Interventional cardiology

Last updated
Coronary angiography and angioplasty in acute myocardial infarction (left: Right Coronary Artery [RCA] closed, right: successfully dilated) HWI PTCA.jpg
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]

Contents

Many procedures can be performed on the heart by catheterization. [2] 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. [3] Downsides to this approach include spasm of the artery and pain, inability to use larger catheters needed in some procedures, and more radiation exposure. But, in recent times radial approach is getting popularity due to its patient comfort after procedure.

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.
Percutaneous coronary intervention (PCI/Coronary angioplasty)
3D Medical Animation still shot of Percutaneous coronary intervention 3D Medical Animation Percutaneous coronary intervention.jpg
3D Medical Animation still shot of Percutaneous coronary intervention
the use of angioplasty for the treatment of obstruction of coronary arteries as a result of coronary artery disease. A deflated balloon catheter is advanced into the obstructed artery and inflated to relieve the narrowing; certain devices such as coronary stents can be deployed to keep the blood vessel open. Various other procedures can also be performed at the same time. After a heart attack, it can be restricted to the culprit vessel (the one whose obstruction or thrombosis is suspected of causing the event) or complete revascularization; complete revascularization is more efficacious in terms of major adverse cardiac events and all-cause mortality. [4]
PCI is also used in people after other forms of myocardial infarction or unstable angina where there is a high risk of further events. The use of PCI in addition to anti-angina medication in stable angina  may reduce the number of patients with angina attacks for up to 3 years following the therapy, [5] but it does not reduce the risk of death, future myocardial infarction, or need for other interventions. [6]
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 [7]
Coronary thrombectomy
Coronary thrombectomy involves the removal of a thrombus (blood clot) from the coronary arteries. [8]

Open heart surgery of the heart is performed by a cardiothoracic surgeon. Some interventional cardiology procedures are performed in conjunction with a cardiothoracic surgeon.

Education

In the US and Canada, interventional cardiology requires a minimum of seven 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

Related Research Articles

<span class="mw-page-title-main">Angioplasty</span> Procedure to widen narrow arteries or veins

Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis.

<span class="mw-page-title-main">Coronary artery bypass surgery</span> Surgical procedure to restore normal blood flow to an obstructed coronary artery

Coronary artery bypass surgery, also known as coronary artery bypass graft, is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pain caused by CAD, slow the progression of CAD, and increase life expectancy. It aims to bypass narrowings in heart arteries by using arteries or veins harvested from other parts of the body, thus restoring adequate blood supply to the previously ischemic heart.

<span class="mw-page-title-main">Cardiac catheterization</span> Insertion of a catheter into a chamber or vessel of the heart

Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes.

<span class="mw-page-title-main">Acute coronary syndrome</span> Medical condition

Acute coronary syndrome (ACS) is a syndrome due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. The most common symptom is centrally located pressure-like chest pain, often radiating to the left shoulder or angle of the jaw, and associated with nausea and sweating. Many people with acute coronary syndromes present with symptoms other than chest pain, particularly women, older people, and people with diabetes mellitus.

<span class="mw-page-title-main">Catheterization laboratory</span> Hospital examination room

A catheterization laboratory, commonly referred to as a cath lab, is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found.

<span class="mw-page-title-main">Percutaneous coronary intervention</span> Medical techniques used to manage coronary occlusion

Percutaneous coronary intervention (PCI) is a minimally invasive non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The procedure is used to place and deploy coronary stents, a permanent wire-meshed tube, to open narrowed coronary arteries. PCI is considered 'non-surgical' as it uses a small hole in a peripheral artery (leg/arm) to gain access to the arterial system, an equivalent surgical procedure would involve the opening of the chest wall to gain access to the heart area. The term 'coronary angioplasty with stent' is synonymous with PCI. The procedure visualises the blood vessels via fluoroscopic imaging and contrast dyes. PCI is performed by an interventional cardiologists in a catheterization laboratory setting.

The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavian artery. The balloon inflates and deflates via counter pulsation, meaning it actively deflates in systole and inflates in diastole. Systolic deflation decreases afterload through a vacuum effect and indirectly increases forward flow from the heart. Diastolic inflation increases blood flow to the coronary arteries via retrograde flow. These actions combine to decrease myocardial oxygen demand and increase myocardial oxygen supply.

<span class="mw-page-title-main">Drug-eluting stent</span> Medical stent that releases drug

A drug-eluting stent (DES) is a thin tube that is used to treat narrowed arteries in medical procedures. It releases drugs to prevent the growth of scar tissue and reduce the risk of stent restenosis, which is the narrowing of the stented area of an artery after treatment. A drug-eluting stent is different from other types of stents because it has a coating that delivers medication directly to the arterial wall. A DES is often made of metal alloys and can be inserted into blocked or narrowed arteries through a catheter placed in a peripheral artery, such as in the arm or leg. DES is fully integrated with a catheter delivery system and is viewed as one integrated medical device.

<span class="mw-page-title-main">Bivalirudin</span> Anticoagulant drug

Bivalirudin (Bivalitroban), sold under the brand names Angiomax and Angiox and manufactured by The Medicines Company, is a specific and reversible direct thrombin inhibitor (DTI).

The history of invasive and interventional cardiology is complex, with multiple groups working independently on similar technologies. Invasive and interventional cardiology is currently closely associated with cardiologists, though the development and most of its early research and procedures were performed by diagnostic and interventional radiologists.

Fractional flow reserve (FFR) is a diagnostic technique used in coronary catheterization. FFR measures pressure differences across a coronary artery stenosis to determine the likelihood that the stenosis impedes oxygen delivery to the heart muscle.

Lourdes Heart Institute and Neuro Centre (LHINC) is a new block set up in Lourdes Hospital, Cochin, Kerala, India, to cater to tertiary level care for the entire spectrum of cardiovascular and neurological disease. It was inaugurated on 16 March 2007, by Mr. A. K. Antony, the Defence Minister of India. This institute was started to meet a long-felt need to provide cardiac and neurological interventional facilities, and especially to provide interventional neurological facilities for the treatment of strokes, including selective thrombolysis and primary angioplasty for stroke which was hitherto unavailable in this part of India.

<span class="mw-page-title-main">Coronary stent</span> Medical stent implanted into coronary arteries

A coronary stent is a tube-shaped device placed in the coronary arteries that supply blood to the heart, to keep the arteries open in patients suffering from coronary heart disease. The vast majority of stents used in modern interventional cardiology are drug-eluting stents (DES). They are used in a medical procedure called percutaneous coronary intervention (PCI). Coronary stents are divided into two broad types: drug-eluting and bare metal stents. As of 2023, drug-eluting stents were used in more than 90% of all PCI procedures. Stents reduce angina and have been shown to improve survival and decrease adverse events after a patient has suffered a heart attack—medically termed an acute myocardial infarction.

The following outline is provided as an overview of and topical guide to cardiology, the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.

<span class="mw-page-title-main">Reperfusion therapy</span> Restoring blood flow post-heart attack

Reperfusion therapy is a medical treatment to restore blood flow, either through or around, blocked arteries, typically after a heart attack. Reperfusion therapy includes drugs and surgery. The drugs are thrombolytics and fibrinolytics used in a process called thrombolysis. Surgeries performed may be minimally-invasive endovascular procedures such as a percutaneous coronary intervention (PCI), which involves coronary angioplasty. The angioplasty uses the insertion of a balloon and/or stents to open up the artery. Other surgeries performed are the more invasive bypass surgeries that graft arteries around blockages.

Transradial catheterization is an endovascular procedure or catheterization procedure performed to diagnose and treat arterial disease. Endovascular procedure can be performed achieving access in to body’s arterial system from either femoral artery, brachial artery or radial artery in the wrist. The transfemoral approach to perform cardiac catheterization has typically been more prevalent in invasive cardiology. But radial access has gained popularity due to technical advances with catheters and lower complication rates than transfemoral access. The European Society of Cardiology and the American Heart Association both support a radial-first approach in acute coronary syndrome.

<span class="mw-page-title-main">Hybrid cardiac surgery</span>

A hybrid cardiac surgical procedure in a narrow sense is defined as a procedure that combines a conventional, more invasive surgical part with an interventional part, using some sort of catheter-based procedure guided by fluoroscopy imaging in a hybrid operating room (OR) without interruption. The hybrid technique has a reduced risk of surgical complications and has shown decreased recovery time. It can be used to treat numerous heart diseases and conditions and with the increasing complexity of each case, the hybrid surgical technique is becoming more common.

<span class="mw-page-title-main">Protected percutaneous coronary intervention</span>

Protected percutaneous coronary intervention, abbreviated as Protected PCI, is a heart procedure that involves a ventricular assist device that is used to treat patients with cardiovascular disease, including advanced heart failure.

<span class="mw-page-title-main">Samin Sharma</span> American interventional cardiologist

Samin K. Sharma is an American philanthropist of Indian descent and an interventional cardiologist who co-founded the Eternal Heart Care Centre and Research Institute in Jaipur (EHCC). Sharma has served on New York State’s Cardiac Advisory Board since 2004. As of 2021, he is Senior Vice-President, Operations & Quality at The Mount Sinai Hospital in New York and runs the Dr. Samin K. Sharma Family Foundation Cardiac Catheterization Laboratory. As of 2018, he is Chairman Board of Trustees, Association of Indians in America (AIA). As of 2022, he has been an investigator on 86 grants and multi-center trials and authored 486 peer-reviewed articles that have been cited 21,734 times.

Alfredo E. Rodríguez is an Argentine interventional cardiologist, clinical researcher, and author. He is the Chief of Interventional Cardiology Service at Otamendi Hospital and Director and Founder of the Cardiovascular Research Center (CECI) a non -profit Research Organization in Buenos Aires Argentina.

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. doi: 10.1186/1755-7682-2-27 . PMC   2745361 . PMID   19740425.
  2. ↑ "Interventional Cardiology Specialty Description". American Medical Association.
  3. ↑ 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.
  4. ↑ Nguyen, An Vu; Thanh, Le Van; Kamel, Mohamed Gomaa; Abdelrahman, Sara Attia Mahmoud; El-Mekawy, Mohamed; Mokhtar, Mohamed Ashraf; Ali, Aya Ashraf; Hoang, Nam Nguyen Nho; Vuong, Nguyen Lam; Abd-Elhay, Fatma Abd-Elshahed; Omer, Omer Abdelbagi; Mohamed, Ahmed Abdou; Hirayama, Kenji; Huy, Nguyen Tien (2017). "Optimal percutaneous coronary intervention in patients with ST-elevation myocardial infarction and multivessel disease: An updated, large-scale systematic review and meta-analysis". International Journal of Cardiology. 244: 67–76. doi:10.1016/j.ijcard.2017.06.027. PMID   28647440.
  5. ↑ Gorenoi, V; Hagen, A (May 2014). "[Percutaneous coronary intervention in addition to optimal medical therapy for stabile coronary artery disease - a systematic review and meta-analysis]". Deutsche Medizinische Wochenschrift. 139 (20): 1039–45. doi:10.1055/s-0034-1369879. PMID   24801298. S2CID   256699436.
  6. ↑ Pursnani, S.; Korley, F.; Gopaul, R.; Kanade, P.; Chandra, N.; Shaw, R. E.; Bangalore, S. (7 August 2012). "Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials". Circulation: Cardiovascular Interventions. 5 (4): 476–490. doi: 10.1161/CIRCINTERVENTIONS.112.970954 . PMID   22872053.
  7. ↑ 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 (1): 115–22. doi:10.1016/j.jcin.2010.08.027. PMID   21251638.
  8. ↑ "Evanston Northwestern Hospital Interventional Cardiology" . Retrieved 2008-03-06.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.