NorthBay Health cardiologists (left to right) Cyrus Mancherje, M.D., Jeffrey Breneisen, M.D., and Milind Dhond, M.D., were instrumental in developing NorthBay’s catheterization labs.

Cath Lab Evolves: Implanting Stents and Ports, Eliminating Clots and More

Cardiac catheterization has come a long way since the first angioplasty was performed in the late 1970s in Europe.

Likewise, procedures and equipment at NorthBay Health’s catheterization labs have advanced since the first lab was opened at NorthBay Health Medical Center in 1992.

“I came to NorthBay in 1987 and within two to three years it was obvious there was a need for a cath lab here because we were sending a large volume of patients to larger Bay Area facilities,” explained cardiologist Cyrus Mancherje, M.D. Dr. Mancherje was instrumental in getting hospital leadership to secure funding and construct that first catheterization lab.

Through the years, equipment evolved and advanced — as did the types of procedures doctors can now perform.

“When I first came to NorthBay in 2005 we were doing coronary angiograms but if the patient needed angioplasty, we still sent them elsewhere,” said cardiologist Milind Dhond, M.D., Medical Director of NorthBay Health Heart & Vascular.

“It’s very unusual for a hospital system of our size to have the level of cardiovascular services that we offer…Having acute angioplasty available here 24/7/365 is definitely saving lives.”
Milind Dhond, M.D., cardiologist

A coronary angiogram is a procedure that uses X-ray imaging to see the heart’s blood vessels. The test is generally done to see if there’s a restriction in blood flow going to the heart.

Angioplasty is a procedure used to open blocked coronary arteries. For angioplasty, a long, thin catheter is put into a blood vessel and guided to the blocked coronary artery. The catheter has a tiny balloon at its tip. Once the catheter is in place, the balloon is inflated at the narrowed area of the heart artery. This presses the plaque or blood clot against the sides of the artery, making more room for blood flow. Coronary stents are now used in nearly all angioplasty procedures. A stent is a tiny, expandable metal mesh coil. It is placed into the newly opened area of the artery to help keep the artery from narrowing or closing again.

NorthBay Health Medical Center’s Cardiac Catheterization Lab underwent a renovation in 2007 to transform it from a diagnostic lab to one that can perform peripheral vascular interventional procedures.

In the fall of 2008, the NorthBay doctors began performing atherec­tomies, scraping plaque from the walls of arteries in patients who have peripheral artery disease (PAD). In March 2009, the first laser atherectomy ever performed in Solano County took place in the cath lab.

A second cath lab was added in 2013, to keep up with the volume of cases.

Procedures Today Include:

Lead extractions (removing implant leads from pacemakers/implantable defibrillators that have been in the body for a long time).

Cardiac implants such as pacemakers and implantable defibrillators.

Insertions of ports, tunneled lines, dialysis catheters, feeding and nephrostomy tubes.

CardioMems implants, which involves a small device inserted into the pulmonary artery of heart failure patients and feeds data directly to their doctor allowing them to monitor the heart’s performance.

Shockwave intravascular lithotripsy, a procedure to blast severely calcified plaque in coronary and peripheral arteries.

Clot removals.

Transesophageal Echocardiograms (TEE), which involves sending a special scope down the throat to get a better picture of the patient’s heart structures; peripheral vascular and vascular procedures.

Cardiac Contractility Modulation (CCM), which involves inserting a device that uses electrical pulses to improve the contraction of the heart; and electrophysiology procedures that identify and potentially eliminate abnormal heart rhythms.

In addition, a new specialty has emerged in the world of cardiology: Transcatheter Aortic Valve Replacement (TAVR), a minimally-invasive procedure that allows the doctor to insert a catheter into the artery in the patient’s groin and then thread it to the heart, inserting a new valve without having to do the traditional open heart surgical procedure.

Dr. Dhond recalls NorthBay’s effort to find interventional cardiologists to help grow NorthBay’s structural heart program. “We brought on Drs. Saba Lahsaei and Mark Villalon (in 2019) and they did all the leg work to get the TAVR program up and running,” he said. The two brought plenty of experience in performing TAVRs. A new hybrid operating room in NorthBay Health Medical Center’s new North Wing allowed for the more complex surgery along with more complex vascular procedures.

The effort to continue to build the NorthBay catheterization program continues, and from Dr. Dhond’s perspective that’s good news for the entire community.

“It’s very unusual for a hospital system of our size to have the level of cardiovascular services that we offer,” he said. “When it comes to heart attacks, time is muscle and if a patient has to travel even 10 – 20 minutes farther away for medical help, they may not make it. Having acute angioplasty available here 24/7/365 is definitely saving lives.”

Meet Cardiologist Jeffrey Breneisen, M.D.

NorthBay Health cardiologist Jeffrey Breneisen, M.D., is another member of the NorthBay Health Heart & Vascular team who got his start with the military. In fact, he served an internship and his residency at David Grant Medical Center on Travis Air Force Base.

He is experienced in treating coronary artery disease and congestive heart failure.

“I have an interest in minimally invasive procedures performed in the cardiac catheterization lab, including diagnostic angiography, pacemaker and defibrillator implants and the whole spectrum of electrocardiology care,” he said.

Dr. Breneisen earned his bachelor’s degree in pre-med from Notre Dame University, and was just starting medical school at the University of Illinois when he decided to join the military. He did his officer’s indoctrination at Lackland Air Force Base in Texas.

He was in private practice for 10 years before joining NorthBay Health in 2014.

To learn more about Dr. Breneisen, visit www.northbay.org/Breneisen

Meet Cardiologist Milind Dhond, M.D.

When he’s not treating and caring for heart and vascular patients at NorthBay Health, Milind Dhond, M.D., is teaching future physicians as an associate professor at the University of California, Davis, or leading cardiac research projects.

That may seem like a full schedule, but Dr. Dhond somehow also finds the time to practice and teach Jujitsu (a martial art in which he holds a sixth-degree black belt) or lead meditation classes. He has studied meditation for 40 years, writing two books on the topic. “I’ve taught it everywhere I have been — England, India and here,” he said simply.

The Jujitsu was something he was interested in as far back as high school but he admits he didn’t find the discipline to really focus until his 30s. “I think I just had better focus by then,” he said with a laugh.

His high school years were also when he decided his future would be in medicine. “At 16, I decided to become a doctor, rather than an engineer like my dad. At the time, a family friend told me that medicine would always be changing and never boring. And it’s very true — my work has always been quite interesting.”

The medical director of cardiology at NorthBay, Dr. Dhond earned his medical degree at the United Medical Schools of Guys and St. Thomas, University of London. He completed his medical internship at Hereford Hospitals and his surgical internship at Colchester Hospitals, University of London.

He completed a medical residency at Oldchurch Hospitals, University of London and cardiology fellowships at the Royal Brompton National Heart and Lung Hospitals, UK, and the University of California, Davis.

He is board-certified in cardiovascular medicine by the American Board of Internal Medicine.

To learn more about Dr. Dhond, visit www.northbay.org/Dhond

Meet Cardiologist Cyrus Mancherje, M.D.

NorthBay Health cardiologist Cyrus Mancherje, M.D., estimates he’s performed more than 10,000 cardiac catheterizations in his 30 years of practice —a skill he learned from the best.

“I was fellowship trained and my professor went to Switzerland to train with (Andreas Roland Grüntzig) who invented the angioplasty procedure,” he explained. It’s not his only connection with pioneers in the field of cardiac procedures. As a medical student in South Africa, one of his professors was Christiaan Barnard, who performed the world’s first human-to-human heart transplant. “It’s what got me into cardiology,” he said. “I was fortunate enough to watch him operate and to help take care of his post-transplant patients. He inspired me to pursue a career in cardiology.”

He earned his medical degree at the University of Cape Town Medical School, did his residency at Boston University affiliated programs and was fellowship trained in cardiology at Tufts University Medical School/St. Elizabeth Hospital in Boston. He has practiced cardiology in Fairfield and Vacaville since 1987.

“I like my patients to be well-informed about their health and I make sure they understand their condition and how we will care for it. I will present the options that are available and we will decide on a schedule of care together,” he said.

To learn more about Dr. Mancherje, visit www.northbay.org/Mancherje

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