Interventional cardiology is a branch of

cardiology Cardiology () is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular h ...

that deals specifically with the

catheter In medicine, a catheter (/ˈkæθətər/) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgi ...

based treatment of structural

heart disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...

s. Andreas Gruentzig is considered the father of interventional cardiology after the development of

angioplasty Angioplasty, is 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 atheroscle ...

by interventional radiologist

Charles Dotter Charles Theodore Dotter (14 June 1920 – 15 February 1985) was a pioneering US vascular radiologist who is credited with developing interventional radiology. Dotter, with his trainee Dr Melvin P. Judkins, described angioplasty in 1964. Dot ...

. Many procedures can be performed on the

heart The heart is a muscular Organ (biology), organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as ca ...

catheterization In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Cat ...

. This most commonly involves the insertion of a sheath into the

femoral artery The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the f ...

(but, in practice, any large peripheral artery or vein) and cannulating the heart under

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

visualization (most commonly

fluoroscopy Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and function ...

). The

radial artery In human anatomy, the radial artery is the main artery of the lateral aspect of the forearm. Structure The radial artery arises from the bifurcation of the brachial artery in the antecubital fossa. It runs distally on the anterior part of the f ...

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

sequela A sequela (, ; usually used in the plural, sequelae ) is a pathological condition resulting from a disease, injury, therapy, or other trauma. Derived from the Latin word, meaning “sequel”, it is used in the medical field to mean a complication ...

e in patients with a normal

Allen test In medicine, Allen's test or the Allen test is a medical sign used in physical examination of arterial blood flow to the hands. It was named for Edgar Van Nuys Allen, who described the original version of the test in 1942. An altered test, first ...

. Downsides to this approach include spasm of the artery and pain, inability to use larger catheters needed in some procedures, and more radiation exposure. The main advantages of using the interventional cardiology or

radiology Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...

approach are the avoidance of the scars and pain, and long post-operative recovery. Additionally, interventional cardiology procedure of primary

is now the gold standard of care for an acute

myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which ma ...

. 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 Angioplasty, is 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 atheroscle ...

: is an intervention to dilate either arteries or veins. ;

Percutaneous coronary intervention Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the ...

(PCI/Coronary angioplasty): 3D Medical Animation Percutaneous coronary intervention

the use of angioplasty for the treatment of obstruction of

coronary arteries The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle. The heart requires a continuous supply of oxygen to function and survive, much like any other tissue or organ ...

as a result of

coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pl ...

. A deflated

balloon catheter A balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the body. The deflated balloon catheter is positioned, then infl ...

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 A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which ma ...

, 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. :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, but it does not reduce the risk of death, future myocardial infarction, or need for other interventions. ;

Valvuloplasty Heart valve repair is a cardiac surgery procedure, carried out to repair one or more faulty heart valves. In some valvular heart diseases repair where possible is preferable to valve replacement. A mechanical heart valve is a replacement valve ...

: It is the dilation of narrowed cardiac valves (usually

mitral The mitral valve (), also known as the bicuspid valve or left atrioventricular valve, is one of the four heart valves. It has two cusps or flaps and lies between the left atrium and the left ventricle of the heart. The heart valves are all o ...

aortic The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes ox ...

, or

pulmonary The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...

). ; Congenital heart defect correction: Percutaneous approaches can be employed to correct atrial septal and ventricular septal defects, closure of a

patent ductus arteriosus ''Patent ductus arteriosus'' (PDA) is a medical condition in which the ''ductus arteriosus'' fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta, which has ...

, and angioplasty of the great vessels. ; Percutaneous valve replacement: An alternative to

open heart surgery Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to c ...

, percutaneous valve replacement is the replacement of a heart valve using percutaneous methods. This is performed on the

aortic valve The aortic valve is a valve in the heart of humans and most other animals, located between the left ventricle and the aorta. It is one of the four valves of the heart and one of the two semilunar valves, the other being the pulmonary valve. Th ...

( percutaneous aortic valve replacement/TAVI procedure), pulmonary valve and recently the

mitral valve The mitral valve (), also known as the bicuspid valve or left atrioventricular valve, is one of the four heart valves. It has two cusps or flaps and lies between the left atrium and the left ventricle of the heart. The heart valves are all on ...

; Percutaneous valve repair: An alternative to

, percutaneous valve repair is performed on the

using the MONARC system or MitraClip system ; Coronary thrombectomy: Coronary thrombectomy involves the removal of a

thrombus A thrombus (plural thrombi), colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of ...

(blood clot) from the

. Open heart surgery of the heart is performed by a

cardiothoracic surgeon Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart (heart disease), lungs (lung disease), and other pleural or mediastinal stru ...

. 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. *Undergraduate degree (4 years) *Medical degree (4 years) *Internal Medicine residency (3 years) *Cardiology fellowship (3 years) *Interventional Cardiology fellowship (1–2 years) *Structural Heart Intervention fellowship (1 year)

References

External links

Society for Cardiovascular Angiography & Interventions

Angioplasty.Org

European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Interventional Portal: Relevant links for interventional cardiologists

Interventional Cardiology Review
{{DEFAULTSORT:Interventional Cardiology

Procedures

Education

See also

References

External links