Saturday, April 29, 2006

 

Interventional Cardiology

Interventional Cardiology is the most happening field in Cardiology, more so after the arrival of drug eluting stents, distal protection devices and specially designed coronary guide wires. All types of lesions are aggressively being taken up by the interventional cardiologist, thanks to the technical advances. World over coronary interventions have taken over coronary artery bypass surgery in terms of numbers. It is expected, since surgery had always been a crude method to treat a disease condition. Every advancement in medicine was a replacement for surgery, proton pump inhibitors replaced gastro jejunostomies, anti tuberculosis drugs most of the surgeries for tuberculosis. It is crude to treat atheroscerosis by metal tubes called stents, I agree, but fact is that it works and is here to stay. Until in future , medications comes in that will dissolve an atheromatous plaque like a drain cleaner, angioplasty will be the front runner in revascularization arena.

Technically, it is feasible to attempt most of the lesion subsets with angioplasty. Bifurcated lesions are no longer a problem. Calcified and long segment disease is now a days not an indication for surgery. Totally occluded arteries have given way to the current generation coronary wires. Tough fibrous lesions and ostial location of the disease have become staple diet for cutting balloons. Rotablation is for that diffuse disease, heavy calcifications were surgical graft is out of question. Distal protection devices are for the protection of the distal circulation from embolism.

We are into complex angioplasty procedures. Has reasonable experience in such demanding job, complication rates are among the least. We specialize in cutting balloon use and rotablations. Our centre has facility to perform any complex angioplasty, includig state of the art catherization suites, support systems and devices. This is a JCIA accredited centre.

My training in cardiology was from the prestigious National Institutes , Sanjay Gandhi Post Gradute Institute of Medical sciences, Lucknow and Sree Chitra Tirunal Institute of Medical Sciences in Trivandrum where I had the honour to serve as a faculty, before I joined Dr Mathew samuel Kalarickal at Apollo Hospital Madras, the father of Angioplasty in India. Had observational fellow ship with Dr Fayaz Shawl, at Washington adventist Hospital, Washington.

I believe, in India angioplasty has not reached where it should have . Though we have the best of the facilities and expertise , number of procedures performed is only a fraction of what is done in the west. May the current economic boom will make a difference.

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