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PubMed1999

Interventional cardiac catheterization advances in nonsurgical approaches to congenital heart disease.

Interventional cardiac catheterization offers increased therapeutic options to many patients with congenital heart disease. Over the past year encouraging results have been reported in hundreds of patients with interatrial communications, patent ductus arteriosus, and pulmonary artery stenosis requiring stenting. The Amplatzer (AGA Medical Corporation, Golden Valley, MN, USA) family of atrial septal, ventricular septal, and ductus occluding devices shows particular promise. Other studies support the efficacy and safety of established procedures such as balloon valvuloplasty and coarctation angioplasty. In some areas, such as transcatheter perforation of atretic pulmonary valves and endovascular stenting for coarctation of the aorta, our technical abilities may be advancing faster than our understanding of the ultimate clinical impact of our treatment. As interventional cardiac catheterization procedures continue to develop, they must be evaluated carefully against alternative treatments.

Angioplasty, Balloon↗
PubMed1999

Acute complications in the current era of therapeutic cardiac catheterization for congenital heart disease.

The acute complications of therapeutic cardiac catheterization for congenital heart disease as performed currently in a small unit were reviewed. In recent years, there has been a significant increase in the number of lesions thought amenable to catheter therapy. Only a few reports, however, have addressed the overall incidence of acute complications of therapeutic cardiac catheterization, all representing the experience of centres performing moderate-to-large numbers of procedures. A retrospective review was performed of 425 therapeutic catheter procedures performed at our institution between May 1993 and November 1997. Acute complications were retrieved from the database. This included all adverse events that were clinically recognized at the time of or within 2 weeks after the procedure and which, to the best of the authors' clinical judgement, were related to the catheterization and not part of the natural history of the child's illness. All patients were observed overnight following the procedure, and stayed in hospital if a complication developed. There were 49 acute complications (11.5%), of which 43 (10.1%) were deemed minor and 6 (1.4%) were considered major. The rate was low in patients with valvar pulmonary stenosis, including three neonates (3/45, 6.7%), for those undergoing angioplasty of native co-arctation (1/15, 6.7%) and pulmonary arteries (2/27, 7.4%); and for coil embolization of systemic to pulmonary collateral arteries (1/16, 6.3%). The rate was high in patients with valvar aortic stenosis, including 12 neonates (9/37, 24.3%), and for angioplasty of re-coarctation (4/23, 21.7%). There were more overall complications in neonates (25.6%) than in older patients (10.1%) (p < 0.01). Two patients died (0.5%), but no patient required emergency surgical intervention. In spite of the introduction of many new therapeutic modalities with greater intrinsic risk, and the fact that patients with more complex lesions and who are more acutely ill are being treated, the overall rate of complications remains relatively low. This probably reflects improvements in pericatheterization medical management, in selection of patients, in procedural techniques, and in the experience of operators.

Adolescent↗
PubMedDate not supplied

Massage therapy for patients undergoing cardiac catheterization.

CONTEXT: Anxiety and its pharmacological treatment can interfere with cardiac catheterization. Massage therapy has been used primarily in nonmedical settings for relaxation and stress reduction, and some research demonstrates its efficacy in medical environments. OBJECTIVE: First, to determine whether massage could be administered under "normal" conditions in an interventional cardiology center. Second, to evaluate the efficacy of massage in reducing anxiety before, during, and after a cardiac catheterization procedure. DESIGN: A prospective, randomized, controlled, single-masked, pilot study. SETTING: An interventional cardiology center at an urban hospital in New York, NY PATIENTS: Seventy-eight patients (59 men, 19 women), with a mean age of 60.1 years who were scheduled for an elective, diagnostic catheterization based on routine clinical practices. INTERVENTION: Treatment subjects received a standardized, 10-minute massage. Control subjects spent 10 minutes of quiet time with a massage therapist. MAIN OUTCOME MEASURES: We evaluated the feasibility of incorporating massage into the time period between the patient's arrival at the hospital and catheterization, patient interest in receiving massage, and staff support of this complementary therapy. We further evaluated self-ratings of anxiety and pain or discomfort on visual analog scales, vital signs, cortisol levels, and analgesic or anxiolytic intake. RESULTS: A 10-minute massage was feasibly incorporated before catheterization. Seventy percent of the patients consented to participate, and staff supported the intervention. Mean anxiety scores on a 166 mm visual analog scale dropped by 16.2 mm (SD, 24.6) in the massaged group and by 6.8 mm (SD, 17.3) in the control group (P = .081). No statistically significant results were found in pain or discomfort visual analog scale scores (P =.491), blood pressure (P = .827), heart rate (P = .935), respiration rate (P=.916), or analgesic and anxiolytic usage (P > or = .252). Cortisol levels are discussed as exploratory, data. CONCLUSIONS: The results of the study suggest that a 10-minute massage before an invasive cardiac procedure is insufficient to decrease stress measurably.

Adaptation, Psychological↗
PubMed1996

Training in cardiac catheterization at high-volume and low-volume centers: is there a difference in case mix?

Current guidelines recommend that cardiology trainees participate+ in a minimum of 100 cardiac catheterization procedures during their clinical training (volume minimum level 1 training). To examine the differences in case mix seen by cardiology trainees during their training in cardiac catheterization, we examined the first 100 cases done by two trainees at different hospitals. One hospital was a high-volume center performing > 5500 procedures/year, and the other was a low-volume center performing < 1500 procedures/year. Demographic and clinical characteristics of the patients undergoing cardiac catheterization were similar at the two hospitals. Indications were also similar, with the only exception being a higher rate of urgent/emergent cases among patients seen at the low-volume center (8% vs 1%). Minor differences in procedural techniques were present at the two hospitals, with the trainee at the high-volume center having more experience with arm cases (4% vs 0%) and left ventriculograms (77% vs 48%) and the trainee at the low-volume center having more experience with right-heart catheterizations (36% vs 11%) and temporary pacing wires (5% vs 2%). Neither trainee had significant experience with valvular or adult congenital heart disease (2%, low-volume center; 1%, high-volume center). These results suggest that current volume minimums may ensure relatively uniform case mix among physicians who are training in cardiac catheterization at different centers. However, training may be deficient in several areas such as valvular heart disease, congenital heart disease, and arm cases.

Adult↗
PubMed1981

Outpatient cardiac catheterization and coronary angiography.

The cost of hospitalization required for cardiac catheterization led us to evaluate this procedure in 308 adult outpatients. Patients wee scheduled on the basis of stability of symptoms. Two hundred eighty-eight underwent left heart catheterizations and coronary arteriography. Ninety-five percent of the procedures were performed by the percutaneous technique. Fifty patients had normal studies and 30 patients had congenital or valvular disease. Two hundred twenty-eight patients had significant coronary artery disease, 85 patients had triple vessel disease, and 45 patients had left main coronary artery disease. There were six significant complications: one death; two myocardial infarctions; one air embolism, and two patients with hematomas. Three of the complications were in patients with left main disease. Only two of the complications can be ascribed to the outpatient nature of the procedure. The complication rate is comparable to that reported in the literature. Fifteen hundred subsequent cases were studied as outpatients, with a very low mortality and morbidity. It is concluded that cardiac catheterization can be performed on an outpatient basis with safety comparable to inpatient studies, and at a great economic savings.

Adult↗
PubMed2003

A prospective and randomized comparison of the safety and effects of therapeutic levels of enoxaparin versus unfractionated heparin in chronically anticoagulated patients undergoing elective cardiac catheterization.

Consecutive patients with atrial fibrillation and/or prosthetic heart valves, receiving chronic anticoagulation with phenprocoumon and scheduled to undergo cardiac catheterization, were randomized to subcutaneous enoxaparin twice daily (n = 32) or intravenous UFH (n = 36). Cardiac catheterization was performed at an international normalized ratio <1.5. Activated partial thromboplastin times and levels of anti-Factor Xa activity were measured daily. The time until effective anticoagulation (primary endpoint) was significantly shorter for enoxaparin than for UFH (1.1 +/- 0.4 days versus 3.7 +/- 2.5 days, p<0.0001). The percentage of days of effective anticoagulation was significantly higher in the enoxaparin group than in the UFH group (93.3 +/- 9.5% versus 53.7 +/- 26.6%, p <0.0001). In conclusion, enoxaparin achieves therapeutic levels of anticoagulation more rapidly and consistently than UFH in chronically anticoagulated patients with prosthetic heart valves and/or atrial fibrillation undergoing cardiac catheterization.

Aged↗
PubMed1989

Permanent cerebral blindness after cardiac catheterization.

Cerebral blindness is usually a transient event that can complicate cardiac catheterization. The neurologic deficit clears in 1-3 days. We present a patient who developed permanent cerebral blindness after undergoing transfemoral cardiac catheterization. Bilateral hemorrhagic occipitotemporal infarcts were demonstrated on magnetic resonance imaging (MRI). The patient also demonstrated denial of blindness and had transient memory disturbances due to occipitotemporal lobe infarct. The probable source of the emboli was cardiac.

Aged↗
PubMed2006

Cerebral microembolism during cardiac catheterization and risk of acute brain injury: a prospective diffusion-weighted magnetic resonance imaging study.

BACKGROUND AND PURPOSE: Cerebral microembolism detected by transcranial Doppler occurs systematically during cardiac catheterization, but its clinical relevance remains unknown. Studies suggest that asymptomatic embolic cerebral infarction detectable by diffusion-weighted (DW) MRI might exist after percutaneous cardiac interventions, especially after retrograde catheterization of the aortic valve in patients with valvular aortic stenosis, with a frequency as high as 22% of cases. We investigated the incidence of new ischemic lesions on serial cerebral DW MRI after cardiac catheterization. METHODS: This prospective study involved 46 patients with severe aortic valve stenosis. To assess the occurrence of cerebral infarction, all patients underwent cerebral DW MRI and neurological assessment within 24 hours before and 48 hours after cardiac catheterization and retrograde catheterization of the aortic valve. A subgroup was monitored by transcranial power M-mode Doppler during cardiac catheterization to observe cerebral blood flow and track emboli. RESULTS: One patient had a focal diffusion abnormality on DW MRI before cardiac catheterization. After catheterization, we detected only 1 additional acute cerebral diffusion abnormality in a single case (2.2%), although cerebral microemboli were detected in all transcranial Doppler-monitored patients during cardiac catheterization, as expected. All patients remained asymptomatic. Based on these results a mid-point incidence of 5.9% (95% CI, 0.01 to 12.5) for abnormalities on DW MRI in asymptomatic cardiac catheterization patients in our center can be assigned. CONCLUSIONS: Unsuspected cerebral infarctions can be detected by DW MRI after cardiac catheterization, but this phenomenon remains unfrequent in our series. Further studies are needed to identify factors explaining the discrepancy between these results and those of previous studies.

Aged↗
PubMedDate not supplied

Undergoing cardiac catheterization: the effects of informational preparation and coping style on patient anxiety during the procedure.

OBJECTIVE: To examine the effects of coping styles and preparatory informational treatments on patient anxiety during cardiac catheterization. DESIGN: Prospective, experimental, random assignment, repeated measures design. SETTING: Canadian, university-affiliated, large urban hospital. SUBJECTS: 145 adult patients (107 men and 38 women) scheduled for their first cardiac catheterization. Age range was from 34 to 78 years. Mean educational level was 10.72 years. OUTCOME MEASURES: Subject's coping style, "monitoring" (information seeking) or "blunting" (information avoiding) was assessed by means of Miller's Behavioral Style Scale. Subjects' anxiety was assessed using three measures: (1) a self-report measure, the Subjective Units of Distress (SUDS) Scale; (2) a behavioral measure, the Cardiac Catheterization Adjustment (CA) Scale; and (3) physiologic measures, heart rate and systolic and diastolic blood pressure. INTERVENTION: After coping style assessment, monitors and blunters were randomly assigned to receive one of three preparatory informational treatments: (1) videotaped procedural modeling information, (2) videotaped procedural-sensory modeling information, and (3) procedural-sensory information booklet. RESULTS: Analysis of variance techniques applied to the anxiety data revealed the following: (1) significant changes in self-reported patient anxiety occurred as a function of occasion rather than preparatory informational treatment or coping style, (2) subjects receiving the three preparatory informational treatments demonstrated significantly different behavioral adjustments during cardiac catheterization, and (3) most subjects demonstrated heart rate and blood pressure readings in the normal range; however, significant changes in cardiovascular reactivity were found to be associated with contrast dye insertion. CONCLUSIONS: Subjects who received the videotaped modeling treatments demonstrated greater behavioral adjustment than patients who received the information booklet. Questions remain as to whether the procedural modeling treatment is more efficacious than the procedural-sensory modeling treatment. Increases in subjects' SUDS levels were found to be associated with changes in ideational content. Changes in blood pressure and heart rate were attributed to physiologic and psychologic factors. Coping style did not appear to significantly influence any of the measures of patient anxiety.

Adaptation, Psychological↗