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 5. Annual Evaluation of Trainees and Training Centers At the end of each year of training, the CPC, in conjunction with the SBHCI, will make a structured form (Annex 17) available on the SBHCI intranet for all trainees, who will confidentially assess whether the training center is fulfilling this Position Paper’s recommendations. Each form must be forwarded to the SBHCI. 6. Percutaneous Intervention in Congenital and Structural Heart Diseases and in the Extracardiac Vascular Bed As observed, the theoretical-practical program which is applied over the two-year period is rich and comprehensive, and it allows interventional cardiologists, following training and certification, to act with proficiency in the treatment of coronary artery disease in their most varied forms of presentation. Furthermore, during this formative period or even after the conclusion of this phase, it is possible to participate in specific training processes, which will provide interventional cardiologists with the competences necessary to act in congenital and structural heart diseases and in the extracardiac arterial and venous vascular bed. We will subsequently detail the specific processes that ensure that an interventional cardiologist has obtained competences in the areas mentioned. 6.1. Congenital Heart Diseases The knowledge, the abilities, and the training necessary for therapeutic interventions of congenital heart disease in children and adults are different than those required for PCI. Knowledge of the natural history of diverse congenital heart diseases is a prerequisite for the procedure’s safety and effectiveness. Trainees are also required to know the indications for percutaneous treatment, as well as diverse types of surgery (palliative and corrective), hemodynamic evaluation and interpretation of diverse conditions in the catheterization laboratory, study and management of pulmonary hypertension, angiography, and interpretation of reports and complementary exam images, such as transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), intracardiac echocardiography, CT, andMR. In contemporary interventional cardiology practice, we also recommend that trainees develop abilities for software or computer programs dedicated to reconstruction and measurement of cardiovascular structures. This new set of abilities aims to increase the capacity for planning and carrying out highly complex procedures, with the goal of increasing efficacy and safety for patients. Training should proceed starting with less complex procedures until the abilities have been acquired which will allow trainees to perform procedures considered more complex. Among the abilities that should be acquired, basic training, by means of supervised practice, includes handling diverse vascular accesses, guides, wires, balloons, and devices, and, especially, orientation on how to anticipate, recognize, and treat possible complications. Great effort should be put forth to disseminate precautions with ionizing radiation and rational use of different means of contrast. Concomitant to this technical formation, it is recommended that trainees participate in didactic sessions, case discussions, post- procedure follow-up of patients, outpatient clinical follow-up, research, databanks and registries, assessment of quality and results, and participation in multidisciplinary groups (heart teams). Also recommended are training and familiarity with the particularities of handling newborns and young infants. We consider that, for a complete formation, this training should last at least two years for pediatric or adult cardiologists or at least one additional year for general interventional cardiologists. Due to the numerous procedures currently performed for congenital and structural heart disease, the minimum number of exams carried out in order to have proper qualification varies in accordance with the complexity of the condition and intervention; however, qualified centers for formation of interventional cardiologists in congenital heart diseases should perform at least 100 therapeutic procedures per year, and trainees should participate as first operators in at least 40 cases during the training period. Subsequently, we will describe the recommendations for acquisition and maintenance of competences in interventional treatment of congenital heart diseases, which are here divided by degree of complexity. 6.1.1 Basic Interventions in Congenital Heart Diseases 6.1.1.1 Interatrial Communication Occlusion 6.1.1.1.1. Basic Knowledge • Natural history, classification, and hemodynamic repercussion of septal atrial defects. • Indications for intervention. • Proper differentiation between simple and complex defects. 6.1.1.1.2. Interventional Cardiologists’ Abilities • Knowledge and proper handling of introducers, sheaths, guidewires, and catheters utilized. • Interpretation and familiarity with different imaging tests: atrial septal characteristics; determination of defect location, number, borders, and adjacent structures by TTE, TEE, intracardiac echocardiography, and fluoroscopy. • Invasive assessment of pulmonary vascular pressure and reactivity, including the need for temporary balloon occlusion. • When and how to use balloons for measurement. • In-depth knowledge of different available devices, their characteristics, sizes, and forms of release. • Mastery of techniques necessary to remove devices in the event of device embolization. • Patient care and recognition of immediate and late complications and long-term patient guidance. 145