Interventional cardiology
Encyclopedia
Interventional cardiology is a branch of cardiology
that deals specifically with the catheter
based treatment of structural heart disease
s. Andreas Gruentzig
is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist
, Dr. Charles Dotter.
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.
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"), thereby leaving no scars.
Procedures performed by specialists in interventional cardiology:
Angioplasty: Also called percutaneous transluminal coronary angioplasty (PTCA), 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 defect
s, closure of a patent ductus arteriosus
, and angioplasty of the great vessels.
Coronary thrombectomy: Coronary thrombectomy involves the removal of a thrombus
(blood clot) from the coronary arteries.
Cardiac ablation: A technique performed by clinical electrophysiologists
, cardiac ablation is used in the treatment of arrhythmias.
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.
Cardiology
Cardiology is a medical specialty dealing with disorders of the heart . The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology...
that deals specifically with the catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
based treatment of structural heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
s. Andreas Gruentzig
Andreas Gruentzig
Andreas Roland Grüntzig was a German cardiologist who first developed successful balloon angioplasty for expanding lumens of narrowed arteries.-Angioplasties:...
is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist
Interventional radiology
Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...
, Dr. Charles Dotter.
A large number of procedures can be performed on the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
by catheterization
Coronary catheterization
A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional purposes....
. This most commonly involves the insertion of a sheath into the femoral artery
Femoral artery
The femoral artery is a general term comprising a few large arteries in the thigh. They begin at the inguinal ligament and end just above the knee at adductor canal or Hunter's canal traversing the extent of the femur bone....
(but, in practice, any large peripheral artery or vein) and cannulating the heart under X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
visualization (most commonly fluoroscopy
Fluoroscopy
Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...
. The radial artery
Radial artery
In human anatomy, the radial artery is the main blood vessel, with oxygenated blood, of the lateral aspect of the forearm.-Course:The radial artery arises from the bifurcation of the brachial artery in the cubital fossa. It runs distally on the anterior part of the forearm...
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.
The main advantages of using the interventional cardiology or radiology
Interventional radiology
Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...
approach are the avoidance of the scars and pain, and long post-operative recovery. Additionally, interventional cardiology procedure of primary angioplasty
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
is now the gold standard of care for an acute myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
. 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"), thereby leaving no scars.
Procedures performed by specialists in interventional cardiology:
Angioplasty: Also called percutaneous transluminal coronary angioplasty (PTCA), angioplasty
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
is an intervention for the treatment of coronary artery disease.
Valvuloplasty: It is the dilation of narrowed cardiac valves (usually mitral
Mitral valve
The mitral valve is a dual-flap valve in the heart that lies between the left atrium and the left ventricle...
, aortic
Aortic valve
The aortic valve is one of the valves of the heart. It is normally tricuspid , although in 1% of the population it is found to be congenitally bicuspid . It lies between the left ventricle and the aorta....
, or pulmonary
Pulmonary valve
The pulmonary valve is the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. Similar to the aortic valve, the pulmonary valve opens in ventricular systole, when the pressure in the right ventricle rises above the pressure in the...
).
Congenital heart defect correction: Percutaneous approaches can be employed to correct atrial septal
Atrial septal defect
Atrial septal defect is a form of congenital heart defect that enables blood flow between the left and right atria via the interatrial septum. The interatrial septum is the tissue that divides the right and left atria...
and ventricular septal defect
Ventricular septal defect
A ventricular septal defect is a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart.The ventricular septum consists of an inferior muscular and superior membranous portion and is extensively innervated with conducting cardiomyocytes.The membranous...
s, closure of a patent ductus arteriosus
Patent ductus arteriosus
Patent ductus arteriosus is a congenital disorder in the heart wherein a neonate's ductus arteriosus fails to close after birth. Early symptoms are uncommon, but in the first year of life include increased work of breathing and poor weight gain...
, and angioplasty of the great vessels.
- Percutaneous valve replacement: An alternative to open heart surgeryOpen Heart SurgeryOpen Heart Surgery was released on August 8, 2000 by rock band Virginwool. The band signed to Breaking/Atlantic Records after initially beginning signed to Universal Records. The album was produced and mixed by Brad Wood....
, percutaneous valve replacement is the replacementValve replacementValve replacement surgery is the replacement of one or more of the heart valves with either an artificial heart valve or a bioprosthesis . It is an alternative to valve repair.There are four procedures:...
of a heart valve using percutaneous methods.
Coronary thrombectomy: Coronary thrombectomy involves the removal of a thrombus
Thrombus
A thrombus , or blood clot, is the final product of the blood coagulation step in hemostasis. It is achieved via the aggregation of platelets that form a platelet plug, and the activation of the humoral coagulation system...
(blood clot) from the coronary arteries.
Cardiac ablation: A technique performed by clinical electrophysiologists
Clinical cardiac electrophysiology
Cardiac Electrophysiology , is a branch of the medical specialty of clinical cardiology and is concerned with the study and treatment of rhythm disorders of the heart. Cardiologists with expertise in this area are usually referred to as electrophysiologists...
, cardiac ablation is used in the treatment of arrhythmias.
Surgery of the heart is termed cardiothoracic surgery
Cardiothoracic Surgery
Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax —generally treatment of conditions of the heart and lungs .-Cardiac / Thoracic:...
. Some interventional cardiology procedures are only performed when there is cardiothoracic surgery expertise in the hospital, in case of complications.
See also
- Interventional radiologyInterventional radiologyInterventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...
- CatheterCatheterIn medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
- CannulaCannulaA cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...
- StentStentIn the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
- RestenosisRestenosisRestenosis literally means the reoccurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow. Restenosis usually pertains to an artery or other large blood vessel that has become narrowed, received treatment to clear the blockage and subsequently become renarrowed...