Interventional cardiology
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
- Also called percutaneous coronary intervention (PCI), angioplasty 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[3] Pulmonary valve replacement at the right ventricle outflow tract is also performed with the MEDTRONIC Melody valve.
- Coronary thrombectomy
- Coronary thrombectomy involves the removal of a thrombus (blood clot) from the coronary arteries.[4]
Surgery of the heart is termed cardiothoracic surgery. Some interventional cardiology procedures are only performed when there is cardiothoracic surgery expertise in the hospital, in case of complications.
