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GROSSMAN & BAIM’S Cardiac Catheterization, Angiography, and Intervention

Mauro Moscucci

NINTH EDITION

Grossman & Baim’s Cardiac Catheterization, Angiography, and Intervention

NINTH EDITION

EDITOR MAURO MOSCUCCI | MD, MBA Adjunct Professor of Medicine Division of Cardiovascular Medicine Department of Internal Medicine

University of Michigan Ann Arbor, Michigan

Executive Editor: Sharon Zinner Senior Development Editor: Ashley Fischer Senior Editorial Coordinator: Lindsay Ries Production Project Manager: David Saltzberg Design Coordinator: Stephen Druding Manufacturing Coordinator: Beth Welsh Prepress Vendor: TNQ Technologies

9th edition

8th edition Copyright © 2014 Lippincott Williams & Wilkins, a Wolters Kluwer business. 7th edition Copyright © 2006 by Lippincott Williams & Wilkins. 6th edition Copyright © 2000 by Lippincott Williams & Wilkins. 5th edi tion Copyright © 1996 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at shop. lww.com (products and services).

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Library of Congress Cataloging-in-Publication Data ISBN-13: 978-1-4963-8637-3

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To my mentors and colleagues—Bill Grossman and Donald Baim—recognizing their charismatic vision and persistence in creating and sustaining this textbook and in training and mentoring multiple generations of cardiologists. And to my wife Adriana and my children, Alessandra and Matteo. To Adriana for her love and support, and for adapting her life to the many months of night and weekend work that were required to create the prior and this ninth Edition, and to my now grown up children for their continuous understanding and support over the many years of my journey in cardiology.

Contributors

Paolo Angelini, MD Medical Director Center for Coronary Artery Anomalies Texas Heart Institute Houston, Texas Gabriele Egidy Assenza, MD Attending in Cardiology Adult Congenital Heart Disease Program Department of Cardiac, Thoracic and Vascular Medicine Azienda Ospedaliera-Universitaria Policlinico Sant’Orsola-Malpighi Bologna, Italy Luiza Bagno, DVM, PhD Assistant Scientist Interdisciplinary Stem Cell Institute University of Miami Miller School of Medicine Miami, Florida Stephen Balter, PhD Professor of Clinical Radiology (Physics) in Medicine Columbia University Medical Center New York, New York Wayne B. Batchelor, M.D, MHS, FACC, FSCAI Director of the Interventional Heart Program, Inova Health System Director of Interventional Heart Disease Research, Education, and Innovation Associate Director, Inova Heart and Vascular Institute Inova Heart & Vascular Institute Falls Church, Virginia

Michael I. Brener, MD Fellow, Cardiovascular Medicine Division of Cardiology Columbia University Medical Center New, York, New York Daniel Burkhoff, MD, PhD Director Heart Failure, Hemodynamics and Mechanical Circulatory Support Research Cardiovascular Research Foundation New York, New York Joseph D. Campbell, MD Staff Physician Department of Cardiovascular Medicine

Cleveland Clinic Cleveland, Ohio Ronald P. Caputo, MD, FACC, FSCAI Director, Cardiac Services St. Joseph’s Health East Syracuse, New York Blase A. Carabello, MD Professor and Chief, Division of Cardiology

Brody School of Medicine East Carolina University Greenville, North Carolina

John D. Carroll, MD Professor of Medicine Director, Interventional Cardiology and Structural Heart Disease Interventions Divisions of Cardiology Departments of Medicine University of Colorado Anschutz Medical Campus Aurora, Colorado Sandra V. Chaparro, MD, FACC Director of Advanced Heart Failure Program Miami Cardiac and Vascular Institute Baptist Health South Florida Miami, Florida

Arnon Blum, MD Associate Professor Department of Medicine Baruch Padeh Medical Center Azrieli Faculty of Medicine

Bar-Ilan University Lower Galilee, Israel Barry A. Borlaug, MD Professor of Medicine Department of Cardiovascular Medicine Mayo Clinic Rochester, Minnesota

Contributors

Stanley J. Chetcuti, MD Professor of Medicine Eric J. Topol Professor of CVM Director Cardiac Catheterization Laboratory

Marc D. Feldman, MD Professor of Medicine Briscoe Distinguished Professor of Cardiology Research

Director, Cardiac Care Unit University of Texas Health San Antonio, Texas Michael A. Fifer, MD Professor Department of Medicine Massachusetts General Hospital Harvard Medical School Boston, Massachusetts Peter J. Fitzgerald, MD, PhD

Co-Director Structural Heart Service Division of Cardiovascular Medicine Department of Internal Medicine

University of Michigan Ann Arbor, Michigan Kyung J. Cho, MD Professor Emeritus Department of Radiology

University of Michigan Ann Arbor, Michigan Mauricio G. Cohen, MD, FACC, FSCAI Professor of Medicine University of Miami Miller School of Medicine Director, Cardiac Catheterization Laboratory University of Miami Hospitals & Clinics Miami, Florida Kevin Croce, MD, PhD Assistant Professor of Medicine Harvard Medical School Cardiovascular Medicine Brigham and Women’s Hospital Boston, Massachusetts Abdulla A. Damluji, MD, PhD, MPH Assistant Professor of Medicine Department of Medicine, Johns Hopkins University Cardiovascular Division Department of Medicine

Professor Emeritus of Medicine and Engineering Director, Center for Cardiovascular Innovation Stanford University Stanford, California William Grossman, MD Charles and Helen Schwab Endowed Chair in Preventive Cardiology Center for Prevention of Heart & Vascular Disease

Professor of Medicine University of California Cardiovascular Research Institute San Francisco, California Haris M. Haqqani, MBBS(Hons), PhD

Inova Center of Outcomes Research Inova Heart and Vascular Institute Falls Church, Virginia Andre D’avila, MD, PhD Director of Cardiac Electrophysiology Hospital SOS Cárdio de Florianópolis Florianópolis, Brazil Douglas E. Drachman, MD Director of Education Corrigan Minehan Heart Center Cardiology Division Massachusetts General Hospital Boston, Massachusetts James C. Fang, MD Professor of Medicine Chief, Division of Cardiovascular Medicine Department of Medicine Associate Professor Faculty of Medicine University of Queensland Brisbane, Australia Joshua M. Hare, MD Louis Lemberg Professor of Medicine Director of ISCI Interdisciplinary Stem Cell Institute Department of Medicine University of Miami Miller School of Medicine Miami, Florida Beau M. Hawkins, MD Associate Professor Department of Internal Medicine University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma Alan W. Heldman, MD, FSCAI Chief Executive Officer Vestion, Inc. Miami, Florida Copyright © 2020 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

University of Utah Salt Lake City, Utah

Contributors

Robert C. Hendel, MD, FACC, FAHA, FSCCT, MASNC Professor of Medicine and Radiology Sidney W. & Marilyn S. Lassen Chair in Cardiovascular Medicine Tulane University School of Medicine Chief, Section of Cardiology Director Tulane University Heart and Vascular Institute New Orleans, Louisiana David R. Holmes Jr, MD, MACC Scripps Professor in Cardiovascular Medicine Consultant, Division of Interventional Cardiology Department of Cardiovascular Medicine Mayo Clinic Rochester, Minnesota Yasuhiro Honda, MD Clinical Professor of Medicine Director, Cardiovascular Core Analysis Laboratory Division of Cardiovascular Medicine Cleveland Clinic Cleveland, Ohio Morton J. Kern, MD, MSCAI, FACC, FAHA Chief of Medicine Long Beach Veterans Administration Medical Center Long Beach, California Professor Department of Medicine University of California, Irvine Orange, California Ajay J. Kirtane, MD, SM, FACC, FSCAI Chief Academic Officer, Center for Interventional Vascular Therapy Director, NYP/Columbia Cardiac Catheterization Laboratories Stanford University Stanford, California Samir R. Kapadia, MD Chairman Department of Cardiovascular Medicine

Aaron Kugelmass, MD Professor Department of Medicine

University of Massachusetts Medical School-Baystate System Vice President and Medical Director, Heart and Vascular Program Chief of Cardiology Baystate Health System Springfield, Massachusetts Roger J. Laham, MD Associate Professor of Medicine

Department of Medicine Harvard Medical School Director, Structural Heart Center Department of Medicine Beth Israel Deaconess Medical Center Boston, Massachusetts

Michael J. Landzberg, MD Associate Professor of Medicine Departments of Medicine and Cardiology BACH Group: Brigham and Women’s Hospital and Boston

Children’s Hospital Harvard University Boston, Massachusetts Azeem Latib, MD Associate Professor

Department of Cardiology Montefiore Medical Center New York, New York Michael J. Lim, MD, FACC, FSCAI Jack Ford Endowed Professor Director, Center for Comprehensive Cardiovascular Care Saint Louis University School of Medicine Saint Louis, Missouri Charles J. Lutz, MD St. Joseph’s Health East Syracuse, New York Francis E. Marchlinski, MD Richard T and Angela Clark President’s Distinguished Pro fessor of Medicine Director of Cardiac Electrophysiology

Professor of Medicine Division of Cardiology Columbia University Medical Center New York-Presbyterian Hospital New York, New York Nils Kucher, MD Professor of Angiology Director University Clinic of Angiology Cardiovascular Division

University of Pennsylvania Health System Director of Electrophysiology Laboratory Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Vallerie V. McLaughlin, MD Professor Department of Internal Medicine Division of Cardiovascular Medicine

University Hospital Zurich, Switzerland

University of Michigan Ann Arbor, Michigan

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Contributors

Daniel Menees, MD Assistant Professor of Medicine Division of Cardiovascular Medicine Department of Internal Medicine University of Michigan Ann Arbor, Michigan Jorge Monge, MD Assistant Professor of Medicine Department of Medicine Weill Cornell Medical College New York, New York Mauro Moscucci, MD, MBA Adjunct Professor of Medicine Division of Cardiovascular Medicine Department of Internal Medicine

Abhiram Prasad, MD, FRCP, FESC, FACC Consultant, Department of Cardiovascular Diseases Professor of Medicine, Mayo Clinic College of Medicine Program Director, Interventional Cardiology Fellowship Mayo Clinic Rochester, Minnesota Robert A. Quaife, MD Professor, Medicine and Radiology Director, Advanced Cardiac Imaging Divisions of Cardiology, Nuclear Medicine, and Cardiotho racic Radiology Departments of Medicine and Radiology University of Colorado Anschutz Medical Campus Aurora, Colorado Stephen R. Ramee, MD, MS Medical Director Ochsner Heart Valve Center

University of Michigan Ann Arbor, Michigan

Ochsner Medical Center New Orleans, Los Angeles Sunil V. Rao, MD, FACC, FSCAI Professor of Medicine Division of Cardiovascular Medicine Duke University Health System Duke Clinical Research Institute

David W. M. Muller, MBBS, MD Associate Professor of Medicine University of New South Wales Cardiology Department, St Vincent’s Hospital Sydney Darlinghurst, New South Wales, Australia William W. O’Neill, MD Medical Director Center for Structural Heart Disease Henry Ford Hospital Detroit, Michigan Himanshu J. Patel, MD

Section Chief, Cardiology Durham VA Health System Durham, North Carolina Jon R. Resar, MD Professor of Medicine-Cardiology Department of Medicine/Division of Cardiology Johns Hopkins University Baltimore, Maryland John F. Robb, MD, FAHA, FACC, FSCAI, FSVM Professor of Medicine Geisel School of Medicine

Joe D. Morris Collegiate Professor Section Head, Adult Cardiac Surgery Department of Cardiac Surgery University of Michigan Hospitals Ann Arbor, Michigan

Tejas Patel, MD, DM, FACC, FESC, FSCAI Chairman and Chief Interventional Cardiologist, Apex Heart Institute, Ahmedabad, Gujarat, India Robert N. Piana, MD Professor of Medicine Director, Adult Congenital Cardiology Interventional Program Vanderbilt University Medical Center Nashville, Tennessee Duane S. Pinto, MD, MPH Associate Professor of Medicine Harvard Medical School Chief, Interventional Cardiology Department of Medicine Beth Israel Deaconess Medical Center Boston, Massachusetts Cardiology, Department of Medicine Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire Kenneth Rosenfield, MD, MSc Section Head, Vascular Medicine and Intervention Division of Cardiology Massachusetts General Hospital Boston, Massachusetts Arnold H. Seto, MD, MPA Chief of Cardiology Long Beach Veterans Administration Medical Center Long Beach, California Associate Clinical Professor Department of Medicine University of California Irvine Orange, California Copyright © 2020 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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Contributors

Mehdi H. Shishehbor, DO, MPH, PhD Director, Cardiovascular International Center Co-Director, Vascular Center Department of Medicine University Hospitals Cleveland Medical Center Cleveland, Ohio Daniel I. Simon, MD, FACC, FAHA, FSCAI Professor, CWRU School of Medicine President, University Hospitals Cleveland Medical Center Cleveland, Ohio Robert J. Sommer, MD Associate Professor Department of Medicine

Scott H. Visovatti, MD Assistant Professor Department of Internal Medicine Division of Cardiovascular Medicine

University of Michigan Ann Arbor, Michigan John G. Webb, MD Professor, Cardiology University of British Columbia Medical Director, Catheterization Lab St. Paul’s Hospital Director, Interventional Cardiology Research St. Paul’s Hospital Vancouver, British Columbia, Canada Christopher J. White, MD Professor and Chair of Medicine & Cardiology Medical Director Value Based Care System Chair for Cardiovascular Diseases Ochsner Medical Center New Orleans, Los Angeles Paul G. Yock, MD Weiland Professor of Medicine and Bioengineering Director, Byers Center for Biodesign

Columbia University New York, New York Alejandro J. Torres, MD Associate Professor Department of Pediatric Cardiology

Columbia University New York, New York Zoltan G. Turi, MD Professor of Medicine Cooper Medical School of Rowan University Camden, New Jersey Professor of Cardiology and Medicine Hackensack Meridian School of Medicine Hackensack, New Jersey

Stanford University Stanford, California Michael N. Young, MD Assistant Professor of Medicine Cardiovascular Medicine

Dartmouth-Hitchcock Medical Center Geisel School of Medicine at Dartmouth Lebanon, New Hampshire

Juan Viles-Gonzalez, MD Cardiac Arrhythmia Service Miami Cardiac & Vascular Institute Baptist Health South Florida Miami, Florida

Preface

My personal experience with Grossman’s Cardiac Catheterization, Angiography, and Intervention textbook started with the fourth edition in 1991, during my cardiac catheterization rotation as a cardiology fellow at the University of Chicago. That rota tion, under the mentorship of John Carroll and Ted Feldman, was sensational and led to a major change in my career. For the next 6 months, Grossman’s textbook became my evening reading, cover to cover, and I made the decision that inter ventional cardiology was going to be the future of my career. One year later, I moved to the Beth Israel Hospital in Boston for further training in interventional cardiology under the mentorship of Donald Baim and William Grossman. The rich ness of the Beth Israel Hospital program, the quality of the training both from a clinical and research perspective, and the charismatic leadership of Don Baim are unforgettable. Those two additional training years further shaped my professional development, and the friendships that I developed with many colleagues and with Don became a highlight of my career for the next three decades. Beginning with the fourth edition and all the way through the seventh, I did not miss a single edi tion of the textbook and I was delighted to see its evolution through the years. The publication in 2006 of the seventh edition of Grossman’s Cardiac Catheterization, Angiography, and Intervention was a milestone. After 30 years of shaping the textbook through six editions, William Grossman had stepped down as coeditor and Don Baim had taken the new duty as the lead editor. Unfortunately, the unexpected and premature death of Don Baim in 2009 was a major loss for the interventional community and a personal loss for me. I was thrilled to be asked to become the editor of the eighth edition of the textbook, which represented a new milestone. Dr. Grossman’s and Dr. Baim’s legacy remained, and the title was modified to Grossman and Baim’s Cardiac Catheterization, Angiography, and Intervention , to further reflect that legacy. The addition of color was a major, exciting new change in the textbook, while the basic structure was retained. Furthermore, to address the tremendous growth that had occurred in cardiac catheterization and interventional cardi ology, the total number of chapters increased from 34 to 46, and every chapter from the prior edition was updated where needed and expanded with further emphasis on hemodynamic data, hemodynamic tracings, interventional procedures, and the addition of new tables and images. A companion website containing cases covering a broad range of classic findings, specific procedures, anomalies, and complications was also included.

The 8th edition was released in 2014. Not-unexpectedly, since then, the field of interventional cardiology has con tinued to grow exponentially. Transcatheter aortic valve replacement has been expanded to low surgical risk patient populations, new technology for mitral valve, tricuspid valve, and pulmonic valve replacement and repair has been devel oped, left atrial appendage occlusion is now available for the prevention of stroke in patients with atrial fibrillation, and additional progress has been made in the management of congenital heart disease, and in better understanding of how older diagnostic and therapeutic technology can be further optimized. Thus, I was thrilled to be asked in 2018 to start working on this 9th edition and to continue to be the editor of the textbook. Returning readers will notice that the classic chapters in Section I—General Principles, Section II—Basic tech niques, Section III—Hemodynamic Principles, Section IV— Angiographic Techniques, Section V—Evaluation of Cardiac Function, and Section VI—Special Catheter Techniques from the 8th edition have been updated, while the overall structure has been maintained. Section VII—Interventional Techniques has been expanded with the addition of 3 new chapters. In the 8th edition, Chapter 33 provided a general overview of percutaneous therapies for valvular heart dis ease. Given the tremendous growth that has occurred in the transcatheter valve replacement and repair space, the infor mation provided in the 8th edition has been updated and provided in 2 separate chapters; Chapter 35 is dedicated to percutaneous therapies for aortic and pulmonic valve dis ease, and Chapter 36 is dedicated to percutaneous thera pies for mitral and tricuspid valve disease. With regards to the pulmonic valve, additional information is provided in Chapters 37 and 47. The third new chapter (Chapter 34) is dedicated to left atrial appendage occlusion and to alcohol ablation for hypertrophic cardiomyopathy, two important nonvalvular interventions.

As in the 8th edition, throughout this 9th new edition, particular effort has been made to referring the reader to updated guidelines, position statements, new clinical infor mation and technology developments, while maintaining the overall structure and historical character of the textbook. I hope that this new edition will elicit in returning and new readers the same excitement that I felt when I read cover to cover the 4th edition during my fellowship training at the University of Chicago. In addition, I hope that all the work of contributing authors and of the Wolter Kluwer’s editorial team will ultimately benefit our patients. Copyright © 2020 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

Preface

Finally, production of this textbook was completed during the Covid-19 pandemic, which as of this writing is still affecting all of us and the entire world. I do not have enough words to express my gratitude to the Wolter Kluwer’s team and to all the contributors of the textbook for their

support and dedication in making this project completed during such a challenging time. Mauro Moscucci, MD, MBA Baltimore, Maryland

Acknowledgments

First and foremost, I would like to thank Dr. William Grossman and Dr. Donald Baim for their charismatic men torship and guidance during my 2 years of training at the Beth Israel Hospital in Boston in the early 1990s and for their continued friendship during the following decades. I would also like to thank the entire Wolters Kluwer team, with whom I have been working since 2008. Fran DeStefano, in her role as the Acquisitions Editor of prior editions, had a critical role while I was shaping and planning the eighth edition. Following Fran’s retirement, Julie Goolsby, as acquisitions editor, and Leanne Vandetty, as product manager, provided

outstanding assistance for the 8th edition. More recently, Sharon Zinner, in her role as Executive Editor has contin ued to provide incredible support with recent past and ongo ing projects, including this 9th edition. In addition, I would like to thank Ashley Fischer, for her outstanding assistance and patience as Senior Development Editor and Lindsay Ries, for her support as Senior Editorial Coordinator. The incredible support (and patience) of the Wolters Kluwer team is what has made this 9th edition become true. Finally, I am extremely grateful to all the authors and many colleagues and friends who have contributed to this textbook.

Contents

Section III Hemodynamic Principles 227 10. Pressure Measurement 227 MAURO MOSCUCCI AND WILLIAM GROSSMAN 11. Blood Flow Measurement: Cardiac Output and Vascular Resistance 255 MAURO MOSCUCCI AND WILLIAM GROSSMAN 12. Shunt Detection and Quantification 271 WILLIAM GROSSMAN AND MAURO MOSCUCCI 13. Calculation of Stenotic Valve Orifice Area 281 BLASE A. CARABELLO AND WILLIAM GROSSMAN 14. Pitfalls in the Evaluation of Hemodynamic Data 293 ZOLTAN G. TURI Section IV Angiographic Techniques 303 15. Coronary Angiography 303 MAURO MOSCUCCI 16. Coronary Artery Anomalies 343 PAOLO ANGELINI AND JORGE MONGE 17. Cardiac Ventriculography 363 MAURO MOSCUCCI AND ROBERT C. HENDEL 18. Pulmonary Angiography 379 KYUNG J. CHO AND NILS KUCHER 19. Angiography of the Aorta and Peripheral Arteries 407 MICHAEL N. YOUNG, BEAU M. HAWKINS, KENNETH ROSENFIELD, AND DOUGLAS E. DRACHMAN

Contributors iv Preface ix Acknowledgments xi Online Cases xiv

Section I General Principles 1 1. Cardiac Catheterization History and Current Practice Standards 1 MAURO MOSCUCCI 2. Cineangiographic Imaging, Radiation Safety, and Contrast Agents 19 STEPHEN BALTER AND MAURO MOSCUCCI 3. Integrated Imaging Modalities in the Cardiac Catheterization Lab 45 ROBERT A. QUAIFE AND JOHN D. CARROLL 4. Complications 70 MAURO MOSCUCCI 5. Adjunctive Pharmacology for Cardiac Catheterization 101 KEVIN CROCE, MEHDI H. SHISHEHBOR, AND DANIEL I. SIMON Section II Basic Techniques 134 6. Percutaneous Transfemoral, Transseptal, Transcaval, and Apical Approach 134 ABDULLA A. DAMLUJI AND MAURO MOSCUCCI 7. Radial Artery Approach 165 MAURICIO G. COHEN, TEJAS PATEL, AND SUNIL V. RAO 8. Cutdown Approach: Brachial, Femoral, Axillary, Aortic, and Transapical 192 RONALD P. CAPUTO, CHARLES J. LUTZ, AND WILLIAM GROSSMAN 9. Diagnostic Catheterization in Childhood and Adult

Section V Evaluation of Cardiac Function 441

20. Stress Testing During Cardiac Catheterization: Exercise, Pacing, and Dobutamine Challenge 441 MARC D. FELDMAN, WILLIAM GROSSMAN, AND MAURO MOSCUCCI

Congenital Heart Disease 209 GABRIELE EGIDY ASSENZA AND MICHAEL J. LANDZBERG

21. Measurement of Ventricular Volumes, Ejection Fraction, Mass, Wall Stress, and Regional Wall Motion 462 MICHAEL A. FIFER AND WILLIAM GROSSMAN Copyright © 2020 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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Contents

22. Evaluation of Systolic and Diastolic Function of the Ventricles and Myocardium 473 WILLIAM GROSSMAN AND MAURO MOSCUCCI 23. Evaluation of Tamponade, Constrictive, and Restrictive Physiology 496 MAURO MOSCUCCI AND BARRY A. BORLAUG Section VI Special Catheter Techniques 511 24. Evaluation of Myocardial and Coronary Blood Flow and Metabolism 511 MORTON J. KERN, ARNOLD H. SETO, AND MICHAEL J. LIM 25. Intravascular Imaging Techniques 554 YASUHIRO HONDA, PETER J. FITZGERALD, AND PAUL G. YOCK 26. Endomyocardial Biopsy 587 SANDRA V. CHAPARRO AND MAURO MOSCUCCI 27. Percutaneous Mechanical Circulatory Support: Impella, Intra-aortic Balloon Counterpulsation, TandemHeart, Extracorporeal Bypass, and Right Ventricular Support Devices 610 MICHAEL I. BRENER AND DANIEL BURKHOFF Section VII Interventional Techniques 636 28. Percutaneous Balloon Angioplasty and General Coronary Intervention 636 ABHIRAM PRASAD AND DAVID R. HOLMES 29. Atherectomy, Thrombectomy, and Distal Protection Devices 674 ROBERT N. PIANA 30. Intervention for Acute Myocardial Infarction 703 WILLIAM W. O’NEILL 31. Coronary Stenting 717 DAVID W.M. MULLER AND AJAY J. KIRTANE 32. Peripheral Intervention 772 JOSEPH D. CAMPBELL, SAMIR R. KAPADIA, AND MEHDI H. SHISHEHBOR 33. General Overview of Interventions for Structural Heart Disease 807 MAURO MOSCUCCI, JOHN D. CARROLL, AND JOHN G. WEBB 34. Nonvalvular Interventions: Left Atrial Appendage Closure and Alcohol Septal Ablation 819 MAURO MOSCUCCI AND STANLEY J. CHETCUTI 35. Percutaneous Therapies for Aortic and Pulmonary Valvular Heart Disease 841 ABDULLA A. DAMLUJI, WAYNE B. BATCHELOR, AND JON R. RESAR

36. Percutaneous Therapies for Mitral and Tricuspid Valve Disease 862 AZEEM LATIB AND DUANE S. PINTO 37. Intervention for Pediatric and Adult Congenital Heart Disease 893 ALEJANDRO J. TORRES AND ROBERT J. SOMMER 38. Cardiac Cell-Based Therapy: Methods of Application and Delivery Systems 927 JOSHUA M. HARE, LUIZA BAGNO, ARNON BLUM, AND ALAN W. HELDMAN 39. Endovascular Aortic Repair 953 HIMANSHU J. PATEL 40. Pericardial Interventions: Pericardiocentesis, Balloon Pericardiotomy, and Epicardial Approach to Cardiac Procedures 958 JUAN VILES-GONZALEZ, ANDRE D’AVILA, AND MAURO MOSCUCCI 41. Interventions for Cardiac Arrhythmias 974 Section VIII Clinical Profiles 994 42. Profiles in Valvular Heart Disease 994 DANIEL MENEES, MAURO MOSCUCCI, AND STANLEY J. CHETCUTI 43. Profiles in Coronary Artery Disease 1028 ROBERT N. PIANA AND AARON KUGELMASS 44. Profiles in Pulmonary Hypertension and Pulmonary Embolism 1051 SCOTT H. VISOVATTI AND VALLERIE V. MCLAUGHLIN 45. Profiles in Cardiomyopathy and Heart Failure 1073 JAMES C. FANG AND BARRY A. BORLAUG 46. Profiles in Pericardial Disease 1109 JOHN F. ROBB, ROGER J. LAHAM, AND MAURO MOSCUCCI 47. Profiles in Congenital Heart Disease 1125 GABRIELE EGIDY ASSENZA AND MICHAEL J. LANDZBERG 48. Profiles in Peripheral Arterial Disease 1151 CHRISTOPHER J. WHITE AND STEPHEN R. RAMEE HARIS M. HAQQANI AND FRANCIS E. MARCHLINSKI

Index 1179

Online Cases

Coronary Angiography Case 1

Case 29 Coronary anomalies–Anomalous Cx from RCA-2 Case 30 Coronary anomalies–Anomalous left coronary from RCA Case 31 Coronary anomalies–Coronary fistula Case 32 Coronary anomalies–anomalous origin of a coronary artery from the “opposite” sinus of Valsalva (ACAOS) – IVUS Case 33 Coronary Anomalies–Dedicated Catheter for cannulation of ACAOS Case 34 Coronary anomalies–left coronary to coronary sinus fistula Case 35 Coronary anomalies–Myocardial bridge - IVUS Left Ventriculography Case 36 Left Ventriculography–Cardiomyopathy Case 37 Left Ventriculography–Lateral MI with mitral regurgitation Case 38 Left Ventriculography–LV aneurysm with remodeling Case 39 Left Ventriculography–True aneurysm Case 40 Left Ventriculography–Pseudoaneurysm Case 41 Left Ventriculography–Post-MI VSD Case 42 Left Ventriculography–Post-MI VSD–StarFlex closure Case 43 Left Ventriculography–Tako-tsubo-1 Case 44 Left Ventriculography–Tako-tsubo-2 Case 45 Left Ventriculography–Obstructive HCM – alcohol septal ablation Case 46 Left Ventriculography–Mitral valve prolapse Case 47 Left Ventriculography–Papillary muscle rupture Case 50 Aorta and aortic valve–Traumatic aortic transection Case 51 Aorta and aortic valve–Aortic dissection fenestration Case 52 Aorta and aortic valve–Right sinus of Valsalva aneurysm Case 53 Aorta and aortic valve–Left sinus of Valsalva aneurysm Case 54 Aorta and aortic valve–Aortic regurgitation Case 55 Aorta and aortic valve–Peri-valve aortic regurgitation Case 56 Aorta and aortic valve–Aortic stenosis–crossing issues Case 57 Aorta and aortic valve–Cinefluoroscopy of mechanical valves Case 58 Aorta and aortic valve–Balloon aortic valvuloplasty Aorta and Aortic Valve Case 48 Aorta and aortic valve–Aortic dissection Case 49 Aorta and aortic valve–Aortic dissection-2

Coronary angiography–Simulated angiographic projection viewer Coronary angiography–Posterior LM origin, value of RAO caudal Coronary angiography–Superdominant RCA Coronary angiography–Separate ostia of the LAD and Cx Coronary angiography–Vascular left atrial myxoma Coronary angiography–Coronary ectasia Coronary angiography–Atherosclerotic coronary aneurysm Coronary angiography–Coronary aneurysm– Kawasaki-1

Case 2

Case 3 Case 4

Case 5 Case 6 Case 7

Case 8

Case 9 Coronary angiography–Coronary aneurysm– Kawasaki-2 Case 10 Coronary angiography–Non-obstructive coronary disease Case 11 Coronary angiography–Small coronary clot, use of pressure wire for borderline lesion Case 12 Coronary angiography–Ostial left main and RCA lesions Case 13 Coronary angiography–Lucent left main due to eccentric lesion Case 14 Coronary angiography–Borderline left main–IVUS evaluation Case 17 Coronary angiography–Coronary spasm post stent Case 18 Coronary angiography–Catheter tip-induced spasm Case 19 Coronary angiography–Pleating artifact–RCA Case 20 Coronary angiography–Pleating artifact–LAD Case 21 Coronary angiography–Spontaneous and catheter- induced dissections Case 22 Coronary angiography–Left main dissection–stent rescue Case 15 Coronary angiography–Muscle bridge Case 16 Coronary angiography–Coronary spasm

Case 23 Coronary angiography–Bridging collaterals Case 24 Coronary angiography–Kugel collateral Case 25 Coronary angiography–Vieussens collateral Case 26 Coronary angiography–LAD collaterals

Coronary Anomalies Case 27 Coronary anomalies–Anomalous high anterior origin of RCA Case 28 Coronary anomalies–Anomalous Cx from the RCA-1

Online-only cases can be accessed through the eBook bundled with this text. Instructions are located on the inside front cover.

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Online Cases

Case 59 Aorta and aortic valve–Percutaneous aortic valve replacement–-Edwards-Sapien valve - antegrade transseptal approach Case 60 Aorta and aortic valve–Percutaneous aortic valve Case 61 Aorta and aortic valve–Percutaneous aortic valve replacement–Corevalve Case 62 Aorta and aortic valve–Aortic coarctation stent repair Case 63 Aorta and aortic valve–Patent Ductus Arteriosus– Amplatz closure Case 64 Aorta and aortic valve–Patent DuctussArteriosus–coil closure Mitral Valve Case 65 Mitral Valve–Transseptal Puncture Case 66 Mitral valve–Balloon mitral valvotomy Case 67 Mitral Valve–Edge to edge repair Case 68 Mitral valve–Annuloplasty approaches and transcatheter valve replacement Case 69 Mitral Valve–Mechanical valve thrombosis Pericardium Case 70 Pericardium–Heart border in tamponade Case 71 Pericardium–Pericardiocentesis Case 72 Pericardium–Balloon pericardiotomy Case 73 Pericardium–Pericardial approach to the epicardium Pulmonary Case 74 Pulmonary–Congenital valvular pulmonic stenosis Case 75 Pulmonary–Pulmonary Embolus Case 76 Pulmonary–Selective balloon pulmonary angio Case 77 Pulmonary–IVC Filters Congenital Case 78 Congenital–Coil closure of pulmonary AV fistula Case 79 Congenital–Patent foramen ovale, and RV biopsy from below replacement–Edwards-Sapien valve - retrograde approach

Case 88 IVUS–Left Main Assessment Case 89 IVUS/OCT–Plaque Assessment

Stents Case 90 Stent issues–Ostial Cx plaque shift Case 91 Stent issues–Origin LAD stent Case 92 Stent issues–Cx bifurcation stent crush Case 93 Stent issues–Bifurcation kissing stents

Case 94 Stent issues–Left Main stent–alternative approaches Case 95 Stent issues–Force-focused angioplasty approaches Case 96 Stent issues–Re-stenting of stent margin restenosis Case 97 Stent issues–Restenosis of Kissing left main stent Case 98 Stent issues–Failures of crush and T-stent for bifurcations Post CABG Case 99 Post-CABG–Engagement of LIMA and SVG to RCA Case 100 Post-CABG–LAD endarterectomy with LIMA touchdown stenosis Case 101 Post-CABG–SVG venous valve Case 102 Post CABG–Ostial lesion in grafted OM Case 103 Post CABG–Complex native intervention for graft failure Case 104 Post-CABG–LIMA stent Case 105 Post-CABG–Percusurge embolic protection Case 106 Post CABG–FilterWire embolic protection Case 107 Post CABG–Proxis embolic protection Case 108 Post-CABG–Rapid progression of SVG disease

Case 109 Post-CABG–Total occlusion of SVG Case 110 Post-CABG–Complex SVG lesion Case 111 Post-CABG–SVG no-reflow Case 112 Post-CABG–Native vessel no reflow

Case 113 Post-CABG–total native LAD instead of SVG Case 114 Post-CABG–Fistula from SVG to coronary sinus

Total Occlusion Case 115 Total occlusion–Conventional stiff wires Case 116 Total occlusion–ILT SafeCross wire Case 117 Total occlusion in stent restenosis–Lumend Case 118 Total occlusion–Retrograde approach Thrombus Case 119 Thrombus–SVG AngioJet Case 120 Thrombus–Thrombectomy and atherectomy animations Case 121 Thrombus–AMI AngioJet for large thrombus Case 122 Thrombus–Primary PCI, with in stent restenosis

Case 80 Atrial Septal Defect closure Case 81 Congenital–VSD- AR, RVH Case 82 Congenital–Mustard Baffle Obstruction

Noninvasive Angiography Case 83 Noninvasive angiography–magnetic resonance Case 84 Noninvasive angiography–computerized tomography

IVUS AND OCT Case 85 IVUS–Basics Case 86 IVUS–Hematoma Case 87 IVUS–Incomplete Stent Apposition

xvi

Online Cases

Atherectomy Case 123 Atherectomy–Calcified LAD, Rotablator, balloon withdrawal issue Case 124 Atherectomy–Rotablator of calcified LAD Case 125 Atherectomy–Rotablator of calcified RCA Case 126 Atherectomy–Calcified ostial LAD Rota Complications Case 127 Complications–Coronary angio dye stain–VF Case 128 Complications–Coronary air embolism Case 129 Complications–Massive fatal coronary air embolism Case 130 Complications–Guiding catheter dissection into sinus of Valsalva Case 131 Complications–Left sinus of Valsalva dissection Case 132 Complications–DCA left main dissection–stented Case 133 Complications–LAD perforation–covered stent Case 134 Complications–Left main perforation Case 135 Complications–Subacute stent thrombosis, lretroperitoneal bleed Case 136 Complications–Thrombus on the guidewire Case 137 Complications–Retrieval of fractured pacemaker lead Case 138 Complications–Early post-CABG misadventures Case 139 Complications–Cerebral embolus–Neurovascular rescue Case 140 Complications–Fractured IVC Filter Vascular Access Case 141 Vascular access–General issues Case 142 Vascular access–Calcified femoral, occluded iliacs, radial catheterization Case 143 Vascular access–Femoral tips and misadventures Case 144 Vascular access–High stick–retroperitoneal bleed Case 145 Vascular access–Hypogastric artery laceration versus ureter Case 146 Vascular access–Iliac laceration Case 147 Vascular access–Femoral arterio-venous fistula Case 148 Vascular access–Thrombin injection of femoral pseudoaneurysm Case 149 Vascular access–Puncture of an AO-bifemoral graft Case 150 Vascular access–Groin Closure Animations Case 151 Vascular access–Thrombosis of an AngioSeal site

Peripheral Case 152 Peripheral–Renal artery stent–1 Case 153 Peripheral–Renal artery stent–2 Case 154 Peripheral–CHF with renal and subclavian stenosis Case 155 Peripheral–Renal accessory artery stent Case 156 Peripheral–Renal transplant stent Case 157 Peripheral–Renal fibromuscular dysplasia Case 158 Peripheral–Iliac and Subclavian interventions Case 159 Peripheral–Subclavian occlusion with steal Case 160 Peripheral–Total occlusion of subclavian–ILT wire

Case 161 Peripheral–Carotid Case 1 Case 162 Peripheral–Carotid case 2 Case 163 Peripheral–Carotid Case 3 Case 164 Peripheral–SFA Intervention 1 Case 165 Peripheral–Infra-popliteal atherectomy

Integrated Imaging Modalities Case 166 Integrated imaging modalities–Coronary artery disease: use of pre-procedure CTA for challenging coronary graft anatomy Case 167 Integrated imaging modalities–Congenital heart disease: pulmonic stenosis - use of C-Arm CTA and ICE totoptimize placement of valvuloplasty balloon andtdetect unsuspected ASD Case 168 Integrated imaging modalities–Congenital heart disease: secundumlatrial septal defect – CTA pre- procedural planning with transcatheter closure image guidance using realtime 3D TEE Case 169 Integrated imaging modalities–Valvular heart disease: mitral stenosis procedural guidance using real-time 3D TEE Case 170 Integrated imaging modalities–Valvular heart disease: aortic stenosis; CTA pre-planning and 3D model generation prior to TAVR Case 171 Integrated imaging modalities–Valvular heart disease: Preplanning and image guidance of peri-valvular leak closure Tricuspid Valve Case 172 Tricuspid Valve–Annuloplasty approaches Case 173 Tricuspid Valve–Edge to edge repair Case 174 Tricuspid Valve–Transcatheter valve replacement

Complications MAURO MOSCUCCI 4

T he risk of complications is inherent to any medical treat ment, irrespective of its invasive nature. In particular, given that cardiac catheterization involves inserting for eign objects (i.e., cardiac catheters) into the circulatory system and the use of catheters and devices to diagnose and treat vascu lar and structural abnormalities, it is not surprising that cardiac catheterization can be associated with a variety of complica tions. These complications range from minor problems with no long-term sequelae (e.g., transient bradycardia during coronary contrast injection) to major problems (e.g., cardiac perforation, abrupt closure of a coronary artery during percutaneous coro nary intervention [PCI]) that may require immediate surgical attention, to major and irreversible damage (e.g., stroke, myo cardial infarction, renal failure, or death). Fortunately, the risk of producing a major complication during most procedure types is generally below 1%, a level at which the risk-benefit ratio still favors the performance of cardiac catheterization to investigate or treat cardiac disorders that are themselves life-threatening or symptom-limiting. In this chapter, we outline general complica tions that are common to most procedures. For additional infor mation on less common complications, and on corresponding prevention and bailout techniques, our readers are referred to individual chapters in this textbook and to other textbooks that have been written on this topic. 1 OVERVIEW The determinants of the risk for sustaining a complication during an invasive procedure include the clinical character istics of the patient, the procedure type, equipment limita tions, and operator experience. The risk thus varies widely depending on demographics (age, gender), the cardiac anat omy (left main coronary artery disease, severe aortic steno sis, diminished left ventricular function), and the clinical

situation (unstable angina, acute myocardial infarction, car diogenic shock, aortic stenosis). Other variations in risk are based on the type of procedure being performed (diagnostic catheterization, coronary intervention, structural heart dis ease interventions) and to some extent on the experience and familiarity of the operator with that particular procedure. By considering all these factors, the physicians and sup port staff can arrive at a fairly accurate estimate of the level of risk entailed in any given procedure. Familiarity with those risks can be of immeasurable value in the following: (1) antic ipating increased risks of complications; (2) taking extra pre cautions to avoid them (e.g., implementation of an hydration protocol to reduce the risk of contrast nephropathy in patients with baseline chronic kidney disease); (3) promptly recogniz ing complications when they occur (e.g., perforation of the right atrium during a transseptal puncture); and (4) taking corrective and potentially lifesaving action (e.g., pericardio centesis for perforation-induced tamponade). Before proceeding with any procedure, the details of the planned procedure and its anticipated risks must be discussed candidly with the patient and family. 2 This discussion should include which specific procedures are planned, what benefits are hoped for, the attendant risks and their probabilities, and how the risks and benefits of the planned procedure com pare with those of any possible alternatives (e.g., coronary artery bypass graft surgery instead of PCI). By covering these cornerstones of informed consent clearly and candidly, the patient and family will be realistically prepared should a com plication occur. Such a discussion should be documented in the patient’s chart, and that documentation should specify the type of procedure that is planned, the potential major com plications, and their estimated risk of occurrence (see also Chapter 1). If a significant major complication does occur, the patient and family should be informed of the same as soon as the procedure has been completed (or when a delayed

Chapter 4 u Complications

complication occurs, as soon as it is recognized). This discus sion should describe the nature of the complication (without placing blame on anyone), indicate whether any long-term consequences are expected, and outline what corrective actions have been and will continue to be pursued. The cath eterizing physician should also continue daily inpatient fol low-up visits to any patient who has sustained a significant complication because a patient’s feeling of abandonment by an uncaring physician tends to foster a desire for retribution (i.e., a malpractice suit). Therefore, all individuals performing cardiac catheter ization should thoroughly know the potential complications of the procedures they perform, as detailed in this and other chapters. In addition, the catheterization laboratory direc tor should collect information about the frequency of these complications on at least a yearly basis and should review those data with the physician staff to identify where the lab oratory as a whole (or an individual operator) is performing below expected standards. The types of complications that are routinely tracked in this process are shown in Table 4.1 . This type of data collection, analysis (including breakdown by procedure type and by individual operator), reporting, and subsequent adjustment in laboratory policy and procedures 2 is one of the most important jobs of any catheterization labo ratory director and has now become a reporting requirement in several states. Participation to national registries is strongly encouraged, as it not only provides summary data but also provides an opportunity for quality improvement through benchmarking with peer organizations. Death as a complication of diagnostic catheterization has declined progressively over the last 30 years. Whereas a 1% mortality was seen with diagnostic catheterization in the 1960s, 3 the first Society for Cardiac Angiography registry of 53,581 diagnostic catheterizations performed in 1979 to 1981 showed a 0.14% procedure-related mortality. 4 By the second registry of 222,553 patients catheterized in 1984 to 1987, 5 procedure-related mortality for diagnostic catheterization had fallen further, to 0.1% (i.e., 1 in 1,000). This small reduction in mortality, however, belies the fact that the second registry included many more patients who fell into a high-risk sub group for the procedure. Based on variables identified from the 218 deaths in the second registry (age older than 60 years, New York Heart Association [NYHA] functional class IV, left ventricular ejection fraction <30%, or left main disease), the mortality for such patients fell by half between the first and second registry. 6 A third registry of 58,332 patients studied in 1990 showed an even lower overall mortality of 0.08%, with a 1.5% incidence of any major complication. 7 A num ber of baseline variables (including NYHA class, multivessel Because roughly 7% of patients undergoing coronary angiography have significant left main disease, the proto col used for coronary angiography (see Chapter 15) should always begin with careful catheter entry into the left coronary ostium to facilitate early recognition of ostial left main dis ease through catheter pressure damping or performance of a test “puff” immediately after engagement. Even without these early warnings of left main disease, we routinely perform the first left coronary injection in the right anterior oblique (RAO) projection with caudal angulation to screen for mid- and distal left main disease and get the maximal anatomic information on the first injection. If ostial left main stenosis is suspected, a straight anterior (AP) injection may be performed. If severe left main disease is present, the only other left coronary injec tion needed is an RAO projection with cranial angulation (to see the left anterior descending and its diagonal branches). Performing a large number of superfluous contrast injections in a patient with critical left main disease offers little more in the way of important anatomical information and increases the risk of triggering the vicious cycle of ischemia/hypoten sion/more ischemia that may lead to irreversible collapse. Careful attention to all other aspects of technique is essential, since even an otherwise minor complication (e.g., a vasovagal reaction or arrhythmia) may have fatal conse quences in this situation. If a patient with severe left main disease exhibits any significant instability during the proce dure, we usually opt to place an intra-aortic balloon pump (see Chapter 27) and arrange for prompt coronary artery bypass graft surgery. When the hemodynamics are markedly compromised and the patient is a poor surgical candidate, emergency coronary stenting can be performed if a trained operator and the necessary equipment are available (see Chapters 27 and 28). A similar consideration regarding the use of hemodynamic support applies to any patient with an unstable ischemic syndrome or acute myocardial infarction who behaves in a brittle fashion under the stresses of catheter placement and contrast injection. Copyright © 2020 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. DEATH Death as a Complication of Diagnostic Catheterization disease, congestive heart failure, and renal insufficiency) were identified in this registry, whose presence predicted up to 8-fold increase in major complication rates (from 0.3% in patients with none of these factors to 2.5%). 8 Several of the major factors are discussed below. Left Main Disease Although there has been a progressive reduction in the over all mortality of diagnostic cardiac catheterization over the last 25 years, patients with severe left main coronary disease remain at increased risk. Their mortality was 6% in the 1976 report by Bourassa 9 and 2.8% in the study by Boehrer and others performed between 1978 and 1992 (compared with a mortality of 0.13% in patients without such disease). 10 Although the mortality of such patients had fallen to 0.86% in the first Society for Cardiac Angiography registry, this was still more than 20 times higher than the 0.03% mortality seen in patients with single-vessel disease. 4

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