Interventional cardiology: state of the art

Since the advent of percutaneous transluminal coronary angioplasty (PCTA) in 1977, a new breed of cardiologists was born "Interventional Cardiologists". To date, a wide range of new interventions have been developed including percutaneous closure of atrial septal defects and balloon dilatation of the pulmonary valve and mitral valvuloplasty among others. In 1994, the final position of interventional cardiology is not fully defined but indicates what can be expected in the near future. Conventional coronary angioplasty presently accounts for over 90% of all coronary interventions and is likely to remain the cornerstone of coronary interventions. New techniques include stents which have been shown to be effective in acute and threatening occlusions as part of the armamentarium against restenosis. The Rotablator is a technique which uses an olive-shaped high-speed burr coated with diamond chips used for debulking lesions though to represent a high risk/low success rate for balloon angioplasty. Directional coronary atherectomy, transluminal extraction catheters, and Rotacs (a low-speed rotator) have also been developed. Laser angioplasty, which initially created great enthusiasm, probably will be of limited use. Mitral balloon valvuloplasty has emerged as the most common balloon valvuloplasty performed world-wide. It can be performed with or without fluoroscopy, particularly useful in pregnant women. Balloon valvuloplasty is also the treatment of choice in cases of pulmonary stenosis and balloon dilatation of the aortic valve, initially developed for children is now indicated in adults with the exception of elderly patients with calcified valves for whom valve replacement is indicated. Other interventions currently performed include balloon angioplasty for aortic coarctation following surgical repair and transcatheter closure of shunts. Patent ductus arteriosus, atrial septal defect and ventricular septal defect are choice indications. Certain congenital heart diseases including the creation of atrial septal defects in neonates whose survival depends on such a shunt and the treatment of pulmonary branch stenosis, venous obstructions, discrete subaortic stenoses and dilatation of the infundibular stenosis. Coil embolization of arteriovenous fistulae has also been developed. Finally, ablative techniques of invasive electrophysiology have further widened the indications of interventional techniques in cardiology which will continue to develop as an important pole of research and clinical applications in the future.