[Direct registration of oxygen pressure in blood with a special cardiac catheter in cardiac catheterization].
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Cardiac Catheterization↗
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The transcervical cardiac catheter: its transverse pretracheal placement in the treatment of cardiac catheter complications with ventriculo-atrial shunts in infantile hydrocephalus.
In 40 hydrocephalic children with ventriculo-atrial shunts 58 operative revisions of the cardiac catheter were evaluated. The review of the patients with cardiac catheter complications showed that the majority (68%) had undergone the primary shunting procedure as newborn or as prematurely born within the first 6 months of life. Most frequently the revisions had become necessary because of obstruction of the cardiac catheter at its distal end (22 times) and the slipping of the catheter from the valve (21 times). Other revisions were carried out for too long (2 times) or too short (once) cardiac catheter, rupture (5 times), kinking or coiling (7 times) of the catheter. The transcervical cardiac catheter, which was given particular attention, used for insertion in revisions for venous obliteration on the side of the previous catheter placement, was performed in 11 patients. It yielded good results in respect of practicability and prognosis and can be recommended as a useful method for shunt revision in venous obstruction.
Cerebrospinal Fluid Shunts↗
An integrated system for real-time image guided cardiac catheter ablation.
Minimally invasive cardiac catheter ablation procedures require effective visualization of the relevant heart anatomy and electrophysiology (EP). In a typical ablation procedure, the visualization tools available to the cardiologist include bi-plane fluoroscopy, real-time ultrasound, and a coarse 3D model which gives a rough representation of cardiac anatomy and electrical activity. Recently, there has been increased interest in incorporating detailed, patient specific anatomical data into the cardiac ablation procedure. We are currently developing a prototype system which both integrates a patient specific, preoperative data model into the procedure as well as fuses the various visualization modalities (i.e. fluoroscopy, ultrasound, EP) into a single display. In this paper, we focus on two aspects of the prototype system. First, we describe the framework for integrating the various system components, including an efficient communication protocol. Second, using a simple two-chamber phantom of the heart, we demonstrate the ability to integrate preoperative data into the ablation procedure. This involves the registration and visualization of tracked catheter points within the cardiac chambers of the preoperative model.
Cardiac Catheterization↗
The 2002 European registry of cardiac catheter interventions.
OBJECTIVE: The tradition of yearly reports on cardiac catheter interventions in Europe has been initiated in 1992. This 11th report presents aggregated data on cardiac catheter procedures in 30 European countries in the year 2002. DESIGN AND SETTING: A detailed questionnaire addressing summary data of all cardiac interventions was mailed to presidents or delegates of the national societies of cardiology in Europe. The questionnaire was distributed to all institutions with cardiac catheterisation programs. All questionnaires were compiled in a national summary data sheet, then entered into a central database and subsequently analysed. MAIN OUTCOME MEASURES: Coronary angiography, PTCA, and stenting in absolute numbers and per million inhabitants in the participating countries and the whole of Europe. RESULTS: Overall, 1,901,932 coronary angiograms were reported. The population-adjusted rate of coronary angiograms amounted to an absolute mean of 3358 per 10(6) inhabitants, an increase of 7% compared with 2001. A total of 686,869 PTCA procedures were reported. The mean European number of PTCAs per 10(6) inhabitants increased by 10% from 1103 in 2001 to 1213 in 2002. Procedures with stenting increased by 17% from 508,999 to 593,906. The stenting rate was 86% compared with 82% in 2001. CONCLUSIONS: In pace with epidemiological demand and the need to catch-up from underuse in certain countries, a continuous and considerable growth of coronary interventions can be observed. It will take years to find out whether the announced change of paradigm in the treatment of multivessel disease in the wake of drug-eluting stents will come true.
Angioplasty, Balloon, Coronary↗
Cardiac catheter complications related to left main stem disease.
OBJECTIVE: To examine the incidence and outcome of cardiac catheter complications related to left main coronary artery disease or damage using the CECCC (Confidential Enquiry into Cardiac Catheter Complications) database. SETTING: Coordinating centre for national database. DESIGN: Retrospective analysis of reports to a national multicentre database for cardiac catheter complications. Complications involving the left main coronary artery were flagged at entry. Where necessary additional information was sought from participating centres. 112,921 procedures were registered, 12,849 of which were coronary angioplasties and the remainder diagnostic studies. RESULTS: The total number of cases for which complications were recorded was 993 (0.88%). In 61 (6.14%) of the 993 cases complications were associated with left main coronary disease or damage. In 57 (93%) of these 61 cases complications were major, necessitating resuscitation or immediate coronary bypass grafting. Ten patients (16%) died in the catheter laboratory, a further 9 (15%) within 24 hours, and a total of 23 patients (38%) died within one month of the procedure. Left main stem related complications account for 17% of total mortality in the CECCC database. Urgent coronary bypass grafting was attempted in 42 patients, of whom 31 were alive at one month. In all of the six reported PTCA-related complications the cause was traumatic damage to the left main coronary artery. Operators of all grades of seniority experienced complications in similar proportions. CONCLUSIONS: The risk of a complication relating to the left main stem is relatively low, but when such complications occur they tend to be life-threatening and contribute a fifth of total catheter-related mortality. In the absence of a widely available non-invasive investigation with good predictive value for left main stem disease, the best safeguard is careful technique. Patients who do develop complications should have emergency coronary bypass grafting.
Cardiac Catheterization↗
Congenital Heart Surgery Nomenclature and Database Project: therapeutic cardiac catheter interventions.
The extant nomenclature for therapeutic cardiac catheter interventions is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories using synonyms where appropriate. A comprehensive database set is presented which is based on a hierarchical scheme. Data are entered at various levels of complexity and detail which can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented which will allow for data sharing and would lend itself to basic interpretation of trends. Outcome tables relating diagnoses, procedures, and various risk factors are presented.
Cardiac Catheterization↗
A new steerable cardiac catheter for crossing stenotic aortic valves.
A new cardiac catheter for crossing severely stenotic aortic valves is described. This catheter is an externally steerable one and it was used successfully and uneventfully in 12 patients after a conventional catheter had failed to cross the aortic valve. Six of the patients underwent aortic valvuloplasty. The most advantageous feature of the new catheter is its ability to scan the aortic valve orifice under entirely external manipulation.
Aged↗
Significance of intravascular and intracardiac movement of the cardiac catheter in ventriculo-atrial shunts (review of 655 cases).
Proper placement of ventriculo-atrial shunts can be complicated by three phenomena: 1. Movement of the cardiac catheter intravascularly into the internal jugular vein as noted on chest X-ray. 2. Movement of the cardiac catheter during intraoperative X-ray leading to blurring and hence problems in accurate localization. 3. No sign on X-ray of the catheter tip or even of the catheter itself despite previous X-ray visualization and good function, a problem to be obviated by better radiopaque markings.
Adult↗
Report from the Canadian Coordinating Office for Health Technology Assessment (CCOHTA). Reuse of single-use cardiac catheters.
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Canada↗
Air embolism and exsanguination from separation of two-piece side port/hemostasis valve cardiac catheter introducers.
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Cardiac Catheterization↗
Platelet activation caused by cardiac catheter blood collection, and its prevention.
The study of platelet changes occurring across the coronary circulation is important in the investigation of the platelet's role in ischemic heart disease. It requires blood sampling through cardiac catheters. This could activate platelets and alter the results of tests of platelet activation and reactivity. This study was designed to examine this problem and to devise satisfactory methods for obtaining blood for platelet studies through long catheters. Blood collected through catheters introduced with a guide-wire had a much higher plasma heparin neutralising activity (HNA), platelet factor 4(PF4) and beta-thromboglobulin (beta TG) than peripheral venous blood, and lower platelet count(PC). Blood collected through catheters introduced via a sheath, and kept filled with anticoagulant/antiplatelet solution until blood sampling, gave results similar to peripheral venous blood for the PC, platelet aggregate ratio, platelet fluorescent granule count, and for plasma HNA, PF4 and beta TG. It is concluded that platelets are activated during blood collection through cardiac catheters; however, with appropriate precautions, blood which is satisfactory for platelet studies can be obtained.
Adolescent↗
Real-time cardiac catheter navigation on three-dimensional CT images.
INTRODUCTION: Targets for ablation of atrial fibrillation, atrial flutter, and non-idiopathic ventricular tachycardia are increasingly being selected based on anatomic considerations. Because fluoroscopy provides only limited information about the relationship between catheter positions and cardiac structures, and is associated with radiation risk, other approaches to mapping may be beneficial. METHODS: The spatial and temporal information of an electromagnetic catheter tip position sensing system (Magellan, Biosense Inc.) was superimposed on a three-dimensional (3D) CT of the chest in swine using fiducial markers for image registration. Position and orientation of a 6 French catheter with an electromagnetic sensor was displayed in real-time on a corresponding 3D-CT. Catheter navigation within the heart and the great vessels was guided by detailed knowledge about catheter location in relation to cardiac anatomy. RESULTS: Anatomic structures including the atrial septum, pulmonary veins, and valvular apparatus were easily identified and used to direct catheter navigation. During the right heart examination, the catheter was navigated through the superior and inferior vena cava to predetermined anatomic locations in right atrium, right ventricle and pulmonary artery. The ablation catheter was also navigated successfully from the aorta through the aortic valve in the left ventricle. No complication was encountered during the experiments. The accuracy and precision of this novel approach to mapping was 4.69 +/- 1.70 mm and 2.22 +/- 0.69 mm, respectively. CONCLUSIONS: Real-time display of catheter position and orientation on 3D-CT scans allows accurate and precise catheter navigation in the heart. The detailed anatomic information may improve anatomically based procedures like pulmonary vein ablation and has the potential to decrease radiation times.
Animals↗
A simple method for repeated cardiac output determination in the unanesthetized dog using an indwelling cardiac catheter.
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Animals↗
Flow effect on lesion formation in RF cardiac catheter ablation.
This study investigated the flow effect on the lesion formation during radio-frequency cardiac catheter ablation in temperature-controlled mode. The blood flow in heart chambers carries heat away from the endocardium by convection. This cooling effect requires more power from the ablation generator and causes a larger lesion. We set up a flow system to simulate the flow inside the heart chamber. We performed in vitro ablation on bovine myocardium with three different flow rates (0 L/min, 1 L/min and 3 L/min) and two target temperatures (60 degrees C and 80 degrees C). During ablation, we also recorded the temperatures inside the myocardium with a three-thermocouple temperature probe. The results show that lesion dimensions (maximum depth, maximum width and lesion volume) are larger in high flow rates (p<0.01). Also, the temperature recordings show that the tissue temperature rises faster and reaches a higher temperature under higher flow rate.
Animals↗
Application of sonomicrometry and multidimensional scaling to cardiac catheter tracking.
This paper describes a technique for tracking the three-dimensional (3-D) position of a cardiac catheter using sonomicrometry and the mathematical method of multidimensional scaling (MDS). Sonomicrometry is used to measure the distances between ultrasonic transceivers. MDS is then used to calculate the 3-D coordinates of the ultrasonic transceiver locations, including the catheter tip, from the measured distances. Feasibility of catheter tracking was initially studied using simulated data from a geometric model in which the actual coordinates of all transceivers were known. The method was then shown to be feasible in vivo by tracking a catheter-mounted piezoelectric transducer using seven reference crystals sewn to the epicardial surface of a sheep heart. Simulation results indicate that a catheter can be tracked with a root-mean-square (rms) error of 1.51 +/- 0.05 mm and an average-distance error of e = 1.06 +/- 0.27 mm using 12 reference points. In vivo results showed acceptable stress values (G < 0.05) for 95% of the data samples with an average-distance error of e = 0.52 +/- 0.66 mm. These simulation and experimental results show that sonomicrometry and MDS can be used to accurately localize the 3-D position and track the motion of a catheter tip within the heart.
Cardiac Catheterization↗
FEM analysis of predicting electrode-myocardium contact from RF cardiac catheter ablation system impedance.
We used the finite-element method (FEM) to model and analyze the resistance between the catheter tip electrode and the dispersive electrode during radio-frequency cardiac catheter ablation for the prediction of myocardium-electrode contact. We included deformation of the myocardial surface to achieve accurate modeling. For perpendicular catheter contact, we measured the side view of myocardial deformation using X-ray projection imaging. We averaged the deformation contour from nine samples, and then incorporated the contour information into our FEM model. We measured the resistivity of the bovine myocardium using the four-electrode method, and then calculated the resistance change as the catheter penetrated into the myocardium. The FEM result of resistance versus catheter penetration depth matches well with our experimental data.
Animals↗
[Hemodynamic study of external counterpulsation with left and right cardiac catheters in 15 cases].
The hemodynamic changes of 15 cases during external counterpulsation with left and right cardiac catheters were reported. The results showed that the diastolic pressure at the root of the aorta was remarkably increased, the peak value (countercurrent pressure) was 8.02 +/- 2.05 kPa higher than the diastolic pressure before counterpulsation; the aortic systolic pressure during counterpulsation was slightly decreased with a mean value of 0.81 kPa; there was no apparent change in the central venous pressure and pulmonary arterial pressure; pulmonary arterial wedge pressure was slightly reduced during counterpulsation. All the above data are useful in showing the improvement of cardiac and brain perfusion volume and clarifying its mechanism.
Adult↗
Improving water quality can reduce pyrogenic reactions associated with reuse of cardiac catheters.
OBJECTIVE: To report the results of our preintervention investigation and subsequent 19-month three-phase intervention study designed to reduce pyrogenic reactions among patients undergoing cardiac catheterization using reprocessed catheters. DESIGN: A case-control study for the preintervention period and a prospective cohort study for the intervention period. SETTING: A 400-bed hospital in Belo Horizonte, Brazil. PARTICIPANTS: Any patient undergoing cardiac catheterization in the hospital. INTERVENTIONS: Three intervention phases were implemented to improve the quality of the water supplied to the cardiac catheter reprocessing laboratory. Standard operating procedures for reprocessing cardiac catheters were established and reprocessing staff were trained and educated. RESULTS: The rate of pyrogenic reactions decreased significantly during the intervention phases, from 12.8% (159 of 1,239) in phase 1 to 5.3% (38 of 712) in phase 2 to 0.5% (4 of 769) in phase 3 (chi-square test for linear trend, 97.5; P < .001). CONCLUSION: Improving water quality and using standard operating procedures for reprocessing catheters can prevent pyrogenic reactions in hospitalized patients.
Adult↗