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 certificate in the area of hemodynamics and interventional cardiology, a cardiovascular surgeon, and other professionals directly or indirectly related to the procedure. It is highly recommendable that the operators possess vast experience in diagnostic and therapeutic percutaneous procedures for congenital heart diseases, especially stent implantations in pulmonary arteries. Also necessary are mastery of the coronary catheterization technique and knowledge of the anatomical relation of the origins of coronary arteries with the pulmonary artery, given that, in some cases, release of the pulmonary bioprosthesis might lead to coronary occlusion, which would contraindicate the therapy. In addition to these prerequisites, it is necessary to possess specific knowledge regarding the general characteristics of catheter-implanted valve prostheses, their appropriate indications in accordance with the underlying congenital heart disease, anticoagulation control, and adequate management of possible complications, such as coronary compression, cardiac or vascular perforation, partial or total rupture of the treated conduit, prosthesis embolization, prosthetic thrombus formation, infectious endocarditis, cardiac arrhythmias, etc. The specialist physician should possess knowledge of the different surgical strategies used for right ventricular outflow reconstruction, which are necessary to treat complex congenital heart diseases, such as tetralogy of Fallot, pulmonary atresia with IVC, double right ventricular outflow with infundibular pulmonary stenosis, transposition of great arteries with IVC and infundibular pulmonary stenosis, corrected transposition of great arteries with pulmonary stenosis, and common truncus arteriosus. Concerning, moreover, qualification of physicians, specialists responsible for performing TPVI are required to bear a certificate in the area of hemodynamics and interventional cardiology, duly registered with the CRM in the jurisdiction in which they are professionally active, in accordance with current legislation, and they must have participated in at least ten procedures under the supervision of a qualified physician (proctor), in order to have adequate proficiency and safety for the implantation. 6.2.2.14.1 Basic Knowledge • Natural history of different types of conduits or valves (synthetic, biological, homografts, valved, or non-valved) utilized for the connection between the right ventricle and the pulmonary trunk (RV-PT). • Knowledge of the anatomy and physiology of different intra- and extracardiac surgical conduits and tunnels. • Comprehension of the anatomy and hemodynamics of different surgical procedures used for treating complex congenital heart diseases. • Knowledge of the effects of pressure and volume overloads on the pulmonary ventricle in patients with complex congenital heart diseases and conduits. • Indications for intervention. 6.2.2.14.2 Interventional Cardiologists’ Abilities • Hemodynamic interpretation of complex congenital heart diseases in the hemodynamics laboratory. • Choice of access. • Knowledge and abilities with imaging methods for guiding the procedure: echocardiography, CT, MR, and angiography. • Knowledge and appropriate choice of different catheters, guides, balloons, sheaths, stents, covered stents, and devices available for this procedure and their techniques. • Assessment of coronary circulation during balloon compression test in the conduit. • Knowledge of balloon catheters for dilatation. • Techniques for stent implantations. • Adequate and safe implantation of pulmonary valve replacement devices. • Recognition and rapid management of complications (vascular complications, coronary occlusion, stroke, cardiac tamponade, hemodynamic collapse, iatrogenic IVC, cardiac perforations, arrhythmias/atrioventricular blocks, etc.). • Immediate and long-term post-procedural care. 6.3. Extracardiac Interventions Since their appearance, diagnostic and therapeutic endovascular procedures in the extracardiac vascular bed have historically been performed by interventional cardiologists. Interventional cardiologists notably possess extensive scientific knowledge about systemic atherosclerotic diseases and the use of anticoagulants and antiplatelet agents, and they also have mastery of the technical procedures for performing angioplasty with stent implantation, using embolic protection filters, and others. 2,3,8,64 With the expansion and rapid advancement of techniques for peripheral intervention over the past decade, it has become necessary for the SBHCI to accompany the formation and maintenance of training and expertise of its affiliated professionals closely. 6.3.1. Norms for Establishing Hemodynamics and interventional Cardiology Training Centers that Include Extracardiac Interventions The basic rules are the same as those previously described in this Position Paper. Centers must, additionally, routinely perform extracardiac vascular procedures, in a manner that trainees are able to acquire the theoretical and practical knowledge required for good medical practice. In the literature, there is not a defined number of procedures that establish a service’s competence in this area. 6.3.1.1. Medical Teams Medical teams must be made up of preceptors and a coordinator, with the same prerequisites previously defined. There should, additionally, be professionals with experience and recognized expertise in extracardiac interventions. The number of vascular procedures necessary for maintaining competence has not been established, and it is controversial 155