Information About the Field of Interventional Cardiology
Definition: What Is Interventional Cardiology?
Interventional cardiology is a new branch of cardiology that enables examinations and treatments of the heart through placing a called catheter. The catheter is a metal wire that is advanced to the heart via the inguinal artery or brachial artery. Contrast medium can then be administered through this catheter into the heart chambers or coronary vessels to make them visible under X-ray monitoring, which allows an evaluation of the vascular structures (coronary angiography) and also, if necessary, therapeutic options, such as balloon dilation (PTCA) and the insertion of vascular stents.
Indications and Treatment Methods of Interventional Cardiology
Interventional cardiology is one of the invasive methods of medicine. However, as in all medical fields, conservative methods should be used before invasive methods to get to the bottom of a disease. That means that this examination is performed only when the cardiologist decides, after a detailed medical history and based on the findings from ECG and echocardiography, that a catheterization has a therapeutic consequence.
Most often, interventional cardiology is used in patients with suspected myocardial infarction. By administering contrast medium into the coronary vessels, they can be checked for structure and patency. If a narrowing is detected, it can be repaired in the same session by dilating it using balloons. As a preventive measure, in many cases, metal support (stent) is inserted at this site to prevent recurrence of the narrowing. However, in some instances, several complicated constrictions are found in these patients during the examination, e.g., at the bifurcations of the vessels. In these cases, bypass surgery by cardiac surgeons is advised.
Furthermore, interventional cardiology can close structures on the heart. These include interventions for atrial septal defects and patent foramen ovale. Typically, a small umbrella is inserted into the heart via the catheter and stretched over the "hole" to close it.
Interventional cardiology is a gentle procedure that allows older patients or patients with pre-existing conditions specific treatment options. For example, atrial fibrillation, which cannot be treated with anticoagulants, can be treated with atrial appendage closure. This involves closing the atrium part that tends to form blood clots. The insertion of heart valves for valve insufficiency or valve stenosis is also an established cardiology procedure. In this procedure, a folded artificial biological heart valve is advanced via the artery to the correct location in the heart and then opened at the right moment.
If inflammation of the heart muscle (myocarditis) is suspected, the diagnostic procedure involves taking a tissue sample to find out which pathogen is involved. The removal of heart tissue is also performed in the catheter laboratory under X-ray control.
Advantages of Interventional Cardiology
Interventional cardiology was introduced to offer people at increased medical risk (advanced age, many pre-existing conditions, frailty, taking blood thinners, etc.) an option for gentle treatment. The success of such methods quickly caught on, so for many indications, examination, or treatment in the cardiac catheterization laboratory has been established as the gold standard. For example, cardiac catheterization is the best way to confirm or refute a suspicion of coronary artery disease. Similarly, removal of coronary stenoses by balloon dilatation or stent implantation is recommended for simple stenoses.
The advantages of interventional cardiology include:
- A small incision in the groin or at the wrist
- Little blood loss
- Quick procedure
- Short recovery time and early discharge
- Immediate mobilization possibility after the procedure
- Small risk of infection
- Small risk of scarring
Risks and Possible Complications
Risks include:
- Bleeding and bruising at the injection site
- Allergic reaction to the contrast medium
- Exposure of the kidney to the contrast agent
- Exposure of the thyroid gland to the contrast medium
- Mostly temporary cardiac arrhythmia
- Injury to vessels or nerves
- An acute heart attack or stroke
As with any medical procedure, complications must be expected. However, interventional cardiology involves established routine procedures, so complications are rare. Only emergency patients may experience increased difficulties.
- Perforation of the heart
- Myocardial infarction
- Cardiac arrhythmia
- Reduced blood flow in the brain
- Acute renal failure
Which Specialists Are Experts in Interventional Cardiology?
Specialists in cardiology with additional training in interventional cardiology are specialists in this field. Over 24 months, physicians with at least three years of experience in internal medicine gain theoretical knowledge and practical skills by working in the cardiac catheterization laboratory.
Where Can I Find an Experienced Specialist in Interventional Cardiology?
You will exclusively find experienced specialists and clinics for interventional cardiology in Germany, Austria, and Switzerland on the PRIMO MEDICO website. Currently, you can find recognized experts in the following cities:
Interventional Cardiologists in Germany:
Sources:
- Hahn: Checkliste Innere Medizin. 6. Auflage. Thieme 2010, ISBN 978-3-131-07246-7
- Herold et al.: Innere Medizin. Eigenverlag 2012, ISBN 978-3-981-46602-7.
- Winkhardt: Das Herzkatheterlabor. Springer 2017, ISBN 978-3-662-54585-0.
- Fleck et al.: Deutscher Herzbericht 2017: Immer weniger Herzinfarkt-Tote dank Fortschritten der modernen Herz-Medizin. In: DGK Pressemitteilungen. 2018.
- Kelm et al.: Therapie des akuten Herzinfarktes bei Patienten mit ST-Streckenhebung (STEMI). Deutsch Gesellschaft für Kardiologie. Stand Januar 2018. Abgerufen am 23.05.2019.
- Mehilli et al.: Akutes Koronarsyndrom ohne ST-Hebung (NSTEMI). Deutsch Gesellschaft für Kardiologie. Stand Januar 2016. Abgerufen am 23.05.2019.