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PubMed1977

Neurologic complications of cardiac catheterization.

A retrospective survey was made of neurologic complications of cardiac catheterization. Of 10 patients, only one had a diffuse disorder, with seizures of a type associated with reaction to contrast agents. Disorders in the other nine patients appeared to be embolic in nature. Five of these nine involved deficits indicating damage in the vertebrobasilar territories, suggesting local trauma to vessels as a source of the embolic material.

Adolescent↗
PubMed2006

Ischemic strokes after cardiac catheterization: opportune thrombolysis candidates?

Stroke is an important complication after cardiac catheterization procedures, resulting in death and disability for thousands of patients each year. Common risk factors include advanced age, vascular comorbidities, and more complicated and invasive procedures. Several lines of evidence suggest that these strokes are embolic, from either dislodgement of a clot or atheromatous debris off the aortic arch or from thrombus formation on the tip of a guide catheter. These strokes are likely amenable to thrombolysis, although the current literature regarding the use of thrombolysis in this setting is limited to case reports and series. Whether thrombolysis is safe and efficacious remains to be determined, but the existing evidence seems favorable for individual circumstances.

Cardiac Catheterization↗
PubMed2005

Focal seizure and cerebral contrast retention after cardiac catheterization.

Although rare, ionic and nonionic contrast-induced seizures occur as a complication of enhanced cranial computed tomography for both adults and children. However, contrast-induced seizures after cardiac catheterization has only been reported in adults. This report describes an 18-month-old male who developed a new-onset focal seizure 12 hours after cardiac catheterization. Unenhanced cranial computed tomography 1 hour after the seizure demonstrated general cerebral edema and unilateral focal cerebral contrast retention with sparing of the area supplied by the middle cerebral artery. The contrast was reabsorbed from the subarachnoid space over a 48-hour period, the cerebral edema resolved over several days, and the child returned to his baseline state 4 days after the seizure episode. This study documents the evolution of computed tomographic findings after contrast-induced seizures in a child. Contrast toxicity should be considered in any case of a new-onset neurologic deficit arising after angiography or enhanced computed tomography.

Brain↗
PubMed2000

Impact of patient characteristics, complications, and facility volume on the costs and time of cardiac catheterization and coronary angioplasty in 70 catheterization laboratories.

Although over 1 million procedures are performed in cardiac catheterization laboratories (CCLs) annually, little comparative data exist on costs or resource use in these settings. In this study, data from 70 CCLs were used to profile CCL times and total direct costs for 2 high-volume procedures: left heart catheterization (LHC) and percutaneous transluminal coronary angioplasty (PTCA) with or without stent placement. In total, 70,677 consecutive patient examinations for a 12-month period from January 1, 1998 to December 31, 1998 were analyzed. For LHC mean total direct costs averaged $306, whereas for PTCA catheterization laboratory costs averaged $3,172. The average total times for these procedures were 63 and 108 minutes, respectively. Seventy-two percent of the PTCA patients underwent coronary stenting with an associated incremental cost of $1,244. By multivariate linear regression, baseline patient characteristics such as age, gender, and clinical factors had little impact on total time and total costs. The major determinants of CCL time and cost were procedural factors (e.g., number and type of interventions) and in-lab complications, including profound hypotension, abrupt vessel closure, and emergency bypass surgery. Using facility procedure volume as a proxy for potential economies of scale, we found no relation between CCL volume and total direct CCL costs. There did appear to be a significant inverse relation between facility volume and total procedural time with CCLs that performed the highest volumes of LHC and PTCA procedures saving an average of 5 to 9 minutes per procedure. These findings may be useful in defining specific time and cost benchmarks for these commonly performed procedures and serve to underscore the critical role of reducing complications in both quality improvement and cost-saving efforts.

Aged↗
PubMed2003

The effect of early education on patient anxiety while waiting for elective cardiac catheterization.

BACKGROUND: A supply-demand mismatch with respect to cardiac catheterization (CATH) often results in patients experiencing waiting times that vary from a few weeks to several months. Long delays can impose both physical and psychological distress for patients. PURPOSE: The purpose of this study was to examine the effect of a psychoeducational nursing intervention at the beginning of the waiting period on patient anxiety during the waiting time for elective CATH. METHODS: This was a 2-group randomized controlled trial. Intervention patients received a nurse-delivered, detailed information/education session within 2 weeks of being placed on the waiting list for elective CATH. Control group patients received usual care. RESULTS: The mean waiting time for CATH was 13.4+/-7.2 weeks, which did not differ between groups (P=0.509). Anxiety increased in both groups over the waiting time (P=0.028). Health-related quality of life deteriorated over the waiting time in both groups (P<0.05). On a visual analogue scale, there was a significant difference (P=0.002) between the intervention (4.0+/-2.7) and control (5.2+/-3.0) groups in self-reported anxiety 2 weeks prior to CATH. CONCLUSIONS: The waiting period prior to elective CATH has a negative impact on patients' perceived anxiety and quality of life and a simple intervention, provided at the beginning of the waiting period, may positively affect the experience of waiting.

Aged↗
PubMed1988

Infection risk of cardiac catheterization and arterial angiography with single and multiple use disposable catheters.

In a prospective study from November 1986 to June 1987, a cohort of 414 patients underwent cardiac catheterization or angiography with either multiple use or single use disposable catheters: 161 patients were studied with 426 single use catheters, 152 patients with 384 multiple use catheters which were resterilized once or twice, and 101 patients with 325 multiple use catheters reprocessed several times. Postcatheterization temperature did not exceed 38.2 degrees C in any patient, but was greater than 37.4 degrees C in 4-6% of the patients studied. No significant differences between the three groups with respect to fever could be observed. Infectious complications associated with cardiac catheterization or angiography did not occur in any case. Of 414 patients, 38 (9.2%) developed hematoma at the puncture site. It is concluded that careful cleaning, disinfection, and resterilization of intravascular catheters with ethylene oxide does not increase the risk of infection. With the rising pressure for containment of health care costs, it is likely that the practice of reprocessing and reuse of expensive intravascular catheters will expand further.

Angiography↗
PubMed1992

[Historic perspective of cardiac catheterization].

In 1929 Forssman introduced a catheter into one of his left forearm veins and advanced it up to the right atrium, opening the possibility of cardiac catheterization in man. Since 1940, right heart catheterization was systematically performed by Andre Cournard and Dickinson Williams and many other researchers who contributed in the following decade with different approaches; at the present time the retrograde access through the femoral or brachial artery is the most widely used. Angiocardiography evolved in different countries between 1929 and 1959. Selective coronary cineangiography, developed by Sones, has been one of the most important advances in this field. Cardiac catheterization has been a valuable tool in cardiovascular research and diagnosis. Moreover, it has contributed to the progress of cardiac surgery and critical care medicine. Lately, it has derived to therapeutic procedures such as coronary angioplasty and percutaneous, dilatation of stenotic heart valves and closure of some congenital shunts. "Interventional catheterization" has become one of the most frequent indications for this procedure as long as many heart diseases are correctly diagnosed by means of non invasive technique.

Angiocardiography↗
PubMed1982

A new technique for noninvasive evaluation of femoral arterial and venous anatomy before and after percutaneous cardiac catheterization in children and infants.

A new ultrasonic method was applied to image the femoral artery and vein in children for evaluation of short- and long-term effects of cardiac catheterization with femoral percutaneous cannulation. Sixty-six children and infants (aged 5 days to 20 years) were studied with a 9 megahertz electronically focused real time scanner. Adequate studies were obtained in 46 patients before catheterization, in 26 of 30 short-term follow-up studies and in 14 long-term follow-up studies. Femoral arterial size could be quantitatively measured at the inguinal ligament and a correlation existed between imaged femoral arterial diameter and body weight (r = +0.82) or body surface area (r = +0.80). Short-term follow-up ultrasonic imaging studies allowed diagnosis of spasm and other complications of percutaneous femoral arterial puncture. Long-term follow-up studies were performed 4 months to 3 years after catheterization in 14 patients who had no complications recorded at the time of catheterization. These revealed significant differences between vessels on the catheterized and uncatheterized (control) sides in only 3 of the 14. High resolution ultrasonic imaging can provide anatomic and functional information about femoral arteries and veins and appears to be of assistance in planning cardiac catheterization and in studying the short- and long-term effects of percutaneous femoral cannulation.

Adolescent↗
PubMed1993

Unplanned admissions after outpatient cardiac catheterization.

Increasing numbers of patients are undergoing diagnostic catheterization as outpatients; however, a small proportion of patients requires hospital admission following the procedure. Unplanned admissions after consecutive outpatient cardiac catheterizations performed during 1 year were prospectively reviewed to determine the incidence of and reasons for admission. Among 847 patients undergoing outpatient cardiac catheterization, 130 patients (15%) required hospital admission after the procedure. Admitted patients were divided into four groups: patients undergoing immediate percutaneous transluminal coronary angioplasty (PTCA) (Group 1; 33%), patients with severe cardiac disease requiring urgent intervention (Group 2; 48%), patients suffering complications or hemodynamic instability (Group 3; 15%), and patients whose procedures were completed too late to allow same-day discharge (Group 4; 4%). Patients over 65 were more likely to require admission and women were more likely to be admitted with complications or hemodynamic instability. Findings are compared with results of other outpatient series, and implications regarding appropriate setting for outpatient catheterization are discussed.

Adult↗
PubMed1997

Myocardial contrast echocardiography in acute myocardial infarction using aortic root injections of microbubbles in conjunction with harmonic imaging: potential application in the cardiac catheterization laboratory.

OBJECTIVES: The aim of this study was to evaluate myocardial contrast echocardiography using aortic root injections with harmonic imaging in experimental acute myocardial infarction to determine the potential of this approach in the cardiac catheterization laboratory. BACKGROUND: It would be desirable to have an adjunctive procedure that could evaluate myocardial perfusion at the time of cardiac catheterization in patients with acute myocardial infarction. A single injection of contrast medium in the aortic root would provide complete information on myocardial perfusion in a cross section of the heart. High quality images would provide on-line assessment of myocardial perfusion without recourse to image processing. These data could be very valuable for determining patient management. METHODS: Perfusion defects on myocardial contrast echocardiography were measured during coronary occlusion and reflow, using fundamental and harmonic imaging in both continuous and intermittent modes in nine open chest dogs. These defects were compared with risk area on technetium-99m autoradiography and infarct size on tissue staining. RESULTS: Whereas harmonic imaging increased myocardial video intensity by more than twofold (p < 0.001) compared with fundamental imaging after aortic root injection of contrast medium, intermittent imaging was not superior to continuous imaging. The improved signal to noise ratio of harmonic imaging allowed on-line definition of risk area (r = 0.98) and infarct size (r = 0.93) without recourse to off-line processing. Similar results could be obtained with fundamental imaging only after off-line processing. CONCLUSIONS: Aortic root injection of contrast medium coupled with harmonic imaging can be used to provide accurate on-line assessment of risk area and infarct size during acute myocardial infarction. These results have important implications for the catheterization laboratory.

Adenosine↗
PubMed2005

[Radial artery spasm in transradial cardiac catheterization. Assessment of factors related to its occurrence, and of its consequences during follow-up].

INTRODUCTION AND OBJECTIVES: Radial artery spasm is the most frequent complication of transradial cardiac catheterization. It causes patient discomfort and reduces the procedure's success rate. The aims of this study were to identify variables associated with this complication, such as clinical parameters, angiographic characteristics of the radial artery and factors related to the procedure, and to analyze the clinical consequences of spasm, both generally and for radial artery patency, during follow-up. PATIENTS AND METHOD: The study included 637 patients who were undergoing transradial cardiac catheterization. Radial artery spasm was recorded using a scale that reflected the presence of pain and the technical difficulty of the procedure. RESULTS: Radial artery spasm was reported in 127 patients (20.2%). Multivariate analysis showed that the variables associated with radial artery spasm were radial artery anatomical anomalies (odds ratio [OR]=5.1; 95% confidence interval [95% CI]: 2.1-11.4), use of >size-3 catheters (OR=3.0; 95% CI: 1.9-4.7), moderate-to-severe pain during radial artery cannulation (OR=2.6; 95% CI: 1.4-4.9), the use of phentolamine as a spasmolytic (OR=1.8; 95% CI: 1.1-2.9), and postvasodilation radial artery diameter (OR=0.98; 95% CI: 0.98-0.99). At follow-up [20 (18) days], severe pain in the forearm was more frequent in patients who presented with radial artery spasm (12.4% vs 5.3%), but there was no significant difference in the radial artery occlusion rate (4.5% vs 2.2%). CONCLUSION: Radial artery spasm during transradial catheterization mainly depends on radial artery characteristics and procedural variables. At follow-up, radial artery spasm was associated with more frequent severe pain in the forearm, but the radial artery occlusion rate was not increased.

Cardiac Catheterization↗
PubMed1981

Clinical significance and hemodynamic correlates of the third heart sound gallop in aortic regurgitation. A guide to optimal timing of cardiac catheterization.

The hemodynamic and clinical data of 42 patients with chronic significant aortic regurgitation and 31 normal subjects were examined. Of the patients with aortic regurgitation, 28 had a third heart sound (S3) gallop and 14 did not. There was no significant difference in the severity of regurgitation between the patients with or without an S3 gallop. However, all patients with an S3 gallop had an abnormality increased left ventricular residual volume and depressed contractile state. These findings were supported by the hemodynamic data of two patients who underwent cardiac catheterization before and after the development of an S3 gallop. We conclude that the S3 gallop in patients with chronic AR reflects left ventricular dysfunction, rather than more severe degrees of regurgitation per se, and may therefore be useful for selecting patients for cardiac catheterization and consideration for prosthetic aortic valve replacement.

Adolescent↗
PubMed2006

[The value of augmentation index and myocardial performance index obtained from cardiac catheterization pressure recordings in predicting coronary artery disease].

OBJECTIVE: The aim of the study was to determine the relation between some parameters, which can be obtained from cardiac catheterization pressure records, and coronary artery disease. METHODS: The study included 65 patients, in whom coronary angiography was performed by the cardiologists of the study. The parameters could be obtained in 40 patients (59+/-6 years; 28 male), and statistical analysis included the data of these patients. From the pressure recordings, myocardial performance index (MPI), isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), ejection time (ET), augmentation wave amplitude (AW), augmentation wave time (AWT) and augmentation index (AI) were measured manually. Coronary artery disease was defined as the presence of any lesion, without regarding the degree of narrowing. The parameters were evaluated with respect to relation with presence of coronary artery disease (Mann-Whitney U test), relation with risk factors for atherosclerosis (Mann-Whitney U test and Chi square test) and capability of predicting coronary artery disease (area under ROC curve, AUC). Statistical significance was set at 0.05. RESULTS: The presence of coronary artery was significantly related to AI, AWT, AW, IVCT and MPI (p<0.001 for all). The most sensitive parameters for coronary artery disease were AI (sensitivity 94%, AUC -0.846, p<0.001) and AW (sensitivity 94%, AUC -0.848, p<0.001), while the most specific one was AWT (specificity 82%, AUC -0.833, p<0.001). The MPI and IVCT were weakly related with risk factors, while IVRT had stronger relation. The parameters of augmentation wave were significantly related with high density lipoprotein cholesterol, whereas the relation with low density lipoprotein cholesterol was weak. CONCLUSION: The parameters, which are obtained from cardiac catheterization pressure recordings, are related with coronary artery disease. They may be useful for predicting future coronary artery disease especially in patients with normal coronary angiogram. It is useful to add these parameters into the reports of coronary angiograms.

Cardiac Catheterization↗
PubMedDate not supplied

Subadventitial hematoma of a patent ductus arteriosus and thrombus formation within the aorta secondary to cardiac catheterization.

An 18-month-old boy with patent ductus arteriosus (PDA) underwent surgical closure of PDA. Cardiac catheterization determined the PDA was not suitable for transcatheter closure. After the chest was opened, subadventitial hematoma was seen on the aortic end of the PDA. Incision of the aorta revealed a thrombus secondary to intimal laceration. The thrombus was extracted and the PDA was closed using division technique. Because no similar report was found in English-language literature, the technique and the surgical strategy are discussed.

Aorta↗
PubMed1987

Coarctation repair without cardiac catheterization in infants.

Of 35 infants who underwent an operation for coarctation of the aorta, 15 did not undergo cardiac catheterization before surgery. The diagnoses in all uncatheterized patients were made by clinical examination, chest radiography, ECG, and two-dimensional echocardiography combined with pulsed Doppler echocardiography. Associated anomalies diagnosed by two-dimensional/Doppler echocardiography included a patent ductus arteriosus in all patients, bicuspid aortic valve in six, small ventricular septal defect in four, and complete common atrioventricular canal in one. In no instance was the diagnosis of coarctation in error. In addition, the clinical significance of the ventricular septal defect was judged correctly by two-dimensional echocardiography, and no patient required an early reoperation because of significant left-to-right shunt. Two significant lesions were missed in one patient each: mitral stenosis and aortic stenosis. These diagnoses were missed in patients who were first seen with either profound congestive heart failure or shock. Coarctation of the aorta and associated lesions can be diagnosed accurately by two-dimensional echocardiography. This permits proper patient management without the added risk of cardiac catheterization. Although mitral and aortic lesions may be missed because of low cardiac output, this does not result in management errors.

Aortic Coarctation↗
PubMed1995

Use of intra-aortic nitroglycerin in the cardiac catheterization laboratory.

The purpose of this study was to determine whether nitroglycerin (NTG) injected into the ascending aorta or left ventricle would safely and effectively lower blood pressure in hypertensive patients undergoing cardiac catheterization. Fifty bolus injections of 297 +/- 67 micrograms (mean +/- SD) NTG were given to patients with a systolic blood pressure (SBP) of > or = 140 mm Hg (mean SBP 188 +/- 20.1 mm Hg). An average drop in systolic blood pressure of 36 +/- 16 mmHg (P < 0.001), diastolic blood pressure of 19 +/- 7 mm Hg (P < 0.001), and left ventricular end-diastolic pressure of 4.7 +/- 4 mm Hg (P = 0.001) was well tolerated in each patient. The mean time to response was 11 +/- 3 sec. Intra-aortic injection of NTG is a safe and effective means to treat hypertensive patients in the cardiac catheterization laboratory.

Adult↗
PubMed2000

Coronary physiology revisited : practical insights from the cardiac catheterization laboratory.

Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making.

Animals↗
PubMed1993

Left ventricular rupture following myocardial infarction treated with streptokinase: successful resuscitation in the cardiac catheterization laboratory using pericardiocentesis and autotransfusion.

An 80-year-old female developed left ventricular rupture in the cardiac catheterization laboratory following myocardial infarction treated with streptokinase. The patient was resuscitated using pericardiocentesis and autotransfusion. This technique and the predisposing factors for left ventricular rupture are discussed.

Aged↗