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 DOl: 10.1007/978-1-4612-3534-7

e-ISBN-13: 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

Printed on acid-free paper

© 1989 by Springer-Verlag New York Inc. Softcover reprint of the hardcover 1st edition 1989

88-16016 CIP

All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag, 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter devel­oped is forbidden. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. 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 in­farction to a much more aggressive stance of contemporary interventional cardiac care. Patients with cardiovascular instability are not only moni­tored in a protective environment, but are treated with innovative ap­proaches requiring aggressive interventions.

The traditional role of the cardiologist has also changed because of interventional cardiology. Interventional cardiology embraces the appli­cation of cardiac procedures and active intervention for diagnostic or therapeutic studies. For example, management of acute myocardial in­farction could involve early drug therapy to preserve ischemic or stunned myocardium, thrombolytic therapy for clot dissolution, and acute revas­cularization 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 defibril­lators. Eventually, an occasional patient who develops end-stage isch­emic 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, hemody­namic measurements, cineangiographic views, and coronary angiogra­phy. Cardiac catheterization is fundamental for all invasive procedures, and one needs to have a solid background in this procedure before con­templating 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 infor­mation 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 applica­tions 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 inter­ventions, 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 se­lected patient.

Thus, this book aspires to provide the guidelines for the modern cardi­ologist 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 ... Contributors

Part I Invasive Procedures

The Scope of Interventions in Cardiovascular Conditions AMAR S. KAPOOR ................ .

2 Techniques of Cardiac Catheterization and Coronary Angiography AMAR S. KAPOOR

3 Coronary Blood Flow and Coronary Vascular Reserve TERRENCE J.W. BARUCH, AMAR S. KAPOOR, and

vii xiii

3

10

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.

6 Outpatient Cardiac Catheterization PETER R. MAHRER . . . . . . .

7 The Evolution of Coronary Artery Disease: New Definitions from Coronary Angioscopy JAMES S. FORRESTER, ANN HICKEY, FI~ANK LITVACK, and

48

63

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 ............. .

10 Introduction to Clinical Electrophysiology DONALD G. RUBENSTEIN and CAROL ZAHER

11 Invasive Electrophysiologic Studies in the Evaluation and Treatment of Patients with Ventricular Arrhythmias

89

100

NICHOLAS J. STAMATO and MARK E. JOSEPHSON. . . . . 119

12 Electrophysiologic Approach to Patients with Supraventricular Tachycardia DONALD G. RUBENSTEIN and CAROL ZAHER

13 Technique of Pericardiocentesis and Intrapericardial Drainage

133

AMAR S. KAPOOR . . . . . . . . . . . . . . . . . . . . 146

14 Endomyocardial Biopsy Techniques and Interpretation AMAR S. KAPOOR and MIR ALI . . . . . . .

15 Dipyridamole Thallium for Evaluating Coronary Artery Disease DIANE SOBKOWICZ and DAVID E. BLUMFIELD.

Part III Therapeutic Interventions

16 Principles and Techniques of Intra-aortic Balloon Pump Counterpulsation

154

161

SHALE GORDON . . . . . . . . . . . . . . . . . . 171

17 Temporary and Permanent Pacemakers AMAR S. KAPOOR ........ .

18 Automatic Implantable Defibrillator: Six-Year Clinical Experience ENRICO P. VELTRI, MORTON M. MOWER, and MICHEL MIROWSKI . . . . . . . . . . . . .

19 Catheter Ablation Techniques for Treatment of Cardiac Arrhythmias

180

193

MELVIN M. SCHEINMAN . . . . . . . . . . . . . . . . . 201

Contents xi

20 Interventional Pediatric Cardiac Catheterization ZUHDI LABABIDI and IHAB ATTIA . . . . . . . 214

21 Balloon Aortic Valvuloplasty BRICE LET AC 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 .......... .

24 Complex Coronary Angioplasty: The Outcome and Long-term Effect of Angioplasty in Multivessel Coronary Disease and Multiple Lesion Anigoplasty

267

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 STEIN, and VALENTIN FUSTER . . . . . . . . . . . . . . . . . . . . 329

29 Thrombolysis in Acute Myocardial Infarction DAVID E. BLUMFIELD . . . . . . . . .. ....... 355

30 Interventional Approach in the Management of Cardiogenic Shock AMAR S. KAPOOR . . . . . . . . . . . . . . . . . . . . 368

xii

31 Emergency Coronary Artery Bypass Surgery for Acute Coronary Syndromes SAMUEL L. SELINGER, RALPH BERG JR, WILLIAM S. COLEMAN, JACK J. LEONARD, and

Contents

MARCUS A. DEWOOD. . . . . . . . . . . . . . . . . . . 377

32 Cardiac Transplantation DAVIS DRINKWATER, LYNNE WARNER STEVENSON, and HILLEL LAKS . . . . . . . . . . . . . . . . . . . . . . 387

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . 401

Contributors

MIR ALI, MD

Fellow in Cardiology, Kaiser Foundation Hospital, Los Angeles, California, USA

AGUSTIN J. ARGENAL, MD, FACC

Director, Cardiac Catheterization Laboratory, Northern California Heart and Lung Institute, Concord, California, USA

IHAB ATTIA, MD

Fellow in Cardiology, University of Missouri Hospital and Clinics, Columbia, Missouri, USA

TERRENCE J. W. BARUCH, MD

Fellow in Cardiology, Kaiser Foundation Hospital, Los Angeles, California, USA

RALPH BERG JR, MD

Cardiovascular Surgery, Sacred Heart Medical Center, Spokane, Washington, USA

DAVID E. BLUMFIELD, MD, FACC

Director, Coronary Care Unit, Kaiser Foundation Hospital, Los Angeles, California, USA

B. GREG BROWN, MD, PHD

Professor of Medicine, University of Washington, School of Medicine, Seattle, Washington, USA

MING C. CHAN, MD

Professor of Medicine, Chairman, Department of Medicine, Beijing Medical University, Beijing, China

WILLIAM S. COLEMAN, MD, FACC, FACS

Caridovascular Surgery, Sacred Heart Medical Center, Spokane, Washington, USA

ALAIN CRISlER, MD

Associate Professor of Cardiology, Centre Hospitalo-U niversitaire de Rouen, Rouen, France

xiv Contributors

MARCUS A. DEWOOD, MD, FACC

Director, Cardiology Research, Sacred Heart Medical Center, Spokane, Washington, USA

HAROLD T. DODGE, MD, FACC

Professor of Medicine, University of Washington, Director, Division of Cardiology, Seattle, Washington, USA

GERALD DORROS, MD, FACC

Assistant Clinical Professor of Medicine, St. Luke's Medical Center, Milwaukee, Wisconsin, USA

DAVIS DRINKWATER, MD

Assistant Professor of Surgery, Cardiothoracic Surgery, University of California, Los Angeles, California, USA

ADAM FISCHER, MD

Staff Cardiovascular Surgeon, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

JAMES S. FORRESTER, MD, FACC

Professor of Medicine, University of California, Director of Cardiovascular Research, Cedars-Sinai Medical Center, Los Angeles, California, USA

VALENTIN FUSTER, MD, FACC

Arthur M. and Hilda A. Master Professor of Medicine, Mount Sinai School of Medicine, Chief of Cardiology, Mount Sinai Medical Center, New York, New York, USA

SVEIN GOLF, MD

Fellow in Interventional Cardiology, Centre Hospitalier U niversitaire Vaudois, Lausanne, Switzerland

SHALE GORDON, MD

Staff Cardiologist, Kaiser Medical Center, Bellflower, California, USA

WARREN GRUND FEST , MD

Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA

ANN HICKEY, MD

Staff Cardiologist, Cedars Sinai Medical Center, Los Angeles, California, USA

DOUGLAS ISRAEL, MD

Fellow in Cardiology, Mount Sinai School of Medicine, New York, New York, USA

MARK E. JOSEPHSON, MD, FACC

Director, Division of Cardiology, Robinette Foundation Professor of Medicine, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania, USA

AMAR S. KAPOOR, MD, FACP, FACC

Director of Cardiovascular Research, Regional Medical Director of Heart Transplant Program, Kaiser Foundation Hospital, Clinical

Contributors

Associate Professor of Medicine, University of Southern California, Los Angeles, California, USA

LUKAS KAPPENBERGER, MD

Professor of Medicine, Chief of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

URS KAUFMANN, MD

xv

Staff Cardiologist, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

ZUHDI LABABIDI, MD, FACC

Director, Division of Pediatric Cardiology, Professor of Pediatric Cardiology, University of Missouri Hospital and Clinics, Columbia, Missouri, USA

HILLEL LAKS, MD, FACS

Director, Cardiovascular Surgery and Cardiac Transplantation, Professor of Surgery, University of California, Los Angeles, California, USA

GARRET T. LEE, MD, FACC

Director of Research, Northern California Heart and Lung Institute, Mount Diablo Hospital Medical Center, Concord, California, USA

JACK J. LEONARD, MD

Cardiovascular Surgery, Sacred Heart Medical Center, Spokane, Washington, USA

BRICE LETAC, MD

Professor of Cardiology, Chief of Cardiology, Centre Hospitalo-Universitaire de Rouen, Rouen, France

RUBEN F. LEWIN, MD

Isadore Feuer Fellow in Interventional Cardiology, St. Luke's Medical Center, Milwaukee, Wisconsin, USA

FRANK LITVACK, MD

Assistant Professor of Medicine, University of California, Director, Catheterization Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA

REGINALD 1. Low, MD, FACC

Interventional Cardiologist, Diagnostic and Interventional Cardiology Consultants, Sacramento, California, USA

PETER R. MAHRER, MD, FACC

Director, Division of Cardiology, Director, Regional Cardiac Catheterization Laboratory, Kaiser Foundation Hospital, Clinical Professor of Medicine, University of Southern California, Los Angeles, California, USA

DEAN T. MASON, MD, FACC

Physician-in-Chief, Western Heart Institute, Chairman, Department of Cardiology, St. Mary's Hospital Medical Center, San Francisco, California, USA

xvi Contributors

LYNNE MA THIAK, RN St. Luke's Medical Center, Milwaukee, Wisconsin, USA

MICHEL MIROWSKI, MD, FACC Director, Coronary Care Unit, Professor of Medicine, John Hopkins School of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

MORTON M. MOWER, MD, FACC Director, Cardiology Division, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

SURESH RAMAMURTI, MD Staff Cardiologist, Kaiser Medical Center, Panorama City, California, USA

DONALD G. RUBENSTEIN, MD Staff Cardiologist, Kaiser Medical Center, Panorama City, California, USA

HOSSEIN SADEGHI, MD Professor of Surgery, Chief of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

TIMOTHY A. SANBORN, MD Associate Professor of Medicine, Mount Sinai School of Medicine, Director, Interventional Cardiology Research and Laser Angioplasty Program, Mount Sinai Hospital, New York, New York, USA

MELVIN M. SCHEINMAN, MD, FACC Director, Electrophysiology Laboratory, Moffit Hospital, Professor of Medicine, University of California, San Francisco, California, USA

SAMUEL L. SELINGER, MD, FACS, FACC Cardiovascular Surgery, Sacred Heart Medical Center, Spokane, Washington, USA

ULRICH SIGWART, MD, FACC Associate Professor of Medicine, Centre Hospitalier Universitaire Vaudois, Division of Cardiology, Lausanne, Switzerland

BUDGE H. SMITH, MD Acting Instructor, University of Washington, Division of Cardiology, Seattle, Washington, USA

DIANE SOBKOWICZ, MD Fellow in Cardiology, Kaiser Foundation Hospital, Los Angeles, California, USA

ROLF G. SOMMERHAUG, MD Chief, Cardiac, Thoracic and Vascular Surgery, Northern California Heart and Lung Institute, Concord, California, USA

NICHOLAS J. STAMATO, MD, FACC Clinical Assistant Professor of Medicine, Loyola University, Stritch School of Medicine, Midwest Heart Specialists, Lombard, Illinois, USA

Contributors

BERNARDO STEIN, MD

Fellow in Cardiology, Mount Sinai School of Medicine, New York, New York, USA

LYNNE WARNER STEVENSON, MD

xvii

Assistant Professor of Medicine, University of California, Los Angeles, California, USA

INDUBALA N. V ARDHAN, MD

Fellow in Cardiology, Kaiser Foundation Hospital, Los Angeles, California, USA

ENRICO P. VELTRI, MD

Director, Sudden Death Prevention Program, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

CAROL ZAHER, MD, FACC

Chief of Cardiology and Director of Electrophysiology, Kaiser Medical Center, Panorama City, California, USA