Interventional cardiology in Israel at 2005—state of practice

Objective: To assess the current practice of interventional cardiology in Israel. Method: Under the auspices of the ‘Working group of interventional cardiology’ of the ‘Israel Heart Society,’ a questionnaire regarding the practice of interventional cardiology sent to directors of interventional cardiology in all public hospitals. Results: Twenty centers received the questionnaires; however, complete data was obtained from 18. Most interventional cardiology units in Israel are merely engaged in percutaneous coronary interventions (PCIs). PCIs are executed mostly via the femoral artery, using almost exclusively stents, of which 36% were drug eluting. Noted was an infrequent use of other therapeutic, diagnostic devices, or femoral arteriotomy closure devices. Only 22% of the patients receive glycoprotein IIb/IIIa blockers (GPB). Most centers used conventional unfractionated heparin dosing (70?u/kg) and did not routinely monitor activated clotting time. Abciximab, bivalirudin or enoxaparine were rarely used. All laboratories performed both elective and emergency‐PCI, although 12 facilities were not supported by on‐site surgical backup. Conclusion: Most cardiovascular intervention programs have restricted their activity to the coronary stenting, and are using a limited array of diagnostic and therapeutic devices, along with patient‐tailored adjunctive pharmacotherapy, to sustain cost‐effectiveness. Currently, ambulatory angiography and coronary interventions are not widely practiced in Israel.     

Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes.

AIMS: Although underestimated by interventional cardiologists for a long time, radiation exposure of operators and patients is currently a major concern. The objective of the present operator-blinded registry was to compare related-peripheral arterial route radiation exposure of operators. METHODS AND RESULTS: During 420 consecutive coronary angiograms (CAs) and percutaneous coronary interventions (PCIs), four interventional cardiologists were blindly screened. Radiation exposures were assessed using electronic personal dosimeters. Protection of operator was ensured using a lead apron, low leaded flaps, and leaded glass. Radiation exposure of operators was significantly higher using the radial route when compared with the femoral route for both CAs and CAs followed by ad hoc PCIs: 29.0 [1.0-195.0] microSv vs. 13.0 [1.0-164.0] microSv; P < 0.0001 and 69.5 [4.0-531.0] microSv vs. 41.0 [2.0-360.0] microSv; P = 0.018, respectively. Similarly, radiation exposure of patients was significantly higher using the radial route when compared with the femoral route for both CAs and CAs followed by ad hoc PCIs. Moreover, procedural durations and fluoroscopy times were significantly higher throughout the radial route. CONCLUSIONS: Although the radial route decreases peripheral arterial complication rates, increased radiation exposure of operators despite extensive use of specific protection devices is currently a growing problem for the interventional cardiologist health. Radial route indication should be promptly reconsidered in the light of the present findings.     

The Portuguese Interventional Cardiology Registry from 1992 to 2003.

OBJECTIVE: The aim of the present paper was to report trends in Portuguese interventional cardiology from 1992 to 2003 and to compare these data with other European countries. METHODS: Based on questionnaires distributed to and completed by Portuguese interventional cardiology centers we give an overview of the development of coronary interventions since 1992, when data were first collected. In 2003, 24,834 diagnostic catheterization procedures were performed, representing an increase of 315% in comparison to 1992. In 2003 the population-adjusted rate was 2483 coronary angiograms per million population. Coronary interventions increased by 1193% in comparison to 1992, with a total of 8465 procedures and a rate of coronary interventions of 848 per million population in 2003. Coronary stents were the most frequently used devices, with an increase from 53% in 1996 to 89% in 2003. The present rate of stent implantation in Portugal is similar to that in Europe and Spain, but the rate of use of drug-eluting stents in Portugal is one of the highest in Europe (55%). In 2003, multivessel percutaneous coronary interventions were performed in 24% of cases, with no significant increase during the last 10 years, and ad hoc interventions were performed in the course of diagnostic coronary angiography in 73 % of patients; glycoprotein IIb-IIIa inhibitors were used in 30% of procedures; percutaneous coronary interventions in patients with acute myocardial infarction accounted for 16% of all procedures; of the noncoronary interventions recorded, 49 percutaneous mitral valvuloplasties, 37 atrial septal defect closures and 15 patent foramen ovale closures were reported. The PCI rate per million population in Portugal was lower than the mean European rate (848 vs. 1194). CONCLUSION: Interventional cardiology in Portugal and other European countries has been expanding since 1992. We would emphasize the high rate of reporting by laboratories, which enables the Registry to compile data that are highly representative of activity in Portugal since 1992.     

Effectiveness of in-ward management of femoral access after invasive procedures using large sheaths

BACKGROUND: The cost-effectiveness of expensive suture mediation devices for the management of femoral access is currently under investigation, while the effectiveness of in-ward femoral access management by standard care has not yet been assessed. METHODS: To determine whether a logistic model that includes management of femoral access by the cardiology ward staff is effective, 945 consecutive invasive procedures using > or = 8 Fr sheaths were prospectively screened over a 6-month study period. Vascular complications included: any need for surgical or endovascular repair, ultrasound-guided compression, any femoral or iliac bleeding requiring blood transfusion. RESULTS: During the study period there were 581 diagnostic procedures, and 364 interventional procedures. Interventional procedures included 98 primary PTCA, 42 coronary atherectomies, and 39 intraaortic balloon pump supported PTCA. Vascular complication rate was 1.6% (surgical repair 0.2%, ultrasound-guided compression 1.1%, blood transfusion 0.3%). CONCLUSIONS: The vascular access management by the cardiology ward staff was associated with a very low rate of vascular complications. This policy may play a role in reducing costs and improving logistics.     

Immediate hemostasis of the femoral artery after heart catheterization: the present situation of closure systems

The femoral approach is the most commonly used route for diagnostic cardiac catheterization and coronary interventions today. Manual compression and pressure bandages usually lead to immobilisation of the patient for several hours and may result in significant discomfort. Since the introduction of the first femoral closure device in 1991, many devices have proven their efficacy in significantly reducing time to hemostasis while simultaneously improving patient comfort. Twenty four closure device systems with different concepts are on the market, e. g. pure collagen, collagen + thrombin, collagen + anchor, vascular suture, hemostatic patches and pads, staples and more. The four predominantly used are Angio-Seal (46 %), Perclose (32 %), VasoSeal (14 %) and Duett (3 %). The effectiveness of all four systems has been proven in a prospective, randomized, controlled multicenter trial each. Efficacy and safety were analyzed using data from ten comparative studies in 8832 predominantly or exclusively interventional patients, however none of the closure systems proved to be superior. Fortunately, recent years have shown a trend toward a reduction in local complications by vascular closure devices compared to manual compression. Closure devices are thus becoming increasingly cost effective. Vascular closure systems should be preferred when the prolonged supine position is not tolerated, a protein IIb/IIIa-inhibitor was used during the procedure, or early discharge of patient is anticipated. In the presence of peripheral vascular disease, small diameter of the femoral vessels or stenotic lesions in the femoral artery, closure devices should be used with caution. Closure systems for immediate femoral puncture site hemostasis are now an important tool of invasive cardiology today.     

Patient Radiation Doses in Interventional Cardiology Procedures

Interventional cardiology procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. The procedures that are most frequently performed are coronary angiography, percutaneous coronary interventions, diagnostic electrophysiology studies and radiofrequency catheter ablation. Patient radiation dose in these procedures can be assessed either by measurements on a series of patients in real clinical practice or measurements using patient-equivalent phantoms. In this article we review the derived doses at non-pediatric patients from 72 relevant studies published during the last 22 years in international scientific literature. Published results indicate that patient radiation doses vary widely among the different interventional cardiology procedures but also among equivalent studies. Discrepancies of the derived results are patient-, procedure-, physician-, and fluoroscopic equipmentrelated. Nevertheless, interventional cardiology procedures can subject patients to considerable radiation doses. Efforts to minimize patient exposure should always be undertaken.     

Achievements of Invasive Cardiology 2003. Part II.

The authors present a review of research works completed or conducted in 2003 which according to their opinion contributed most to the rapidly progressing field of invasive/interventional cardiology. The year passed was characterized by wide introduction into clinical practice of stents coated with antirestenotic agents, substantial advances in pharmacological support and improvements of safety of coronary interventions, active studies of contrast induced nephropathy and assessment of novel devices for myocardial protection against distal embolism during interventions both on coronary arteries and vein grafts. Recent results of comparisons of mechanical and pharmacological myocardial reperfusion in acute ST-elevation myocardial infarction can be considered revolutionary for clinical cardiology. Part I of the review deals with invasive treatment of acute coronary syndrome and pharmacological support of coronary interventions.     

Achievements of invasive cardiology 2003. Part I.

The authors present a review of research works completed or conducted in 2003 which according to their opinion contributed most to the rapidly progressing field of invasive/interventional cardiology. The year passed was characterized by wide introduction into clinical practice of stents coated with antirestenotic agents, substantial advances in pharmacological support and improvements of safety of coronary interventions, active studies of contrast induced nephropathy and assessment of novel devices for myocardial protection against distal embolism during interventions both on coronary arteries and vein grafts. Recent results of comparisons of mechanical and pharmacological myocardial reperfusion in acute ST-elevation myocardial infarction can be considered revolutionary for clinical cardiology. Part I of the review deals with invasive treatment of acute coronary syndrome and pharmacological support of coronary interventions.     

Multivariate prediction of in-hospital mortality after percutaneous coronary interventions in 1994-1996. Northern New England Cardiovascular Disease Study Group.

OBJECTIVES: Using recent data, we sought to identify risk factors associated with in-hospital mortality among patients undergoing percutaneous coronary interventions. BACKGROUND: The ability to accurately predict the risk of an adverse outcome is important in clinical decision making and for risk adjustment when assessing quality of care. Most clinical prediction rules for percutaneous coronary intervention (PCI) were developed using data collected before the broader use of new interventional devices. METHODS: Data were collected on 15,331 consecutive hospital admissions by six clinical centers. Logistic regression analysis was used to predict the risk of in-hospital mortality. RESULTS: Variables associated with an increased risk of in-hospital mortality included older age, congestive heart failure, peripheral or cerebrovascular disease, increased creatinine levels, lowered ejection fraction, treatment of cardiogenic shock, treatment of an acute myocardial infarction, urgent priority, emergent priority, preprocedure insertion of an intraaortic balloon pump and PCI of a type C lesion. The receiver operating characteristic area for the predicted probability of death was 0.88, indicating a good ability to discriminate. The rule was well calibrated, predicting accurately at all levels of risk. Bootstrapping demonstrated that the estimate was stable and performed well among different patient subsets. CONCLUSIONS: In the current era of interventional cardiology, accurate calculation of the risk of in-hospital mortality after a percutaneous coronary intervention is feasible and may be useful for patient counseling and for quality improvement purposes.     

The relationship between operator volume and outcomes after percutaneous coronary interventions in high volume hospitals in 1994-1996: the northern New England experience. Northern New England Cardiovascular Disease Study Group.

OBJECTIVES: The purpose of this study was to examine the relationship between annual operator volume and outcomes of percutaneous coronary interventions (PCIs) using contemporaneous data. BACKGROUND: The 1997 American College of Cardiology (ACC)/American Heart Association task force based their recommendation that interventionists perform > or = 75 procedures per year to maintain competency in PCI on data collected largely in the early 1990s. The practice of interventional cardiology has since changed with the availability of new devices and drugs. METHODS: Data were collected from 1994 through 1996 on 15,080 PCIs performed during 14,498 hospitalizations by 47 interventional cardiologists practicing at the five high volume (>600 procedures per hospital per year) hospitals in northern New England and one Massachusetts-based institution that support these procedures. Operators were categorized into terciles based on their annualized volume of procedures. Multivariate regression analysis was used to control for case-mix. In-hospital outcomes included death, emergency coronary artery bypass graft surgery (eCABG), non-emergency CABG (non-eCABG), myocardial infarction (MI), death and clinical success (> or = 1 attempted lesion dilated to < 50% residual stenosis and no death, CABG or MI). RESULTS: Average annual procedure rates varied across terciles from low = 68, middle = 115 and high = 209. After adjusting for case-mix, clinical success rates were comparable across terciles (low, middle and high terciles: 90.9%, 88.8% and 90.7%, Ptrend = 0.237), as were all the adverse outcomes including death (low-risk patients = 0.45%, 0.41%, 0.71%, Ptrend = 0.086; high-risk patients = 5.68%, 5.99%, 7.23%, Ptrend = 0.324), eCABG (1.74%, 2.05%, 1.75%, Ptrend = 0.733) and MI (2.57%, 1.90%, 1.86%, Ptrend = 0.065). CONCLUSIONS: Using current data, there is no significant relationship between operator volumes averaging > or = 68 per year and outcomes at high volume hospitals. Future efforts should be directed at determining the generalizability of these results.     

The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) collaborative quality improvement initiative in percutaneous coronary interventions

The past decade has been characterized by increased scrutiny of outcomes of surgical and percutaneous coronary interventions (PCIs). This increased scrutiny has led to the development of regional, state, and national databases for outcome assessment and for public reporting. This report describes the initial development of a regional, collaborative, cardiovascular consortium and the progress made so far by this collaborative group. In 1997, a group of hospitals in the state Michigan agreed to create a regional collaborative consortium for the development of a quality improvement program in interventional cardiology. The project included the creation of a comprehensive database of PCIs to be used for risk assessment, feedback on absolute and risk-adjusted outcomes, and sharing of information. To date, information from nearly 20,000 PCIs have been collected. A risk prediction tool for death in the hospital and additional risk prediction tools for other outcomes have been developed from the data collected, and are currently used by the participating centers for risk assessment and for quality improvement. As the project enters into year 5, the participating centers are deeply engaged in the quality improvement phase, and expansion to a total of 17 hospitals with active PCI programs is in process. In conclusion, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium is an example of a regional collaborative effort to assess and improve quality of care and outcomes that overcome the barriers of traditional market and academic competition.     

Changing outcomes in percutaneous coronary interventions: a study of 34,752 procedures in northern New England, 1990 to 1997. Northern New England Cardiovascular Disease Study Group.

OBJECTIVES: We sought to evaluate the changing outcomes of percutaneous coronary interventions (PCIs) in recent years. BACKGROUND: The field of interventional cardiology has seen considerable growth in recent years, both in the number of patients undergoing procedures and in the development of new technology. In view of recent changes, we evaluated the experience of a large, regional registry of PCIs and outcomes over time. METHODS: Data were collected from 1990 to 1997 on 34,752 consecutive PCIs performed at all hospitals in Maine (two), New Hampshire (two) and Vermont (one) supporting these procedures, and one hospital in Massachusetts. Univariate and multivariate regression analyses were used to control for case mix. Clinical success was defined as at least one lesion dilated to <50% residual stenosis and no adverse outcomes. In-hospital adverse outcomes included coronary artery bypass graft surgery (CABG), myocardial infarction and mortality. RESULTS: Over time, the population undergoing PCIs tended to be older with increasing comorbidity. After adjustment for case mix, clinical success continued to improve from a low of 88.2% in earlier years to a peak of 91.9% in recent years (p trend <0.001). The rate of emergency CABG after PCI fell in recent years from a peak of 2.3% to 1.3% (p trend <0.001). Mortality rates decreased slightly from 1.2% to 1.1% (p trend 0.007). CONCLUSIONS: There has been a significant improvement in clinical outcomes for patients undergoing PCIs in northern New England, including a significant decline in the need for emergency CABG.     

Elective and primary angioplasty at hospitals without on-site surgery versus with on-site surgery: results from a national registry

INTRODUCTION: Current European clinical guidelines do not restrict interventional cardiology at centers without on-site surgical backup, but disagreement still exists whether hospitals with cardiac catheterization laboratories, but without on-site cardiac surgery, should develop percutaneous coronary intervention (PCI) programs. Technical improvements in equipment and pharmacologic adjunctive therapy have increased the safety margins of diagnostic and therapeutic cardiac catheterization and more than half of the patients treated by PCI in Portugal are treated at hospitals without on-site cardiac surgery. OBJECTIVES: We set out to compare clinical outcomes of elective and primary PCI for ST-segment elevation myocardial infarction at centers without on-site cardiac surgery with those at centers with on-site cardiac surgery. METHODS: Based on the Portuguese Registry of Interventional Cardiology, we retrospectively reviewed a total of 13,235 PCI procedures performed from January 2002 to June 2006 and compared the results for 7,112 patients treated at hospitals without on-site cardiac surgery with 6,123 patients treated at hospitals with on-site cardiac surgery. RESULTS: Demographic data were similar, with a mean age of 64 (55-72) vs. 63 (54-71) years, 75% vs. 76% male and 25.0% vs. 24.2% with diabetes respectively at centers without and with on-site surgical backup. Hospital mortality at centers without and with on-site surgical backup respectively was: chronic angina: 0.3% vs. 0.3% (NS); acute coronary syndromes: 1.5% vs. 1.0% (NS); acute myocardial infarction with ST elevation and without cardiogenic shock: 4.0% vs. 5.0% (NS); cardiogenic shock: 50.9% vs. 53.4% (NS). CONCLUSIONS: Similar clinical outcomes for interventional cardiology were achieved at hospitals without on-site cardiac surgery and those with on-site cardiac surgery. In the era of coronary stents, adjunctive therapy and experienced operators, elective and primary PCI can safely be performed without on-site surgical backup.     

Transradial Interventions at the Forefront of Innovation

Interventional cardiology has witnessed tremendous changes over the years from a mainly diagnostic approach in an elective population to therapeutic strategies in critically ill patients. Currently, we can treat a broad spectrum of coronary artery, peripheral artery, and structural heart diseases with less invasive, percutaneous approaches that we did not anticipate to be possible just a decade ago. It is certain that the interventional techniques will see further development and we will be able to treat by percutaneous methods more conditions previously thought beyond our reach. Regardless of the advances in catheter-based diagnostic and therapeutic techniques, one thing remains constant. They all require vascular access. And, vascular access is the first technical part of any percutaneous cardiovascular procedure that can determine its overall success. High-quality data together with the availability of training courses for interventional cardiologists and fellows-in-training ensure systematic use of the transradial approach (TRA) which has demonstrated a considerable benefit compared to transfemoral approach both in chronic and acute coronary syndromes. Constant improvement of TRA techniques will further facilitate transradial endovascular and structural interventions, and the growing use for high-risk and complex percutaneous coronary interventions. A continuously growing body of evidence is focused on surpassing current TRA limitations (specifically radial artery occlusion) and expanding alternative vascular accesses such as transulnar approach or distal TRA (“snuff-box” technique). Should this downsizing trend continue, we could see a further paradigm shift toward using the snuff-box technique.     

Impact of the COVID-19 pandemic on percutaneous coronary interventions in Portugal

IntroductionThe COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity.ObjectivesTo quantify and compare the number of percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years.MethodsData on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017–2019).ResultsThe total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (?36%, p<0.001). The reduction in PCI procedures for STEMI, NSTE-ACS and CCS was, respectively, ?25% (p<0.019), ?20% (p<0.068) and ?59% (p<0.001).ConclusionsCompared with the corresponding period in the previous three years, the number of PCI procedures performed for STEMI and CCS decreased markedly during the first wave of the COVID-19 pandemic in Portugal.     

Spanish Cardiac Catheterization and Coronary Intervention Registry. 14th official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2004)

This article presents the findings of the Spanish Society of Cardiology registry of cardiac catheterization and interventional cardiology in the year 2004. Data were obtained from 121 centers, which comprise almost all cardiac catheterization laboratories in Spain. Of these, 110 performed catheterization mainly in adults, and 11 carried out procedures in only pediatric patients. In 2005, 111,451 diagnostic catheterization procedures were performed, including 97,785 coronary angiograms. This was 6.6% higher than in 2003. The population-adjusted rate was 2263 coronary angiograms per million inhabitants. A total of 45,469 coronary interventions were performed, 12% more than in 2003. The population-adjusted rate was 1052 per million inhabitants. Coronary stents were used in 91.4% of procedures; 68,892 stents were implanted, which was 12% more than in 2003. Of these, 25,148 (36.5%) were drug-eluting stents. Some 7326 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, 20.5% more than in 2003. These accounted for 16.1% of all percutaneous coronary interventions. Among non-coronary interventions, there was a decrease in the number of percutaneous mitral valvuloplasties (8%) and atrial septal defect closures (7%). In addition, there was a small increase in pediatric interventions (12%). Finally, it is important to note that the percentage of centers participating in the registry was high, what ensures that the data presented here are highly representative of the work carried out in cardiac catheterization laboratories in Spain.     

Propensity score analysis of vascular complications after diagnostic cardiac catheterization and percutaneous coronary intervention 1998-2003.

OBJECTIVES: To evaluate the adjusted risk of vascular complications after manual compression and vascular closure devices for femoral artery access site management in a large contemporary cohort, using propensity score analysis. BACKGROUND: Vascular closure devices (VCD) allow early ambulation after cardiac procedures involving femoral artery access, but whether the benefit of use of vascular closure devices (VCD) is offset by reduced safety in contemporary practice remains uncertain. Methods: Twenty one thousand eight hundred and forty one consecutive diagnostic cardiac catheterization (n = 13,124) and percutaneous coronary intervention procedures (n = 8,717) performed via a femoral access at a single site (WFUBMC) between 1998 and 2003 were evaluated. VCD's were used based on operator preference. Propensity to receive a vascular closure device (VCD) was calculated. The relative incidence of vascular complications was evaluated by logistic regression models, using the propensity score as a covariate. RESULTS: Overall, the unadjusted incidence of any vascular complication was 1.3% for VCD use and 1.4% for manual compression, p = NS. The propensity score-adjusted odds ratio for any vascular complication comparing VCD (n = 8,707) to manual compression (n = 13,034) was 0.86 (0.67-1.11) for all procedures, 0.80 (0.53-1.21) for diagnostic procedure, and 0.90 (0.65-1.26) for interventional procedures. CONCLUSIONS: In this large single-center, contemporary observational study, the risk-adjusted occurrence of vascular complications following VCD use for femoral artery access management is not increased by VCD use. Thus, in the current era, the benefit of VCD use is not offset by reduced safety.     

22. Bericht über die Leistungszahlen der Herzkatheterlabore in der Bundesrepublik Deutschland

The 22nd report updates the statistics of German cath labs published annually since 1985. Data are based on the information supplied by 486 cath labs (470 in 2004). There were 603 (+3.8%) cath labs in Germany in 2005 (compared with 580 labs in 2004). A total of 770,704 diagnostic hearth catheterizations (+8.3% compared with 2004) and 269,503 percutaneous coronary interventions (PCIs; +8.3%) were performed in 2005. As in the previous year, the relation between diagnostic catheterizations and coronary interventions was 34.97%. Eighty-six per cent of the PCIs were performed using a coronary stent. More than a quarter (27.9%) of all stents used had drug-eluting properties. In 2005, an average of 935 catheterizations (863 in 2004) and 327 PCIs (302 in 2004) were performed per 100,000 inhabitants. These figures varied between the different German states. In the field of electrophysiology, once again an increasing number of ablations (+16.2%) and electrophysiological studies (+4.2%) were conducted.     

Pediatric cardiac catheterization

The publications of 2000 and 2001 stress how interventional pediatric cardiology has moved from angioplasty to device placement. This review summarizes the important articles during the past year that evaluated the safety and efficacy of atrial septal defect devices, patent ductus occluders, and stents to treat coarctation of the aorta. The past year has also seen the emergence of old technologies that have been modified and expanded for new applications. The three areas of old technology reviewed are (1) using balloon angioplasty to palliate low birth weight infants with critical coarctation, (2) using coronary interventions in the pediatric patient, and (3) using balloon pulmonary angioplasty to treat patients with chronic thromboembolic pulmonary hypertension. Finally, this review describes the development of a new interventional technique, transcatheter implantation of a pulmonary valve, and outlines how real-time MRI in the next decade likely will replace x-ray fluoroscopy as the primary diagnostic and interventional imaging tool for the pediatric cardiologist.     

The society for cardiovascular angiography and interventions structural heart disease early career task force survey results: Endorsed by the society for cardiovascular angiography and interventions

Over the last decade, structural heart disease interventions have emerged as a new field in interventional cardiology. Currently, the Accreditation Council for Graduate Medical Education accredited interventional cardiology fellowship programs in the United States provide high‐quality and well established training curriculum in coronary and peripheral interventions, but training in structural interventions remains in its infancy. The current survey seeks to collect relevant information and assess the opinion of interventional cardiology program directors in ACGME‐accredited institutions that are actively involved in structural interventional training. Our study describes the actual number of structural procedures performed by interventional cardiology fellows in ACGME‐accredited programs, the form of the structural training today and the suggestions from program directors who are actively trying to integrate structural training in the interventional cardiology fellowship programs. © 2012 Wiley Periodicals, Inc.