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PubMed1987

Cardiac catheterization for patients with postinfarction angina.

A retrospective review was conducted to determine the incidence of cardiac catheterization for postinfarction angina, the associated coronary anatomy, and the subsequent clinical course. Over one year, 30 of 178 myocardial infarctions were complicated by postinfarction angina resulting in cardiac catheterization. This was 18% of cardiac catheterizations for evaluation of coronary artery disease. Among the 30 patients, 3 had left main disease, 3 had triple-vessel disease, 11 had double-vessel disease, 11 had single-vessel disease, and 2 had no significant disease. Nine patients had proximal left anterior descending disease without left main disease. In contrast to previous autopsy or surgical series, the extent of coronary artery involvement was less severe and followed a distribution similar to that found in uncomplicated myocardial infarctions. Nevertheless, 17 of the 30 patients underwent revascularization with angioplasty or bypass surgery compared with 41 of 137 without postinfarction angina (p = 0.01). Clinical characteristics of the patients with postinfarction angina did not predict who would ultimately require revascularization. Cardiac catheterization is necessary for management of patients with postinfarction angina, because a majority of them will require revascularization.

Angina Pectoris↗

PubMed1993

Unplanned admissions after outpatient cardiac catheterization.

Increasing numbers of patients are undergoing diagnostic catheterization as outpatients; however, a small proportion of patients requires hospital admission following the procedure. Unplanned admissions after consecutive outpatient cardiac catheterizations performed during 1 year were prospectively reviewed to determine the incidence of and reasons for admission. Among 847 patients undergoing outpatient cardiac catheterization, 130 patients (15%) required hospital admission after the procedure. Admitted patients were divided into four groups: patients undergoing immediate percutaneous transluminal coronary angioplasty (PTCA) (Group 1; 33%), patients with severe cardiac disease requiring urgent intervention (Group 2; 48%), patients suffering complications or hemodynamic instability (Group 3; 15%), and patients whose procedures were completed too late to allow same-day discharge (Group 4; 4%). Patients over 65 were more likely to require admission and women were more likely to be admitted with complications or hemodynamic instability. Findings are compared with results of other outpatient series, and implications regarding appropriate setting for outpatient catheterization are discussed.

Adult↗

PubMed1995

Transesophageal echocardiographically guided atrial transseptal catheterization in patients with normal-sized atria: incidence of complications.

The incidence of cardiac complications from atrial transseptal catheterization has never been quantified in patients with normal-sized atria. Series defining the complication rate are derived from diseased hearts with structural changes that may alter the complication rate of the procedure. The generation of a standardized incidence of perforation in a population of structurally normal atria has important implications. A total of 46 atrial transseptal catheterizations guided by transesophageal echocardiography (TEE) for radiofrequency ablation of left-sided accessory pathways was performed in 42 patients during a 3-year period (1990-1993). Clinical and echocardiographic data were analyzed, with special attention given to TEE reports pre- and post-transseptal catheterization. Only one complication occurred in the 46 procedures (2.2%): a perforation of the left atrium that led to pericardial effusion and cardiac tamponade. In a small series of patients with normal sized atria, we have demonstrated that TEE-guided transseptal catheterization in a procedure with a low complication rate.

Adult↗

PubMed1997

Transvenous defibrillator systems implanted by electrophysiologists in the catheterization laboratory.

BACKGROUND: A significantly lower perioperative mortality has established the nonthoracotomy approach as the preferred technique in implantable cardioverter defibrillation (ICD) implantation. With the currently available transvenous endocardial leads in combination with the expanded use of biphasic ICD devices, the need for use of an additional subcutaneous lead has almost been eliminated. Thus, implantation of these systems has been simplified and reports have appeared in the literature that the procedure can now be performed by an electrophysiologist alone without surgical assistance in the electrophysiology or catheterization laboratory. HYPOTHESIS: The purpose of this study was to investigate the feasibility and safety of ICD implantation by an electrophysiologist in a procedure performed entirely in the catheterization laboratory without the assistance of a surgeon. METHODS: Over a period of 28 months, we implanted transvenous ICDs in 40 consecutive patients with (n = 34) and without (n = 6) use of general anesthesia in the catheterization laboratory with minor surgical assistance in abdominal pocket fashioning for the first two cases and then working alone for the remainder. The study included 36 men and 4 women, aged 59 +/- 12.5 years, with coronary artery (n = 22) or valvular heart disease (n = 4), cardiomyopathy (n = 12), and long QT syndrome (n = 1) or idiopathic ventricular tachycardia (n = 1), and a mean left ventricular ejection fraction of 34%, who presented with ventricular tachycardia (n = 30) or ventricular fibrillation (n = 10). RESULTS: One-lead ICD systems (Endotak, n = 21; Transvene, n = 8; or EnGuard, n = 1) were used in 30 patients, and 2-lead (EnGuard, n = 5 or Transvene, n = 5) systems in 10 patients. Generators were implanted in an abdominal (n = 17) or pectoral (n = 23) pocket. Active can devices were employed in 17 patients. The defibrillation threshold averaged 9 J. All implants were entirely transvenous with no subcutaneous patch. Biphasic ICD devices were employed in all patients. There were three complications (8%); one pulmonary edema that responded to drug therapy, one lead insulation break that required reoperation on the third day, and one pocket hematoma in a patient receiving anticoagulation, with no need for evacuation. There were no operative deaths and no infections. After implant, patients were discharged at a mean of 3 days. All devices functioned well at predischarge testing. During follow-up (12 +/- 8 months), 20 patients received appropriate and 5 patients inappropriate shocks. Three patients died of pump failure at 3, 7, and 19 months, respectively; they had received 0, 42, and 15 appropriate shocks, respectively, over these months. Another patient succumbed to a myocardial infarction at 9 months. At 6 months, one patient developed subacute subclavian vein thrombosis which resolved with anticoagulation therapy. CONCLUSIONS: Current transvenous biphasic ICD systems allow experienced electrophysiologists to implant them safely alone in the catheterization laboratory without surgical assistance, even for abdominal implants, with a high success rate and no need for use of a subcutaneous patch.

Adult↗

PubMedDate not supplied

No-touch catheterization and infection rates in a select spinal cord injured population.

A clinical trial comparing two intermittent catheterization techniques used with spinal cord injured patients at Parkwood Hospital, a long-term care facility in London, ON, Canada, was conducted to evaluate the techniques' effect on urinary tract infections (UTIs). Charts were reviewed retrospectively for 92 patients with traumatic spinal cord injury who were on intermittent catheterization between January 1985 and December 1988. Nearly 80% of these patients had more than one UTI per admission. A convenience sample of 18 patients with traumatic spinal cord injury participated in a prospective study using a no-touch method of catheterization for 7 months. Preliminary findings at the completion of the study revealed that 44.4% of this experimental group had more than one UTI per admission--a 44.5% reduction. The no-touch method using the O'Neil Sterile Field urinary catheter was successful in reducing the total number of infections and duration of infection for the experimental group. A nurse satisfaction questionnaire revealed that nursing staff preferred this method of intermittent catheterization to the traditional method.

Adult↗

PubMed1991

Jugular bulb catheterization does not increase intracranial pressure.

Cerebral venous monitoring through jugular bulb catheterization (JBC) allows assessment of global oxygen delivery adequacy. Because of concern that venous obstruction by catheterization may cause or exacerbate intracranial hypertension, physicians are reluctant to puncture this vessel in brain-injured patients. We evaluated the impact of JBC on intracranial pressure (ICP). 37 consecutive pediatric patients with jugular bulb catheters and ICP monitoring were studied. ICP was monitored in 28 patients during JBC. Also immediately after JBC and daily thereafter the contralateral, ipsilateral, and bilateral jugular veins were compressed in all 37 patients to assess patency of these vessels. Change in ICP was noted. If ICP increased more than 5 torr, compression was stopped. Preinsertion ICP was 17.3 +/- 5.1 and postinsertion 17.2 +/- 5.1 torr. The maximum rise in ICP was 2 torr in a single patient while 6 others had a decrease in ICP. 120 compression tests were performed. Compression ipsilateral to the catheter caused the ICP to rise from 16.0 +/- 4.3 to 18.4 +/- 4.4 torr, and in contralateral compression 15.9 +/- 4.2 to 17.0 +/- 4.4. Neither the duration of catheterization nor the precompression ICP correlated with the rise in ICP. These data revealed no evidence of jugular venous obstruction in the catheterized vessel. We conclude that JBC can be performed in patients without aggravating an elevated ICP.

Adolescent↗

PubMed1986

Pulmonary artery catheterization--uses and abuses.

Pulmonary artery (PA) catheterization has been extensively employed in the care of the critically ill and injured patients. As the clinical experience has increased, so has the list of indications and complications. Doubts have arisen as to the appropriateness of PA catheterization and positive contributions to patients care. Consensus can be reached as to the usefulness of PA catheterization in patients with severe shock syndromes, adult respiratory distress syndrome and refractory cardiac failure. Patients who require large doses of vasoactive agents may benefit from assessment of hemodynamics. Patients with minimal disease or easily correctable hypovolemia can be safely managed without PA catheter. Similarly patients with chronic obstructive pulmonary disease and renal failure requiring dialysis rarely need PA catheterization. Since technical, septic and thromboembolic complications can develop in a significant number of patients, cost benefit oriented analysis in various subsets of patients is needed. Diagnostic information derived from PA catheters should be related to the clinical condition and shortcomings and pitfalls of data clearly understood. Various indications and their relevance to patient care is reviewed.

Catheterization↗

PubMed1994

Sternoclavicular septic arthritis: a rare but serious complication of subclavian venous catheterization.

Sternoclavicular septic arthritis is a rare complication of subclavian venous catheterization. We estimate that septic involvement of this joint may be as common as one in 500 catheterizations. We report two patients with insidious onset of shoulder pain, chest discomfort, low-grade fever and slight but painful swelling of a sternoclavicular joint four weeks following subclavian venous catheterization. Positive blood cultures in the presence of abnormal bone scan and abnormal conventional X-ray examination or computed tomography of the sternoclavicular joint led to the diagnosis of septic arthritis. Both patients responded well to antibiotic treatment. Based on our observations and that reported in the literature, the earliest changes of sternoclavicular septic arthritis may be detected by bone scan while plain X-ray studies and CT become abnormal during advanced stages of this type of arthritis. We would like to alert physicians to this cause of fever and joint pain in patients who previously underwent subclavian venous catheterization.

Arthritis, Infectious↗

PubMed1986

Coronary arterial lesions of Kawasaki disease: cardiac catheterization findings of 1100 cases.

In our institute, 1100 patients with a history of Kawasaki disease have been catheterized for selective coronary arteriography. Their age at examination ranged from four months to 13 years. Coronary artery lesions (CAL) were found in 262 patients. As far as the type of the CAL was concerned, occlusion was noted in 20 (7.6%), segmental stenosis in 15 (5.7%), localized stenosis in 62 (23.7%), aneurysm in 93 (35.5%), and dilatation in 72 patients (27.5%). In terms of the total number of lesions, there were 23 occlusions, 19 segmental stenoses, 109 localized stenoses, 449 aneurysms and 307 dilatations. The 262 patients with CAL were analyzed according to the interval from the onset to the time of selective coronary arteriography. The incidence of both occlusion and segmental stenosis was lowest in the group who were catheterized shortly after the onset of disease, whereas the prevalence of aneurysm was highest in this group. But the prevalence of dilatation was highest in the group of patients who were catheterized late. A total of 12 patients had to undergo femoral arterial thrombectomy for arterial thrombosis following the catheterization, but no other major complication was experienced.

Biopsy↗

PubMed1978

A "wire-whip" catheter for selective catheterization of aortic branches.

A multipurpose "wire-ship" catheter has been developed for selective catheterization of branches arising from the aorta. The catheter tip is formed in three dimensions to allow simple selective catheterization and to provide improved stability during injection of contrast media by power injector or by hand. For successful catheterization it is essential to match the diameter of the catheter coil to the aortic lumen at the specific level to be studied; consequently, five standard sizes of coil diameter from 10--18 mm are currently produced. With an additional side hole in the coil, semiselective angiograms may be obtained. The wire-whip catheter has been used in over 200 angiographic examinations. The renal, celiac, superior and inferior mesenteric circulations have been most commonly studied, but other aortic branches such as the bronchial, intercostal, phrenic, and lumbar arteries have been catheterized as well. There have been no serious complications.

Adolescent↗

PubMedDate not supplied

Can cardiac catheterization accurately assess the severity of aortic stenosis? An in vitro pulsatile flow study.

An accurate hemodynamic assessment of aortic stenosis has important clinical implications. In clinical practice, cardiac catheterization is often used to assess the severity of aortic stenosis. However, in conducting catheterization, the precise position of the catheter tip is often not known or controlled. From the standpoint of hydrodynamics, the position of the catheter tip may affect pressure measurement due to the complicated flow fields distal to the valve. This fact is particularly true when the diagnosed valve is stenotic. The study was aimed to investigate how the position of the catheter tip in catheterizing aortic stenosis affects pressure measurement. The experiments were conducted in an in vitro pulse duplicator system. Laser flow visualization was used to examine the flow fields in the vicinity of varying degrees of aortic stenosis, and a pressure transducer with a side-hole catheter was used to measure pressures. Minimal variation in transvalvular pressure drop measured along the radial direction was observed for varying degrees of valvular aortic stenosis. This implies that, in catheterization, the placement of the catheter tip along the radial direction does not seem to affect pressure measurement. However, along the axial direction, pressure recovery was observed for all the cases studied. Therefore, within the region of pressure recovery, the position of the catheter tip may affect the pressure drop measurement. This may cause inaccuracy in assessing the severity of aortic stenosis. However, this concern may be overcome by pulling the catheter slightly further downstream, so that the position of the catheter tip is outside of the pressure recovery region.

Adult↗

PubMedDate not supplied

Should every patient undergo cardiac catheterization after myocardial infarction?

During the past few decades, management of patients with myocardial infarction has dramatically evolved. High-risk patients are now identified by a variety of noninvasive tests, and aggressive use of reperfusion strategies has improved clinical outcomes. Despite the benefits of reperfusion, only a few patients are eligible to receive thrombolytic therapy. Mortality rates among patients excluded from thrombolytic trials (15% to 20%) have been far greater than those eligible for treatment (3% to 10%). Because most deaths occur within the first few days of infarction, interventions designed to reduce mortality should be performed acutely. Immediate catheterization allows identification of high-risk anatomy that may benefit from surgery and allows coronary angioplasty to be performed as a reperfusion strategy (when appropriate). Furthermore, catheterization allows documentation of ejection fraction, vessel patency, number of diseased vessels, and residual stenosis, all of which have been predictive of prognosis. Conversely, frequently repeated noninvasive diagnostic tests are associated with increased cost, are generally performed in low-risk patients, and 60% to 80% of patients with myocardial infarction ultimately require catheterization anyway. It is possible that early catheterization and percutaneous transluminal coronary angioplasty when indicated may effectively risk stratify patients (eliminating the need for noninvasive testing), may reduce morbidity and mortality, and shorten the length of hospital stay.

Cardiac Catheterization↗

PubMed1998

[First annual report of practitioners of interventional cardiology in private practice in Germany. Results of procedures of left heart catheterization and coronary interventions in the year 1996].

The German Society for Cardiac Angiography and Interventions in Private Practice has started a registry of cardiac procedures since 1996 in order to establish a standard for performance. Although quality management for the cath lab makes sense and is also legally required, there is no generally recommended infrastructure for quality assurance existing in Germany at this time. Therefore, the German Society of Cardiologists in Private Practice (BNK) initiated a project in 1994 to develop a computer program for paperless documentation of diagnostic cardiac catheterizations and coronary interventions (PTCA) using a minimal data set. In 1996, 8 private associated groups participated in this project. The (anonymous) analysis of 10,316 diagnostic cardiac catheterizations and 2597 PTCA yielded the following results: In 95% of the patients, diagnostic cardiac catheterization was performed using the femoral and in 5% the brachial/radial approach. The mean volume of administered contrast medium was 164 +/- 138 ml/patient. The mean LV-EF was greater than 50% in 58.4% of the patients and between 30% and 50% in 10.1%. Coronary artery disease was diagnosed in 69.6% of the patients and valvular/congenital heart disease in 8.5%. In 18.4% of the patients undergoing diagnostic cardiac catheterizations no significant heart disease was identified. Mortality in the cath lab as well as the rate of cerebral insults was 0.05%. In 22.9% and 19% of the patients PTCA and cardiac surgery respectively was recommended. In patients undergoing PTCA, stable angina was present in 74.4% and unstable angina in 13.1%. Of the total number of PTCA procedures, 5.8% were performed in the setting of acute myocardial infarction. The PTCA lesion success rate was 96%, the mean diameter stenosis was 81% pre and 6% post-intervention. The mortality rate at 1 month post-PTCA was 0.4%, and myocardial infarction 1.0%. An acute occlusion occurred in 1.3% of the PTCA patients; 0.6% had to be transferred for emergency bypass surgery. None of the cath labs had on-site surgery. In comparison to other registries, our data show some similarities but also some different trends. Thus, our newly developed software proved to be reliable, fast and easy to use. Participating centers receive immediate feedback regarding their position within the whole group.

Angiocardiography↗

PubMedDate not supplied

Is routine cardiac catheterization necessary in the management of patients with single ventricles across staged Fontan reconstruction? No!

With the advent of cardiac magnetic resonance imaging and high-resolution echocardiography, cardiac catheterization is unnecessary in clinical protocols in the "routine" single ventricle patient. Catheterization adds little to clinical care in these cases, and there are significant risks and costs associated with it. Catheterization should be reserved for cases in which noninvasive evaluations are equivocal, conflictory, demonstrate deterioration, or needed for intervention. This article delineates the role of noninvasive evaluations relative to cardiac catheterization in the routine single ventricle patient.

Cardiac Catheterization↗

PubMedDate not supplied

Simplified pulmonary vasodilatory testing in the cardiac catheterization laboratory with nasal cannula nitric oxide.

In patients with pulmonary hypertension, pulmonary vasodilator testing with inhaled nitric oxide (NO) during cardiac catheterization provides valuable data for defining future care plans. Previously, the use of delivery systems for spontaneously breathing individuals required a tight-fitting seal by face mask and an approved delivery and dilution device. We hypothesized that a simplified delivery system using nasal cannula could be utilized to effectively deliver NO during cardiac catheterization. We developed a simple delivery system to deliver through a nasal cannula a concentration of NO at 50 ppm at the nares along with supplemental oxygen (O2) via face tent. We prospectively employed this system for 10-minute intervals on 11 patients (age range, 7 months to 41 years) with pulmonary hypertension undergoing scheduled cardiac catheterization. Mean pulmonary artery pressure (PAp) decreased from 62 mmHg (range, 38-99) at room air testing to 45 mmHg (range, 36-91) with the addition of NO plus O2 (p = 0.014). Pulmonary vascular resistance (PVR) decreased from 11.6 U.m2 (range, 4.5-43.4) to 6.3 U.m2 (range, 2.0-34.2) (p = 0.001). A response of 20% or more reduction in PVR was seen in all 11 patients. The initial ratio of pulmonary to systemic vascular resistance (Rp:Rs) was 0.49 (range, 0.25-3.5) and decreased to 0.35 (range 0.1-2.6) (p = 0.002). No adverse side effects were noted. We found this NO delivery system to be a simple and effective method of pulmonary vasodilatory testing that may have wide applicability in the cardiac catheterization laboratory.

Administration, Inhalation↗

PubMedDate not supplied

Managing inadvertent arterial catheterization during central venous access procedures.

PURPOSE: Approximately 200,000 central venous catheterizations are carried out annually in the National Health Service in the United Kingdom. Inadvertent arterial puncture occurs in up to 3.7%. Significant morbidity and death has been reported. We report on our experience in the endovascular treatment of this iatrogenic complication. METHODS: Retrospective analysis was carried out of 9 cases referred for endovascular treatment of inadvertent arterial puncture during central venous catheterization over a 5 year period. RESULTS: It was not possible to obtain accurate figures on the numbers of central venous catheterizations carried out during the time period. Five patients were referred with carotid or subclavian pseudoaneurysms and hemothorax following inadvertent arterial catheter insertion and subsequent removal. These patients all underwent percutaneous balloon tamponade and/or stent-graft insertion. More recently 4 patients were referred with the catheter still in situ and were successfully treated with a percutaneous closure device. CONCLUSION: If inadvertent arterial catheterization during central venous access procedures is recognized and catheters removed, sequelae can be treated percutaneously. However, once the complication is recognized it is better to leave the catheter in situ and seal the artery percutaneously with a closure device.

Adult↗

PubMed1986

The efficacy of ambulatory cardiac catheterization in the hospital and free-standing setting.

The optimal site for performing cardiac catheterization depends upon complications of the procedure, access to care in the event of complications, costs, quality of the catheterization studies, access to the procedure, and patient satisfaction. Performing ambulatory cardiac catheterization at or adjacent to a hospital may assume equivalent access to emergent or urgent services, equivalent quality, and improved patient satisfaction at reduced cost for low-risk patients (stable coronary symptoms, no active congestive heart failure, no significant arrhythmias, and no significant comorbid factor--bleeding diathesis, renal insufficiency, uncontrolled systolic hypertension). However, moving an outpatient catheterization from the hospital site to a free-standing unit, physically remote from a hospital, may be associated with a reduction in access to emergency care and less standardized quality assurance.

Ambulatory Care↗

PubMed1988

Findings on routine right heart catheterization in patients with suspected coronary artery disease.

Whether catheterization of the right heart should be performed routinely in all patients undergoing coronary angiography for assessment of coronary artery disease is controversial. To objectively assess the utility of routine right heart catheterization, hemodynamic data from 2,178 patients studied for angina having no signs, symptoms, or history of congestive heart failure were analyzed retrospectively. The salient results are as follows: 0.9% patients had unsuspected mitral valve gradients greater than or equal to 5 mm Hg; 0.4% had occult left-to-right shunts; 1% had pulmonary hypertension (pulmonary artery systolic pressure greater than or equal to 40 mm Hg) not attributable to an elevated mean pulmonary capillary wedge pressure (PCWP); 4.8% had PCWP greater than or equal to 18 mm Hg; 6% had cardiac indexes less than or equal to 2.0 L/min/m2, suggesting subclinical left ventricular failure. Overall, 14.5% of patients had at least one abnormal right-sided hemodynamic variable revealed by right heart catheterization. The frequency of abnormalities increased with increasing Canadian Cardiovascular Society grade of angina. Ten percent of grade 1, 14% of grade 2, 15% of grade 3, and 19% of patient 4 patients had at least one abnormality (phi 2 test, p less than or equal to 0.005). It is concluded that the right heart catheterization adds an important dimension to the diagnosis and treatment of patients undergoing coronary angiography for assessment of coronary artery disease and might significantly influence subsequent patient management.

Angina Pectoris↗