ABC | Volume 114, Nº1, January 2019

Statement Position Statement of the Brazilian Cardiology Society and the Brazilian Society of Hemodynamics and Interventional Cardiology on Training Centers and Professional Certification in Hemodynamics and Interventional Cardiology – 2020 Arq Bras Cardiol. 2020; 114(1):137-193 • Calculation of valve areas, vascular resistances, and arteriovenous shunts. • Evaluation of hemodynamic response to pharmacological agents to study ventricular performance and pulmonary vascular reactivity. • Means of contrast (types, doses, complications, prevention and treatment of adverse reactions). • Knowledge of cardiac, coronary, and vascular radiological anatomy and the corresponding angiographic projections for proper performance of cardiovascular procedures. • A review of cardiovascular anatomy and physiology with a focus on interventional cardiology. • Cardiovascular pathology andphysiopathology (determinants of atherosclerosis and thrombosis; systemic manifestations of atherosclerosis and risk factors that contribute to its development; established guidelines for modifying these risk factors; physiopathology, clinical manifestations, natural history, assessment, and management of other structural and functional cardiovascular diseases; prothrombotic states, encompassing hereditary and acquired disorders; and proinflammatory states that contribute to appearance of unstable coronary lesions). • Indications and contraindications for therapeutic and diagnostic percutaneous cardiovascular procedures. • Interpretation of images and quantitative angiography for assessment of coronary lesions, valve dysfunctions, and systolic ventricular function. • Methods for evaluating functional significance of coronary obstructions. • Methods for obtaining and interpreting intravascular imaging. • Technical knowledge of materials utilized for diagnostic and interventional cardiovascular procedures. • Recognition and management of complications of diagnostic and therapeutic cardiovascular procedures. • Pharmacology applied to diagnostic and therapeutic percutaneous cardiovascular procedures. • Hemodynamic and angiographic diagnoses of the main congenital and structural cardiovascular diseases in children and adults. • Indications, contraindications, techniques, and limitations of diverse therapeutic procedures in interventional cardiology for congenital heart diseases (atrial septostomy [diverse techniques] and pulmonary and aortic valvuloplasty; angioplasty and pulmonary artery stent implantation, conduct and other arteries and veins; aortoplasty and aortic stent; occlusion techniques, embolizations and cardiac occlusion devices; and transcatheter pulmonary valve implantation [TPVI]). • Peculiar technical aspects of all percutaneous cardiovascular intervention devices. • Indications, contraindications, methods, techniques, and limitations of diverse therapeutic procedures in interventional cardiology (coronary and vascular interventions; utilization of distal protection devices; valvuloplasties; alcohol septal ablation in obstructive hypertrophic cardiomyopathy; embolization of coronary arteries to treat complications and other vascular beds for therapeutic purposes; and retrieval of intravascular foreign bodies by percutaneous methods). • Indications, contraindications, techniques, and limitations of diverse percutaneous procedures employed to treat structural heart diseases, such as percutaneous aortic valve implantation (transcatheter aortic valve replacement (TAVR), transcatheter mitral valve repair (TMVR), atrial appendage occlusion, percutaneous treatment of paravalvular leaks and patent foramen ovale (PFO) closure. • Indications and management of ventricular assist devices. • Critical analysis of published studies, in accordance with the principles of medicine based on scientific evidence. • Ethics and compliance in interventional cardiology. • Writing and obtaining consent forms in interventional cardiology. Examples of consent forms suggested by the SBHCI for the most common procedures may be found in Annexes 2 to 15. • Writing reports in interventional cardiology (Annex 16). 4. Approval, Maintenance, and Revalidation of Accredited Centers The definition of norms for accreditation and maintenance of hemodynamics and interventional cardiology training centers will be governed by self-regulation of which the Corporate Advisory Council is in charge. Verification of compliance with the requirements established in this Position Paper is the responsibility of the SBHCI’s Permanent Certification Commission (Comissão Permanente de Certificação – CPC). To this end, a Verification Committee will be designated, consisting of three members, one belonging to the Directory Board, one belonging to the Advisory Council, and one belonging to the CPC. Training centers will be submitted to a re-registration process every four years. In the event that the requirements of these guidelines are infringed, the Verification Committee will advise the coordinator of the training center to redress the irregularities observed, by means of a report based on the corrections necessary for the training center’s maintenance. Six months later, a new inspection will be carried out. In the event that the recommendations have not been met, a final opinion will be emitted by the Advisory Council, deciding on the center’s loss of accreditation. Loss of accreditation of a training center will also occur under any one of the following conditions: • Absence of at least one trainee who has completed training within a continuous four-year period. • Absence of at least one graduate trainee from the training center who has passed the test to obtain certification in the area of interventional cardiology and interventional cardiology from the SBHCI, over the past four years. Formal authorization is mandatory from the technical director of the hospital where the training center will operate. 144