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 prevention. 25 Within this same scenario, it has also been demonstrated that the cost-effectiveness relationship is favorable for PFO occlusion, in comparison with isolated medical treatment. 26 6.2.1.3.1. Basic Knowledge • Natural history and mechanisms of paradoxical thromboembolic events; stroke related to PFO; hemodynamic repercussion of atrial septal defects. • Medical management of stroke related to PFO. • Interpretation and familiarity with different imaging exams related to the atrial septum, adjacent structures, and the brain structures as well: TTE, TEE, intracardiac echocardiography, MR, CT, transcranial Doppler, and fluoroscopy. • Knowledge of current guidelines for PFO occlusion in the scenario of paradoxical embolism (secondary prevention). • Indications for intervention. 6.2.1.3.2. Interventional Cardiologists’ Abilities • Techniques for crossing the PFO. • Knowledge and proper handling of introducers, sheaths, guidewires, and catheters utilized. • Knowledge and abilities with imaging methods for guiding the procedure: TEE, intracardiac echocardiography, and fluoroscopy. • When and how to use balloons for measurement. • In-depth knowledge of different devices available, their characteristics, sizes, and forms of release. • Mastery of techniques necessary to remove devices in the event of embolization. • Recognition and rapid management of complications (vascular occlusion, dissection, thromboembolism, hemodynamic collapse, cardiac perforation, arrhythmias/ atrioventricular block, coronary occlusion, etc.). • Immediate and long-term post-procedural care. 6.2.2. Complex Interventions in Structural Cardiovascular Diseases 6.2.2.1. Transapical Ventricular Access 6.2.2.1.1. Basic Knowledge • Normal anatomy and morphospatial variations resulting from diverse conditions (right and/or left atrial dilatation, ascending aortic dilatation, dextrocardia, heterotaxy, etc.). • Hemodynamic interpretation of pressure curves. • Familiarity with different imaging exams (CT, TTE, TEE, intracardiac echocardiography). • Indications for intervention. 6.2.2.1.2. Interventional Cardiologists’ Abilities • Micropuncture needles, wires, and introducers. • Selective puncture guided by CT, ultrasound, and fluoroscopy. • Knowledge and techniques for utilization of different hemostasis devices. • Immediate and long-term post-procedural care. 6.2.2.2. Transhepatic Access 6.2.2.2.1. Basic Knowledge • Normal anatomy and morphospatial variations resulting from diverse conditions. • Indications for intervention. 6.2.2.2.2. Interventional Cardiologists’ Abilities • Micropuncture needles, wires, and introducers. • Selective puncture guided by ultrasound and fluoroscopy. • Knowledge and techniques for utilization of different hemostasis devices • Immediate and long-term post-procedural care. 6.2.2.3. Mitral and Tricuspid Valvuloplasty in Adults 6.2.2.3.1. Basic Knowledge • Natural history and etiology of mitral and tricuspid stenosis. • Hemodynamics of severe mitral and tricuspid stenoses. • Interpretation and familiarity with different imaging methods related to the aortic and tricuspid valves: echocardiography, CT, MR, angiography. • Knowledge of current guidelines for treatment of mitral and tricuspid stenoses. • Therapeutic options and outcomes. • Indications for intervention. 6.2.2.3.2. Interventional Cardiologists’ Abilities • Hemodynamic interpretation of pressure curves in mitral and tricuspid stenoses in the hemodynamics laboratory. • Choice of vascular access. • Selective transseptal puncture (for mitral stenosis). • Techniques for crossing mitral and tricuspid stenoses. • Sheaths, wires, and catheters utilized. • Balloon catheters for valvuloplasty. • Knowledge and techniques for utilization of different hemostasis devices. • Recognition and rapid management of complications (vascular occlusions, dissections, thromboembolism, hemodynamic collapse, retroperitoneal bleeding, cardiac perforations, tamponade, arrhythmias/atrioventricular blocks, etc.). • Immediate and long-term post-procedural care. 149