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PubMed2005

Incidents and complications during pediatric cardiac catheterization.

BACKGROUND: Cardiac catheterization has revolutionized the management of pediatric cardiac disease. There has been little information on adverse events during these cases from an anesthesia viewpoint. The aim of this audit was to determine the incident rate during pediatric cardiac catheterization as contemporaneously reported by the anesthetist and to identify both the types of events and which procedures had the highest risk. METHODS: Since 1993, data have been collected prospectively on an audit form for every anesthetic given in our institution, and in-theatre events were recorded on this form. We have reviewed the data collected on pediatric cardiac catheterizations over a period of 9 years. RESULTS: A total of 4454 cardiac catheterizations were recorded. The overall incidence of events was 9.3%. Cardiac catheterization with occlusion of a patent ductus arteriosus (PDA) or a secundum atrial septal defect (ASD) had the lowest event rate at 4.2%. The figure for cardiac catheterization with other therapeutic interventions was 11.6 and 9.3% for solely diagnostic cardiac catheterization. The event rate in infants under the age of 1 year was 13.9% compared with 6.7% for those children over the age of 1 year. Of the 253 reports from cardiac catheterizations that could be analyzed further, there were 91 major complications including four deaths, 72 minor complications and 90 other incidents. CONCLUSIONS: Adverse events occur more commonly during cardiac catheterization than during pediatric anesthesia in general. Cases with highest risk are those in the under 1 year olds and those including a therapeutic intervention other than PDA or ASD occlusion.

Cardiac Catheterization↗
PubMed1994

Use of cardiac catheterization in pediatric cardiac surgical decisions.

Current practice patterns relating to pediatric cardiac catheterization (Cath) have considerable economic implications. The decreased cost and risk of noninvasive methods such as echocardiography (ECHO) and magnetic resonance imaging (MRI) make them attractive alternative diagnostic methods if they can sufficiently define cardiac anatomy and the need for surgical intervention. We reviewed a recent cardiac surgical series of 465 cases in 1.5 years to determine how often a Cath was performed prior to surgery. Overall, 59.4% of the procedures were preceded by a Cath (76% of open heart operations, and 26.7% of closed heart operations). We specify the situations where we feel enough information is available for preoperative decision making from non-invasive testing, and we present some diagnostic pitfalls that have been encountered.

Cardiac Catheterization↗
PubMed1985

Radiation exposure and protection in cardiac catheterization laboratories.

Cardiac catheterization with angiography can deliver the greatest dose of x-radiation of any diagnostic medical examination. The physicians and technologists in the angiography room receive low-level scattered radiation over a period of months to decades. Although the radiobiology is complex, the physicians who perform cardiac catheterization should be familiar with the potential genetic and somatic effects of radiation and with the methods to reduce or eliminate x-ray exposure. The aim of radiation protection criteria is to reduce the risk of cancer death to less than the fatality risk for other occupations regarded as safe. This report is a review of the literature relating to radiation exposure and protection in cardiac catheterization laboratories. Catheterization personnel have control over the time duration of exposure, placement of technologists, shielding, location of equipment and monitoring of dose received.

Adult↗
PubMed2004

[Diagnosis of vascular complications at the puncture site after cardiac catheterization].

OBJECTIVES: Cardiac catheterization is increasingly used for the diagnosis or treatment of coronary artery disease. Previous studies that revealed the incidence of complications such as arteriovenous fistula and pseudoaneurysm were based on retrospective analysis of cohorts referred to vascular surgery. This study was designed to determine the incidence of arteriovenous fistula and pseudoaneurysm after percutaneous transluminal angiography. METHODS: All 557 consecutive patients undergoing cardiac catheterization were examined by ultrasonography from March 1, 2001 to April 1, 2002, to investigate the occurrence of arteriovenous fistula and pseudoaneurysm at the puncture site. RESULTS: Pseudoaneurysm was found in 16 patients (2.9%), and arteriovenous fistula in 12 patients (2.2%). Pseudoaneurysm in 7 patients (43.8%) and arteriovenous fistula in 6 patients (50.0%) were diagnosed only by ultrasonic examination. There were more female patients (9 patients, 56.3%) than male with pseudoaneurysm (p < 0.01). The puncture site was located after the division of the deep femoral artery and superficial femoral artery in all patients with complications. CONCLUSIONS: Ultrasonic examination was useful for diagnosis of complications such as arteriovenous fistula and pseudoaneurysm after cardiac catheterization.

Aged↗
PubMed1990

Value of right-sided cardiac catheterization in patients undergoing left-sided cardiac catheterization for evaluation of coronary artery disease.

The value of right-sided cardiac catheterization was assessed prospectively in 200 patients undergoing left-sided catheterization for evaluation of known or suspected coronary artery disease. Before catheterization, data from right-sided catheterization was not felt to be necessary for clinical management. There were 6 +/- 2 extra minutes of procedure time and 86 +/- 63 extra seconds of fluoroscopy time used. Abnormalities were detected in 69 (35%) patients. These findings were unexpected in 37 of these patients and in 3 patients, further evaluation was prompted. However, management was altered in only 3 (1.5%) patients as a result of data obtained by right-sided catheterization. In conclusion this additional procedure rarely adds clinically useful information about patients undergoing left-sided catheterization and angiography for coronary artery disease without a clinical indication for right-sided catheterization.

Cardiac Catheterization↗
PubMed1999

Utility of cardiac catheterization in pediatric cardiac patients on ECMO.

Cardiac catheterization has been utilized rarely in children on extracorporeal membrane oxygenation (ECMO). We performed a retrospective review of 15 children with congenital heart disease who had undergone catheterization while on ECMO from December 1990-December 1995. The procedures, including four interventions, were successful in all patients with adequate evaluation of clinical questions. Unexpected diagnostic information of clinical importance was obtained in 40%, and clinical management of patients was significantly altered in 73%. All patients tolerated the procedure and transport well. The only significant complication was a retroperitoneal hemorrhage in one patient after approximately 12 hr. Although no patients died at catheterization, overall survival was poor, with 50% weaning from ECMO, 29% surviving to discharge, and 14% surviving at follow-up. We conclude that diagnostic and interventional catheterization may be performed in patients on ECMO with acceptable morbidity and mortality; however, long-term survival in this population is poor.

Cardiac Catheterization↗
PubMed1989

Two-dimensional and Doppler-echocardiographic and cardiac catheterization correlates of survival in primary pulmonary hypertension.

To determine correlates of survival in primary pulmonary hypertension, we compared 41 echocardiography-Doppler and nine catheterization parameters with outcome in 26 patients. Mean follow-up was 19.7 months in survivors; mean survival was 4.8 months in 16 nonsurvivors. Cox life-table univariate analysis correlated two echocardiographic, three Doppler, and three catheterization variables with poor survival (p less than or equal to 0.05), and chi 2 analysis ensured the best critical values: severity of pericardial effusion, heart rate of more than 87 beats/min, pulmonic flow acceleration time of less than 62 msec, tricuspid early flow deceleration (T-DEC) equal to or less than -300 cm2/sec, mitral early flow-to-atrial flow velocity ratio (M-E/A) equal to or less than 1.0, catheterization cardiac index (CI) equal to or less than 2.3 l/min/m2, mean pulmonary artery pressure of more than 61 mm Hg, and diastolic pulmonary artery pressure of more than 43 mm Hg. Multivariate life-table analysis of noninvasive variables revealed the severity of pericardial effusion to be independently significant (p = 0.006), whereas analysis of catheterization variables revealed cardiac index to be independently significant (p = 0.014). Combined multivariate analysis did not differ from the noninvasive results alone. Categorical modeling of the eight significant variables split at their critical values (present or absent) revealed M-E/A, T-DEC, and CI to be independently significant by multivariate analysis (p = 0.0014). Analysis of the five echocardiography-Doppler variables alone revealed M-E/A, T-DEC, and heart rate to be independently significant (p = 0.0016). In both cases, mortality increased with the number of critical values reached.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMedDate not supplied

Efficacy and safety of outpatient cardiac catheterization.

Outpatient cardiac catheterization has become the standard in our laboratory. The only exclusion for outpatient study is current hospitalization for cardiac symptoms. Thus, any patient well enough to be at home is studied on an outpatient basis. We reviewed our experience on 4,094 diagnostic studies of which 3,537 (86%) were done on a same-day basis. The complication rates were generally lower than in published series with a mortality of 0.05%. There were no admissions for late bleeding. Ninety-seven percent of the procedures were done by the percutaneous technique utilizing 7-French catheters. Patients were heparinized, and protamine was not used. The low complication rate is to a large extent due to meticulous postoperative care by critical care nurses in an outpatient observation unit contiguous to the laboratory. Outpatient cardiac catheterization is a safe, cost-saving approach applicable to a large majority of cardiac patients.

Ambulatory Care Facilities↗
PubMed2003

[Spanish Registry on Cardiac Catheterization and Coronary Interventions. Twelfth official report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (1990-2002)].

The results of the Registry of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology for 2002 are presented. Data were obtained from 101 centers representing all cardiac catheterization laboratories in Spain; 95 centers performed mainly adult catheterization and 6 carried out only pediatric procedures. In 2002, 97,609 diagnostic catheterization procedures were performed, including 83,667 coronary angiograms, representing a total increase of 5.1% in comparison to 2001. The population-adjusted rate was 2,053 coronary angiograms per 106 inhabitants. Coronary interventions increased by 11% in comparison to 2001, with a total of 34,723 procedures and a rate of coronary interventions of 850 per 106 inhabitants. Coronary stents were the devices used most frequently, with 47,249 implanted in 2002, for a total increase of 20% in comparison to 2001. Stenting accounted for 91.7% of all procedures. Direct stenting was done in 13 768 procedures (43.2%). IIb-IIIa glycoprotein inhibitors were used in 9966 procedures (28.7%). Multivessel percutaneous coronary interventions were performed in 9,830 patients (28%), and ad hoc interventions were done in the course of diagnostic coronary angiography in 26,341 patients (76%).A total of 4,766 percutaneous coronary interventions were done in patients with acute myocardial infarction, representing an increase of 23.9% in comparison to 2001, and accounting for 13.7% of all interventional procedures. Of the noncoronary interventions recorded, we note the decrease in percutaneous mitral valvuloplasties (21.2%) and atrial septal defect closures (11.1%), and the slight increase in pediatric interventions (3.7%). In conclusion, we emphasize the high rate of reporting by laboratories, which allows the Registry to compile data that are highly representative of the activity at cardiac catheterization laboratories in Spain

Adult↗
PubMed2004

[Spanish Registry of Cardiac Catheterization and Coronary Interventions. Thirteenth Official Report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (1990-2003)].

The results of the Registry of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology for 2003 are presented. Data were obtained from 112 centers representing nearly all cardiac catheterization laboratories in Spain; 104 centers performed mainly adult catheterization and 8 carried out pediatric procedures only. In 2003, 105,939 diagnostic catheterization procedures were performed, including 90 939 coronary angiograms, representing a total increase of 8.5% in comparison to 2002. The population-adjusted rate was 2171 coronary angiograms per 106 inhabitants. Coronary interventions increased by 14.4% in comparison to 2002, with a total of 40,584 procedures and a rate of coronary interventions of 969 per 106 inhabitants. Coronary stents were used in 92.5% of the procedures (47,249 units implanted, for a total increase of 22% in comparison to 2002). About one fifth (20.2%) of the implanted stents were drug-eluting stents (11,699 units). A total of 6080 percutaneous coronary interventions were done in patients with acute myocardial infarction, representing an increase of 27.5% in comparison to 2002, and accounting for 14.9% of all interventional procedures. Of the noncoronary interventions recorded, we note the increase in percutaneous mitral valvuloplasties (21.6%) and atrial septal defect closures (86%), and also the increase in pediatric interventions (13.3%). In conclusion, we emphasize the high rate of reporting by laboratories, which allows the Registry to compile data that are highly representative of the activity at cardiac catheterization laboratories in Spain.

Angioplasty, Balloon, Coronary↗
PubMed2002

[Spanish Registry on Cardiac Catheterization Interventions. 11th official report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001)].

The results of the Spanish Registry of the Working Group on cardiac catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001) are presented. One-hundred-and-three centers contributed data, all the cardiac catheterization laboratories in Spain; 97 centers performed mainly adult catheterization and 6 carried out only pediatric procedures. In 2001, 95,430 diagnostic catheterization procedures were performed, with 79,607 coronary angiograms, representing a total increase of 8.4% over 2000. The population-adjusted incidence was 1947 coronary angiograms per 106 inhabitants. Coronary interventions increased by 15.4% compared with 2000, with a total of 31,290 procedures and an incidence of coronary interventions of 761 per 106 inhabitants. Coronary stents were the most frequently used devices with 39,356 implanted in 2001, and increase of 33.4% over 2000. Stenting accounted for 88.2% of procedures. Direct stenting was done in 11,280 procedures (40.9%). IIb-IIIa glycoprotein inhibitors were given in 7,012 procedures (22.4%). Multivessel percutaneous coronary interventions were performed in 8,445 cases (27%) and interventions were performed ad hoc during diagnostic study in 23,144 cases (74 %).A total of 3,845 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, an increase of 22.9% over 2000 and 12.3% of all interventional procedures. Among non-coronary interventions, atrial septal defect closure was performed more often (161 cases, a 60% increase over 2000). Pediatric interventions increased by 15.4% (from 817 to 943 cases).Lastly, we would like to underline the high rate of reporting by laboratories, which allowed the Registry to compile data that are highly representative of hemodynamic interventions in Spain.

Adult↗
PubMed2004

Factors that affect back pain among Hong Kong Chinese patients after cardiac catheterization.

BACKGROUND: Cardiac catheterization (CC) is a widely used cardiac investigation procedure in Hong Kong. However, back pain is frequently reported following CC due the prolonged bed rest after the procedure. AIM: The overall aim of this study was to examine factors associated with back pain among Hong Kong Chinese patients after femoral access for CC. METHODS: A prospective study, nested within a randomized clinical trial (RCT), employing secondary analysis of an existing data set from 419 Chinese adults receiving nonemergency CC, were used. Following a review of literature, gender, age, history of back pain, type of dressing on the puncture site, length of bed rest duration, turning privilege during bed rest, catheter size used for CC, duration of the procedure, duration of hemostasis, and body weight were identified as potential factors affecting back pain level. Back pain was assessed at 6 h and the next morning after CC, using the Numeric Pain Intensity Scale (NPIS). Analysis was done using multivariate analysis of variance (MANOVA), after testing for normality of the distribution. RESULTS: Turning privilege (p = 0.001), age (p = 0.04), and body weight (p = 0.006) were significantly related to level of back pain at 6 h and the next morning after CC. CONCLUSION: Results of this study may help nurses have a better understanding about patients' physical needs and appropriate nursing interventions that can be planned to enhance patient comfort following CC.

Adult↗
PubMed1995

Is cardiac catheterization necessary in the era of echocardiography? Cost-effective approach combining echocardiography and cardiac catheterization.

Definitive evaluation of cardiovascular disease is traditionally accomplished by cardiac catheterization. Advances in transthoracic and transesophageal Doppler echocardiography provides an accurate and cost-effective approach when compared to cardiac catheterization. Recent data suggests that for most adult patients with aortic or mitral valve disease, Doppler echocardiographic data enables the clinician to make the same decision reached with catheterization data. Echo and Doppler studies are useful in guiding certain therapeutic interventional procedures, and in the diagnosis of aortic dissection, mechanical complications of myocardial infarction, and in identifying aortic atheromas as a potential source of embolism. Future research will need to demonstrate that not only is echocardiography cost-effective, but that it will change the outcome of the patient.

Aortic Dissection↗