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 • Techniques for entering the left ventricular pseudoaneurysm. • 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. 6.2.2.8. Occlusion of Endovascular Endoleaks 6.2.2.8.1. Basic Knowledge • Natural history and recognition of endovascular endoleaks. • Endovascular endoleaks in different endoprosthesis types. • Knowledge of the collateral and arterial ramifications of the aorta. • Interpretation and familiarity with different imaging exams: CT, MR, angiography, and ultrasound. • Indications for intervention. 6.2.2.8.2. Interventional Cardiologists’ Abilities • Choice of vascular access. • Direct selective access. • Knowledge and proper handling of introducers, sheaths, guidewires, and catheters utilized. • Proper technical knowledge of different types of occlusion devices and chemical agents. • 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. 6.2.2.9. Aortic Pseudoaneurysm Occlusion 6.2.2.9.1. Basic Knowledge • Natural history and etiology of aortic pseudoaneurysms. • Interpretation and familiarity with different imaging exams related to accurate localization and characterization of the pseudoaneurysm: ultrasound, CT, MR, and angiography. • Indications for intervention. 6.2.2.9.2. Interventional Cardiologists’ Abilities • Choice of vascular access. • Knowledge and proper handling of introducers, sheaths, guidewires, and catheters utilized. • Proper technical knowledge of different types of occlusion devices, chemical agents, covered stents, and endoprostheses. • Mastery of techniques necessary to remove devices in the event of device 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. 6.2.2.10. Hypertrophic Cardiomyopathy and Alcohol Septal Ablation Hypertrophic cardiomyopathy is the most common genetic cardiovascular disease, with an estimated prevalence of 0.2% in the general population. 27 Interventional cardiologists who perform this procedure should possess extensive knowledge of the results, limitations, and complications of medical therapy, surgical myectomy, dual-chamber pacemaker pacing, and alcohol septal ablation itself. 27-29 Alcohol septal ablation should involve a multidisciplinary program that includes the contributions of a cardiac surgeon, an echocardiographist, a clinical cardiologist, and an electrophysiologist. The first procedures should be supervised by an experienced operator in training centers or in services outside of training centers under the supervision of a medical instructor (proctor). 6.2.2.10.1. Basic Knowledge • Natural history and etiologies of left ventricular outlet obstructions. • Hemodynamics of left ventricular outlet obstructions. • Interpretation and familiarity with different imaging exams: TTE, TEE, CT, MR, and angiography. • Knowledge of current guidelines for treatment of hypertrophic cardiomyopathy. • Therapeutic options. • Indications for intervention. 6.2.2.10.2. Interventional Cardiologists’ Abilities • Hemodynamic interpretation of left ventricular outlet obstruction. • Choice of vascular access. • Sheaths, wires, balloons, and catheters utilized. • Angiographic projections for septal ablation. • Pacemaker in the right ventricle during intervention. • Ablative substances (alcohol, microspheres, etc.). • Recognition and rapid management of complications (vascular occlusion, dissection, thromboembolism, hemodynamic collapse, extension of infarction, iatrogenic 151