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At least 865 records · Page 48Linked to original sources
PubMed1996

Time to dP/dt(max), a useful index for evaluation of contractility in the catheterization laboratory.

HYPOTHESIS: The time from onset of contraction to dP/dt(max), td, is suggested as an index of contractility in the catheterization laboratory. METHODS: We studied 22 normal patients and 18 patients with myocardial failure in the catheterization laboratory. The two groups were completely separated on the td-heart rate (HR) plane. In the normal patients, HR = 73 +/- 19 beats/min, td = 73 +/- 11 ms, and an inverse linear relation td = 109-0.49 x HR (p < 0.001) exist. In the patients with myocardial failure, despite significantly higher HR than in normal patients (HR = 93 +/- 14 beats/min) (p < 0.001), td paradoxically increased (td = 89 +/- 11 ms, p < 0.0001). CONCLUSIONS: These findings support a mathematical analysis of the left ventricular pressure (LVP) during isovolumic contraction in the time domain which shows that td and (dP/dt)/P reflect the time-dependent aspects of contraction and, hence, decrease with increasing contractility. This study shows that td, at any given HR, is a reliable index of contractility. Thus, a ready-to-use td-HR plot containing a well-based separation line can provide a reliable and simple method for determining contractility in the catheterization laboratory by examining whether a patient's td value at any HR is below (normal) or above (impaired contractility) the separation line.

Cardiac Catheterization↗
PubMed2000

Should interventional cardiac catheterization procedures take place at the time of diagnostic procedures?

BACKGROUND: In many cardiac catheterization laboratories interventional procedures are performed at a date later than the diagnostic study, causing increased hospital days and costs. Few data exist which compare procedural success, complications, and costs between procedures performed at the time of diagnostic study and those performed later. HYPOTHESIS: The purpose of this study was to evaluate the safety and success of same-day interventional procedures and to quantitate hospital cost savings with this strategy. METHOD: In all, 357 consecutive patients who underwent an elective interventional procedure of a native coronary artery either at the time of diagnostic study (same day, n = 244) or later (delayed, n = 113) were reviewed. Procedural success [< 30% residual lesion post-percutaneous transluminal coronary angioplasty (PTCA) or 0% residual lesion post-stent], major complications [death, emergent coronary artery bypass grafting (CABG), myocardial infarction, and ventricular fibrillation], hospital days, and costs were analyzed. Procedural expense, including the diagnostic and interventional procedure in the cardiac catheterization laboratory, and hospital expense were analyzed. RESULTS: Both groups were similar in terms of age, gender, coronary risk factors, indications (myocardial infarction, unstable angina, abnormal stress test), the culprit coronary artery, type of intervention (PTCA, stent), and lesion complexity (type A, B, C). The average hospital stay for the two groups was 4.37 +/- 2 and 6.55 +/- 2.4 days, respectively (p < 0.0001). The procedural charges were $8,207.99 and 10,581.87, respectively (p < 0.0001). CONCLUSION: Catheter intervention performed at the same time as the diagnostic cardiac catheterization procedure is as successful and as safe as that performed at a later date. Hospital stay and costs, as well as procedural expenses are significantly reduced by this practice.

Adult↗
PubMed2006

Primary percutaneous coronary intervention in acute myocardial infarction: direct transportation to catheterization laboratory by emergency teams reduces door-to-balloon time.

BACKGROUND: Primary percutaneous coronary intervention (PCI) is the recommended revascularization strategy for patients presenting with acute ST-elevation myocardial infarction (STEMI). In most hospitals, transfer of patients with STEMI is organized from the emergency site via emergency room (medical and cardiologic evaluation) and then to the catheterization laboratory. HYPOTHESIS: In this prospective study, we sought to evaluate the effect of a logistic modification in this treatment process. METHODS: Local emergency ambulance teams were instructed to identify and evaluate patients with STEMI eligible for direct PCI and to transport them directly to the cardiac catheterization laboratory for immediate percutaneous coronary intervention ("ER bypass"). This study prospectively included 74 consecutive patients with acute coronary syndromes (STEMI) and compared them with a matched historic control group ("ER evaluation"). Primary endpoint was the reduction in door-to-balloon time; secondary endpoint was quality of preclinical emergency diagnosis. RESULTS: Median door-to-balloon time was reduced by 27 min. Primary interventional success was achieved in 92% of patients. Preclinical emergency diagnoses were correct in 95% of patients. CONCLUSION: The preclinical emergency diagnosis of STEMI was reliable. Direct transport of patients with STEMI to the cardiac catheterization laboratory and early preclinical alert by the interventional PCI team significantly reduces door-to-balloon-times compared with established standard processes-of-care for patients considered for primary PCI.

Adult↗
PubMed1991

The effect of cardiac catheterization on fasting lipids.

Fasting lipid profiles were measured in 20 selected patients the day of and after cardiac catheterization in EDTA tubes. Samples were randomly labelled A or B, centrifuged, and stored at 3 degrees Centigrade. Lipid profiles were analyzed by a laboratory, which was participating in the Center for Disease Control Lipid Standardization Program, by using standard methods. The coefficients of variation for repeated measurements were: cholesterol = 1.9%, triglycerides = 3.6%, HDL cholesterol = 4.3%, and VLDL and LDL cholesterol = 2.6%. Data were evaluated by a two-tailed paired t-test and correlation coefficient. The total cholesterol was significantly lower (P less than .001) the day after cardiac catheterization as was the LDL cholesterol (P less than .002). Both VLDL and HDL cholesterol and triglycerides were lower, but these were not statistically significant. The mean dose of heparin was 3500 +/- 1469 units, and the mean dose of contrast was 181 +/- 30 cc. The total dose of heparin or contrast did not correlate with any change in lipid profiles. These results have implications on the number and timing of venous blood sampling for lipid measurements in regard to diagnosis and treatment of hyperlipidemia. Lipid profiles should not be drawn after cardiac catheterization but rather before and/or in the free-living state.

Adult↗
PubMedDate not supplied

Intermittent catheterization: sterile or clean?

Bacteriuria--asymptomatic and symptomatic--always has the potential to develop into a serious problem when intermittent catheterization is being used. Research on the best method of reducing bacteriuria is inconclusive. Studies have focused on the use of sterile technique, oral or vesical antibiotics, and the frequency of catheterization. This article presents a summary of current research on bacteriuria in the patient requiring intermittent catheterization.

Bacteriuria↗
PubMed1992

Cardiac natriuretic peptide hormones during artificial cardiac pacemaker stimulation and left heart catheterization.

Brain natriuretic peptide (BNP) is synthesized and released predominantly in the ventricular myocardium whereas atrial natriuretic peptide (ANP) is produced mainly in the atria. This study evaluated whether artificial pacemaker stimulation or left heart catheterization results in specific changes in BNP and ANP plasma levels. Both BNP and ANP responded sensitively to changes in pacemaker stimulation (single-chamber pacemakers; pacing rates of 72 and 92/min) and during the left heart catheterization procedure. However, whereas higher pacing resulted in a more pronounced increase in plasma BNP levels, a stronger ANP release followed catheterization. This incongruous rise in ANP and BNP plasma concentrations points to at least partly independent mechanisms governing the release of BNP and ANP.

Atrial Natriuretic Factor↗
PubMedDate not supplied

Parathyroid localization by catheterization of large cervical and mediastinal veins to determine serum concentrations of intact parathyroid hormone.

A success rate of about 90% has been achieved after primary operations for hyperparathyroidism, compared with 60% to 80% in most series of secondary operations. The present reoperative series involved 29 patients who underwent venous catheterization with blood sampling for the determination of intact parathyroid hormone before undergoing repeat parathyroid surgery. Blood samples were taken from the internal jugular veins, innominate veins, and superior caval vein. No attempt was made to perform superselective catheterization of the small neck and mediastinal veins. The reoperations were done by four surgeons who did 1, 2, 13, and 13 of the reoperations, respectively. In all patients, distinct step-ups in parathyroid hormone concentrations were found. On average, the gradient between the highest and lowest value was about 5. Close to the location of the step-ups, diseased parathyroid tissue was found in 27 of the patients. In two cases no parathyroid tissue was found, and these patients remained hyperparathyroid postoperatively. They had been treated by the surgeon who did only two of the operations. When the step-up was observed in the left innominate vein, we could not differentiate mediastinal from low cervical adenomas. No patient developed hypoparathyroidism. To avoid this complication, autotransplantation of diseased parathyroid tissue into the abdominal subcutaneous fat was done in nine patients. No case of recurrent laryngeal nerve paralysis occurred. The introduction of reliable assays for the analysis of parathyroid hormone can make selective catheterization unnecessary when localizing remaining parathyroid glands in patients with persistent hyperparathyroidism.

Adolescent↗
PubMed1992

Central venous catheterization in infants and children with congenital heart diseases: experiences with 500 consecutive catheter placements.

In a prospective study results of central venous catheter (CVC) placements in a consecutive group of 500 patients with less than 20 kg body weight undergoing cardiac surgery were evaluated. The incidence of previous cardiac surgery was 21% and the incidence of factors preventing the primary puncture of the right jugular or innominate vein was 13.4%. The anesthesiologists were free to select the catheterization technique, site of puncture, and catheter type. All CVC insertions were performed prior to surgery under continuous circulatory monitoring and optimal positioning of the anesthetized patient. Ninety-six percent of all catheterizations were successful, 81% of them on the first attempt. In the 4% of cases where catheterization failed, a CVC had to be placed by the surgeon. Of all catheters, 66% were positioned via the right internal jugular (IJV) or innominate vein (IV), 8% via the left, 16% via an external jugular vein (EJV), and 5% via other veins. Seventy-six percent of CVC insertions were performed with the Seldinger technique. Of the four catheter types used in this study, double lumen catheters were most frequently selected (38%). Placement of 22-ga single lumen catheters was preferred in infants with less than 5 kg body weight, in spite of their tendency to kink. Observed complications (10% arterial puncture, 4% hematoma, and 1% intrathoracic bleeding) never required immediate surgical intervention. Careful selection of appropriate catheters, as well as extensive experience and knowledge of the anatomical structures involved in special heart defects, helped to keep the risk of complications low.

Body Weight↗
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↗
PubMed1994

Prophylactic ureteral catheterization in colon surgery. A five-year review.

PURPOSE: The preoperative placement of prophylactic ureteral catheters in operations of the distal colon is both commonplace and controversial. We assessed the frequency, safety, and effectiveness of their use over a five and one-half-year period in a teaching hospital. METHODS: The charts of 561 consecutive patients who underwent sigmoid or rectosigmoid colectomy from 1986 to 1991 were analyzed for age, sex, diagnosis, type of colectomy, placement of ureteral catheters, and ureteral complications. RESULTS: Ureteral catheterization was attempted in 92 patients (16.4 percent); it was successful bilaterally in 80 patients (87 percent) and unilaterally in an additional 10 patients (98 percent). Four (0.71 percent) transmural ureteral injuries were identified. Two surgical injuries (0.43 percent) occurred in the 469 patients without prophylactic catheter placement (95 percent confidence interval = 0.00549-0.0153). Two injuries (2.2 percent), consisting of one surgical injury and one iatrogenic injury directly related to catheter placement, occurred in the 92 patients with prophylactic catheters (95 percent confidence interval = 0.00262-0.0764). This latter injury resulting from catheter placement represents a rate of 1.1 percent per patient and 0.55 percent per ureteral catheterization attempted. Using a 24-hour staged removal, these catheterizations were associated with a 0 percent incidence of reflux anuria. CONCLUSIONS: Experienced surgeons requested prophylactic ureteral catheter placement in 16.4 percent of their sigmoid and rectosigmoid colectomies. The risk of ureteral injury (1.1 percent) as a direct result of catheter insertion is small, but not insignificant. Prophylactic ureteral catheters do not assure the prevention of transmural ureteral injuries, but may assist in their immediate recognition.

Adolescent↗
PubMed1982

Heparinization for prevention of thrombosis following pediatric percutaneous arterial catheterization.

One thousand three hundred and sixteen consecutively catheterized infants and children were evaluated prospectively for femoral artery thrombosis following percutaneous cardiac catheterization. One hundred units/kg heparin bolus was given to 649 patients after arterial puncture (group A). A supplementary 50 units/kg of heparin bolus was given to 381 patients 75 minutes later, followed by a continuous heparin infusion if pulses were decreased (group B). Two hundred forty-one patients were managed similarly except the first supplementary bolus was given 45 minutes after initial heparinization, if necessary, and the second bolus and continuous infusion were begun 45 minutes later, if necessary (group C). Arterial thrombosis was diagnosed if pulses were not equal to those of the unused extremity 6 hours following catheterization. The overall incidence of arterial thrombosis was 0.8%. No statistically significant (p less than .05) differences occurred related to the heparinization method used. However, absence of thrombosis in the last 241 consecutive patients (group C) and in the last 480 patients of groups B and C weighing more than 10 kg approaches significance (p less than .1). Incidence of thrombosis was less than in previous studies (p less than .0005 to .05). This study indicates that a very low incidence of arterial thrombosis can be achieved with systemic heparinization.

Adolescent↗
PubMed1981

Femoral artery catheterization and vessel tortuosity.

In the era of selective and superselective arteriography, vessel tortuosity, even in the presence of good pulses, can impede catheterization of the aorta and its branches. We assessed 101 patients who had femoral arteriography to determine whether there was a significant difference in tortuosity between the right and left sides and to define the degree to which significant tortuosity was bilateral. Fourteen and 21 patients had tortuosity greater than 1 standard deviation above the mean of the population on the right and left sides, respectively. This difference was not statistically significant. Twenty-three of the 29 patients with tortuosity greater than 1 standard deviation above the mean had this finding unilaterally. There is no advantage to preferentially beginning catheterization on a particular side. Furthermore, since 80% of significant tortuosity is unilateral, the contralateral femoral artery should be approached with only minimal delay when tortuosity that impedes catheterization is encountered.

Angiography↗
PubMedDate not supplied

"Retroantegrade" catheterization of the branches of the femoral artery: technical note.

Antegrade catheterization is the preferred approach to angioplasty and selective fibrinolysis of branches of the femoral artery. A simple method of antegrade catheterization beginning with a retrograde puncture and using a new catheter is described. The method can reduce the number of punctures and manipulations needed for selective antegrade catheterization of the common femoral artery.

Catheterization, Peripheral↗
PubMed1997

An alternative statistical approach for predicting prolonged catheterization after Burch colposuspension during reconstructive pelvic surgery.

Our objective was to use an alternative statistical approach to identify clinical and urodynamic predictors of prolonged catheterization following Burch colposuspension. Seventy women with genuine stress incontinence underwent Burch colposuspension with suprapubic catheter placement at Rush Presbyterian-St. Luke's Medical Center from 1 July 1992 to 1 October 1993. Patient charts were retrospectively reviewed to extract pertinent variables from their history, examination and preoperative urodynamic evaluation. The day of suprapubic catheter removal was considered the end-point 'event' for the purposes of survival analysis. This statistical model allowed us to identify preoperative clinical parameters important in determining the percentage of patients requiring catheters as a function of time. The need for defining prolonged postoperative catheterization was eliminated. Aging (P=0.01), increasing maximal urethral pressures (P=0.02) and menopausal status (P=0.02) were important in determining the percentage of patients requiring catheters as a function of time. Data from our preoperative voiding studies were not predictive of prolonged catheterization following Burch colposuspension.

Adult↗
PubMedDate not supplied

Should all patients undergo cardiac catheterization after a myocardial infarction?

Between one half and two thirds of patients who survive an acute myocardial infarction (AMI) may be at low risk for future complications and hence can be managed with medical therapy. However, the remaining patients are prone to future complications, which by and large occur within the subsequent 3 months and include cardiac death, recurrent AMI, unstable angina, and congestive heart failure. Current available methods for risk stratification include a good clinical evaluation, rest and stress electrocardiograms (preferentially combined with radionuclide imaging), and possibly two-dimensional stress echocardiography. In patients unable to exercise, pharmacologic perfusion scintigraphy affords a powerful means to identify high-risk patients. Patients deemed to be at high risk should be referred for cardiac catheterization and myocardial revascularization. The practice of performing routine cardiac catheterization after an AMI has led to an over use of resources in the United States. Such a practice is not based on any scientific evidence of enhanced benefit. In fact, in other Western world countries where only selected patients are referred for cardiac catheterization, patient survival appears to be similar to that in the United States. In conclusion, most patients after AMI, whether treated with thrombolytic therapy or not, can be managed conservatively and risk stratified on the basis of noninvasive testing, after which patients deemed to be at high risk should undergo invasive evaluation.

Cardiac Catheterization↗
PubMed1998

[Percutaneous suture of femoral artery access sites after diagnostic heart catheterization and or coronary intervention. Safety and effectiveness of a new arterial suture technic].

UNLABELLED: The safety and efficacy of a suture-based closure device designed to achieve hemostasis at the femoral access site post catheterization procedures was compared to manual compression in a 600 patients randomized trial (data available for 590 patients). The patients were randomized to percutaneous vascular surgery (PVS) or manual compression after diagnostic (401 patients) and interventional (189 patients) procedures. Two types of PVS devices were used delivering 1 or 2 sutures at the arterial access site. The overall results as well as the results by procedure type demonstrated a significant reduction in time of hemostasis (7.8 +/- 4.8 min vs 19.6 +/- 13.2 min, p < 0.01) and time to ambulation (4.5 +/- 6.5 hours vs 17.8 +/- 5.0 hours, p < 0.01) with the use of the PVS device. The safety results showed no significant differences in the incidence of vascular complications (5.7% for PVS vs 11.3% for compression) in the overall population or in the interventional patients subset (8.4% for PVS vs 9.6% for compression). However, the PVS device demonstrated a significant reduction in the incidence of vascular complications post diagnostic catheterization procedures (4.4 for PVS vs 12.1% for compression, p < 0.05). The incidence of vascular complications and the time of hemostasis was similar in an American multicenter study (STAND II). CONCLUSION: Percutaneous vascular surgery is a safe and effective method to achieve hemostasis post catheterization procedure providing faster hemostasis and ambulation without increasing the rate of complication.

Cardiac Catheterization↗
PubMed1991

Selective venous catheterization in the evaluation of hyperandrogenism.

Retrograde bilateral ovarian-adrenal vein catheterization was carried out in 16 patients with plasma testosterone levels exceeding 1.4 ng/ml (4.85 nmol/l). While pelvic ultrasonography and computerized axial tomographic scan failed to locate the androgen-producing ovarian tumors, catheterization led to a diagnosis of occult ovarian tumor in 5 patients, based on the observation of an abnormally-high and unilateral ovarian-peripheral vein testosterone gradient, which was subsequently confirmed histopathologically. In one case, unilateral elevation of the adrenal-peripheral vein testosterone gradient was found, complementing the ultrasonographic finding of an adrenal mass and confirming the diagnosis of a virilizing adrenal tumor. In the other 10 patients, gradient analysis ruled out an androgen-producing tumor, leading to the identification of nontumoral hyperandrogeny, such as a severe form of the polycystic ovary syndrome in the 6 premenopausal patients and of ovarian stromal and hilus cell hyperplasia in the 4 menopausal patients. In conclusion, appropriate indication of selective catheterization may considerably reduce the need for exploratory surgery and may help in selecting the adequate surgical approach.

Adrenal Gland Neoplasms↗