Cardiac Catheterization and Imaging (From Pediatrics to Geriatrics) IB Vijayalakshmi
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1Cardiac Catheterization and Imaging (From Pediatrics to Geriatrics)2
3Cardiac Catheterization and Imaging (From Pediatrics to Geriatrics)
IB Vijayalakshmi MD DM FICC FIAMS FIAE FCSI FICP FAMS DSc Professor of Pediatric Cardiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bengaluru, Karnataka, India Foreword Charles E Mullinsi
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Cardiac Catheterization and Imaging (From Pediatrics to Geriatrics)
First Edition: 2015
9789351528661
Printed at
5Dedicated to
Dr William J Rashkind
Dr Joseph K Perloff
Dr Andreas Grüntzig
Dr Kurt Amplatz
Dr William J Rashkind
Father of Pediatric Interventional Cardiology, who pioneered catheter interventional techniques in infants and children
Dr Joseph K Perloff
who laid a strong foundation for the clinical recognition of congenital heart diseases in adults
Dr Andreas Grüntzig
who pioneered coronary angioplasty
and
Living legend, Dr Kurt Amplatz
who has paved the way for catheter-based device closures that leave no scars on the chest!
We respectfully salute these great GURUs for laying the solid foundation on which great empire of cardiac catheterization and catheter-based interventions rests.
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7Contributors 13Foreword
This book is a reference encyclopedia of cardiac catheterization. It is authored by many contributors, tapping into their broad spectrum of expertise and years of experience in their particular areas of cardiac catheterization.
The text is unique for multiple reasons. First, it covers the spectrum of patients from the fetus to the geriatric patient. This includes coverage of congenital heart and central vascular lesions in the fetus, neonate, pediatric, and adult patients as well as extensive coverage of the acquired heart and vascular disease in the adult. The sections on coronary artery disease and its management especially are very comprehensive.
In addition, the text encompasses the entirety of cardiac, cardiovascular catheterization from the history of cardiac catheterization, the preparation of the patient, the imaging modalities available in preparation and during the procedure, the capital and expendable equipment required and, of course, the details of the techniques as well as the complications for all of the innumerable diagnostic and therapeutic procedures currently available to the interventional cardiologists.
The entirety of cardiac catheterization procedures starting with the basic techniques of catheter introduction, catheter manipulation, hemodynamics and anatomic assessment are included. From there, the latest therapeutic/interventional procedures including the latest equipment and procedures for cardiovascular support are covered. Finally, complications and their management are covered within each section on specific procedures. The exception is a separate chapter on contrast-induced nephropathy, which of course, potentially is common to every catheterization using contrast.
Finally, different from most texts on interventional cardiac catheterization and a welcome addition is the inclusion of an extensive section on electrophysiological diagnostics and therapeutics in the catheterization laboratory—those procedures which are performed in “the other room” from the general interventional procedures and from which many interventionalists might learn something!
The title of this text, edited by Dr IB Vijayalakshmi, Cardiac Catheterization and Imaging (From Pediatrics to Geriatrics) is a gross understatement on the magnitude of its encyclopedic content. The book should be a valuable reference source for the library of any interventional cardiologist, and/or institution supporting a cardiac catheterization laboratory.
Charles E Mullins md facc mscai
Professor Emeritus of Pediatrics
Baylor College of Medicine
Director Emeritus of Cardiac Catheterization Laboratories
Texas Children's Hospital
Houston, Texas, USA
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15Preface
Among the greatest achievements in the cardiovascular medicine over the past century are the advent, development and refinement of invasive, diagnostic as well as therapeutic modalities in cardiac catheterization and catheter-based interventions.
Cournand in his 1956 Nobel Lecture rightly said that, “The Catheter is… the key in the lock”. How true are his words even to this day. Cardiac catheterization is the “gold standard” for the anatomical and physiological assessment of cardiac anomalies, coronary and most peripheral vascular diseases prior to interventions or surgery. It plays a vital role in children and in adults with congenital heart disease (CHD). Real-time fluoroscopy with contrast injection, coupled with rapid digital angiography has provided high-resolution images of the heart and the vessels offering a road map to cardiac surgeons for successful surgical management and interventional cardiologist to accomplish nonsurgical intervention with very high success rate.
In the preinterventional era, surgery was the only option. Over the past couple of decades, catheter-based interventions have taken over and become the minimally-invasive, effective and very attractive alternative to surgery in most patients with coronary artery diseases. Unique indications have developed in selected cases with valvular and peripheral vascular diseases. Greater understanding of the technical knowledge is now required for a wider range of available catheters, balloons, delivery systems, and devices. Novel applications have extended to acquired valve diseases, paravalvular leaks, postinfarction ventricular septal rupture, closure of left atrial appendage and degenerative diseases of the aorta. Transcatheter interventions are also used for palliative procedures in high-risk individuals where surgery could lead to high morbidity and mortality.
In the current era, nonsurgical and catheter-based interventions have revolutionized the management of congenital heart defects, such as pulmonary stenosis/regurgitation, aortic stenosis, coarctation of aorta, atrial septal defects, ventricular septal defects, patent ductus arteriosus, aortopulmonary window, ruptured sinus of Valsalva, aortic ventricular tunnels, coronary arteriovenous fistulae and palliation in many complex CHDs.
The book addresses the scope of cardiac catheterization and catheter-based interventions that have increased by leaps and bounds over the past fifty years. Thorough background knowledge of normal and abnormal cardiac anatomy, physiology and hemodynamics is required by the operators. We have therefore discussed these essentials in many chapters. Each chapter/set of chapters is arranged in an organized format, starting with a concise discussion of the lesion(s), followed by indications, procedural details, precautions and potential pitfalls. Contributions from a wide range of experts are amalgamated in the book. The goal has been to address a wide range of procedures/interventions available for a diverse group of diseases or defects. New emerging procedures and future directions for valvular diseases are also discussed.
The book offers the spectrum of cardiac catheterization and catheter-based interventions from pediatric to geriatrics. It covers literally the scope of these procedures from ‘womb to tomb’. It is intended as a practical guide for the interventional treatment of congenital, structural heart disease, coronary and peripheral vascular diseases to be used by invasive pediatric and adult cardiologists. Wherever possible, an attempt has been made to emphasize practical aspects related to procedures; such as patient selection, absolute and relative indications, contraindications and potential complications.
Some of the procedures discussed in the book are emerging techniques in the forefront of interventional cardiology, and may not be practiced in every cardiac catheterization laboratory. These represent the expertise of selected interventional cardiologists from around the world. The goal has also been to share clinical experiences in order to provide a practical procedural reference guide to catheter laboratory staff at all levels. We hope to offer guidance in acquiring these skills, while sharing the experience of using these techniques. Diagnostic catheterization only is as good as the accuracy of the acquired data and since all the interpretations are based on it.
The information contained in the book is free from bias. The fundamental concepts and recommendations are based on evidence-based data, clinical guidelines and peer-reviewed research. It also represents an accumulation of knowledge, techniques and procedures that have been learned, utilized and/or developed by various experienced cardiologists with rich experiences in teaching cardiac catheterization and interventions. We are grateful to all the authors for their contributions. We are truly grateful to Dr Chitra Narasimhan for untiring selfless help.
We are extremely fortunate and deeply indebted to the legendary Charles E Mullins, who has done the pioneering work and has contributed immensely for the growth of catheterization, especially most commonly used ‘Mullins sheath’, for writing the fabulous foreword for the book.
IB Vijayalakshmi