Presentation on theme: "Dr. Giuseppe Sangiorgi, FESC, FSCAI Laboratorio di Emodinamica"— Presentation transcript:
1 Dr. Giuseppe Sangiorgi, FESC, FSCAI Laboratorio di Emodinamica Ruolo della cardiologia interventistica nel paziente con patologia extracoronarica complessaDr. Giuseppe Sangiorgi, FESC, FSCAILaboratorio di EmodinamicaUniversità di Modena
2 Giuseppe Sangiorgi, MDCardiac Cath LabModena Policlinic
3 L’idraulico dell’Extracoronarico Quanti di voi hanno mai chiamato l’idraulico?Avete chiamato l’idraulico per il gabinetto ed è arrivato uno specialista solo in docce?Noi emodinamisti dovremmo saper riparare tutto?
6 Chi vede il Paziente Affetto da Patologia Extracoronarica ? Medicina InternaChirurgiaChirurgo GeneraleCardiochirurgoChirurgo VascolareNeurochirurgoRadiologiaNon-interventistaInterventistaNeuroradiologoMEDICINA DI BASEMEDICINA D’URGENZAInternistaCardiologo clinicoCardiologo interventistaAngiologoNefrologoNeurologo
8 My personal experience in developing an “open cath-lab platform”
9 In 15 MinutesHow all this developed in the places where I have been working up to nowand how this could develop in your place (I really hope your dreams comes true)What you really need to make that happenand what could be helpful in these daysHow this will develop in the futureand where we should work on
11 1989University of Tor Vergata - RomeCoronary angiogramsPTCA
12 Max Sangiorgi: "Is there anything else I could do?" Senior Physician (Prof. Gioffrè): "Well, I have just got this balloon from Meditech. Some crazy people have started to dilate pulmonary valves"
13 Starting a pulmonary valvuloplasty program was pretty easy at that time Doctor: "Listen, you have a blocked heart valve! We are going to balloon it"Patient: "Great, please go ahead"No ethical committeeNo regulatory issuesNo reimbursement issuesNo paperwork at all
14 That's how we started to do something else beside coronaries 1989
15 If you are doing coronaries only … … could you start a pulmonary valvuloplasty program in your institution today?
16 Of course!! No problem You may just need … some discussion with the general director of the hospitalsome discussion with CADMsome discussion with administrationsome discussion with pharmacysome discussion with clinical engineera little bit more of discussion with the surgeons than we had in the 80iesa dedicated 3 day training organized by the medical device companya certificate from the scientific society of somethingMay be you will need IRB approvaland may be some other paper work
17 Needless to mention …… that it is an absolute requirement that you already have done 100 cases (for the general director and CADM) with excellent outcome before you start your program
18 1990 PTCA in a 68 y/o patient I punctured the right femoral and failedI punctured the left femoralI punctured the right brachialI did not know about the radial approachand punctured the left brachialcrossed a proximal stenosis of the left subclavian… finally performed the PTCA"Would be nice to have that subclavian artery open"The cath lab nurse run into the radiology department for a 5 mm balloonI did my first peripheral angioplasty… and finally learned what turf battle means
19 Next morning in the office of the head of radiology Head of radiology (Prof. Giovanni Simonetti): "How could you as a cardiologist do a peripheral angioplasty without permission?!?! What would you say if I as a radiologist would start coronary angiography?"My answer: "I would be more than happy to train you"Head of radiology: very angry with cardiologists after 20 years
20 We moved on with other procedures which required big balloons
30 So you will become involved in post-Myocardial infarction VSD closure Of course, you are still involved in the sometimes boring coronary workSo you will become involved in post-Myocardial infarction VSD closure
31 Post Myocardial Infarction VSD Device released Final angio
32 Do not forget the coronary fistulas By the way:Do not forget the coronary fistulas
59 PTA Carotide Comune Post PTA Post stent J&J 204 Remo S. Rx 11323 22\02\1995
60 Bartolomeo G.Rx24\01\2007Association of critical left CCA ostialand distal calcified stenosis atbifurcation.Strategy : exposure of CCA, directstenting of ostial and CEA atPost direct JOMED P 38 stenting
71 High prevalence and high morbidity (non-healing wounds, gangrene, and amputation) lead to the publication of a “call to action” to physicians to increase detection of and treatment for PADThe Prevention of Atherothrombotic Disease NetworkArch Intern Med 2003;63:884–92.
77 Sensitivity and specificity Resting ABI value <0.9 approaches 95% sensitivity in detecting angiogram positive disease, and it is associated with the presence of 50% or greater stenosis in 1 or more major vessels.It is almost 100% specific in excluding healthy individuals.
79 We have been involved in all of this Can you become involved as well?
80 Of course!! No problem You may just need … some discussion with the director of the hospitalsome discussion with the administrationsome discussion with the health care insurancesa little bit more of discussion with the surgeons than we had in the 80iesa dedicated 3 day training organized by the medical device companya certificate from the scientific society of somethingMay be you will need IRB approvaland may be some other paper work
82 You really need Cath lab Echo and TEE and someone who helps you with that… and for some more complex procedures… anestesiologist, Vascular surgeons, neurologists, cardiothoracic surgeons
83 You don't really need Hybrid room CT MRI 3 D Angio Although all this may be helpful
84 And of course all of the following is helpful in these days some discussion with the director of the hospitalsome discussion with the administrationsome discussion with the health care insurancesa little bit more of discussion with the surgeons than we had in the 80iesa dedicated 3 day training organized by the medical device companya certificate from the scientific society of somethingIRB approvaland may be some other paper work
85 In 15 MinutesHow all this I have been wish that could developed in my place that now is Modenaand how this could develop in your placeWhat you really need to make that happenand what could be helpful in these daysHow this will develop in the futureand where we should work on
86 There will be much more catheter techniques available to treat all kind of cardiovascular diseases
88 We should always try to keep the doors open to stop over-regulation to avoid turf battlesand to train the radiologists and vascular surgeons in coronary angiography
89 ConclusioniIl trattamento percutaneo delle diverse patologie periferiche si è rapidamente sviluppato ed è in rapida evoluzioneMolte applicazioni interventistiche periferiche hanno tratto enorme vantaggio dalla traslazione della tecnologia coronaricaL’intero campo ha avuto ed avrà enormi benefici dalla partecipazione di un maggior numero di colleghi cardiologiCome cardiologi, la partecipazione in questo programma di sviluppo è imperativa