Preface iv
Acknowledgments v

Section I Gener al Principles 1

Cardiac Catheterization History and Current Practice
Standar ds 1
2. Cineangiographic Imaging, Radiation Safety, and Contrast
A gen ts 18
Integrated Imaging Modalities in the Cardiac Catheterization
Lab 4 1
Complica tions 6 1
Adjunctive Pharmacology for Cardiac Catheterization 85
Informed Consent and Legal Considerations 103

Section II B asic T echniques 110

Radial Art ery Appr oach 110
Percutaneous Transfemoral, Transseptal, Transcaval, and Apical
Appr oach 13 2
Cutdown Approach: Brachial, Femoral, Axillary, Aortic, and
T r ansapical 156
Diagnostic Catheterization in Childhood and Adult Congenital
Heart Disease 17 4

Section III Hemodynamic Principles 194

Pressure and Blood Flow Measurement 194
Shunt Detection and Quanti? cation 228
Calculation of Stenotic Valve Ori? ce Area 239
Pitfalls in the Evaluation of Hemodynamic Data 252

Section IV Angiographic Techniques 262

15. Coronary Angiography, Coronary Artery Anomalies, and Cardiac
Ventriculography 262
16. Angiography of the Aorta, Peripheral, and Pulmonary
Arteries 314

Section V Evaluation of Cardiac Function 340

17. Stress Testing During Cardiac Catheterization: Exercise and
Dobutamine Challenge 340
18. Measurement of Ventricular Volumes, Ejection Fraction, Mass,
Wall Stress, and Regional Wall Motion 359
19. Evaluation of Systolic and Diastolic Function of the Ventricles
and Myocardium 370
20. Evaluation of Tamponade, Constrictive, and Restrictive
Physiology 392

Section VI Special Catheter Techniques 406

21. Evaluation of Myocardial and Coronary Blood Flow and
Metabolism 406
22. Intravascular Imaging Techniques 433
23. Endomyocardial Biopsy 458
24. Percutaneous Mechanical Circulatory Support 482

Section VII Interventional Techniques 513

25. Percutaneous Balloon Angioplasty and General Percutaneous Coronary Intervention 513
26. Atherectomy, Thrombectomy, and Distal Protection Devices 539
27. Coronary Stenting 564
28. General Overview of Interventions for Structural Heart Disease 589
29. Patent Foramen Ovale, Atrial Septal Defect, and Ventricular Septal Defect Closure 598
30. Alcohol Septal Ablation 611
31. Closure of Paravalvular Leaks 623

Left Atrial Appendage Closure 627
Percutaneous Therapies for Mitral and Tricuspid Valve Disease 639
Percutaneous Therapies for Aortic and Pulmonary Valvular Heart Disease 660
Peripheral Intervention 681
Interventions for Pediatric and Adult Congenital Heart Disease 712
Endovascular Aortic Repair 739
Pericardial Interventions: Pericardiocentesis, Balloon Pericardiotomy, and Epicardial Approach to Cardiac
Procedures 744
Index 763