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PubMedDate not supplied

Complications of cardiac catheterization: a single-center study.

In Turkey as well as in the whole world, cardiac catheterization is an invasive intervention that is being increasingly used both for diagnosis and treatment. With technological and pharmacologic development and experience, the indications for this intervention are ever increasing. This invasive intervention brings, of course, some complications with it. These may range from local ones to death. In this study the authors analyzed the local cardiac complications and those related to other systems that they encountered in 10,445 catheterizations conducted for diagnosis and treatment in their clinic over a 26-month period. They found the rate of all complications to be 3.54% (2.05% diagnostic, 9.1% therapeutic). Of these complications, 1.89% (0.80% diagnostic, 6.02% therapeutic) were cardiac, 1.27% (0.97% diagnostic, 2.4% therapeutic) local. They found that the ratios of death were 0.09% for diagnostic interventions, 1.13% for therapeutic interventions, and 0.31% altogether. In the diagnostic group 0.02% required urgent coronary bypass surgery, and 0.41% needed urgent coronary bypass surgery in the therapeutic group. In conclusion, despite the noticeable changes in patient profile and application, the ratios for cardiac catheterization have changed little over the years.

Actuarial Analysis↗
PubMed1991

Evaluation of combination thrombolytic therapy and timing of cardiac catheterization in acute myocardial infarction. Results of thrombolysis and angioplasty in myocardial infarction--phase 5 randomized trial. TAMI Study Group.

Recent trials of myocardial reperfusion using single-agent thrombolytic therapy and sequential cardiac catheterization have supported a conservative approach to the patient with acute myocardial infarction. To evaluate combination thrombolytic therapy and the role of a previously untested strategy for the aggressive use of cardiac catheterization, we performed a multicenter clinical trial with a 3 x 2 factorial design in which 575 patients were randomly allocated to one of three drug regimens--tissue-type plasminogen activator (t-PA) (n = 191), urokinase (n = 190), or both (n = 194) - and one of two catheterization strategies--immediate catheterization with angioplasty for failed thrombolysis (n = 287) or deferred predischarge catheterization on days 5-10 (n = 288). Patients with contraindications to thrombolytic therapy, cardiogenic shock, or age of more than 75 years were excluded. Global left ventricular ejection fraction was well preserved and almost identical at predischarge catheterization (54%), regardless of the catheterization or thrombolytic strategy used (p = 0.98). Combination thrombolytic therapy was associated with a less complicated clinical course, most clearly documented by a lower rate of reocclusion (2%) compared with urokinase (7%) and t-PA (12%) (p = 0.04) and a lower rate of recurrent ischemia (25%) compared with urokinase (35%) and t-PA (31%). When a composite clinical end point (e.g., death, stroke, reinfarction, reocclusion, heart failure, or recurrent ischemia) was examined, combination thrombolytic therapy was associated with greater freedom from any adverse event (68%) compared with either single agent (urokinase, 55%; t-PA, 60%) (p = 0.04) and with a less complicated clinical course when the composite clinical end points were ranked according to clinical severity (p = 0.024). Early patency rates were greater with combination therapy, although predischarge patency rates after considering interventions to maintain patency were similar among drug regimens. No difference in bleeding complication rates was observed with any thrombolytic regimen. The aggressive catheterization strategy led to an overall early patency rate of 96% and a predischarge patency rate of 94% compared with a 90% predischarge patency in the conservative strategy (p = 0.065). The aggressive strategy improved regional wall motion in the infarct region (-2.16 SDs/chord) compared with deferred catheterization (-2.49 SDs/chord) (p = 0.004). More patients treated with the aggressive strategy were free from adverse outcomes (67% versus 55% in the conservative strategy, p = 0.004), and the clinical course was less complicated when the adverse outcomes were ranked according to severity (p = 0.016). No significant increase in use of blood products resulted from the aggressive strategy.(ABSTRACT TRUNCATED AT 400 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1993

Contrast echocardiography during cardiac catheterization in patients with congenital heart diseases.

Contrast echocardiography performed during cardiac catheterization has mostly been limited to a few published case reports. We studied 37 patients with congenital heart disease to assess the capability of the method to diagnose cardiac shunts and valve regurgitation. Injections of 5% dextrose in water through an angiographic catheter were made to evaluate septal integrity and valve competence compared with conventional contrast angiography. An overall sensitivity of 93% and specificity of 78% were found. In four cases of atrial septal defect and seven of mitral regurgitation, the sensitivity was 100%. It was slightly lower for eleven cases of ventricular septal defect (91%) and four of patent ductus arteriosus (75%). When assessing aortic, tricuspid and pulmonary valve competence, the method proved to be more sensitive than conventional angiography to detect mild regurgitation. Contrast echocardiography is a sensitive and safe technique that may be used in association with conventional angiography reducing the need for radiographic contrast and ionizing radiation time.

Adolescent↗
PubMed1995

Paediatric cardiac catheterization: innovations.

In recent years interventional procedures have been introduced to the field of paediatric cardiac catheterization. These procedures continue to develop in complexity and increasingly are being applied to patients with reduced cardiovascular reserve, as an alternative to cardiac surgery or when cardiac surgery with cardiopulmonary bypass is contraindicated. More frequently anaesthetists are being called upon to provide support in sedating, anaesthetizing or/and resuscitating these patients. The purpose of this review is to give a comprehensive update of the interventional procedures and to review the anaesthetic management techniques as they apply to the catheterization laboratory. We will discuss possible complications and management strategies from our own experience and the experience of others. We have observed that as more complicated procedures are performed the anaesthetist plays a pivotal role in the management of the patient from arrival to departure from the cardiac catheterization laboratory, and in preventing mortality and major morbidity. Although the economic consequences of interventional cardiological techniques remain unclear, the field continues to expand and more complex procedures are continually being introduced.

Anesthesia, General↗
PubMed1999

Value of saphenous vein graft markers during subsequent diagnostic cardiac catheterization.

BACKGROUND: Although saphenous vein graft (SVG) markers have been available for many years, they have not been widely used in coronary artery bypass graft (CABG) surgery. This is likely due to the paucity of data regarding the utility of these markers in postsurgery cardiac catheterization. METHODS: We performed a prospective study of all post-CABG patients undergoing cardiac catheterization at Barnes-Jewish Hospital over a 6-month period to test our hypothesis that SVG markers would have a beneficial effect on these procedures. Differences in total procedure (arterial) time, time to image only the SVGs, fluoroscopy time, amount of contrast used, number of aortotomies, and number of views required were compared in patients with and without markers. RESULTS: Post-CABG patients undergoing catheterization who had markers (n = 76) required significantly less total procedure time (p = 0.007), fluoroscopy time (p = 0.02), and contrast use (p = 0.008). Even after adjusting for the numbers of SVG ostia and numbers of cine views, patients with markers still required less catheterization and fluoroscopy time (p < 0.01, p < 0.02) and time to image only the SVGs (p < 0.05) than those without markers (n = 106). CONCLUSIONS: SVG markers improve the efficiency of post-CABG catheterizations; they decrease the exposure of patients and cardiologists to ionizing radiation, and they decrease the exposure of patients to potentially toxic contrast agents. SVG markers are beneficial to the vast majority of post-CABG patients.

Cardiac Catheterization↗
PubMedDate not supplied

Prediction of prognosis of patients with idiopathic dilated cardiomyopathy: a comparison of echocardiography with cardiac catheterization.

The prognostic values of indices obtained by M-mode and two-dimensional echocardiography (Echo) and by cardiac catheterization (Cathe) were assessed in patients with idiopathic dilated cardiomyopathy. Fifty-one patients with this disorder (38 males and 13 females) were studied for an average of 4.2 years. Of those, 24 died of cardiac causes during follow-up. The overall 5-year survival rate was 49%. Significant differences between the surviving patients and the patients who died were noted in the following indices measured by Cathe: left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic pressure (LVEDP), ejection fraction (EF), and the cardiac index (CI). The 5-year survival rate in patients with the following index values measured by Cathe at the initial examination were: LVEDV greater than or equal to 150 ml/M2 - 29%; LVEDP greater than 12 mmHg - 35%, EF less than 30% - 21%, and CI less than 3.0 L/min/M2 - 29%. In contrast, the 5-year survival rate in patients with the following parameter values measured by Echo were: left ventricular end-diastolic dimension greater than or equal to 45 mm/M2 - 16%; left atrial dimension greater than or equal to 25 mm/M2 - 12%; ejection fraction less than 30% - 31%; and a relative wall thickness (a ratio of left ventricular posterior wall thickness to left ventricular end-diastolic dimension) less than or equal to 0.12 - 9%. In assessing the cumulative survival rate, the indices provided by Echo revealed similar values when compared with those obtained by Cathe. The relative wall thickness determined by Echo would be the most reliable parameter for forecasting the 5-year survival rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Bilateral cardiac catheterizations: the safety and feasibility of a superficial forearm venous and transradial arterial approach.

The transradial approach for left heart catheterization has become increasingly popular recently because of its clinical benefits. We examined the safety and feasibility of a transforearm approach for bilateral cardiac catheterizations, using the radial artery and a superficial forearm vein (the cephalic, basilic, or median antecubital vein). Between August 2002 and October 2003, 296 right heart catheterizations were performed in our hospital. A superficial forearm vein was used in one group of 101 patients, of which 98 had a concomitant left heart catheterization through the radial artery. The femoral vein was used for right heart catheterization in the second group of 195 patients. Of these patients, 37 underwent left heart catheterization through the radial artery and 157 through the femoral artery. All instances of bilateral catheterizations were successful except for one complication of pseudoaneurysm occurring in the transfemoral group. The procedure time for right heart catheterization was significantly less in the forearm group than the femoral group. The transforearm group had a larger proportion of males and of patients undergoing diagnostic right heart catheterization for congestive heart failure, dilated cardiomyopathy, and ischemic cardiomyopathy. Patients with aortic stenosis (AS), atrial septal defect (ASD), and mitral stenosis (MS) were mainly restricted to the transfemoral approach. We conclude that the transradial artery and superficial forearm venous approach for bilateral cardiac catheterizations is a safe and feasible alternative to the femoral approach in a wide range of patients, with the exception of patients with AS, ASD, or MS.

Adult↗
PubMed1981

Correlation between cardiac catheterization and echocardiography in assessing the severity of mitral stenosis.

During a 12-mth period 162 consecutive patients with mitral stenosis underwent examination by M-mode as well as cross-sectional echocardiography. The mitral valve area was measured by cross-sectional echocardiography ad the severity of mitral stenosis by M-mode echocardiography. Out of the total, 69 patients underwent left and right heart catheterization and in 53 of these the mitral valve area was calculated. A correlation of r=0.92 for the mitral valve area was found between sector scan echocardiography and cardiac catheterization, whereas the correlation between M-mode echocardiography and catheterization yielded a result of only r=0.38. Thus the assessment of the severity of mitral stenosis by cross-sectional echocardiography is a reliable alternative to cardiac catheterization.

Cardiac Catheterization↗
PubMed1994

Health data collection and verification in a collaborative model: development of a position paper on cardiac catheterization laboratories by the Rocky Mountain Heart Consortium.

The framework of cooperation and collaboration enabled a unique voluntary organization of health care providers and consumers to develop and publish a position paper regarding the utilization of cardiac catheterization laboratories in the state of Colorado. The collection and analysis of valid, consistent, and comparable administrative health data provided the basis for recommendations regarding current utilization of cardiac catheterization laboratories, assessment of need by geographic area, and development of criteria for the establishment of additional laboratories. The article describes the methodology used to collect and analyze health data on a statewide basis, the issues of data reliability and validity that resulted, and the process of public release of such data.

Cardiac Catheterization↗
PubMed1982

Determinants of total body oxygen consumption in adults undergoing cardiac catheterization.

Oxygen consumption was measured in 500 patients (151 F, 349 M, ages 12-84 yr.) undergoing routine cardiac catheterization. Sex, age, and heart rate were found to be the strongest predictors of oxygen consumption index (OCI). Males had higher OCI values than females at any age. Older patients of both sexes had lower OCI values than younger patients. Heart rate correlated directly with OCI. Treatment with propranolol correlated inversely with OCI. However, after correction for heart rate, there were no significant differences in OCI values between propranolol treated and nontreated patients. A linear regression equation was developed using combinations of variables to predict OCI, and tables are presented for predicting OCI in those patients in whom this variable cannot be directly measured.

Adolescent↗
PubMed2005

"Rubral" tremor after cardiac catheterization: report of 2 cases.

The so-called rubral tremor is a clinical diagnosis that involves involuntary shaking limb movements during rest and voluntary motion. We report the cases of 2 patients who developed rubral tremor after cardiac catheterization. To our knowledge, this is the 1st report of such an association. In each case, brain magnetic resonance imaging revealed nothing unusual. The onset of tremor after cardiac catheterization may signal the presence of a complex neurologic syndrome, which warrants consultation with a neurologist.

Aged↗
PubMed1984

Is routine preoperative cardiac catheterization necessary before repair of secundum and sinus venosus atrial septal defects?

Between January 1976 and July 1983, 217 patients with atrial septal defect underwent surgical repair at Children's Hospital. Thirty with a primum atrial septal defect and 26 who underwent cardiac catheterization elsewhere before being seen were excluded from analysis. Of the 161 remaining patients, 52 (31%) underwent preoperative cardiac catheterization, 38 because the physical examination was considered atypical for a secundum atrial septal defect and 14 because of a preexisting routine indication. One hundred nine (69%) underwent surgery without catheterization, with the attending cardiologist relying on clinical examination alone in 5, additional technetium radionuclide angiocardiography in 5, M-mode echocardiography in 13 and two-dimensional echocardiography in 43; both M-mode echocardiography and radionuclide angiography were performed in 24 and two-dimensional echocardiography and radionuclide angiography in 19. Since 1976, there has been a trend toward a reduction in the use of catheterization and use of one rather than two noninvasive or semiinvasive techniques for the detection of atrial defects. Of the 52 patients who underwent catheterization, the correct anatomic diagnosis was made before catheterization in 47 (90%). Two patients with a sinus venosus defect and one each with a sinus venosus defect plus partial anomalous pulmonary venous connection, partial anomalous pulmonary venous connection without an atrial septal defect and a sinoseptal defect were missed. Of 109 patients without catheterization, a correct morphologic diagnosis was made before surgery in 92 (84%). Nine patients with a sinus venosus defect, three with sinus venous defect and partial anomolous pulmonary venous connection, four with partial anomalous pulmonary venous return without an atrial septal defect and one with a secundum defect were incorrectly diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Spinal anesthesia for diagnostic cardiac catheterization in high-risk infants.

BACKGROUND: The main goals of diagnostic cardiac catheterization (DCC) in infants are to evaluate the anatomy and physiology of congenital and acquired cardiac defects while maintaining normal respiratory and hemodynamic variables. The aims of anesthesia for infants undergoing DCC are to prevent pain and movement during the procedure. General anesthesia (GA) or deep sedation could have undesirable respiratory and hemodynamic effects for conducting such studies. Furthermore, GA is associated with increased risks, especially in high-risk infants. Spinal anesthesia (SA) is a successful alternative to GA in surgery on infants with a history of prematurity and respiratory problems, with minimal respiratory and hemodynamic changes. METHODS: We studied whether those advantages were applicable to DCC, and used a predetermined SA protocol in a cohort of 12 infants with compromised respiratory status. Success rate, study completion, complications, hemodynamic and respiratory effects and recovery profile were recorded. RESULTS: Failure rate was significantly higher in infants older than 6 months. There was no significant difference between baseline and intraprocedure hemodynamic and respiratory parameters. The time to discharge was relatively short (33 +/- 12 min). CONCLUSIONS: Spinal anesthesia apparently provides stable hemodynamics and respiratory variables, rapid recovery and discharge time, and may be a viable alternative to GA or deep sedation in high-risk infants <6 months old undergoing DCC.

Anesthesia, Spinal↗
PubMed2004

Flat-panel detectors in the cardiac catheterization laboratory: revolution or evolution-what are the issues?

Continuous developments in digital imaging technology have contributed to the vital role held today by digital X-ray imaging in the cardiac catheterization laboratory. Foremost among these developments is the replacement of cine film with digital data equivalents as the procedure record. Other improvements include software innovations and processing algorithms, along with new types of hardware capable of delivering required functionality more rapidly. A significant recent development is that of the flat-panel X-ray detector as a replacement for the image intensifier, which has served the needs of the cardiac catheterization laboratory for nearly 5 decades. Clinical users must evaluate the respective technologies and determine whether one or the other meets the needs of their own laboratories. In this review, the two competing detector technologies are reviewed and a summary of general advantages and disadvantages of each is provided. A qualitative description is provided of parameters that can be used to assess quantitatively the performance of detectors and imaging systems. Using such objective measurements, together with standard techniques for evaluating imaging systems, angiographers and managers can better arrive at informed decisions for their own situation.

Cardiac Catheterization↗
PubMed1999

A comparison of arterial versus venous-activated clotting time in patients with congenital heart disease undergoing cardiac catheterization.

Studies in adult patients undergoing percutaneous coronary angioplasty have demonstrated differences in measured activated clotting time (ACT) in venous vs. arterial blood samples. Ninety-two patients with congenital heart disease undergoing cardiac catheterization were prospectively evaluated to compare venous vs. arterial ACT values in monitoring heparin effect in this population. Simultaneous venous and arterial ACT samples were drawn at baseline, 10 min, 60 min, and every 30 min thereafter until each case was finished. ACT values were determined simultaneously with a dual-chambered Hemochron 801 instrument. At baseline and throughout the study up to 90 min, venous and arterial ACT values were not significantly different. They were also no different in the subgroup of cyanotic patients. Therefore, venous and arterial ACT values can be safely used alternatively to guide heparin dosing during cardiac catheterization in patients with congenital heart disease without the risk of undercoagulation.

Adolescent↗
PubMed1975

Operative repair of atrial septal defect without cardiac catheterization.

Thirty-three children with secundum or sinus venosus atrial septal defects underwent operative correction at the University of Minnesota Hospitals between January, 1972, and December, 1973. Nineteen of these patients (58%) did not have cardiac catheterization as part of their preoperative evaluation, since clinical assessment of the child, with or without corroborative evidence obtained by echocardiography and radionuclide angiocardiography, provided sufficient information to permit recommendation of operation. In the majority of patients with uncomplicated atrial septal defect, cardiac catheterization is not a necessary part of the preoperative evaluation and may be reserved for those patients with unusual clinical or laboratory features.

Adolescent↗
PubMed1989

A new method for estimating left ventricular dP/dt by continuous wave Doppler-echocardiography. Validation studies at cardiac catheterization.

In this study, we explored the use of continuous wave Doppler-echocardiography guided by color Doppler flow-mapping as a method for noninvasively calculating the rate of pressure rise (RPR) in the left ventricle. Continuous wave Doppler determination of the velocities in mitral regurgitant jets allows calculation of instantaneous pressure gradients between the left ventricle and the left atrium. Left atrial pressure variations in early systole can be considered negligible; therefore, the rising segment of the mitral regurgitation velocity curve should reflect left ventricular pressure increase. We studied 50 patients (mean age, 51 years; range, 25-66 years) in normal sinus rhythm with color Doppler-proven mitral regurgitation and compared the Doppler-derived left ventricular RPR with peak dP/dt obtained at cardiac catheterization. Doppler studies were performed simultaneously with cardiac catheterization in 11 patients and immediately before in the remaining cases. Two points were arbitrarily selected on the steepest rising segment of the continuous wave mitral regurgitation velocity curve (point A, 1 m/sec, point B, 3 m/sec), and the time interval (t) between them was measured. Following the Bernoulli relation, the pressure rise between points A and B is 32 mm Hg (4vB2-4vA2) and the RPR is 32 mm Hg/t. Results showed a linear correlation between the Doppler RPR and peak dP/dt (r = 0.87, SEE = 316 mm Hg/sec). The RPR in the left ventricle can be derived from the continuous wave Doppler mitral regurgitation velocity curve.

Blood Flow Velocity↗