Cardiologia Intervencional: Presente e Futuro

What is Interventional Cardiology?

 Minimally invasive diagnostic/interventional techniques

 Developed to diagnose, palliate, or cure cardiac diseases

 Guided by imaging (ultrasound, fluoroscopy)

Benefits?

 Shorter recovery time

 Reduced pain

 Decreased risks

 Less expensive

Historical perspective

 1967 = 1st pacemaker in a dog

 1980 = 1st balloon valvuloplasty in a dog

 1993 = 1st PDA coil in a dog

Clinical Applications

 Angiography and intra-cardiac pressures

 Congenital heart disease

 Pulmonic stenosis, patent ductus arteriosus, and rare congenital heart defects

 Heartworm retrieval

 Pacemaker placement

 Endomyocardial biopsies

Vascular Access

 Introducer

 Arteriotomy/venotomy

Angiography/Intracardiac Pressures

 Identification of a cardiac condition by injection of contrast monitored by fluoroscopy

 Measurement of intra-cardiac pressures

Congenital Heart Disease

 Pulmonic stenosis (PS)

 Intervention

 Results

 R2a coronary artery anomaly (English bulldog, boxer, mastiff)

 Patent ductus arteriosus (PDA)

 Coil embolization

 Size restrictions, shunt size

 Newer occlusion devices

 Amplatz canine duct occluder (ACDO)

 Vascular plug

 Cor triatriatum dexter

 Intervention

 Follow-up

Pacemaker Implantation

 Intervention

 Follow-up

Pacemaker Implantation Complications

Major

Lead dislodgement, cardiac arrest, and infection

Multicenter 33%, UC Davis 13%

Minor

 Seroma, muscle twitch, inconsequential arrhythmia

 Multicenter 31%, UC Davis 11%

Heartworm Retrieval

Real-Time Three-Dimensional Echocardiography (RT3DE)

 RT3DE is a new ultrasound modality

 Provides comprehensive views of the cardiac valves and congenital heart defects

 Accurate evaluation of chamber volumes

 Precise interventional and postoperative tool

Real-Time Three-Dimensional Transesophageal Echocardiography (RT3D TEE)

 RT3D TEE may overcome technical and image quality limitations

 Advantages:

 Ability to visualize catheters, balloons and devices

 Possibility to image the structure that is undergoing intervention

 May reduce fluoroscopy time and increase procedure safety and efficacy

 May become the technique of choice for guidance of percutaneous catheter procedures

Conclusions and Future Directions

Interventional cardiology consists of a variety of minimally invasive techniques targeted to diagnose, palliate, or cure cardiac disease. The benefits of these techniques include reduced pain, shorter recovery time, lower mortality rate, and a higher success rate at a lower cost.

Real-time three-dimensional echocardiography has become a clinically relevant imaging technique. Its main advantages are more accurate quantification of cardiac chamber size and function and unlimited image plane orientation for better evaluation of valvular and congenital heart diseases.

Real-time three-dimensional transesophageal imaging is currently used in human interventional cardiology and will likely have similar applications in veterinary cardiology. It has the potential to overcome some technical and image quality limitations of transthoracic techniques.

References

1.  Kittleson MD, Kienle RD. Small Animal Cardiovascular Medicine. St. Louis, MO: Mosby; 1997.

2.  Fox PR, Sisson DD, Moise NS, eds. Textbook of Canine and Feline Cardiology. 2nd edition. Philadelphia, PA: WB Saunders Co.;1999:67–105..

3.  Lang RM, et al. Three-dimensional echocardiography: the benefits of the additional dimension. J Am Coll Cardiol. 2006;48:2053–2069.

4.  Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7:79–108.

5.  Hage FG, et al. Real time three-dimensional transthoracic echocardiography in congenital heart disease. Echocardiography. 2012;29:220–231.

6.  Perk G, et al. Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions. J Am Soc Echocardiogr. 2009;22:865–82.

7.  Lee AP-W, et al. Role of real time three-dimensional transesophageal echocardiography in guidance of interventional procedures in cardiology. Heart. 2010;96:1485–1493.