Interventional cardiology is a branch which has been extremely exciting since its inception. Starting with Werner Frossman who in 1935 did a self-catheterization to Charles Dotter the father of peripheral angiography and then onto Mason Soanes who perform the first coronary angiography albit by chance in a young girl while performing an aortic Root Shoot.
 | |
It was Andreas Grunzig a young East
German who had settled in Zurich who did the first peripheral balloon
angioplasty in 1974 and subsequently did the first coronary angioplasty in 1978
in a 38 year old insurance agent who is still alive. It was a pity that Grunzig
perished in a plane crash in 1985. In India interventional cardiology however
was only started in 1986 when people like Samuel
Mathew, Ashwin Mehta, Ashok Seth, D. B
Palajani and Brian Pinto did the first procedures in 1986 & 1987.
Equipment was not the best and it was
necessary for Cardiac surgical standby for all cases as there was a 5-10%
chance of complications.
In 1991 Campeu did the first Trans
radial angiography and by 1992 Ferdinand kimenji had performed Trans radial
angioplasty. This Trans radial approach only came to India in 2000 when doctors
like Tejas Patel, Abhichand Rajput and Brian Pinto started this in the country
and now this is a standard procedure in most cardiac cath labs across the
country.
Somewhere in the early 1980's the
Beaumont hospital with Bill O'Neil at the helm started the procedure of PAMI
(Primary Angioplasty in Myocardial Infarction) which is now the procedure of
choice for patients with heart attack.
In the early 90's for calcified
lesions the Rotablator was introduced by David Auth and this has a niche
indication.
Subsequently the imaging modalities of
IVUS and OCT have made life much easier by giving excellent intra-luminal
pictures and guiding angioplasty in a better way.
FFR (Fractional Flow Reserve) has made
angioplasty more physiological by giving intra-luminal pressure and flow
dynamics guiding cardiologists to what blocks need to be tackled and those that
can be left alone.
Stents became available in the early
90's and then by 1995 J&J and Boston Scientific had introduced them in our
country and stenting was the next dimension to take care of complications and
reduce restenosis.
Drug eluting stents was the next
frontier to further reduce complications and restenosis and the field of
interventional cardiology has never looked back.
In the last few years the IVL balloon
which is form of lithotripsy to deal with both superficial and deep calcium has
further expanded the field.
Add to this the changes which have
come up in structural heart including TAVI (Trans Catheter Aortic Valve Implantation),
LA(Left Atrial), Appendage closure, Mitra clip and other procedures such as ASD
(Atrial Septal Defect) closure and VSD (Ventricular Septal defect) closure and
you can see that the hands of the interventional cardiologist is full and is
ever expanding.
(MD, DM, FACC, FESC)
Director Cardiology & Cardiovascular Services
Holy Family Hospital Bandra West, Mumbai
Comments
Post a Comment