The IX t h Makassed Medical Congress - American University of Beirut

T h e I X t h M a k a s e d M e d i c a l C o n g r e s s
Conclusion: In our preliminary group, SVR may afford significant improvement of symptoms and
ejection fraction, and that the procedure can be performed safely. Further studies are needed
to define the patients best served with the procedure,
Stich trial is not the final answer to SVR.
EVOLUTION OF INTERVENTIONAL CARDIOLOGY
Spencer B. King, III, M.D., M.A.C.C.
Interventional cardiology evolved from concepts created in the disciplines of surgery, radiology
and cardiology. The pivotal developments of radiographic imaging enabled the development
of coronary arteriography which facilitated coronary bypass surgery and the dilatation of vessels
was a peripheral procedure developed to improve claudication.
All of these elements were integrated by the father of interventional cardiology, Andreas
Gruentzig. From the earliest experiments of vascular dilatation to the clinical application of
coronary angioplasty, the development of steerable guidewire techniques, the introduction of
coronary stents, and the control of restenosis, interventional cardiology has been at the forefront
of modern medical evolution. No other specialty has created so many areas of research interests
or performed as many clinical trials to establish the effectiveness of those interventions.
The technologic developments have been dramatic and now have their greatest potential in
managing structural heart disease. As we pass 33 years of interventional cardiology, the disciplines
that were necessary for its foundation are reuniting to move developments forward.
The recently published guidelines of the European Society of Cardiology were developed by
cardiologists and cardiac surgeons working in tandem. The evolution has been dramatic but the
future looks even more promising.
TREATMENT OF STABLE ISCHEMIC HEART DISEASE
Spencer B. King, III, M.D., M.A.C.C.
Ischemic heart disease comes in various forms and is most feared when it is acute and abrupt.
The occurrence of myocardial infarction is often life-threatening and its’ treatment has been the
most important success story for interventional cardiology.
Cardiac surgery demonstrated the ability to manage highly symptomatic ischemic heart
disease, albeit through significantly invasive methods. Now interventional cardiology’s role in
the management of stable ischemic heart disease is being questioned. Whereas a mortality
benefit is clearly demonstrated in the patients presenting with acute coronary events, studies to
date have not demonstrated a comparable result for patients with stable conditions. Because
of that many advocate the use of revascularization primarily for symptomatic relief, and indeed,
revascularization is the most effective method for alleviating symptoms due to ischemic heart
disease. The two questions being asked are whether revascularization should be performed at
all in patients with stable ischemic heart disease, and, if revascularization is to be performed,
which method, i.e. percutaneous coronary intervention or coronary bypass surgery, should be
employed.
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