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PubMed1992

The safety of pediatric cardiac catheterization in an adult hospital setting.

OBJECTIVE: To assess the safety of performing diagnostic and interventional cardiac catheterization of neonates, infants and children in a laboratory located in an adult hospital. DESIGN: Retrospective medical record review. SETTING: Children's Hospital of Western Ontario. PATIENTS: All patients 18 years or younger undergoing cardiac catheterization procedures performed by pediatric cardiologists between January 1986 and December 1989. MAIN RESULTS: The total number of procedures performed was 289. Three major (1%), nine moderate (3%) and 20 minor (7%) complications were documented with none fatal. These rates are comparable with complications documented for larger centres with dedicated pediatric catheterization facilities. CONCLUSION: Although less than ideal, the use of an adult facility for pediatric cardiac catheterization appears to be a safe and reasonable alternative.

Adolescent↗
PubMed1990

Dynamic arm exercise during cardiac catheterization in the assessment of stenotic valvular disease.

Assessment of hemodynamic responses during some form of exertion or stress during cardiac catheterization is useful among patients suspected of having valvular stenosis who demonstrate normal or borderline valve gradients at rest. Leg raising exercise and drug administration are commonly used for this purpose, but each has inherent limitations. To evaluate the usefulness of dynamic arm raising exercise as a means of altering hemodynamics during cardiac catheterization, 23 such patients were studied. Measurements obtained during arm raising exercise were compared with those at rest. Heart rate rose by 34 +/- 4 beats/min (p less than 0.001), while cardiac output increased by 1.4 +/- 0.2 l/min (p less than 0.001). Stroke volume decreased slightly, although left ventricular filling pressures and pulmonary capillary wedge pressures rose in nearly all subjects. The change in valvular gradients was variable. These data were compared with those obtained in 11 similar patients receiving either dopamine or isoproterenol as an intervention. The changes in heart rate and cardiac output from the resting state were similar between the groups, with fewer side effects occurring during arm exercise. Dynamic arm exercise is a safe and effective maneuver which can be performed during cardiac catheterization in patients undergoing diagnostic evaluation of stenotic valvular disease.

Adult↗
PubMed1993

Update on cardiac catheterization and coronary arteriography.

Indications for cardiac catheterization--including coronary angiography--have substantially broadened with the advent of nonsurgical therapeutic interventions performed in the catheterization laboratory. Consequently, the increasing number of facilities performing these procedures require clear and unmistakable guidelines regarding the indications for and the safety and ethical aspects of the procedure. Technical developments in image acquisition and evaluation, such as quantitative analysis, allow the exact, reproducible assessment of minute changes in cardiac morphology and function, the evaluation of which becomes increasingly important in prognosis-related clinical trials.

Cardiac Catheterization↗
PubMed2003

Use of low-dose ketamine and/or midazolam for pediatric cardiac catheterization.

Ketamine and midazolam are commonly used in children undergoing cardiac catheterization. However, there is controversy regarding the safety of administering these agents in the absence of an anesthesiologist. We retrospectively reviewed pediatric cardiac catheterization procedures at our institution between 1996 and 1997. A total of 154 patients (0.3-192 months) underwent a total of 205 procedures. They received ketamine (n = 79, 1.05 +/- 0.88 mg/kg/hr), midazolam (n = 35, 0.14 +/- 0.09 mg/kg/hr), or both (n = 91; ketamine, 1.13 +/- 0.84 mg/kg/hr; midazolam, 1.57 +/- 1.03 mg/kg//hr). In 18.5% of patients there were complex cardiac lesions. Mean procedure time was 79 +/- 36.2 minutes. Pre- and postprocedure systolic and diastolic mean blood procedure 72 +/- 14 and 68 +/- 12 mmHg, respectively. Pre- and postprocedure O2 saturation was 93.19 +/- 8.72 and 93.63 +/- 8.3, respectively. One patient required intubation, and 15% required oxygen therapy. The mortality rate was zero. The anesthesiologist's assistance was requested by the cardiologist in 21 procedures (group A) and not requested in 184 procedures (group B). The two groups were not different in relation to the drug used (p = 0.283) or the complexity of the cardiac lesions (p = 0.051). However, there was significant difference between the two regarding the need for supporting drugs (3/21 vs 3/184, p = 0.02) or oxygen treatment (7/21 vs 26/184, p = 0.014). No patients in group B required intubation, whereas 14% and 1.6% required oxygen therapy and supporting drugs, respectively. We conclude that low-dose ketamine and midazolam can be administered safely to most pediatric patients by the cardiologist, who can safely predict the need for an anesthesiologist.

Adolescent↗
PubMed1988

Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization.

The purpose of this study was to determine the prognostic utility of quantitative exercise thallium-201 imaging and compare it with that of cardiac catheterization in ambulatory patients. Accordingly, long-term (4 to 9 years) follow-up was obtained in 293 patients who underwent both tests for the evaluation of chest pain: 89 had undergone coronary artery bypass graft surgery within 3 months of testing and were excluded from analysis, 119 experienced no cardiac events and 91 had an event (death in 20, nonfatal myocardial infarction in 21 and coronary artery bypass operations performed greater than 3 months after cardiac catheterization in 50). When all variables were analyzed using Cox regression analysis, the quantitatively assessed lung/heart ratio of thallium-201 activity was the most important predictor of a future cardiac event (chi 2 = 40.21). Other significant predictors were the number of diseased vessels (chi 2 = 17.11), patient gender (chi 2 = 9.43) and change in heart rate from rest to exercise (chi 2 = 4.19). Whereas the number of diseased vessels was an important independent predictor of cardiac events, it did not add significantly to the overall ability of the exercise thallium-201 test to predict events. Furthermore, information obtained from thallium-201 imaging alone was marginally superior to that obtained from cardiac catheterization alone (p = 0.04) and significantly superior to that obtained from exercise testing alone (p = 0.02) in determining the occurrence of events. In addition, unlike the exercise thallium-201 test, which could predict the occurrence of all categories of events, catheterization data were not able to predict the occurrence of nonfatal myocardial infarction. The exclusion of bypass surgery and previous myocardial infarction did not alter the results. In conclusion, data from this study demonstrate that exercise thallium-201 imaging may be superior to data from both exercise testing alone and cardiac catheterization data alone for predicting future events in ambulatory patients who have undergone both exercise thallium-201 imaging and catheterization for the evaluation of chest pain.

Adult↗
PubMedDate not supplied

Control of vascular complications after cardiac catheterization: a research-based protocol.

Cardiac catheterization has become a common diagnostic procedure. However, many institutions arbitrarily decide the postprocedure method used to achieve hemostasis, the approach to femoral site care, the patient's position while on bedrest, and the length of bedrest. The authors review past research studies and present a research-based protocol for postcatheterization nursing care.

Bed Rest↗
PubMed1998

Comparative value of Doppler echocardiography and cardiac catheterization in the decision to operate on patients with aortic stenosis.

With the use of Doppler echocardiography, severity of valvular stenosis, etiology and type of valve lesions, and left ventricular function can be assessed accurately in patients with aortic stenosis. The purpose of this study was to compare the value of noninvasive clinical and Doppler echocardiographic findings, with cardiac catheterization, in the management decision-making for patients with aortic stenosis. One hundred and seventy consecutive patients with aortic stenosis who underwent cardiac catheterization and Doppler echocardiography were prospectively studied. A decision to operate, not operate or remain uncertain was made independently by experienced cardiologists given clinical information in combination with either Doppler echocardiographic (group I) or cardiac catheterization (group II) data. The severity of aortic stenosis agreed between Doppler echocardiography and cardiac catheterization in 168 patients (98.8%), and disagreed in two patients. There was agreement on clinical decision to operate or not operate between Group I and Group II in 160 patients (94.1%) and a discrepant decision in only two patients (1.1%). In eight patients (4.7%) with poor echogenecity or with discordance between clinical and echocardiographic data, the decision made by group I remained uncertain. We conclude that in a large majority of patients with aortic stenosis, Doppler echocardiographic assessment provides the same management decision reached by cardiac catheterization findings.

Aged↗
PubMed2003

Signs of thrombin generation in pediatric cardiac catheterization with unfractionated heparin bolus or subcutaneous low molecular weight heparin for antithrombotic cover.

INTRODUCTION: Thrombosis is one of the most frequent adverse events after cardiac catheterization, which can be reduced by anticoagulation with unfractionated heparin (UFH) in both children and adults. Low molecular weight heparin (LMWH) might possibly offer advantages. Laboratory signs of thrombin generation during pediatric cardiac catheterization, with unfractionated heparin (UFH) bolus or subcutaneous LMWH for thrombosis prophylaxis, were determined in a first step to investigate the potential of LMWH for antithrombotic cover. MATERIALS AND METHODS: Signs of thrombin generation (D-dimer and F1+2), anti-Xa activity and activated clotting time (ACT) were measured in 65 patients with congenital heart disease. A total of 40 patients were treated with a UFH bolus of 100 IU/kg bodyweight and, in 25 children, enoxaparin was subcutaneously administered at a dosage of 1/1.6 mg/kg bodyweight. RESULTS: The dose to plasma activity of enoxaparin was more consistent than in the UFH group. Only a slight elevation of F1+2 was found in some patients, which was a little higher in the enoxaparin group, but no difference of incidence of increased F1+2 generation was detected between the two groups. D-dimer was elevated in three children after UFH bolus application, but no such effect was observed in any child after LMWH administration. CONCLUSIONS: Application of LMWH was equally efficacious during pediatric cardiac catheterization than UFH bolus administration, as determined by plasma levels and markers of clotting activation. In contrast to UFH bolus, no further monitoring was necessary after the application of LMWH during cardiac catheterization due to a consistent dose to plasma activity.

Adolescent↗
PubMedDate not supplied

Complications of cardiac catheterization, coronary angiography, and coronary interventions.

Cardiac catheterization and coronary angiography have evolved, especially after the advent of percutaneous coronary interventions. Although older patients with more advanced disease are being studied, the overall rate of complications has not dramatically increased and the spectrum of complications has somewhat changed to select the more acute nature of the procedures performed. Careful prophylactic measures such as anticoagulation, ischemia prevention, blood pressure control, hydration as well as the availability of defibrillation and pharmacologic and mechanical means of circulatory support have helped minimize these complications and improve outcome.

Anaphylaxis↗
PubMed1988

Double-chambered right ventricle demonstrated by magnetic resonance imaging before cardiac catheterization--case report.

Double-chambered right ventricle is often misdiagnosed clinically and may be missed at cardiac catheterization. The authors encountered a fifty-six-year-old man who had double-chambered right ventricle, which was clearly demonstrated by magnetic resonance imaging (MRI) before cardiac catheterization. The right ventricle was divided into two chambers by hypertrophic muscular bands at the coronal planes. This finding was confirmed by selective angiography, and the pressure gradient in the right ventricle was 98 mmHg. Thus, MRI should be performed in the case of right ventricular obstruction to evaluate the site and extent of obstruction before cardiac catheterization.

Angiocardiography↗
PubMed1978

"Zero reference" during cardiac catheterization.

Hemodynamic pressure measurements obtained during cardiac catheterization studies are calibrated to an arbitrary level where the pressure is considered zero. Despite the fundamental nature of the zero reference level, there is no standardized method for determination of "zero reference." A horizontal metal rod has been constructed to be level with the pressure transducer domes. With lateral radiographic viewing, the metal rod is adjusted to be level with the junction of the inferior vena cava and the right atrium. The technique is rapid, reliable, without risk and allows accurate comparison of hemodynamic data between patients and in the same patient longitudinally.

Blood Pressure↗
PubMed1991

Interventional cardiac catheterization.

The use of the pediatric cardiac catheterization laboratory as a therapeutic modality has become standard practice in most pediatric cardiology centers. Accordingly, reviewing the results of this form of therapy has become very important. This review focuses on the initial and long-term results of balloon dilation procedures in infants and children. As the efficacy and safety has been proven for these early procedures, dilatation therapy has become available for the critically ill neonate with pulmonary and aortic stenosis. The usefulness of implantable devices for closing abnormal shunt pathways, such as the patent ductus arteriosus and atrial septal defect, has become clear. The importance of both transthoracic color-flow Doppler and transesophageal echocardiography in proper placement and follow-up of these implantable devices is now becoming apparent and also will be evaluated in this review.

Cardiac Catheterization↗
PubMed1984

The role of cardiac catheterization in patients after myocardial infarction.

Cardiac catheterization is extremely important in defining prognosis and determining the approach to therapy in many subsets of patients with a recent myocardial infarction in addition to those undergoing early thrombolytic therapy or operation for potentially lethal complication of acute myocardial infarction. Such an approach seems prudent for most patients with nontransmural myocardial infarctions, patients under age 40 with a first infarction, and patients with post-infarction angina. In patients with uncomplicated myocardial infarction it is usually possible to separate relatively low-risk and high-risk patients, with risk stratification depending upon the results of low-level early post-infarction, symptom-limited electrocardiographic exercise testing and other noninvasive methods when indicated. Such an approach does not preclude the necessity of assessing each patient as an individual as well as within the subgroup in which he or she belongs.

Angina Pectoris↗
PubMed1986

Percutaneous cardiac catheterization via the internal jugular vein in infants and children.

Cardiac catheterization was performed via the internal jugular vein in 14 pediatric patients using a percutaneous sheath technique. Patients were 2 months to 16 years old and weighed 3.2-69 kg. We found that a low lateral approach for puncture of the vein was faster and more often successful than the high approach most often utilized in adult patients. No complications occurred in this series of patients. The internal jugular vein is a safe and reliable alternative to the femoral vein for cardiac catheterization if there is obstruction to the inferior vena cava or if it is desirable to leave an indwelling cardiac catheter.

Adolescent↗
PubMed1982

Analysis of the complications of cardiac catheterization over nine years.

The mortality and morbidity associated with cardiac catheterization at the Minneapolis VA Medical Center has been analysed over a period of nine years (1971-1979) in order to identify correctable problem, obtain accurate data for patient information, and allow comparison with other institutions. In common with reports from other catheter laboratories, the mortality has fallen from 0.74% (952 patients) between 1971 and 1975 to 0.24% (819) patients between 1976 and 1979. There has been a similar decline in the combined incidence of myocardial infarction and cerebral embolism from 1.05% to 0.24% over the same period. Our patients with ischemic heart disease included many at high risk of complications in that three vessel disease was present in 53% and the ejection fraction was less than 50% in 24% of cases. In order to ensure that the best standards of cardiac catheterization are maintained, we agree with a recent suggestion that there should be a national surveillance program monitoring fatality and complication rates in all catheterization laboratories.

Cardiac Catheterization↗
PubMed1982

Evaluation of infants with bronchopulmonary dysplasia using cardiac catheterization.

Nine infants with bronchopulmonary dysplasia underwent cardiac catheterization to define thier circulatory status. In room air, the mean cardiac index was normal (3.4 liters/min/sq m), but pulmonary arterial pressure (39 mm Hg, mean) and pulmonary vascular resistance (8.6 Wood units . sq m) were elevated. Preejection period/right ventricular ejection time ratios determined echocardiographically correlated well with values obtained at catheterization, but did not correlate well with hemodynamic values. Administration of 40% and 88% oxygen caused variable responses in hemodynamic measurements. Studies of left ventricular function were normal in all patients. These findings raise questions about the long-term prognosis of infants with bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗
PubMed1995

Correlation of rates of coronary artery bypass surgery, angioplasty, and cardiac catheterization in 305 large communities for persons age 65 and older.

OBJECTIVE: The rate of coronary artery bypass surgery (CABG) has been shown to vary greatly across geographic regions. This study examined whether these rates were associated with the rate of coronary artery angioplasty (PTCA) and with other community characteristics. DATA SOURCES/STUDY SETTING: The health care financing administration provided the number of Medicare hospitalizations in 1988 for conditions and procedures related to coronary artery disease. Information on physicians and hospitals was obtained from the Area Resource File, and the number of persons in each age, sex, and race category was obtained from US. census data. STATISTICAL METHODS: Age-and sex-adjusted hospitalization rates based on the patient's zip code of residence were calculated at the level of the Metropolitan Statistical Area (MSA) for white patients age 65 or older. Rates were obtained for 305 MSAs for CABG, PTCA, cardiac catheterization, angina, and myocardial infarction. PRINCIPAL FINDINGS: The rate of cardiac catheterization had a correlation of .72 with the CABG rate and .64 with the PTCA rate. The correlation of the PTCA and CABG rates with each other was .49. This correlation was not charged by adjusting for the rates of hospitalization for angina or myocardial infection, but it was reduced to only .05 (ns) after adjusting for the rate of cardiac catheterization. The rates of all three procedures had rank correlations of about .15 with the density of thoracic surgeons and about .30 with the density of hospitals with cardiac catheterization and open heart surgery units. CONCLUSIONS: Community CABG and PTCA rates tend to move in the same direction due to community factors that also affect the rates of cardiac catheterization. These community factors do not appear to include the rate of coronary artery disease, but may include resources or attitudes toward aggressive treatment of coronary artery disease.

Aged↗