cardiographic images. The lab is equipped with three state-of-the-art echo-Doppler machines, transesophageal probes (multi-plane instrument), and a digital stress echo acquisition and reading system.

Heart Failure Program
Director: Daniel Levine, MD
The heart failure program has a dedicated outpatient office facility and cardiopulmonary exercise testing facility. A new 1500 square foot Heart Failure clinic will open November 1, 2002, in the Ambulatory Patient Center.

The VA Hospital
Director: Satish Sharma, MD
The Providence VAH is the only VA facility in RI. The catchment area includes RI, southeastern MA and northern CT. There are 66 operating beds. The unique VA population affords patients for clinical research projects under the direction of Dr. Sharma. The Coronary Risk Factor Reduction Clinic is a unique multi-disciplinary prevention clinic that manages patients with metabolic syndrome.

Cardiac Rehabilitation
Director: Peter Tilkemeier, MD
The cardiac rehabilitation program is a joint clinical program of both Miriam and Rhode Island Hospital's. It is a free standing 12,000 square foot fully equipped facility including a wide array of aerobic and resistance exercise equipment. The facility is staffed by exercise physiologists and nurses with support provided by collaborative practice with nutrition services and behavioral medicine. There are multiple ongoing research projects based primarily in nationally funded behavioral medicine interventions. Fellows participate in the program allowing them to better understand exercise physiology as well as the multi-disciplinary approach to the complex cardiology patient.

Vascular Medicine/Peripheral Arterial Disease
Director: Robert Patterson, MD
This experience is designed to allow the fellow an opportunity to participate in multiple approaches to the patient with vascular disease. This ranges from a peripheral vascular exercise program to surgical intervention and includes peripheral vascular intervention. The fellow also gains experience in peripheral vascular ultrasound including venous, arterial and carotid imaging.

Cardiac Surgery
Director: Richard Hopkins, MD
Cardiothoracic surgery at Miriam and Rhode Island hospitals uses the newest procedures that offer the most patient benefit while maintaining the highest care standards From 20 to 30 percent of all procedures are performed with minimally invasive techniques, including off-bypass coronary artery bypass (OPCAB), less invasive sternal approach (LISA) and minimal access surgery (MACS). These keyhole surgery techniques have been effective in repairing heart valves and congenital heart defects.

The cardiothoracic surgery team includes 10 board-certified surgeons, specifically trained cardiac care nurses, physician assistants, perfusionists and anesthesiologists.

Cardiothoracic surgeons provide an innovative array of treatment options for coronary artery disease, including arterial revascularization, coronary artery bypass grafting (CABG), combination therapy with catheter-based techniques, internal mammary arterial (unilateral and bilateral),off-bypass CABG (beating heart surgery), radial artery grafts for CABG, sequential grafting and several minimally invasive techniques. Recognizing that no two patients with valvular disease are alike, a wide range of valve choices are offered including, valve reconstruction, Ross procedure, semi-stentless valves, stentless valves, complex left ventricular outflow tract reconstruction, multiple valve repair/replacements, reconstruction for acquired and congenital heart disorders, valve sparing surgery.

For patients with congestive heart failure, left ventricular assist devices, left ventricular remodeling surgery, mitral valve repairs, and off-bypass limited procedures as well as several minimally invasive procedures are performed. Ongoing research currently includes studies on bioengineered heart valves for both pediatric and adult use, and gene therapy for congestive heart failure.