Interventional cardiology

Coronary angiography and angioplasty in acute myocardial infarction (left: Right Coronary Artery [RCA] closed, right: successfully dilated)

Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist Charles Dotter.[1]

A large number of procedures can be performed on the heart by catheterization. This most commonly involves the insertion of a sheath into the femoral artery (but, in practice, any large peripheral artery or vein) and cannulating the heart under X-ray visualization (most commonly fluoroscopy). The radial artery may also be used for cannulation; this approach offers several advantages, including the accessibility of the artery in most patients, the easy control of bleeding even in anticoagulated patients, the enhancement of comfort because patients are capable of sitting up and walking immediately following the procedure, and the near absence of clinically significant sequelae in patients with a normal Allen test.[2]

The main advantages of using the interventional cardiology or radiology approach are the avoidance of the scars and pain, and long post-operative recovery. Additionally, interventional cardiology procedure of primary angioplasty is now the gold standard of care for an acute myocardial infarction. It involves the extraction of clots from occluded coronary arteries and deployment of stents and balloons through a small hole made in a major artery, which has given it the name "pin-hole surgery" (as opposed to "key-hole surgery").

Procedures

Angioplasty
is an intervention to dilate either arteries or veins.
Coronary angioplasty/Percutaneous coronary intervention
is an intervention for the treatment of coronary artery disease.
Valvuloplasty
It is the dilation of narrowed cardiac valves (usually mitral, aortic, or pulmonary).
Congenital heart defect correction
Percutaneous approaches can be employed to correct atrial septal and ventricular septal defects, closure of a patent ductus arteriosus, and angioplasty of the great vessels.
Percutaneous valve replacement
An alternative to open heart surgery, percutaneous valve replacement is the replacement of a heart valve using percutaneous methods. This is performed on the aortic valve (percutaneous aortic valve replacement/TAVI procedure), pulmonary valve and recently the mitral valve
Percutaneous valve repair
An alternative to open heart surgery, percutaneous valve repair is performed on the mitral valve using the MONARC system or MitraClip system[3]
Coronary thrombectomy
Coronary thrombectomy involves the removal of a thrombus (blood clot) from the coronary arteries.[4]

Open heart surgery of the heart is performed by a cardiothoracic surgeon. Some interventional cardiology procedures are only performed when there is cardiothoracic surgery expertise in the hospital, in case of complications.

Education

In the US and Canada, interventional cardiology requires a minimum of 7 years of post-graduate medical education and up to 9 years of post-graduate medical education for those wanting to perform advanced structural heart procedures.

See also

References

  1. ↑ Lakhan SE, Kaplan A, Laird C, Leiter Y (2009). "The interventionalism of medicine: interventional radiology, cardiology, and neuroradiology". International Archives of Medicine. 2 (27): 27. PMC 2745361 Freely accessible. PMID 19740425. doi:10.1186/1755-7682-2-27.
  2. ↑ Hurst, J. Willis; Fuster, Valentin; O'Rourke, Robert A. (2004). Hurst's The Heart. New York: McGraw-Hill, Medical Publishing Division. p. 484. ISBN 0-07-142264-1.
  3. ↑ Harnek, J (Jan 2011). "Transcatheter implantation of the MONARC coronary sinus device for mitral regurgitation: 1-year results from the EVOLUTION phase I study (Clinical Evaluation of the Edwards Lifesciences Percutaneous Mitral Annuloplasty System for the Treatment of Mitral Regurgitation)". JACC Cardiovascular Interventions. 4: 115–22. PMID 21251638. doi:10.1016/j.jcin.2010.08.027.
  4. ↑ "Evanston Northwestern Hospital Interventional Cardiology". Retrieved 2008-03-06.
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