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PubMed1991

Doppler echocardiography versus cardiac catheterization in the evaluation of valvular heart disease: do we have a gold standard?

Definitive evaluation of valvular heart disease is traditionally accomplished by cardiac catheterization. Recent advances in Doppler echocardiography allow noninvasive assessment of valvular heart disease with a high degree of accuracy compared to the cardiac catheterization gold standard. Doppler echocardiography may occasionally yield erroneous results due to technical difficulties in the performance of the study. A number of patient related and echo-machine related factors may also affect the Doppler measurements independent of the severity of the lesion. Thus, a discrepancy between Doppler and catheterization data is generally considered to be a failure of Doppler methods. However, catheterization data may also be flawed due to errors in the measurement of pressure and cardiac output, as well as the known shortcomings of qualitative angiography. The Gorlin equation itself suffers from several limitations, including the substitution of pressure gradient for velocity in the basic hydrodynamic equation, and the use of a constant which may not be appropriate in all circumstances. Therefore, when Doppler echocardiography and cardiac catheterization yield discordant results, both studies should be carefully reviewed and correlated with other clinical data in order to elucidate the sources of the discrepancy and ascertain the actual severity of the valvular lesion.

Cardiac Catheterization↗
PubMed1996

Chronic radiodermatitis following cardiac catheterization.

BACKGROUND: Fluoroscopy and cineradiography used during coronary angiography expose patients to some of the highest doses of ionizing radiation in diagnostic radiology. The possibility of radiation-induced damage has been discussed by several authors in the past. However, to the best of our knowledge, chronic radiation dermatitis caused by exposure to x-rays during cardiac catheterization has not been described. OBSERVATIONS: We describe 4 patients in whom chronic radiodermatitis developed following multiple cardiac catheterizations and coronary angioplasties. The cumulative radiation doses to which these patients were exposed were retrospectively calculated to be a mean of 24.6 Gy per patient, with a range of 11.4 to 34.9 Gy. CONCLUSIONS: Chronic radiodermatitis is a threat in patients undergoing multiple cardiac catheterizations and angioplasties. In susceptible patients, radiation doses as small as 11.4 Gy, which can sometimes be emitted during 1 or 2 procedures, are potentially harmful. Awareness and protective measures against this long-term side effect of cardiac catheterization should be encouraged.

Aged↗
PubMed1998

Platelet and Thrombin Activity Following Cardiac Catheterization Despite Treatment with Aspirin.

Thromboembolic complications are reported to occur in up to 0.5-2% of left cardiac catheterizations and angiographies. Activation of the hemostatic system may contribute to their onset. To prevent platelet and thrombin activity during catheterization, aspirin or systemic heparin are often used in addition to heparinized flush solutions. We investigated whether aspirin alone can prevent platelet and thrombin activity induced by catheterization in ten consecutive patients (nine males, mean 50 +/- 8 years) undergoing elective left cardiac catheterization after at least 5 days of oral aspirin (75-300 mg/d). Anticoagulant drugs were not given. Peripheral venous samples were drawn before, immediately after (time 0), and at 15, 60, and 180 minutes after the procedure for measurement of thrombin-antithrombin (TAT), prothrombin fragment 1.2 (F 1.2), fibrinopeptide A (FPA), and beta-thromboglobulin (beta-TG). TAT, F1.2, and FPA increased significantly at time 0 compared with both before and 180 minutes after the procedure (P < 0.04); beta-TG values were higher at time 0 compared with 180 minutes later (P = 0.01). TAT levels were related to those of FPA (r = 0.66; P = 0.0003), F1.2 (r = 0.35; P = 0.01), and beta-TG (r = 0.37; p = 0.04). Thus, routine left cardiac catheterization is associated with transient, systematically detectable, activation of coagulation and platelets, despite aspirin therapy. Newer antiplatelet agents may be more effective in preventing hemostatic activation induced by catheterization.

Journal Article↗
PubMed1982

Total occlusion of the left main coronary artery: report of seven cases from 5312 cardiac catheterizations and review of the literature.

Of the 5312 cardiac catheterizations performed at the Clayton Foundation for Research Cardiovascular Laboratories from 1974 to early 1981, seven patients (0.13%) had total occlusion of the left main coronary artery. All seven had a history of myocardial infarction, and were markedly symptomatic (New York Heart Association, Classes III and IV), with anginal pain that had existed from 2 to 13 years. Left ventricular end-diastolic pressure was notably elevated in all patients, and ejection fractions ranged from 16% to 69%. In all patients, there was significant collateral circulatory flow to the left coronary system from the right coronary artery and its branches. Six underwent coronary artery bypass at our institution, and one was operated on at another hospital. The six patients operated on in our institution were markedly improved after the operation. Our results support previously reported findings about patients with total occlusion of the left main coronary artery in that (1) no definitive clinical pattern leads to simple diagnosis, (2) the anomaly is rarely encountered during cardiac catheterization, and (3) myocardial revascularization alleviates symptoms and prolongs life.

Journal Article↗
PubMed2005

Thromboembolic cerebral ischaemic attack complicating cardiac catheterization. Successful local thrombolytic therapy with reduced dose rt-PA.

Cerebral ischaemia caused by thromboembolism is a possible complication of diagnostic and interventional cardiac catheterization. In this case report we describe the diagnostic steps and successful treatment strategy in the management of a patient who suffered from cerebral ischaemia during cardiac catheterization. Initial CT scanning to exclude cerebral haemorrhage was followed by angiography through the cardiac catheterization sheath in the right femoral artery. Occlusion just before the intracranial bifurcation of the right internal carotid artery was found and local thrombolysis given with a reduced dose of 34 mg rt-PA. The subsequent angiogram showed restored perfusion in the affected vessel after completion of thrombolytic therapy and resolution of neurological symptoms.

Brain Ischemia↗
PubMed2005

Transhepatic ultrasound-guided cardiac catheterization in the fetal lamb: a new approach for cardiac interventions in fetuses.

BACKGROUND: Percutaneous transventricular and fetoscopic umbilical catheterization have been applied to animal and human fetuses. These methods have a high rate of failure and complications. Here, we propose an alternative route for anterograde echocardiography-guided cardiac catheterization through a transhepatic approach of the intra-abdominal vessels in the fetal lamb. METHODS AND RESULTS: After exteriorization of the uterus in 12 pregnant ewes between 118 to 122 days' gestation, a 4F sheath mounted over a 1.2-mm needle was placed into the intra-abdominal portion of the umbilical vein (n=2) and into the subdiaphragmatic portion of the inferior vena cava via a transhepatic approach (n=10) under ultrasound guidance. In the first 2 animals using a transumbilical approach, it was impossible to reach the heart through the ductus venosus. In the next 10 animals, using a conventional technique, echocardiography-guided catheterization of the 4 chambers was performed in the all fetuses, atrial or ventricular pacing in 6 fetuses, and ballooning of the pulmonary valve in 9 of 10 fetuses. Among the 10 fetuses catheterized through the transhepatic approach, 2 were euthanized immediately after the procedure to evaluate intraperitoneal bleeding (23 and 29 mL, respectively), and 3 died after the procedure (1 of major bleeding and 2 deaths related to balloon catheter manipulation). Finally, 5 were delivered vaginally after an uneventful pregnancy, and autopsy at day 5 did not show significant liver, vascular, or cardiac injury. CONCLUSIONS: Echocardiography-guided fetal cardiac catheterization through a transhepatic approach is feasible and provides an interesting alternative approach for human fetal cardiac interventions.

Animals↗
PubMed2006

Ambulation 1 hour after diagnostic cardiac catheterization: a prospective study of 1009 procedures.

OBJECTIVE: To study the safety of a protocol that allows ambulation 1 hour after diagnostic cardiac catheterization with a transfemoral approach using a 5F catheter system. PATIENTS AND METHODS: A total of 1005 consecutive patients (1009 procedures) undergoing outpatient diagnostic cardiac catheterization with a transfemoral approach using a 5F catheter system at the Mayo Clinic in Rochester, Minn, were included in this study from January 1, 2004, to August 31, 2005. All patients underwent standard manual compression to achieve hemostasis and were ambulated after 1 hour of bed rest. RESULTS: The mean age of the patients was 64.5 years, and 62% were male. Minor vascular complications occurred in 33 procedures (3.3%), Including 14 hematomas (1.4%) less than 4 cm and 19 cases of rebleeding (1.9%) that required repeated manual compression. Only 1 patient (0.1%) had a hematoma greater than 4 cm. No patient had a major complication, such as surgical repair, red blood cell transfusion, retroperitoneal bleeding, formation of an arteriovenous fistula or pseudoaneurysm, arterial occlusion, or an infection. CONCLUSIONS: Ambulation 1 hour after diagnostic cardiac catheterization with a transfemoral approach using a 5F catheter system is safe and associated with low rates of vascular complications. This strategy may improve patient comfort, reduce resource utilization, and be preferable to use of vascular closure devices.

Aged↗
PubMed2006

Refined characterization of the association between kidney function and mortality in patients undergoing cardiac catheterization.

AIMS: Chronic kidney disease is associated with an increased risk of cardiovascular morbidity and mortality. The level of kidney function at which this risk increases remains to be determined. We sought to characterize the relationship between kidney function and survival among patients with cardiovascular disease (CVD) undergoing cardiac catheterization using estimated glomerular filtration rate (eGFR) and graded refinements in the classification of kidney function. METHODS AND RESULTS: We included 8521 of 11 778 (72.3%) consecutive patients undergoing cardiac catheterization between 1 January 1999 and 31 December 2001 from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease database. eGFR as a categorical and continuous variable was used to define kidney function. The outcome was all-cause mortality. During a median (interquartile range) follow-up of 2.2 (1.5-3.1) years, and after adjustment for clinical risk factors and severity of coronary disease, there was a steady incremental decrease in survival post-catheterization corresponding to a decline in eGFR categories of 10 mL/min/1.73 m(2). When eGFR was modelled as a continuous variable, there was an increased risk of death noted at an eGFR below 79 mL/min/1.73 m(2). Below an eGFR of 70 mL/min/1.73 m,(2), there was an approximate 17.2% relative increase in risk for every 10 unit decrease in eGFR (95% CI 8.4-26.6%). CONCLUSION: The risk of death post-cardiac catheterization is elevated when eGFR is < or =79 mL/min/1.73 m(2). These findings provide considerable refinement in our understanding of eGFR as a powerful prognostic marker in patients with CVD undergoing cardiac catheterization.

Cardiac Catheterization↗
PubMed2001

Age and the utilization of cardiac catheterization following uncomplicated first acute myocardial infarction treated with thrombolytic therapy (The Second National Registry of Myocardial Infarction [NRMI-2]).

Considerable data indicates that patients <50 years of age have lower morbidity and mortality after acute myocardial infarction (AMI) than older patients. It has been demonstrated that use of routine cardiac catheterization and revascularization in younger patients with AMI and successful thrombolysis does not confer benefit compared with a more conservative approach. Despite this, it has been our impression that cardiac catheterization is frequently employed in younger patients with AMI. Patients with uncomplicated initial AMI treated with thrombolytic therapy in the Second National Registry of Myocardial Infarction (NRMI-2) between June 1994 and April 1998 were identified. Patients were categorized into 4 age strata for purposes of analysis. A total of 61,232 cases met our inclusion criteria. Cardiac catheterization was performed during hospitalization in 78% of patients after an uncomplicated initial AMI. Age was inversely associated with receipt of cardiac catheterization: 85% of those < or =49 years old underwent catheterization compared with 63% of those > or =70 years old. Regression analysis revealed that use of catheterization was 2.9 times greater (95% confidence intervals 2.7 to 3.2) in patients < or =49 years old compared with those > or =70 years old. Geographic location and payor status also strongly influenced utilization of this procedure. In conclusion, routine coronary angiography after uncomplicated AMI is extensively utilized in all age groups, particularly in those <50 years of age. The efficacy and cost effectiveness of this strategy in these patients has not yet been determined in clinical trials.

Age Factors↗
PubMed1999

Transradial cardiac catheterization in patients with prior brachial artery cutdown.

The safety and efficacy of transradial cardiac catheterization in patients with prior ipsilateral brachial cutdown is not known. Using standard techniques we performed transradial catheterization in 278 consecutive patients, of which 63 had prior brachial cutdown. All patients had a strongly palpable radial pulse and a negative Allen's test. Although patients with prior cutdown were older and had a higher incidence of hypertension and prior coronary artery bypass surgery, there was no significant difference in success rates for transradial catheterization (93.6% vs. 95.3%; P = NS). There were no periprocedural complications. Brachial artery occlusion was responsible for only two unsuccessful catheterization attempts. We conclude that, with careful preprocedural screening, ipsilateral transradial cardiac catheterization can be successfully performed in a majority of patients with prior brachial cutdown.

Brachial Artery↗
PubMed2000

Potential embolization by atherosclerotic debris dislodged from aortic wall during cardiac catheterization:: histological and clinical findings in 7,621 patients.

Embolic events during cardiac catheterization have been attributed to atherosclerotic aortic debris dislodged by catheter manipulation. We evaluated the frequency and the histologic morphology of atherothrombotic material retrieved during placement of coronary catheters in patients undergoing diagnostic or interventional cardiac procedures. Over a 4-year period, macroscopically visible aortic debris from coronary catheters, if present after advancement to the ascending aorta, was obtained for histologic examination. In 41 of 7,621 patients (0.54%), visible atherothrombotic material was present in the backflow of catheters. Debris occurred most frequently with 8 Fr guiding catheters (98%). Histologic examination showed foam cells, cholesterol crystals, and amorphic lipoid substance as markers of atheromatous material from atherosclerotic plaques in 38/41 patients (93%) with former plaque hemorrhage in 55% of them. In three patients, fresh thrombus material was observed (7%). None of these patients showed in-hospital ischemic complications. Although visible atheromatous material is a rare phenomenon in cardiac catheterization, an increased risk of scraping debris is associated with large-lumen guiding catheters. In order to avoid vascular embolization, the use of smaller guiding catheters and sufficient free backflow of catheters after advancement are recommended.

Adult↗
PubMed1989

Caring for patients undergoing therapeutic cardiac catheterization.

Since the advent of pediatric interventional catheterization, the necessity of multiple cardiac surgeries has been reduced. Therefore, the morbidity and mortality of multiple thoracotomies in infancy is also minimized. The role of the critical care nurse in the cardiac catheterization laboratory has become a necessity and a challange. With courage and skill, the risk of interventional catheterization can be minimized and the results are rewarding.

Cardiac Catheterization↗
PubMedDate not supplied

Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization.

We investigated the effects of propofol and propofol-ketamine on hemodynamics, sedation level, and recovery period in pediatric patients undergoing cardiac catheterization. We performed a prospective, randomized, double-blind study. The study included 60 American Society of Anesthesiologists physical status II or III (age range, 1 month-13 years) undergoing cardiac catheterization for evaluation of congenital heart disease. Propofol and ketamine were prepared in 5% glucose solution to a final concentration of 5 and 1 mg/ml, respectively; similar injectors containing 5% glucose solution only were prepared. Fentanyl (1 microg/kg) and propofol (1.5 mg/kg) were given to both groups. Then, group 1 received 0.5 ml/kg of 5% glucose and group 2 0.5 ml/kg of ketamine solution by an anesthesiologist who was unaware of the groups of patients. Local anesthesia with 1% lidocaine was administered before intervention in all patients. The noninvasively measured mean arterial pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded at the baseline, following drug administration, at 3, 5, 10, 15, 20, and 30 minutes and then at 15-minute intervals until the end of the procedure. Additional drug and fentanyl requirements to maintain a sedation level of 4 or 5 were recorded. After the procedure, the time to a Steward recovery score of 6 and adverse effects in the first 24 hours were recorded. The number of patients with more than a 20% decrease in mean arterial pressure was 11 in group 1 and 3 in group 2 (p < 0.05). The number of patients who experienced more than a 20% decrease in heart rate was 12 in group 1 and 5 in group 2 (p = 0.054). Ten patients in group 1 and 3 patients in group 2 required additional fentanyl doses (p = 0.057). The number of additional propofol doses was lower in group 2 (p < 0.05). Propofol combined with low-dose ketamine preserves mean arterial pressure better without affecting the recovery and thus is a good option in pediatric patients undergoing cardiac catheterization.

Adolescent↗
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

Are routine preoperative cardiac catheterization and angiography necessary before repair of ostium primum atrial septal defect?

Two-dimensional and Doppler echocardiography were compared with cardiac catheterization and angiography in the preoperative evaluation of ostium primum atrial septal defect. Preoperative echocardiographic examinations as well as operative reports of all patients (33 patients aged 2 months to 23 years at surgery) with ostium primum atrial septal defect or transitional atrioventricular (AV) canal defect having had echocardiography and surgical repair at The Children's Hospital, Boston from July 1983 to January 1986 were retrospectively reviewed. Original cardiac catheterization and angiographic reports also were reviewed. Preoperative echocardiography resulted in no false positive or false negative primary diagnoses when compared with the diagnoses obtained at preoperative angiography or surgery. Doppler assessment of mitral regurgitation correlated well with angiographic (93% agreement) and intraoperative (85% agreement) assessments of mitral regurgitation to within two diagnostic categories on the six level scoring system used. There was reasonably good agreement between the two-dimensional echocardiographic estimate of right ventricular systolic pressure and that measured at catheterization when expressed as percent of the simultaneous left ventricular pressure. Seven of nine ventricular septal defects observed intraoperatively were noted on preoperative echocardiography; five of these defects were detected on preoperative angiography. A variety of other surgically confirmed associated cardiovascular defects were observed by both preoperative techniques. However, echocardiography appeared to be superior to angiography for evaluation of AV valve morphology and papillary muscle architecture. This study implies that in children with typical clinical and two-dimensional echocardiographic and Doppler findings for ostium primum atrial septal defect or transitional AV canal defect, routine preoperative cardiac catheterization and angiography are unnecessary.

Adolescent↗
PubMed2005

Cardiac troponin I elevation in paediatric cardiac catheterization.

OBJECTIVE: The aim of this study is to investigate prospectively whether intracardiac catheterization produces myocardial damage in paediatric heart. METHODS: The study was performed in all patients undergoing diagnostic cardiac catheterization at our institute. A baseline serum sample was drawn before the procedure. The second serum sample was obtained 4-6 hours after the procedure. Cardiac troponin-I and creatine kinase isoenzyme MB fraction levels were determined quantitatively. RESULTS: Diagnostic cardiac catheterization was performed in 30 patients. There were 17 males and 13 females in the study group. The median age was 12 months (range 1 to 204 months); the median body weight was 8 kilograms (range 2.1 to 45 kilograms). The increase in cardiac troponin I (0.21+/-0.04 ng/ml to 1.16+/-1.40 ng/ml, p<0.05) and creatine kinase isoenzyme MB (26.68+/-7.53 U/L to 41.65+/-22.12 U/L, p< 0.05) levels after the procedure was significant. CONCLUSION: This study shows that serum elevations of cardiac troponin I and creatine kinase isoenzyme MB occur after the most of paediatric diagnostic cardiac catheterization procedures.

Adolescent↗
PubMed1979

Iliac venous thrombosis in infants and children after cardiac catheterization.

Twenty-two patients developed thrombosis of the lower abdominal portion of the inferior vena cava, iliac or femoral vein (IVT) after cardiac catheterization. All patients has at least one previous study from 1 day to 11 months of age (mean, 2 months) and seven had two catheterizations before discovery of IVT. Transposition of the great arteries was the most common defect associated with IVT (12/22, 55%). From one to seven catheter changes were made during the time of venous cannulation (mean, 105 minutes). No clinical evidence of IVT was present immediately after the preceding cardiac catheterization. The discovery of significant IVT usually necessitated the use of a vein from the upper extremity to complete the cardiac catheterization. IVT was associated with previous balloon atrial septostomy using either a Fogarty or Rashkind septostomy catheter in 13/22 patients (59%). In addition, 86% of the patients had either of these balloon catheters or a Swan-Ganz catheter used during a previous study. The potential development of IVT should be considered especially in cyanotic infants and small children in whom balloon catheters are used.

Cardiac Catheterization↗
PubMed1985

The diagnosis of coronary artery spasm in the cardiac catheterization laboratory.

Coronary artery spasm can now be well documented in the cardiac catheterization laboratory. At present, reliable criteria are available for the diagnosis of severe episodes that are characteristic of patients with Prinzmetal's variant angina. Newer criteria for the diagnosis of milder episodes of spasm are gradually being developed. Optimal criteria may become available with further progress of quantitative angiography. Provocation techniques for the induction of an attack of spasm in the cardiac catheterization laboratory are widely available. Of these, ergonovine testing is the most popular. The tests can usually be performed by experienced angiographers with impressive safety and provide a high degree of sensitivity and specificity when used in patients with the clinical diagnosis of variant angina. Although the research applications of such techniques are extremely broad, their practical clinical indications are somewhat limited to the work-up of patients with infrequent chest pains and normal or near-normal coronary arteriograms. There are other indirect methods for the diagnosis of coronary spasm, but the ideal technique is not available yet. Further expansion of newer modalities for the diagnosis of coronary artery spasm will certainly enhance our understanding of myocardial ischemia and will improve our ability to manage patients with ischemic heart disease.

Angina Pectoris, Variant↗