If medical treatments fail, which of the following invasive procedures is necessary for treating cardiomyopathy?
A. Cardiac catheterization
B. Coronary artery bypass graft (CABG)
C. Heart transplantation
D. Intra-aortic balloon pump (IABP)
Correct Answer: C. Heart transplantation
The only definitive treatment for cardiomyopathy that can’t be controlled medically is a heart transplant because the damage to the heart muscle is irreversible. Historically, two types of transplant procedures have been described. ‘orthotopic heart transplant’ involves excision of the recipient’s heart and implantation of a donor’s heart in the chest of the recipient, and ‘heterotopic heart transplant’ in which the recipient’s heart is not excised and the donor heart is implanted into the recipient’s chest.
Option A: Although it is used for cardiac hemodynamics and assessment of valvular lesions, its main diagnostic role is the assessment of coronary artery disease. In the contemporary era, left heart catheterization, especially selective coronary angiogram, is considered the gold standard test for coronary artery disease diagnosis.
Option B: Coronary artery bypass grafting (CABG) is a major surgical operation where atheromatous blockages in a patient’s coronary arteries are bypassed with harvested venous or arterial conduits. The bypass restores blood flow to the ischemic myocardium which, in turn, restores function, viability, and relieves anginal symptoms.
Option D: The IABP assists the heart indirectly by decreasing the afterload and augments diastolic aortic pressure with subsequent enhancement in diastolic blood flow resulting in better perfusion of the peripheral organ as well as a possible improvement in the coronary blood flow.
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