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 6.2.2.4. Balloon Pericardiotomy and Pericardiocentesis 6.2.2.4.1. Basic Knowledge • Natural history of recurrent or malign pericardial effusion. • Therapeutic options and outcomes. • Pericardial sac anatomy. • Indications for intervention. 6.2.2.4.2. Interventional Cardiologists’ Abilities • Techniques for percutaneous access to the pericardial sac. • Puncture guided by echocardiography and fluoroscopy. • Needles, wires, introducers, catheters, and balloon catheters. • Immediate and long-term post-procedural care. 6.2.2.5. Post-infarction Interventricular Communication Occlusion 6.2.2.5.1. Basic Knowledge • Natural history of post-infarction IVC (anterior and inferior infarctions). • Management of cardiogenic shock. • Hemodynamic repercussion and assessment of pulmonary hypertension. • Interpretation and familiarity with different imaging exams related to characteristics of the ventricular septum, determination of defect location, number, and adjacent structures: TTE, TEE, CT, MR, and angiography. • Feasibility and indications for intervention. 6.2.2.5.2. Interventional Cardiologists’ Abilities • Hemodynamic interpretation of post-infarction IVC in the hemodynamics laboratory. • Choice of vascular access (superior vena cava, inferior vena cava, transapical, etc.). • Techniques for crossing the IVC. • Knowledge and proper handling of sheaths, guidewires, and catheters utilized. • Knowledge of when and how to use balloons for measurement. • Appropriate angiography for defect characterization. • Techniques for crossing and releasing the device: anterograde and retrograde. • Proper technical knowledge of different devices available, 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 occlusions, dissections, thromboembolism, hemodynamic collapse, cardiac perforations, cardiac tamponade, device embolism, arrhythmias/atrioventricular blocks, coronary occlusion etc.). • Immediate and long-term post-procedural care. 6.2.2.6. Occlusion of Paravalvular Leaks 6.2.2.6.1. Basic Knowledge • Natural history of paravalvular leaks. • Paravalvular leaks in mechanical and biological valve prostheses. • Recognition and clinical management of mechanical device hemolysis. • Interpretation and familiarity with different imaging exams related to accurate localization of the leak: TTE, TEE, CT, MR, and angiography. • Indications for intervention. 6.2.2.6.2. Interventional Cardiologists’ Abilities • Hemodynamic interpretation of paravalvular leaks in the hemodynamics laboratory. • Choice of vascular access: retrograde, anterograde transseptal, and transapical. • Selective transapical puncture. • Techniques for crossing paravalvular leaks. • Knowledge and proper handling of introducers, sheaths, guidewires, and catheters utilized. • Proper technical 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, cardiac tamponade, device embolism, arrhythmias/atrioventricular block, coronary occlusion etc.). • Immediate and long-term post-procedural care. 6.2.2.7. Left Ventricular Pseudoaneurysm Occlusion 6.2.2.7.1. Basic Knowledge • Natural history of ventricular pseudoaneurysms. • Pseudoaneurysms as complication of mechanical and biological valve prostheses. • Recognition and clinical management of mechanical device hemolysis. • Management of cardiac insufficiency. • Interpretation and familiarity with different imaging exams: accurate localization and characterization of the pseudoaneurysm by TTE, TEE, CT, MR, and angiography. • Indications for intervention. 6.2.2.7.2. Interventional Cardiologists’ Abilities • Choice of access route: retrograde, anterograde transseptal, and transapical. • Selective transseptal puncture. • Selective transapical puncture. 150