Interventional Cardiology Amar S. Kapoor Editor Interventional Cardiology With 135 Figures Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Amar S. Kapoor, MD, Kaiser Foundation Hospital, University of Southern California, Los Angeles, CA 90027, USA Library of Congress Cataloging-in-Publication Data Interventional cardiology/Amar S. Kapoor, editor. p. cm. Includes bibliographies and index. ISBN-13: 978-1-4612-8145-0 e-ISBN-13: 978-1-4612-3534-7 DOl: 10.1007/978-1-4612-3534-7 1. Heart-Diseases-Treatment. I. Kapoor, Amar S. [DNLM: 1. Cardiology-methods. 2. Heart Diseases-diagnosis. 3. Heart Diseases-therapy. 4. Heart Function Tests-methods. WG 200 163] RC683.8.157 1988 616.1 '2-dc19 DNLMIDLC for Library of Congress 88-16016 CIP Printed on acid-free paper © 1989 by Springer-Verlag New York Inc. Softcover reprint of the hardcover 1st edition 1989 All rights reserved. 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The publisher makes no warranty, express or implied, with respect to the material contained herein. Typeset by Bi-Comp, Inc., York, Pennsylvania. 9 8 7 6 5 4 3 2 1 Dedicated to dear Rinder for her infinite patience and to the interventional cardiologists who perform complex therapeutic acts of finger calisthenics with finesse Preface In the last decade, invasive procedures in cardiology have blossomed at an unprecedented rate. There is a sea of facts that has to be organized, assimilated, and applied for sound cardiac practice. We have come a long way from our conventional palliative treatment of acute myocardial in­ farction to a much more aggressive stance of contemporary interventional cardiac care. Patients with cardiovascular instability are not only moni­ tored in a protective environment, but are treated with innovative ap­ proaches requiring aggressive interventions. The traditional role of the cardiologist has also changed because of interventional cardiology. Interventional cardiology embraces the appli­ cation of cardiac procedures and active intervention for diagnostic or therapeutic studies. For example, management of acute myocardial in­ farction could involve early drug therapy to preserve ischemic or stunned myocardium, thrombolytic therapy for clot dissolution, and acute revas­ cularization by percutaneous transluminal coronary angioplasty. Some patients may need intra-aortic balloon counterpulsation for stabilization, whereas still a small number of patients may need electrophysiologic studies and implantation of antitachycardia devices or automatic defibril­ lators. Eventually, an occasional patient who develops end-stage isch­ emic cardiomyopathy may require cardiac assist devices and cardiac transplantation. Interventions have become routine accepted practice. In this book, emphasis is placed on the indications, techniques, results, and merits of each procedure. Details of each procedure, instrumentation required, and the techniques are highlighted. This book is divided into five parts. Part I discusses general principles of cardiac catheterization, hemody­ namic measurements, cineangiographic views, and coronary angiogra­ phy. Cardiac catheterization is fundamental for all invasive procedures, and one needs to have a solid background in this procedure before con­ templating interventional cardiology. Part II deals with diagnostic interventions. These are very important for precise and accurate determination of cardiac dysfunction. This kind of hemodynamic or electrophysiologic information is crucial for therapeutic decisions. Part III details therapeutic interventions. This is an area where the viii Preface medical technology and complexity of cardiac procedures have grown exponentially. In this section, the latest technical and therapeutic infor­ mation is provided in a practical format. All the interventional procedures in pediatric cardiology are discussed at length. In Part IV the various facets of coronary angioplasty and its applica­ tions in different subsets of patients are discussed in depth. Coronary angioplasty is a highly technical procedure, requiring greater skills and care than routine coronary angiography. In this section on coronary inter­ ventions, there is also an explosion of information and technology with which we should become familiar. An attempt is made to address all these complex topics in a practical format. Laser angioscopy and angioplasty are still investigational, but will get clinical application in the near future. In this field, there will be a starburst of information and innovations requiring updating. A glimpse into the future is provided. Part V deals with cardiovascular crises and their management by acute pharmacologic interventions. In the setting of a cardiac intensive care unit, one must not only be knowledgeable about the pathophysiology of cardiovascular disease, but be well-versed in the pharmacology of cardiac drugs and their timely and appropriate use. In the management of acute myocardial infarction, we have come to know time is of the essence, and acute pharmacologic intervention becomes the "procedure" in the se­ lected patient. Thus, this book aspires to provide the guidelines for the modern cardi­ ologist of today-one who uses modern techniques and technology and modern drugs for the management and prevention of cardiac disease­ "the interventional cardiologist." AMAR S. KAPOOR Contents Preface ... vii Contributors xiii Part I Invasive Procedures The Scope of Interventions in Cardiovascular Conditions AMAR S. KAPOOR ................ 3 2 Techniques of Cardiac Catheterization and Coronary Angiography AMAR S. KAPOOR 10 3 Coronary Blood Flow and Coronary Vascular Reserve TERRENCE J.W. BARUCH, AMAR S. KAPOOR, and PETER R. MAHRER . .. 22 4 Quantitative Coronary Arteriography BUDGE H. SMITH, B. GREG BROWN, and HAROLD T. DODGE 35 5 Hemodynamic Monitoring by Pulmonary Artery Catheterization SURESH RAMAMURTI and AMAR S. KAPOOR. 48 6 Outpatient Cardiac Catheterization PETER R. MAHRER . 63 7 The Evolution of Coronary Artery Disease: New Definitions from Coronary Angioscopy JAMES S. FORRESTER, ANN HICKEY, FI~ANK LITVACK, and WARREN GRUND FEST. 69 x Contents Part II Diagnostic Interventions 8 Interventions in the Evaluation of Valvular Heart Disease INDUBALA N. VARDHAN and AMAR S. KAPOOR. 81 9 Interventions for Evaluation of Myocardial Ischemia AMAR S. KAPOOR, DIANE SOBKOWICZ, and DAVID E. BLUMFIELD ............. 89 10 Introduction to Clinical Electrophysiology DONALD G. RUBENSTEIN and CAROL ZAHER 100 11 Invasive Electrophysiologic Studies in the Evaluation and Treatment of Patients with Ventricular Arrhythmias NICHOLAS J. STAMATO and MARK E. JOSEPHSON. 119 12 Electrophysiologic Approach to Patients with Supraventricular Tachycardia DONALD G. RUBENSTEIN and CAROL ZAHER 133 13 Technique of Pericardiocentesis and Intrapericardial Drainage AMAR S. KAPOOR . 146 14 Endomyocardial Biopsy Techniques and Interpretation AMAR S. KAPOOR and MIR ALI . 154 15 Dipyridamole Thallium for Evaluating Coronary Artery Disease DIANE SOBKOWICZ and DAVID E. BLUMFIELD. 161 Part III Therapeutic Interventions 16 Principles and Techniques of Intra-aortic Balloon Pump Counterpulsation SHALE GORDON . 171 17 Temporary and Permanent Pacemakers AMAR S. KAPOOR ........ 180 18 Automatic Implantable Defibrillator: Six-Year Clinical Experience ENRICO P. VELTRI, MORTON M. MOWER, and MICHEL MIROWSKI . 193 19 Catheter Ablation Techniques for Treatment of Cardiac Arrhythmias MELVIN M. SCHEINMAN . 201 Contents xi 20 Interventional Pediatric Cardiac Catheterization ZUHDI LABABIDI and IHAB ATTIA . 214 21 Balloon Aortic Valvuloplasty BRICE LETAC and ALAIN CRIBIER ........... 239 22 Peripheral Laser Thermal Angioplasty TIMOTHY A. SANBORN . 254 Part IV Coronary Interventions 23 Practical Aspects of Coronary Angioplasty AMAR S. KAPOOR .......... 267 24 Complex Coronary Angioplasty: The Outcome and Long-term Effect of Angioplasty in Multivessel Coronary Disease and Multiple Lesion Anigoplasty GERALD DORROS, RUBEN F. LEWIN, and LYNNE MATHIAK. 281 25 Management of Early and Late Complications of Coronary Angioplasty AMAR S. KAPOOR and PETER R. MAHRER. .... 306 26 Percutaneous Transluminal Coronary Stenting: ANew Approach to Unresolved Problems in Coronary Angioplasty ULRICH SIGWART, SVEIN GOLF, URS KAUFMANN, LUKAS KAPPENBERGER, ADAM FISCHER, and HOSSEIN SADEGHI . 314 27 Laser Angioplasty of the Coronary Arteries GARRETT LEE, REGINALD I. Low, AGUSTIN J. ARGENAL, ROLF G. SOMMERHAUG, MING C. CHAN, and DEAN T. MASON 319 Part V Acute Pharmacologic and Surgical Interventions 28 Platelet Inhibitor Drugs in Coronary Artery Disease and Coronary Intervention DOUGLAS H. ISRAEL, BERNARDO