Many procedures can be performed on theheart bycatheterization.[2] This most commonly involves the insertion of a sheath into thefemoral artery (but, in practice, any large peripheral artery or vein) andcannulating the heart underX-ray visualization (most commonlyfluoroscopy). Theradial 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 significantsequelae in patients with a normalAllen 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 orradiology approach are the avoidance of the scars and pain, and long post-operative recovery. Additionally, interventional cardiology procedure of primaryangioplasty is now the gold standard of care for an acutemyocardial 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").
3D Medical Animation still shot of Percutaneous coronary interventionthe use of angioplasty for the treatment of obstruction ofcoronary arteries as a result ofcoronary artery disease. A deflatedballoon catheter is advanced into the obstructed artery and inflated to relieve the narrowing; certain devices such ascoronary stents can be deployed to keep the blood vessel open. Various other procedures can also be performed at the same time. After aheart 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 orunstable angina where there is a high risk of further events. The use of PCI in addition toanti-angina medication instable 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]
Open heart surgery of the heart is performed by acardiothoracic surgeon. Some interventional cardiology procedures are performed in conjunction with a cardiothoracic surgeon.
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.
^Hurst, J. Willis; Fuster, Valentin; O'Rourke, Robert A. (2004).Hurst's The Heart. New York: McGraw-Hill, Medical Publishing Division. p. 484.ISBN0-07-142264-1.
^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.PMID28647440.
^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.PMID24801298.S2CID256699436.
^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.PMID21251638.
