An interventional cardiologist evaluates and treats certain heart conditions using catheter-based, minimally invasive procedures. Dr. Nilkanth Patil’s clinical practice focuses on complex coronary and structural heart disease. His areas of care include complex coronary intervention, TAVR/TAVI, structural heart procedures, mitral valve interventions, ASD and congenital heart defect closure, and advanced cardiac imaging. Treatment decisions are based on symptoms, medical history, anatomy, imaging findings and overall clinical condition, with the appropriate approach selected for each patient.

Chest pain does not always indicate a blocked coronary artery, so appropriate evaluation is important. Depending on your symptoms, risk factors and previous test results, assessment may include CT coronary angiography, stress imaging, coronary angiography or other investigations. Dr. Patil’s approach focuses on understanding symptoms and test results together rather than relying on a single investigation. Advanced imaging may sometimes help avoid unnecessary invasive procedures while identifying patients who require further evaluation. The goal is to accurately understand the cause of chest discomfort and plan appropriate treatment.

A coronary angiogram may be considered when symptoms, risk factors and other clinical findings indicate that the coronary arteries require further assessment. It is not automatically necessary for every patient with chest discomfort. The appropriate investigation depends on the clinical question that needs to be answered and the overall clinical picture. Depending on the situation, non-invasive investigations such as CT coronary angiography or stress imaging may provide useful information before deciding whether invasive angiography or intervention is appropriate. Careful evaluation helps ensure that the investigation selected is relevant to the patient's condition.

Complex coronary intervention involves the catheter-based treatment of technically difficult coronary artery disease. This includes complex coronary angioplasty and PCI, left main coronary artery disease, bifurcation lesions, heavily calcified coronary arteries, complex thrombotic lesions and difficult coronary anatomy. Some procedures may require advanced catheter and guidewire techniques or plaque-modification strategies such as rotational atherectomy. Careful planning and selection of the appropriate technique are particularly important in these cases. The treatment strategy is determined according to the patient's coronary anatomy, clinical condition and procedural requirements.

Rotational atherectomy is a plaque-modification technique used in selected patients with heavily calcified coronary arteries. Significant calcification can make coronary intervention technically challenging and may require specialized techniques as part of the treatment strategy. Rotational atherectomy can be considered when plaque modification is required to facilitate treatment of a calcified coronary lesion. It forms part of the advanced techniques used in complex coronary intervention. The suitability of this approach depends on the patient's coronary anatomy, the characteristics of the lesion and the overall strategy planned for coronary intervention.

TAVR, also known as TAVI, is a transcatheter procedure used for appropriately selected patients with severe aortic valve disease. Treatment involves detailed assessment of the patient's anatomy, valve characteristics, access vessels and overall clinical condition. Dr. Patil has been involved in the planning and management of more than 650 TAVR procedures over approximately nine years as part of a structural heart team. This includes pre-procedure assessment and imaging, procedural planning, management of challenging anatomy and management of complications. Each TAVR procedure requires individualized planning based on the patient's specific anatomy and clinical circumstances.

Detailed imaging is an important part of TAVR planning because the patient's anatomy, valve characteristics and access vessels need to be carefully assessed before the procedure. Imaging helps determine the appropriate procedural strategy and identify anatomical challenges that may affect valve delivery or positioning. In challenging cases, understanding the anatomy in detail is particularly important for planning the procedure and anticipating potential complications. TAVR planning therefore begins well before entering the catheterization laboratory. Careful imaging and anatomical assessment help the structural heart team select the safest and most appropriate approach for the individual patient.

Structural heart disease includes conditions affecting the heart valves and structures within the heart. Depending on the condition and patient suitability, some structural heart problems can be treated using minimally invasive, catheter-based procedures, potentially avoiding or reducing the need for open-heart surgery. Treatment options include TAVR/TAVI, transcatheter mitral valve replacement (TMVR), transcatheter edge-to-edge repair (TEER/MitraClip) and catheter-based treatment of congenital heart defects. The choice between catheter-based intervention, surgery or medical management depends on the patient's anatomy, condition and overall clinical assessment.

TEER/MitraClip and TMVR are catheter-based approaches used for selected patients with mitral valve disease. The appropriate treatment depends on the anatomy of the mitral valve, the mechanism of leakage or obstruction, heart function and the patient's overall risk. Detailed echocardiographic and CT assessment may be required to understand the valve anatomy and determine whether a catheter-based treatment is likely to be safe and effective. Treatment planning therefore involves careful evaluation before the procedure. The appropriate approach is individualized according to the patient's valve anatomy, clinical condition and overall treatment requirements.

An atrial septal defect, or ASD, is an opening between the upper chambers of the heart. In appropriately selected patients, an ASD can often be closed through a catheter-based device-closure procedure rather than open-heart surgery. Dr. Patil performs ASD device-closure procedures, including treatment of large and technically challenging defects. Careful assessment of the defect and surrounding structures is essential before selecting the appropriate device and treatment strategy. Procedural imaging also plays an important role in planning the intervention and achieving a safe and durable result.

Advanced cardiac imaging includes echocardiography, transesophageal echocardiography (TEE), cardiac CT, cardiac MRI and PET imaging. These techniques provide detailed information about cardiac anatomy, disease severity and the underlying mechanism of disease. Dr. Patil underwent advanced training in cardiac imaging in Canada, with experience across these imaging modalities. Advanced imaging can help determine whether a procedure is required and guide decisions between medical treatment, catheter-based intervention and surgery. In structural heart disease, it can also assist with procedural planning, including access route, device or valve selection, positioning strategy and assessment of potential risks.

A TEE or another advanced cardiac imaging investigation may be recommended when detailed information about the heart's anatomy, disease severity or mechanism is required. TEE provides detailed echocardiographic assessment, while cardiac CT, MRI and PET can provide additional information depending on the clinical question. In structural heart disease, advanced imaging can help determine whether intervention is appropriate and assist with procedural planning. For mitral valve interventions, echocardiographic and CT assessment may be particularly important for understanding valve anatomy and determining whether a catheter-based treatment is likely to be safe and effective.

No. The need for an intervention depends on the individual patient's symptoms, medical history, anatomy, imaging findings and overall clinical condition. The key consideration is whether a procedure is the right treatment for that particular patient, rather than simply whether it can technically be performed. Depending on the clinical situation, treatment may involve medical management, catheter-based intervention or surgery. A careful evaluation should precede treatment decisions, with the aim of selecting the least invasive approach that can provide a safe and meaningful benefit for the individual patient.