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Results for “HEART CATHETERIZATION”

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PubMed2005

Cerebral emboli during left heart catheterization may cause acute brain injury.

AIMS: Left heart catheterization carries a risk for cerebral complications. The aims of this prospective study were to determine the frequency and composition of catheterization-related cerebral microemboli and to detect cerebral morphological changes and acute cognitive impairment due to catheterization. METHODS AND RESULTS: Forty-seven unselected patients undergoing elective left heart catheterization, either by transradial or by transfemoral access, were monitored for cerebral microemboli using multifrequency transcranial Doppler. Cerebral magnetic resonance imaging (MRI) with diffusion-weighted imaging sequences and neuropsychological assessments were carried out on the day before and the day after catheterization. A median number of 754 cerebral microemboli were detected: 92.1% were gaseous and 7.9% were solid. New cerebral lesions were observed in 15.2% of the transradial, but none of the transfemoral, catheterization patients (P=0.567). These lesions were significantly associated with a higher number of solid microemboli (P=0.016) and a longer fluoroscopy time (P=0.039). There was also a significantly higher number of solid microemboli during transradial than during transfemoral catheterization (P=0.012). Cognitive impairment following the investigations was associated with the degree of pre-catheterization cerebral MRI injury (P=0.03). CONCLUSION: During left heart catheterization, cerebral microemboli, especially those which are solid, may damage the brain. Cardiac catheterization may therefore pose a greater risk for the brain than previously acknowledged.

Aged↗
PubMed1996

Variation among cardiologists in the utilization of right heart catheterization at time of coronary angiography.

To describe how often a right heart catheterization was performed at the time of coronary angiography, the patient characteristics that predicted the use of this procedure, and the variation among cardiologists in the use of this test, we reviewed all cases of coronary angiography (n = 1,282) during the first 2 mo of 1993 at two large community hospitals. Fifty-two percent of the cases received a right heart catheterization at the time of their coronary angiography. The following characteristics were associated with the receipt of a right heart catheterization in a logistic regression analysis: cardiomyopathy (odds ratio = 2.59, 95% CI = 1.01, 6.62), congestive heart failure (odds ratio = 2.07, 95% CI = 1.42, 3.01), valvular heart disease (odds ratio = 2.54, 95% CI = 1.44, 4.49), no coronary angioplasty performed at the procedure (odds ratio = 2.71, 95% CI = 2.12, 3.45), and increased age (odds ratio = 1.13 per decade, 95% CI = 1.03, 1.25). Of 37 cardiologists who performed > 10 coronary angiography procedures, the use of right heart catheterization varied from 10-90%. The cardiologists' practice variation persisted after adjustment for patient clinical characteristics. Because of the high utilization of right heart catheterization at the time of coronary angiography and the variation in use among cardiologists, even when controlling for patient characteristics, the issue of appropriate indications for this procedure needs to be addressed in a rigorous fashion.

Adolescent↗
PubMed1997

Right heart catheterization: is it effective?

OBJECTIVES: To discuss the advantages of different methods of determining the effectiveness of healthcare interventions, to evaluate the basis for the assumption that right heart catheterization is effective, and to consider how right heart catheterization may fail to improve outcomes in some circumstances. DATA SOURCE: Published English language literature on right heart catheterization and patient outcomes. DISCUSSION: We recently reported an association between the use of right heart catheterization in the initial care of critically ill patients and increased risk of death. This finding is troubling and warrants future study. In this article I address the role of randomized controlled trials and observational studies in the evaluation of the effectiveness of healthcare interventions. I discuss the basis in the published literature for assuming that right heart catheterization improves outcomes. Finally I present a variety of problems with right heart catheterization which might allow this procedure, which logically should help patients, to fail to achieve a beneficial effect for some patients. CONCLUSION: We must do appropriate prospective studies to determine who benefits from right heart catheterization and who does not. We owe our patients nothing less.

Catheterization, Swan-Ganz↗
PubMed1983

[Heart catheterization in newborn and young infants. Description of the method].

The data of 343 newborns and young infants were reviewed who, from 1968 until August 1982, had undergone heart catheterization. Variations in frequency of catheterization and diagnoses as well as lethality were investigated. The first rise of heart catheterization performances could be noted in the years of 1968 and 1969 (by routine application of the Rashkind procedure), another remarkable rise took place in the years from 1971 to 1975, probably due to better feasibilities of modern cardiac surgery. Later on, a new dynamic plateau was developed. With the utilization of echocardiography, a significant decrease of heart catheterization performances in certain diagnostic groups (HLH, PFC) was registered. Nowadays, however, new diagnostic challenges (infants with low gestational age, respiratory problems, PDA) require heart catheterization. Comparison of the different diagnostic groups' lethality rate reveals that children undergoing heart catheterization, in order to rule out TGA, demonstrate a remarkably higher lethality rate (27%) than children suffering from TGA (3.7%). Introduction of echocardiography has decreased this risk significantly.

Age Factors↗
PubMed1992

Evaluation of right heart catheterization in critically ill patients. Ontario Intensive Care Study Group.

OBJECTIVE: To determine physicians' assessment of the therapeutic effect and patient benefit of data obtained from right heart catheterization. DESIGN: Before/after study. SETTING: One medical and one surgical academic ICU in two medical centers. PATIENTS: A total of 107 critically ill patients with uncertain hemodynamic status. DATA COLLECTION: Physicians looking after the patients were asked to evaluate the extent to which results of right heart catheterization resulted in changes in therapy and outcome. The same questions were asked of academic intensivists, two of whom reviewed each chart. RESULTS: Agreement regarding whether right heart catheterization had changed therapy was poor (chance corrected agreement [kappas] of -0.02 to 0.33). Treating physicians were more inclined than chart reviewers to conclude that management changes based on right heart catheterization improved outcome. Agreement on which patients benefited was poor (kappas of 0.03 to 0.32). CONCLUSIONS: Physicians' assessment of the effect of right heart catheterization on treatment decisions and patient outcomes is not reliable. Credible information regarding the benefits of right heart catheterization will require randomized trials.

Cardiac Catheterization↗
PubMed1990

Complete heart block complicating retrograde left heart catheterization.

Three cases of complete heart block complicating retrograde left heart catheterization are presented. In two of the three cases, electrophysiologic study documented block below the AV (atrial ventricular) node. In the third recurrent complete heart block was fatal. It appears that complete heart block complicating retrograde left sided cardiac catheterization is not simply a pericatheterization event; rather, it appears that there is high risk of recurrent complete heart block and that electrophysiologic study is mandatory.

Aged↗
PubMed1991

Thrombolytic therapy soon after left heart catheterization--is it safe?

Puncture of a femoral artery for left heart catheterization is considered a relative contraindication for thrombolytic therapy for some days. We treated 9 patients with systemic thrombolysis who had undergone left heart catheterization in the previous hours. Four patients developed a large hematoma, but only 1 required transfusion. We suggest that thrombolytic therapy can be administered soon after left heart catheterization by the femoral approach, provided that continuous care can be taken over the puncture site.

Adult↗
PubMed1986

Percutaneous entry of the brachial artery for left heart catheterization using a sheath: further experience.

Left heart catheterization via percutaneous entry of the brachial artery was attempted in 1,783 cases. A plain sheath without valve or side-port was employed and 7 and 8 French Sones catheters were used for females and males, respectively. Successful performance of the procedure was achieved in 96.5% of the cases. Brachial artery occlusion occurred in 1.3% of the cases and was readily correctable. There were no major complications attributable to the method of brachial artery entry. This technique has advantages over the standard Sones technique employing cutdown and arteriotomy, and may be the preferred method of left heart catheterization by way of the upper extremity.

Adolescent↗
PubMed1993

Indications for routine heart-catheterization after CABG and PTCA.

Routine heart-catheterization after Coronary Artery Bypass Graft surgery (CABG) or Percutaneous Transluminal Coronary Angioplasty (PTCA) has been advocated to determine the change in bypass graft or dilated coronary artery and native coronary artery status, the effective disease remaining after CABG or PTCA and the relation between progression of disease, left ventricular function and symptomatology. Results of angiographic follow-up data after CABG and PTCA are presented and the practical implications are discussed. The reliability of symptoms, invasive and non-invasive test for the detection of ischemia are considered. Finally, recommendations are made for the indication of routine heart-catheterization after CABG and PTCA.

Angina Pectoris↗
PubMed1993

[Adverse effects of a new non-ionic contrast medium in heart catheterization].

Tolerance of a New Non-ionic Contrast Medium during Heart Catheterization The new non-ionic contrast medium iomeprol (CAS 78649-41-9) was investigated for adverse reactions and diagnostic quality in 75 patients undergoing heart catheterization. Blood pressure and ECG were continuously registered. The patients were asked for subjective complaints by using a standardized questionnaire. Experienced cardiologists assessed the diagnostic quality of the angiograms. With iomeprol neither fatal nor severe reactions were observed. The dye had only little influence on diastolic and systolic blood pressure; heart rate was not significantly influenced. Minor and partly moderate adverse reactions all being completely reversible were observed in 14 patients (18.7%). One patient complained of strong heat sensation after dye injection into the left ventricle. The diagnostic quality of the angiograms allowed to make a definitive diagnosis in all cases. Thus, iomeprol proved to be a suitable and safe contrast medium for heart catheterization.

Adult↗
PubMed2006

Transradial right and left heart catheterizations: a comparison to traditional femoral approach.

OBJECTIVES: This study compares the transradial versus transfemoral approach to combined right- and left-heart catheterization. BACKGROUND: Central venous access from peripheral veins has been a historically useful technique. Although the need for right-heart catheterization has been considered an exclusion for transradial catheterization, we have combined a peripheral approach to the central venous system with radial arterial access which permits bilateral heart catheterization using a transradial approach. METHODS: Over an 18-month period all right-heart catheterizations done in conjunction with arterial access were reviewed. Salvage procedures, mixed site access, and biopsy procedures were excluded. Radial procedures were performed using radial artery access and a forearm vein. Femoral procedures used femoral artery/vein. Demographics, procedural information, and postprocedural complications including those requiring vascular ultrasound or transfusion were recorded and used for comparison between groups. RESULTS: Total of 175 femoral/105 radial cases done by 4 operators met criteria for comparison. Both groups had similar procedural indications and age. Procedural durations were shorter (P < .01) with radial 70 +/- 5.0 min (+/-95% CI) vs. femoral 75 +/- 5.4 min (+/-95% CI). Crossover was noted in several patients from both groups; radial procedures (n = 2) failed due to previous shoulder trauma. Femoral crossover to radial involved difficult arterial access. Complications related to access site occurred in 12 femoral and 0 radial patients. CONCLUSIONS: Using the forearm for central venous access appears safer than using the femoral vessels. Transradial catheterizations can be done in combination with forearm venous access procedures with excellent results and enhanced patient safety.

Aged↗