Less than 18 years have passed since the first coronary balloon angioplasty was performed in September 1977 by Andreas Gruntzig. In 1993, 185700 coronary angioplasties were performed in Europe and in many European countries, percutaneous transluminal coronary angioplasty is the most com mon method of myocardial revascularization, well ahead of coronary bypass surgery. This explosive growth of interventional cardiology results from major technological advances. The balloons have been markedly improved with a better profile, excellent trackability, and good pushability. The steer able guide wires are excellent and can reach the most difficult and the most distal parts of the coronary tree. The guiding catheters offer excellent support and good back-up in the ostium. Meanwhile, new tools have been proposed and designed for a "lesion specific" approach. Coronary stenting which is the "second wind" of angioplasty has dethroned most of the so-called new tools and stents are currently implanted in 30-60% of cases. Similar develop ments have occurred in the field of mitral valvuloplasty, ablative techniques in electrophysiology, and in the field of interventions in congenital heart disease. However, these advances would not have been possible without the con comitant development of cardiac imaging. For many interventions, cardiac imaging is an necessary pre-requisite: 1. Imaging is mandatory to identify the lesions needing an intervention. Coronary bypass surgery or angioplasty cannot be performed without prior coronary angiography. However, scintigraphic stress testing is also needed to identify perfusion defects in the area supplied by the diseased artery.

Klappentext

The concept of the book is to give clinicians and interventionalists a unique, up to the minute overview of the use of cardiac imaging techniques in combination with modern interventional procedures such as thrombolysis, catheter-based coronary revascularization, valvuloplasty and interventions in congenital heart disease. br/ The book is divided into sections reflecting the types of interventions listed above. Each section contains several chapters describing how each imaging modality can be used before, during or after intervention to improve outcome, select the optimal interventional strategy or to simply foster our understanding of the interaction between disease and interventional therapy. The idea of the book is to select a number of interventions and imaging techniques stressing scintigraphic and ultrasound techniques rather than producing an encyclopedia which would combine all possible imaging modalities with every type of cardiac intervention. br/ The conjunction of interventional cardiology and an appropriate imaging modality is an interesting concept not only for diagnostic purposes and for the objective documentation of success or failure, but may also provide a significant contribution to quality control and thus indirectly to cost containment in the era of interventional cardiology. br/

Inhalt
One: Thrombolysis.- 1. Serial myocardial perfusion imaging with Tc-99m-labeled myocardial perfusion imaging agents in patients receiving thrombolytic therapy for acute myocardial infarction.- 2. Contraction-perfusion matching in reperfused acute myocardial infarction.- 3. Metabolic characteristics in the infarct zone: PET findings.- 4. Assessment of myocardial viability with positron emission tomography after coronary thrombolysis.- 5. Postthrombolysis noninvasive detection of myocardial ischemia and multivessel disease and the need for additional intervention.- Two: Coronary revascularization: Assessment before intervention.- 6. Imaging to justify no intervention.- 7. Interpretation of coronary angiograms prior to PTCA: Pitfalls and problems.- 8. Diagnostic accuracy of stress-echocardiography for the detection of significant coronary artery disease.- 9. Perfusion imaging with thallium-201 to assess stenosis significance.- 10. Perfusion imaging by PET to assess stenosis significance.- 11. Contrast enhanced magnetic resonance imaging for assessing myocardial perfusion and reperfusion injury.- 12. Non-invasive visualization of the coronary arteries using magnetic resonance imaging - is it good enough to guide interventions?.- 13. MRI as a substitute for scintigraphic techniques in the assessment of inducible ischaemia.- 14. Assessment of viability by MR-techniques.- 15. Assessment of viability in severely hypokinetic myocardium before revascularization and prediction of functional recovery: Contribution of thallium-201 imaging.- 16. Assessment of myocardial viability before revascularization: Can sestamibi accurately predict functional recovery?.- 17. Assessment of viability in noncontractile myocardium before revascularization and prediction of functional recovery by PET.- 18. Assessment of viability in severely hypokinetic myocardium before revascularization and prediction of functional recovery: The role of echocardiography.- 19. Assessment of functional significance of the stenotic substrate by Doppler flow measurements.- Three: Coronary revascularization: Assessment after intervention.- 20. Angiographic assessment of immediate success and the problem (definition) of restenosis after coronary interventions.- 21. Immediate evaluation of percutaneous transluminal coronary balloon angioplasty success by intracoronary Doppler Ultrasound.- 22. Evaluation of the effect of new devices by intravascular ultrasound.- 23. Can restenosis after coronary angioplasty be predicted by scintigraphy?.- 24. Evaluation of immediate and long-term results of intervention by echocardiography: Can restenosis be predicted?.- 25. Predictors of restenosis after angioplasty: Morphologic and quantitative evaluation by intravascular ultrasound.- 26. How to evaluate and to avoid vascular complications at the puncture site.- Four: Imaging and valvular interventions.- 27. Selection of patients and transesophageal echocardiography guidance during balloon mitral valvuloplasty.- 28. Echocardiography for intraprocedural monitoring and postinterventional follow-up of mitral balloon valvuloplasty.- Five: Intervention in congenital heart disease.- 29. Preinterventional imaging in pediatric cardiology.- 30. The role of ultrasound in monitoring of interventional cardiac catheterization in patients with congenital heart disease.- 31. Follow-up of patients after transcatheter procedures in congenital heart disease using noninvasive imaging techniques.- Colour section.