MEDshare - High Quality Medical Resources - Practical Handbook of Advanced Interventional Cardiology Second edition edited by Thach N. Nguyen, MD, FACC, FACP, FSCAI Editorial Consultant, Journal of Interventional Cardiology; Co-editor, Journal of the Institute of Geriatric Cardiology ; Professor of Medicine (Hon.) Capital University of Medical Sciences Beijing, China; Director of Cardiology, Community Health Care System St Mary Medical Center, Hobart, IN Dayi Hu, MD Professor of Medicine Peking University and Capital University of Medical Sciences; President, The Institute of Cardiovascular Diseases; Chief of Cardiology, People and Beijing Tong Ren Hospital Beijing, China Shigeru Saito, MD, FACC, FSCAI, FJCC Chief of Division of Cardiology and Catheterization Laboratories Heart Center of Shonan Kamakura General Hospital Heart and Great Vessel Center of Beijing You-Yi Friendship Hospital Beijing, China Cindy L. Grines, MD Director, Cardiac Catheterization Laboratories William Beaumont Hospital Royal Oak, MI Igor Palacios, MD Director of Cardiac Catheterization Laboratories and Interventional Cardiology Massachusetts General Hospital Boston, MA Futura, an imprint of Blackwell Publishing © 2001, 2003 by Futura, an imprint of Blackwell Publishing Blackwell Publishing, Inc./Futura Division, 3 West Main Street, Elmsford, New York 10523, USA Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148- 5018, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia All rights reserved. No part of this publication may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review. First published 2001 Second edition 2003 Reprinted 2005 ISBN-13: 978-1-4051-1731-9 ISBN-10: 1-4051-1731-1 Library of Congress Cataloging-in-Publication data Pra ct ica l ha nd b oo k of a dva nc ed int er ve nt io na l c ard iol og y / [edited by] Thach Nguyen [et al.]. – 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-4051-1731-9 ISBN-10: 1-4051-1731-1 1. Heart – Surgery. 2. Heart – Endoscopic surgery. 3. Heart – Di seas es – Tr eat me nt . I. N gu ye n, Thac h. [DNLM: 1. Cardiac Surgical Procedures – methods – Hand- books. 2. Cardiovascular Diseases – surgery – Handbooks. WG 39 P895 2003] RD598.P65 2003 617.4'12–dc21 2003013912 A catalogue record for this title is available from the British Library Acquisitions: Jacques Strauss Production: Charlie Hamlyn Typesetter: Sparks Printed and bound in India by Replika Press PVT Ltd For further information on Blackwell Publishing, visit our websites: www.futuraco.com www.blackwellpublishing.com iii CONTRIBUTORS Gérald Barbeau, MD Laval Hospital, Institute de Cardiologie de Quebec, St Foy, Quebec, Canada Sarana Boonbaichaiyapruck, MD, FACC, FSCAI Associate Professor of Medicine, Director, Cardiac Catheteri- zation & Intervention Service, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Tan Huay Cheem, MD Director, Coronary Intervention, The Heart Institute, Singa- pore Buxin Chen, MD Vice-President, Chief, Cardiology Department, Beijing Diali Hospital, Beijing, China Zhang Shuang Chuan, MD Director of Pediatric Department of Peking University Shen- zhen Hospital, Professor of Pediatric Cardiology of Peking University Hospital, Guest Professor of Shenzhen Children’s Hospital, Shenzhen, China Herbert Cordero, MD Phoenix Heart Center at St Joseph Hospital and Medical Center, Phoenix, AZ Alain Cribier, MD Department of Cardiology, Charles Nicolle Hospital, Univer- sity of Rouen, France Vijay Dave, MD Chairman, Department of Medicine, Director of Medical Education, Community Health Care System, St Mary Medical Center, Hobart, IN Edward Diethrich, MD Medical Director, Arizona Heart Institute and Arizona Heart Hospital, Phoenix, AZ John S. Douglas, MD Director of the Cardiac Catheterization Laboratories, Emory University Hospital, Atlanta, GA Ho Thuong Dzung, MD, PhD Cardiology Department, Thong Nhat Hospital, Ho Chi Minh City, Vietnam Helene Eltchaninoff, MD Department of Cardiology, Charles Nicolle Hospital, Univer- sity of Rouen, France Quan Fang, MD Chief, Cardiology Department, Peking Union Hospital, Beijing, China iv Practical Handbook of Advanced Interventional Cardiology Ted Feldman, MD, FACC, FSCAI Professor of Medicine, Evanston-Northwestern Hospital, Evanston IL Kirk Garratt, MD Interventional Cardiology, Mayo Clinics, Rochester, MN C. Michael Gibson, MS, MD Director TIMI Data Coordinating Center and Angiographic Core Laboratory, Brigham and Women’s Hospital; Associate Chief of Cardiology for Academic Affairs, Beth Israel Deacon- ess Medical Center, Harvard Medical School, Boston, MA Cindy Grines, MD Director, Cardiac Catheterization Laboratories, William Beau- mont Hospital, Royal Oak, MI Lee Guterman, PhD, MD Assistant Professor, Department of Neurosurgery, and Co- Director, Toshiba Stroke Research Center, School of Medi- cine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY Richard Heuser, MD Phoenix Heart Center at St Joseph Hospital and Medical Center, Phoenix, AZ Nguyen Lan Hieu, MD Interventional Cardiologist, Vietnam Heart Institute, Hanoi, Vietnam L. Nelson Hopkins, MD Professor and Chairman, Department of Neurosurgery; Professor, Department of Radiology; and Director, Toshiba Stroke Research Center; School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY Jay Howington, MD Assistant Clinical Instructor of Neurosurgery and Neuroen- dovascular Fellow, Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY Dayi Hu, MD Professor of Medicine, Peking University and Capital Univer- sity of Medical Sciences; President, The Institute of Cardio- vascular Diseases; Chief of Cardiology, People and Beijing Tong Ren Hospital, Beijing, China Do Quang Huan, MD Director, Cardiac Catheterization Laboratories, The Heart Institute, Ho Chi Minh City, Vietnam Jui Sung Hung, MD Professor of Medicine, China Medical College, Taichung, Taiwan Contributors v Pham Manh Hung, MD Associate Director, Cardiac Catheterization Laboratories, Vietnam Heart Institute, Bach Mai Hospital, Hanoi Medical University, Hanoi, Vietnam Greg L. Kaluza, MD, PhD Scientifi c Director, Institute for Research in Cardiovascular In- terventions, The Methodist DeBakey Heart Center and Baylor College of Medicine, Houston, TX Huynh Tuan Khanh, MD Pediatric Cardiologist, Pediatric Hospital #2, Ho Chi Minh City, Vietnam Moo-Huyn Kim, MD Director, Cardiac Catheterization Laboratory, Dong-A Univer- sity Hospital, Busan, Korea Rajiv Kumar Illinois Institute of Technology, Chicago IL Kean Wah Lau, MB, FACC Singapore Heart Institute, Singapore Wang Lei, MD Director, Catheterization Laboratories of the Heart & Blood Vessel Center, Beijing Friendship Hospital, Beijing, China Elad Levy, MD Assistant Clinical Instructor of Neurosurgery and Neuroen- dovascular Fellow, Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY Rijie Li, MD Vice-President, Chief, Cardiology Department, Chui Yang Liu Hospital, Beijing, China Tianchan Li, MD Vice Director, The Heart Center, Beijing Tongren Hospital, Beijing, China Meilin Liu, MD Chief, Cardiology Department, Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing, China Do Doan Loi, MD, PhD Director of the Echocardiography Laboratories, Vietnam Heart Institute, Hanoi, Vietnam Caiyi Lu, MD Professor and Vice-Director of Institute of Geriatric Cardiol- ogy, Chinese PLA General Hospital, Beijing, China Nithi Mahanonda, MD, FRACP, FACC, FSCAI, FACA Associate Director, Bangkok Heart Institute, Bangkok Gen- eral Hospital, Bangkok, Thailand Kazuaki Mitsudo, MD Chief of Cardiology, Department of Cardiology, Kurashiki Central Hospital, Japan vi Practical Handbook of Advanced Interventional Cardiology Phillip Moore, MD Associate Professor of Pediatrics, Director of Pediatric Con- genital Heart Disease Program, UCSF, San Francisco, CA Nguyen Thuong Nghia, MD Interventional Cardiology Unit, Cho Ray Hospital, Ho Chi Minh City, Vietnam Thach Nguyen, MD, FACC, FACP, FSCAI Editorial Consultant, Journal of Interventional Cardiology; Co-editor, Journal of the Institute of Geriatric Cardiology ; Pro- fessor of Medicine (Hon.), Capital University of Medical Sci- ences, Chao Yang and Friendship Hospital, Beijing, China; Director of Cardiology, Community Health Care System, St Mary Medical Center, Hobart, IN Phong Nguyen-Ho, MD Interventional Cardiology Fellow, University of Toronto, Uni- versity Health Network – Toronto General Hospital Campus, Toronto, Canada Vo Thanh Nhan, MD, PhD De p ut y He a d o f t h e De p ar tmen t o f Car d iolo g y, H e ad of t he I n - terventional Cardiology Unit, Cho Ray Hospital, Ho Chi Minh City, Vietnam; Senior Lecturer, Faculty of Medicine, Univer- sity of Medical Sciences, Ho Chi Minh City, Vietnam Igor Palacios, MD Director of Cardiac Catheterization Laboratories and In- terventional Cardiology, Massachusetts General Hospital, Boston, MA Seung Jung Park, MD Chief, Division of Cardiology, Asan Medical Center, University of Ulsan, Seoul, Korea Loan Pham, MD McLaren Regional Medical Center, Flint, MI Ta Tien Phuoc, MD Cardiology Consultant, Vietnam Heart Institute, Hanoi, Viet- nam Devan Pillay, MD Consultant Interventional Cardiologist, Gleneagles Medical Centre, Kuala Lumpur, Malaysia Nguyen Ngoc Quang, MD Interventional Cardiologist, Vietnam Heart Institute, Hanoi, Vietnam Kasja Rabe, MD Med. Cand., Cardiovascular Center, Frankfurt, Germany Mark Reisman, MD Director of Cardiovascular Research, Swedish Medical Center, Seattle, WA Gianluca Rigatelli, MD, FSCAI, FCCP, FESC Interventional Cardiologist, Endovascular Therapy Research, Legnago, Verona, Italy Contributors vii Shigeru Saito, MD, FACC, FSCAI, FJCC Chief of Division of Cardiology and Catheterization Labora- tories, Heart Center of Shonan Kamakura General Hospital, Heart and Great Vessel Center of Beijing You-Yi Friendship Hospital, Beijing, China Jia Sanqing, MD, PhD Director, Heart & Blood Vessel Center, Beijing Friendship Hospital, affi liated to Capital University of Medical Sciences, Beijing, China Lihua Shang, MD Director, Cardiac Catheterization Laboratories, The People’s Hospital, Beijing, China Samuel J. Shubrooks, Jr, MD Associate Professor of Medicine, Harvard Medical School, Co-Director of the Cardiac Catheterization Laboratories, Beth Israel Deaconess Medical Center, Boston, MA Horst Sievert, MD Professor of Medicine, Cardiovascular Center, Frankfurt, Germany Krishna Rocha Singh, MD Director Vascular Medicine Program, Clinical Assistant Pro- fessor of Medicine, Southern Illinois University, School of Medicine, Springfi eld, IL Yan Songbiao, MD Vice Director, Heart & Blood Vessel Center, Beijing Friendship Hospital, affi liated to Capital University of Medical Sciences, Beijing, China Pham Hoan Tien, MD Cardiology Consultant, Vietnam Heart Insitute, Hanoi, Viet- nam David Teitel, MD Professor of Pediatric, Chief of Pediatric Cardiology, UCSF, San Francisco, CA Damras Tresukosol, MD Associate Professor of Medicine, Director of Cardiac Cath- eterization Laboratories, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand Christophe Tron Department of Cardiology, Charles Nicolle Hospital, Univer- sity of Rouen, France Nguyen Quang Tuan, MD Interventional Cardiologist, Vietnam Heart Institute, Hanoi, Vietnam Mintu Turakhia, MD Internal Medicine Resident, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA viii Practical Handbook of Advanced Interventional Cardiology Lefeng Wang, MD Deputy Director of the Cardiology Center, Director of the Cath- eterization Laboratories and Associate Professor, Chaoyang Red Cross Hospital, Beijing, China Shiwen Wang, MD, MCAE Member of Chinese Academy of Engineering, Professor and Director of the Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China Guy Weigold, MD Fellow, Division of Cardiology, Washington Hospital Center, Washington, DC Neil J Weissman, MD Director, Cardiac Ultrasound, Cardiovascular Research Insti- tute, Washington Hospital Center, Washington, DC Hong Zhao, MD Cardiology Department, The People’s Hospital, Peking Uni- versity, Beijing, China Mingzhong Zhao, MD Cardiology Department, The People’s Hospital, Peking Uni- versity, Beijing, China ix FOREWORD Interventional cardiovascular medicine has evolved from an extremely crude method of opening femoral arteries initiated by Dotter, to a fi eld that has now been recognized as having a suffi cient fund of knowledge to require boards sanctioned by the American Board of Internal Medicine. From Andreas Gruentzig’s development of the noncompliant balloon meth- od, we have seen an explosion of bioengineering technology. The discipline of interventional cardiovascular medicine has perhaps initiated more registries and clinical trials than any other discipline in medicine. Indeed, the whole emphasis on evidence-based medicine has evolved during the era of interventional cardiology. Many basic science breakthroughs have been stimulated by the advances produced in interven- tional cardiology, as well as the problems and complications created by the new technologies. However, no matter how advanced the science becomes, the success of solving a patient’s problem with interventional techniques usually depends on the operator’s technical abil- ity. This ability springs from the wealth of experience the operator has acquired to deal with routine situations as well as complex and almost unique problems that may present themselves. Because of the large number of interventional cardiologists and the rapidly expanding number of proce- dures that can be performed, it is diffi cult for many cardiolo- gists to experience all of the situations that can be helpful in building this database. Dr Thach Nguyen has prepared a remarkable book, rich with tips and tricks for performing interventional cardiovascu- lar medicine procedures. He has enlisted numerous experts on various aspects of interventional cardiovascular medicine to describe their areas of expertise. Rather than let them re- cite the evidence from registries and trials that are available elsewhere, he forces the contributors to provide the practical tips that they have learned. It is almost as though Dr Nguyen is trying to simulate the type of scenarios that exist in the catheterization laboratories with new cardiology fellows or less experienced operators. It is the type of advice that he has often given to cardiologists in developing countries who are br in g in g inte r ve nti on a l te c hn iq u es t o hel p co pe w it h the r ap id - ly expanding new threat in these countries, vascular disease. Since new techniques are constantly appearing, all opera- tors, experienced or not, can benefi t from these tips. Whereas every operator will not agree with every approach to a problem or a complication, it is always instructive to understand many potential approaches. In this regard, the book does a mas- terful job of collecting not only the authors’ experiences, but those of many others collected from the published literature, [...]... rotation of the thigh Brachial approach Translumbar approach ***Reverse image Transseptal approach ***Manipulation of catheter *Basic; * *Advanced; ***Rare, exotic, or investigational From: Nguyen T, Hu D, Saito S, Grines C, Palacios I (eds), Practical Handbook of Advanced Interventional Cardiology, 2nd edn © 2003 Futura, an imprint of Blackwell Publishing 1 2 Practical Handbook of Advanced Interventional Cardiology. .. Take-Home Message with all of the dramatic colorings or ups and downs – reminiscent of an Italian opera – which xi xii Practical Handbook of Advanced Interventional Cardiology Table 0 -1 Strategic goals during interventions 1 Effectiveness: Problems controlled and results sustained 2 User-friendly performance: Simple manipulations, single operator, low-profile device, and no complex and costly set-up... under Table 1- 1 Tips during deployment of AngioSeal device 1 Insert the insertion sheath exactly 1. 5 cm after seeing squirt of blood 2 After that, pull back the whole device, feel that the anchor is tightly apposed to the arterial wall 3 Advance the tamper tube while keeping steady traction on the suture 4 Be sure there is no severe blood oozing 8 Practical Handbook of Advanced Interventional Cardiology. .. Diagn 19 93; 30 : 313 8 Feldman T Percutaneous vascular closure: Plugs, stitches, and glue Cathet Cardiovasc Diagn 19 98; 45: 89 9 Feldman T Femoral arterial preclosure: Finishing a procedure before it begins Cathet Cardiovasc Interv 20 01; 53: 448 10 Stein B, Terstein P Non-surgical removal of Angio-Seal Device after intra-arterial deposition of collagen plug Cathet Cardiovasc Interv 2000; 50 : 340–2 11 ... **Puncture location **Angle of introduction **Sequential dilation **Kinked wire Closure devices ***Pre-closure of large arterial access ***Non-surgical removal of the AngioSeal device TAKE-HOME MESSAGE: What to do if collagen is inserted intra-arterially ***When to suspect intra-arterial deployment of collagen plug Antegrade puncture **Antegrade puncture **Manipulation of wire **Puncture of CFA with high bifurcation... enlarged by the hemostat The tip of the translumbar access needle (TLA) and the outer Teflon sheath (Cook, Bloomington, IN) are placed in the skin incision and directed toward the T12 vertebral body Three 10 Practical Handbook of Advanced Interventional Cardiology successive attempts are made, with each increasing the vertical degree of the pass in order to “step off” of the vertebral body When the needle... Diagn 19 95; 35: 378 4 Fajadet J, Hayerizadeh B, Ali H et al Transradial approach for interventional procedures In: Fajadet J, ed Syllabus for EuroPCR, 20 01: 11 –28 5 Gerlock AJ, Mirfakhraee M Essentials of Diagnostic and Interventional Angiographic Techniques W.B Saunders, 19 85 6 Mehan VK Doubtful arterial puncture during cardiac catheterization in cyanotics Cathet Cardiovasc Diagn 19 90; 19 : 14 8–9 7... 2 21 Chapter 12 Acute ST-elevation Myocardial Infarction Thach Nguyen, Mintu Turakhia, Pham Hoan Tien, Wang Lefeng, C Michael Gibson 229 Chapter 13 Bifurcation Lesions Samuel J Shubrooks, Jr 259 Chapter 14 Approach to the Patient with Prior Bypass Surgery John S Douglas, Thach Nguyen, Loan Pham, Tan Huay Cheem 279 xv xvi Practical Handbook of Advanced Interventional Cardiology Chapter 15 Left... Main Lesions Seung Jung Park, Thach Nguyen 3 01 Chapter 16 Removal of Embolized Material Kirk Garratt, Thach Nguyen 319 Chapter 17 Complications Thach Nguyen, Damras Tresukosol, Vo Thanh Nhan, Mingzhong Zhao, Hong Zhao 335 Chapter 18 Vascular Brachytherapy and Restenosis Moo-Hyun Kim, Phong Nguyen-Ho, Thach Nguyen, Greg L Kaluza 3 61 Chapter 19 Rotational Atherectomy Thach Nguyen, Mark Reisman,... Do, Meilin Liu, Rijie Li 10 9 Chapter 7 Stenting Thach Nguyen, Jia Sanqing, Wang Lei, Yan Songbiao .12 3 Chapter 8 High-risk Patients Thach Nguyen, Nithi Mahanonda, Tianchan Li, Sarana Boonbaichaiyapruck 15 3 Chapter 9 Complex Lesions Thach Nguyen, Cayi Lu, Shiwen Wang 18 1 Chapter 10 Chronic Total Occlusion Kazuaki Mitsudo, Thach Nguyen, Jui Sung Hung 203 Chapter 11 Ostial Lesions Thach Nguyen, . published 20 01 Second edition 2003 Reprinted 2005 ISBN -1 3 : 97 8 -1 -4 05 1- 1 73 1- 9 ISBN -1 0 : 1- 4 05 1- 1 73 1- 1 Library of Congress Cataloging-in-Publication data Pra ct ica l ha nd b oo k of a dva nc ed. index. ISBN -1 3 : 97 8 -1 -4 05 1- 1 73 1- 9 ISBN -1 0 : 1- 4 05 1- 1 73 1- 1 1. Heart – Surgery. 2. Heart – Endoscopic surgery. 3. Heart – Di seas es – Tr eat me nt . I. N gu ye n, Thac h. [DNLM: 1. Cardiac. of Interventional Cardiology; Co-editor, Journal of the Institute of Geriatric Cardiology ; Professor of Medicine (Hon.) Capital University of Medical Sciences Beijing, China; Director of Cardiology,