Coronary angiography and angioplasty in acute myocardial infarction (left: Right Coronary Artery [RCA] closed, right: successfully dilated)
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").
3D Medical Animation still shot of Percutaneous coronary interventionthe 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]
Open heart surgery of the heart is performed by a cardiothoracic 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.
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.
