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This year, 33 years have passed since the first non-surgical treatment of a congenital heart defect. Nowadays, interventional cardiology, which can heal and save lives without opening the chest, is widely used.
About howinterventional cardiologyenablestreatment of heart diseaseswe talk to Marek Dąbrowski, an outstanding cardiologist, co-author of the extraordinary monograph "Interventional cardiology". Outstanding specialists present their achievements in this field. As the knowledge and healing techniques develop dynamically, the publication will be constantly supplemented with new treatment technologies.
- Modern cardiology is divided into invasive and non-invasive. How is it to be understood?
Doc. dr hab. n. med. Marek Dąbrowski: This division is related to the type of diagnostic and treatment techniques used. Non-invasive cardiology uses those techniques that provide information about the cardiovascular system without aggressive interference with the human body. They include, among others electrocardiography, echocardiography and scintigraphy or computed tomography. However, such tests may not fully show the condition of the affected heart. Invasive cardiology, which is based on cardiac catheterization, allows you to accurately assess its structures and functions. With this knowledge, we can choose the best treatment method for the patient.
- What does invasive cardiology do for the average person?
M.D.: This is, above all, a great opportunity for people with heart disease. The development of this field of cardiology enables less invasive treatment of an increasing number of heart diseases. Diseases that until recently could only be successfully treated by cardiac surgeons are today annexed by interventional cardiology - for example some valve diseases, congenital heart defects. We have the most spectacular successes in the treatment of recent heart attacks. It is important that doctors are able to do this, but for patients, the most important thing is wide access to this method of treatment. It is thanks to the organization of rapid cardiological intervention departments throughout the country. A lot has changed in Polish cardiology over the last 10 years. I remember well the lines of thousands of people waiting for coronary angiography - the basic examinationpaves the way for proper treatment or cardiological intervention. Currently, there are no queues in 100 centers in Poland. Coming back to the benefits for patients, it is a chance that a minimally invasive method, which in many cases replaces cardiosurgery or burdensome pharmacological therapies, will cure cardiovascular defects and diseases.
- What contributed to such a rapid development of interventional cardiology in Poland?
M.D.: The history of Polish interventional cardiology began in the 1970s. The first therapeutic procedure classified as interventional cardiology is considered to be the procedure performed by prof. Witold Ruzyłła - closure of Botall's ductus arteriosus using the Porstman technique. The treatment was a great event not only in Poland, but also in Europe. It was all the more important as those were bad times for Polish medicine. We had to fight for progress. Few people understood that without the development of technology, we would not be able to effectively treat the sick. At the time, many colleagues could not believe that a catheter could be inserted into the heart and that a congenital heart defect that was previously treated after opening the chest could be repaired. The technique used by prof. Ruzyłłę is no longer used today, but that's where it all started.
- Another breakthrough came in the 1980s …
M.D .: Yes, with the development of coronary angioplasty. It is also thanks to prof. They ruined. I was lucky to participate in these treatments. The impressions of those moments are always fresh. The patient had severe stenosis of the coronary artery. He was in danger of having a heart attack. It was not yet a treatment for a recent infarction as surgery is understood today, but that is how it started. The patient was in severe pain, he could not walk, work and was confined to bed. I perfectly remember its limitations. After the coronary artery dilation surgery, all symptoms resolved permanently. The next stage in the development of interventional cardiology is pulmonary valve surgery in children, and later in adults. The introduction of percutaneous valve surgery allowed many patients to avoid cardiac surgery. It's nice to see the sick get out of bed after a few hours and are independent. It is a great boon of interventional cardiology, a micro-surgical discipline.
- Interventional cardiology is entering today where it used to be impossible to do without opening the chest …
M.D .: It's true. Our goal is to develop techniques that will allow you to treat heart disease without the use of a scalpel. This will ensure greater comfort for patients, a shorter stay in the hospital, and reduce the costs of treatment. Interventional cardiology is not required in most situationsgeneral anesthesia, local anesthesia is sufficient, unless the patient is a young child. Classic heart surgery cannot be performed without the use of extracorporeal circulation, which - despite enormous progress - still has many disadvantages. To get inside the heart, the cardiac surgeon has to stop it. This is achieved by administering a cold potassium solution to the coronary arteries. During the operation, it may happen that the heart muscle is damaged. Another problem is bleeding from the surgical wound. Several drains are left in the chest to drain this blood away. It is often necessary to administer foreign blood. The psyche of the sick person is also important. Patients are less afraid of interventional cardiology, which is as important as the doctor's knowledge and experience.
- What then is the most typical interventional cardiology procedure?
M.D.: Various types of catheters are inserted into the heart, on which very specialized devices are mounted, allowing for precise manipulation. The procedure is performed by an interventional cardiologist and does not require dissection of the chest and the heart itself. Catheters and additional devices are inserted through peripheral veins or arteries, most often femoral or radial. This is the fundamental difference between interventional cardiology and cardiac surgery. The cardiac surgeon must work on an open chest. We are a bit softer. Generally speaking, using interventional cardiology procedures, you can widen the narrowed places in the heart or blood vessels, and even open closed vessels, you can close defects in the heart, remove additional blood vessels that have arisen in utero, and you can reduce the effects of various heart defects.
- In what situations are the most common methods of interventional cardiology?
M.D .: Angioplasty procedures involving the introduction of balloons into the narrowed coronary vessels, which effectively expand the vessels and allow blood to flow freely, are commonly performed. When a balloon is introduced through the catheter into the stricture site, it is filled with saline. The bloated balloon widens the vessel. You can also implant a stent. It is a steel cylinder-shaped frame that prevents the vessels dilated with a balloon from narrowing again. When the stent introduced through the catheter reaches its destination, the introducing balloon increases in volume. This allows the stent to expand and the physician to easily withdraw the balloon. Another technique of interventional cardiology allows you to close malfunctioning vessels. Samethis method is used to close the openings in the septum of the heart.
- Do you dream about performing some new heart surgery using non-surgical methods?
M.D .: Maybe it is less a dream and more a need for a moment. I would like to be able to perform procedures on the mitral valve, which will consist of its sealing. This group of patients usually has a history of infarction and their mitral valve is damaged due to ischemia. The valve does not close and this leads to heart failure. Today, this group of patients is treated surgically. But there are chances to do such treatments with the percutaneous method. The first treatments of this type have already been carried out in Poznań, but there is still no distributor of the device needed for this. We are waiting for it. If the device appears, which I hope will happen at the turn of 2009 and 2010, I will be happy to join the rhythm of these treatments. We are more and more effective in saving patients after a heart attack, but we still cannot protect them all from the destruction of the heart muscle. Over time, these people develop heart failure and valve regurgitation.
- We keep hearing about searching for new solutions. What else can we expect from this field of cardiology?
M.D .: Interventional cardiology is developing. very quickly, but it certainly solves only some of the problems, the end of the possibilities has not yet been reached. I believe that with time new methods, techniques and new devices will be developed that will allow to effectively treat further heart defects or diseases of the circulatory system without the need to open the chest. Perhaps we will have to wait many years for new solutions, or maybe they will appear in a few months. Who knows …Important
doc. dr hab. n. med. Marek DĄBROWSKI- An outstanding cardiologist, in 1985, as the first in Poland, he performed an intervention in acute myocardial infarction. He is the head of the clinical cardiology department at the Bielański Hospital in Warsaw.