ABC of Interventional Cardiology by Ever D. Grech

By Ever D. Grech

Vast, and occasionally complicated, features of interventional cardiology are offered in a transparent, concise and balanced demeanour. this simple to learn textual content, supplemented by means of a variety of photos and pix, will attract a wide readership, together with clinical scholars, kin medical professionals, physicians, and cardiology.

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Comparison of ethanol septal reduction therapy with surgical myectomy for the treatment of hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 2001;38:1701-6 x Braun MU, Fassbender D, Schoen SP, Haass M, Schraeder R, Scholtz W, et al. Transcatheter closure of patent foramen ovale in patients with cerebral ischaemia. J Am Coll Cardiol 2002;39: 2019-25 x Waight DJ, Cao Q-L, Hijazi ZM. Interventional cardiac catheterisation in adults with congenital heart disease. In: Grech ED, Ramsdale DR, eds.

The final event is the binding of fibrinogen to activated glycoprotein IIb/IIIa receptors to form a platelet aggregate. Understanding of these mechanisms has led to the development of potent anticoagulants and antiplatelet inhibitors that can be used for percutaneous coronary intervention. Since the early days of percutaneous transluminal coronary angioplasty, heparin and aspirin have remained a fundamental part of percutaneous coronary intervention treatment. Following the introduction of stents, ticlopidine and more recently clopidogrel have allowed a very low rate of stent thrombosis.

This activates prothrombotic factors, leading to localised thrombosis; this may impair blood flow, precipitate vessel occlusion, or cause distal embolisation. Coronary stents exacerbate this problem as they are thrombogenic. For these reasons, drug inhibition of thrombus formation during percutaneous coronary intervention is mandatory, although this must be balanced against the risk of bleeding, both systemic and at the access site. Adhesion Thrombin inhibitors Clopidogrel Ticlopidine Shear Thrombin stress Adenosine diphosphate Thromboxane A2 Activation Platelet Serotonin Collagen Glycoprotein IIb/IIIa Aggregation Antithrombotic therapy Unfractionated heparin and low molecular weight heparin Unfractionated heparin is a heterogeneous mucopolysaccharide that binds antithrombin, which greatly potentiates the inhibition of thrombin and factor Xa.

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