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Textbook of Catheter-Based CardiovascularInterventions

Peter LanzerEditorTextbook ofCatheter-BasedCardiovascularInterventionsA Knowledge-Based ApproachSecond Edition

EditorPeter LanzerMiddle German Heart Center andHealth Care Center Bitterfeld-Wolfen, gGmbHBitterfeld-WolfenGermanyFirst edition published 2013 with the title “Catheter-Based Cardiovascular Interventions;Knowledge-Based Approach”ISBN 978-3-319-55993-3    ISBN -55994-0(eBook)Library of Congress Control Number: 2018933378 Springer International Publishing AG, part of Springer Nature 2013, 2018This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part ofthe material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilarmethodology now known or hereafter developed.The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from therelevant protective laws and regulations and therefore free for general use.The publisher, the authors and the editors are safe to assume that the advice and information in thisbook are believed to be true and accurate at the date of publication. Neither the publisher nor theauthors or the editors give a warranty, express or implied, with respect to the material contained hereinor for any errors or omissions that may have been made. The publisher remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.Printed on acid-free paperThis Springer imprint is published by the registered company Springer International Publishing AGpart of Springer NatureThe registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Labor omnia vincit.Georgica (37–29 BC)Publius Vergilius Maro (70–19 BC)

PrefaceFour years have passed since the first edition of the Catheter-Based CardiovascularInterventions went to press. Based onSpringer statistics, the Textbook was a success, holding stably in the upper ranks ofthe Springer bestseller lists. The mainincentives for this early second editionwere the dramatic new developments andamazing progress in catheter-based cardiovascular interventions in this brief span oftime. The number of cardiovascular interventions continues to grow; nearly astronomical numbers of interventions areperformed worldwide today. Yet, besidessimple multiplications of numbers, numerous other important changes have alsotranspired. While even 4 years ago the fieldwas still dominated by largely vascularinterventions, the pendulum has nowmoved toward new targets and frontiersallowing minimally invasive managementof a steadily growing number of increasingly complex cardiovascular disorders.Besides broadening of the spectrum theinterventional field has dramaticallychanged in a number of other areas as well.Heightened public expectations of transparency, efficacy, and safety of interventional therapies have placed multiple newdemands on health care providers andoperators alike. To meet these new challenges new strategies of training and betterknowledge transfer are required; deliberatepractice, computer simulation, and exploration of the potential of robotics are but afew examples of new directions in whichthe field is moving and will need to explore.The second edition of the Textbookaddresses these new needs and new targets.In the first section, the professional expertise required in catheter-based cardiovascular interventions is reviewed and anoutlook into the new strategies of interventional knowledge acquisition is provided.Topics concerning interventional diagnos-tics are covered in the second section, followed by a section on interventional accessand hemostasis. In subsequent sections,the state of the art of interventional procedures is exposed in detail, allowing bothexperts and less advanced operators easyaccess to both knowledge-that (theory) andknowledge-how (practice) in each of thecardiovascular fields of expertise. In thefinal section of the Textbook, a historicalreview of interventional cardiology, interventional radiology, and interventionalneuro-radiology is covered.To keep up with the pace of progress thevast majority of chapters have been writtenanew by established and emerging leadersin their respective domains of expertise.The wide spectrum of interventional treatments and required specific demandsstresses the need for complementarity ofexpertise. Clearly, the ultimate arbitersof success and quality of interventionaltreatments already are and shall becomeeven more so in the future—the procedural skills of individual operators and theoverall quality of interventional services.Exquisite competence of individual operators and comprehensive complementaryteam expertise are the road to take toassure a bright future of catheter-basedcardiovascular interventions.We are convinced that regardless of thespeed and the direction that the interventional field will be taking, the importance ofpioneers, leaders and role models will continue to grow. While many of the pioneersshould be named, clearly two of them mustbe: Charles Theodore Dotter (1920–1985)and Andreas Grüntzig (1939–1985). It wasthem who blazed the trail, and it was themwho faced the most severe resistance andsometimes even threats, not uncommonlyinspired by their peers.

VIIPrefaceIt is a privilege of the editor to risk a personal note in this context. While morethan 30 years of interventional practice,spanning two continents and many laboratories, have left countless impressionsof remarkable experts and exceptionalskills, in my memory, two figures clearlystand out—solid, singular, and outstanding in the respectable crowd; two leaders and remarkable teachers, as theywere: Cass A. Pinkerton (1947–2011),an interventional cardiologist, andDonald E. Schwarten (1941–2007), aninterventional radiologist, both at the St. Vincent’s Hospital in Indianapolis( Indiana, USA).      Cass, catching fire.      Don, sporting smiles, reading mindsCass, easy going, cool, witty, extremelymeticulous, always with time at hand,always friendly and amazingly even mindedin the face of adversities not uncommonin the prestent era, often confronted withinappropriate questions asked by novicesat the most inappropriate times in the heatof the battle he always managed to keepstraight face and never refused this add onchallenge; Don, gentle as it gets, staggeringlypatient, a paragon of diligence (there werethree needles of different lengths to perform“painless and complete” local anesthesia)and never ceasing concern for the wellbeing of entrusted and trusting patients.These two men were my personal rolemodels, two characters who made me wishto become like them. I wished to acquiretheir expertise, masterful confidence andtheir sustained and amazingly consistentprocedural success. While both Cass andDon were more than willing to share theirexpertise the secret of their unique professional expertise has not been fully unveiled.Despite numerous open, friendly, and longdiscussions, it seemed hard to get to the coreof their professional cognitive and manualphenomenal skills. The desire to modelCass’s and Don’s expertise, and to learn tounderstand their professional “secret”, havebecome lifelong motifs and inspirations.The Textbook is an attempt to promoteprofessional excellence by explicating interventional expertise. I am deeply indebtedto all colleagues who have participated inthis educational project and were willing todonate their time, excellence and expertisein their respective fields. All of them havecreated a unique panorama of the state of theart of catheter-based cardiovascular interventional therapy. I wish to thank them all,colleagues and friends, for this tremendouseffort. It has been a great personal honor toread and review the manuscripts, to engagein discussion concerning individual themesand topics, and to debate all the particulars ofknowledge-that and knowledge-how worthyto explicate, to transfer, and to communicateto all of you, dear and worthy readers.

VIIIPrefaceClearly, expertise is not enough to promotemedical science. It has been a great privilege to join forces with the staff of SpringerNature publishers, a remarkable house andhome for physicians and scientists alike.Renewal and continuation of the wellestablished collaboration has been againan exciting and highly rewarding experience. I am thankful to Karin Bartsch, theAssociate Editor, who has guided andstreamlined the complex process leadingto production and publication of the Textbook. Donatella Rizza, Executive Editorat Springer, was instrumental in gettingthis project on track and took responsibility for the multitude of the old, new andemergent publisher’s risks in the currentdemanding and highly competitive multimedia environment in Medicine and Science. Of course, Karin and Donatella weresupported by a team of highly skilled professionals belonging to the newly createdprestigious and worldwide largest publisher in Medicine and Science, SpringerNature. Thank you all.While nothing gets ever finished, andindeed nothing is ever perfect, we havedone our best to produce a Textbook thatshares and disseminates interventionalknowledge, skills, and expertise, and aimsto promote professional excellence.Whileachievements are shared, all shortcomingsare sole responsibility of the editor.Peter LanzerBitterfeld-Wolfen, Germany

IXContentsIKnowledge and Professional Expertise inCatheter-Based Cardiovascular Interventions1 Knowledge.3Tim Thornton and Peter Lanzer2 Judgment and Reasoning in Professional Contexts.15Joy Higgs3 A Cognitive Neuroscience Perspective on Skill Acquisitionin Catheter-Based Interventions.27Katja Isabel Paul and Fokie Cnossen4 Cognitive Skills in Catheter- Based Cardiovascular Interventions.35Peter Lanzer5 Ethics in Catheter-Based Cardiovascular Interventional Therapy.57Peter Lanzer and Tim Thornton6 Legal Expertise.67Christian Rybak and Alexander P. F. Ehlers7 Curriculum in Interventional Cardiology:Setting Up Professional Standards.83Jared M. O’Leary, Elias V. Haddad, and Henry S. Jennings III8 Image Reading and Interpretation.113Elizabeth A. Krupinski9 Focus on Professional Expertise Acquisition: Simulation Training.125Daniel Schimmel10 Robotic Percutaneous Coronary Intervention.133Mark E. Jacoby, Manivannan Veerasamy, and Ryan D. MadderIICardiovascular Interventional Diagnostics11 Cardiovascular X-ray Imaging: Physics, Equipment, and Techniques.147Arnold R. Cowen12 Radiation Protection.199Aris Karatasakis, Barbara A. Danek, and Emmanouil S. Brilakis13 Transthoracic and Transesophageal Echocardiography in InterventionalCardiovascular Catheter- Based Therapy.Ratnasari Padang and Sunil V. Mankad217