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PubMed2002

Coronary anatomy predicts presence or absence of renal artery stenosis. A prospective study in patients undergoing cardiac catheterization for suspected coronary artery disease.

AIMS: This study aimed to determine the prevalence of renal artery stenosis (RAS) and associated risk factors in patients undergoing cardiac catheterization for suspected coronary artery disease (CAD). METHODS: One hundred and seventy-seven consecutive patients (62 females) with a serum creatinine concentration <2.0mg.dl(-1) were studied. Abdominal aortography followed cardiac catheterization to screen for RAS. RESULTS: In 110 patients (62%) CAD and in 19 patients (11%) significant RAS (luminal narrowing of >or=50%) were detected, 12 of whom had high grade (>or=70%) RAS, and two subjects had significant RAS without CAD. Patients with RAS were older (67+/-8 vs 61+/-11 years, mean+/-SD;P =0.004), had higher systolic blood pressure (150+/-15 vs 138+/-20 mmHg;P =0.005), a lower glomerular filtration rate (GFR; 61+/-16 vs 80+/-22 ml.min(-1), P<0.001) and more often diabetes mellitus (69% vs 30%; P=0.004). In multivariate analysis a low GFR and the extent of CAD were independent predictors of RAS. The presence of >2 significant coronary lesions predicted RAS (sensitivity 0.84, specificity 0.77, positive predictive value 0.30, negative predictive value 0.98). CONCLUSION: Screening for RAS in patients with >2 diseased coronary segments has a high diagnostic yield, which is even greater in the presence of a reduced GFR, diabetes mellitus, and elevated systolic blood pressure.

Aged↗
PubMed1990

Managing scarce services. A waiting list approach to cardiac catheterization.

Relatively little attention has been directed to the provision of health care services when demand exceeds availability. Since "waiting lists" are characteristic of the delivery of cardiovascular services in Manitoba, we hypothesized that the highest priority would be given to cases with the greatest urgency. This study examined the waiting lists for cardiac catheterization in one of two tertiary health care facilities offering comprehensive cardiovascular care to a population of slightly more than one million persons. Hospital records of all patients undergoing cardiac catheterization from May 1981 through December 1982 were abstracted retrospectively. For 871 patients entering a catheterization laboratory by two different routes (Elective Care, N = 557; Immediate Care, N = 314), patient need for immediate catheterization was assessed. Clinical differences between patients in the two groups were striking. Immediate Care patients more frequently had acute congestive heart failure, prior aortic valve surgery, and chronic obstructive pulmonary disease. Immediate Care patients were most frequently in Class 4 of the NYHA functional classification and were more often treated with triple medical therapy. These clinically ill individuals were more likely to enter the hospital via the Emergency Room; they were more likely to have long hospital stays and to die in hospital. As implemented in one Manitoba hospital, the waiting list process appears to have worked fairly well; cardiac arrest, acute myocardial infarction, and death among patients waiting for catheterization were all rare events. Both those patients needing immediate care and those who could wait with a low probability of a poor outcome were successfully identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2006

Emergent use of extracorporeal membrane oxygenation during pediatric cardiac catheterization.

OBJECTIVES: The goal of this study was to evaluate the utility of extracorporeal membrane oxygenation (ECMO) to resuscitate patients following critical cardiac events in the catheterization laboratory. DESIGN: Retrospective review of medical records. SETTING: Cardiac intensive care unit and cardiac catheterization laboratory at a tertiary care children's hospital. PATIENTS: Pediatric patients cannulated emergently for ECMO in the cardiac catheterization laboratory (n = 22). INTERVENTIONS: ECMO was initiated emergently in the cardiac catheterization laboratory for progressive hemodynamic deterioration due to low cardiac output syndrome or catheter-induced complications. MEASUREMENTS AND MAIN RESULTS: Twenty-two patients were cannulated for ECMO in the catheterization laboratory between 1996 and 2004. Median age was 33 months (range 0-192), median weight 14.8 kg (2.4-75), and median duration of ECMO 84 hrs (2-343). Indications included catheter-induced complication (n = 14), severe low cardiac output syndrome (n = 7), and hypoxemia (n = 1). Three patients (14%) were cannulated in the catheterization laboratory before catheterization for low cardiac output or hypoxemia. During cannulation, 19 patients (86%) were receiving chest compressions; median duration of cardiopulmonary resuscitation was 29 mins (20-57). Eighteen patients (82%) survived to discharge (five of whom underwent cardiac transplantation) and four (18%) died. Of 19 patients who received cardiopulmonary resuscitation during cannulation, 15 (79%) survived to discharge and nine (47%) sustained neurologic injury. There was no significant difference between survivors and nonsurvivors in age, weight, duration of cardiopulmonary resuscitation or ECMO support, pH, or lactate levels. CONCLUSIONS: ECMO is a technically feasible and highly successful tool in the resuscitation of pediatric patients following critical events in the cardiac catheterization laboratory.

Adolescent↗
PubMed2005

MRI-guided congenital cardiac catheterization and intervention: the future?

Over the last 10 years, a number of technological advances have allowed real-time magnetic resonance imaging to guide cardiac catheterization, including improved image quality, faster scanning times, and open magnets allowing access to the patient. Potential advantages include better soft tissue imaging to improve catheter manipulation and additional functional information to assist with interventional decision-making, all without exposure to ionizing radiation. MRI-guided diagnostic catheterization, balloon dilation, stent placement, valvar replacement, atrial septal defect closure, and radiofrequency ablation all have been shown feasible in animal models. MRI-guided catheterization has the potential to replace the current X-ray-based diagnostic and interventional procedures for children with congenital heart disease, avoiding all radiation exposure while improving soft tissue imaging.

Animals↗
PubMed2006

Capacity planning for cardiac catheterization: a case study.

BACKGROUND: Excessive waiting for procedures such as cardiac catheterization is an important issue for health care systems. Delays are generally attributed to a mismatch between demand and available capacity. Furthermore, due to the dynamic nature of short-term referral rates, procedure times, and patients' medical urgency, all of which are important contributors to the problem of excessive waiting time, it has been difficult to predict capacity needs accurately. The objective of our paper is to demonstrate how such calculations could be performed. METHODS: After constructing a patient flow model and populating it with appropriate data from 16 consecutive months of operations (n=6215 referrals) of a regional cardiac centre in Ontario, we used computer simulation to simulate the operations of catheterization laboratories in several "what-if" scenarios. We divided the patients into three urgency categories: U1--hospitalized patients, U2--urgent outpatients, U3--elective outpatients. We tested the accuracy of the model by comparing a 1-year sample of computer simulation with actual data which resulted in a highly significant correlation of 0.94. RESULTS: We observed from the referral cohort that waiting times were long, both overall and within each urgency category. We observed from the simulation models that: (1) a one-time infusion of capacity to clear the backlog failed to reduce the waiting times; (2) targeting extra capacity to highest urgency categories reduced waiting times overall and also benefited low urgency patients for whom specific increased capacity was not earmarked; (3) there were no significant effects on waiting times if in some cases patients or referring physicians were able to choose their cath physician; and (4) in situations where the arrival rates increased overall or within specific urgency categories, waiting times increased dramatically and failed to return to baseline for several months to years for the low urgency patients. Efficiency of the labs within the existing capacity could be improved by: (1) reducing changeover time between cases (2) externalizing and standardizing many of the pre- and post-procedural management of the patients, and (3) more carefully balancing the booking to reduce both slack and overtime. INTERPRETATION: Capacity determination is a complex and dynamic process. A combination of available clinical and administrative data, along with a computer simulation model, helps predict capacity needs and is the most appropriate strategy to minimize waiting of patients for procedures. This approach is generalizable and can lead to more effective management of waiting lists for a variety of procedures.

Cardiac Catheterization↗
PubMed2000

The prevalence and associated risk factors of renal artery stenosis in patients undergoing cardiac catheterization.

Renal artery stenosis may be a cause of hypertension and a potential contributor to progressive renal insufficiency. However, the prevalence of renal artery disease in a general population is poorly defined. The purposes of this study were to evaluate the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing routine cardiac catheterization, and to identify the risk factors for renal artery stenosis. After left ventriculography, abdominal aortography was performed to screen for the presence of renal artery stenosis. A total of 427 patients (274 males, 153 females) were studied and the mean age was 59 years. Renal artery narrowing was identified in 10.5% of patients. Significant (> or = 50% diameter narrowing) renal artery stenosis was found in 24 patients (5.6%) and insignificant stenosis was found in 21 patients (4.9%). Significant unilateral stenosis was present in 4.2% of patients and bilateral stenosis was present in 1.4%. The stem of the renal artery was a more common site of stenosis in 62.2% of patients than in the ostium (37.8%), but the severity of stenosis was not significantly different according to the site of stenosis. By univariate and multivariate logistic regression analysis, the association of clinical variables with renal artery stenosis was assessed. Multivariable predictors included age, hypertension and peripheral vascular disease (p < 0.05). The variables such as sex, smoking history, hyperlipidemia, renal insufficiency, as well as the presence of obesity, severity of coronary heart disease and D.M., were not associated. In conclusion, the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing cardiac catheterization is 10.5%. Old age, hypertension and evidence of peripheral vascular disease represent the predictors of renal artery stenosis.

Adult↗
PubMed1991

The adult with congenital heart disease: cardiac catheterization as a therapeutic intervention.

The adult with congenital heart disease who undergoes cardiac catheterization at the present time is most likely to have complex heart disease and is left with clinically important sequelae or residual defects, ventricular dysfunction or arrhythmias. Residual defects such as paravalvular leaks, coronary fistulas and pulmonary artery narrowings may be corrected with transcatheter techniques. Patients with simple forms of congenital heart disease (for example, atrial septal defect, patent ductus arteriosus, aortic valve stenosis, pulmonary valve stenosis) will go to the catheterization laboratory for treatment, not diagnosis. Certain lesions previously considered benign (for example, patent foramen ovale) may require definitive interventional therapy to reduce the risk of stroke from paradoxic embolism.

Adult↗
PubMed2006

Thrombolytic therapy in acute cerebral infarction complicating diagnostic cardiac catheterization.

Diagnostic and interventional percutaneous coronary catheterization is associated with stroke. Many of such strokes are asymptomatic, but some are devastating. Once the diagnosis of acute cerebral infarction is confirmed, thrombolytic therapy should be administrated within the time window of 3 hours. We report a 61-year-old woman who suffered from an acute cerebral infarction during diagnostic cardiac catheterization for unstable angina, which manifested as sudden onset of global aphasia, right hemiplegia and gaze preponderance to the left side. Computed tomography of the head performed immediately after recognition of the symptoms showed a hyperdense middle cerebral artery (MCA) sign. Following prompt recognition and diagnosis, intravenous thrombolytic therapy was administered 2 hours after symptom onset. The patient had a favorable outcome. Initially, National Institutes of Health Stroke Scale score was 21, and 24 hours later it improved to 9. The hyperdense MCA lesion had resolved on the 24-hour follow-up scan. This case illustrates the clinical benefit of thrombolytic therapy in the setting of acute stroke associated with cardiac catheterization.

Angina, Unstable↗
PubMed2005

Improved estimation of GFR by serum cystatin C in patients undergoing cardiac catheterization.

Clinical assessment of glomerular filtration rate (GFR) mainly relies on single determinations of serum creatinine (crea) which is commonly insensitive to mild renal dysfunction. Serum cystatin C (cysC) has been proposed as an alternative endogenous marker of GFR showing higher correlation to standard clearance methods such as inulin or iohexol clearance. We compared serum crea and cysC levels in n=127 patients undergoing cardiac catheterization. The clearance of the iodinated contrast dye iopromide served as reference method for GFR. Serum cysC was determined by a particle-enhanced immunonephelometric method. CysC showed higher non-parametric correlation (r=0.805) to the iopromide clearance compared to crea (r=0.652) and to the estimated GFR according to the Cockcroft-Gault formula (r=0.690), which underestimated true GFR systematically. Receiver operating curves revealed a greater area-under-the-curve (AUC) for cysC (0.957 vs. 0.801, p<0.05). At a cut-off level of >1.3 mg/l cysC exhibited an 88% sensitivity and a 96% specificity for detecting renal dysfunction which was defined as an iopromide clearance less than 80 ml/min/1.73 m2; best values for crea were 63% for sensitivity and 80% for specificity at a cut-off of >1.2 mg/dl. In conclusion, cysC detected reduced GFR more reliably and at an earlier stage in patients undergoing cardiac catheterization allowing a better identification of patients with renal dysfunction and those at risk for contrast damage.

Adult↗
PubMed1994

Effects of heparin and cardiac catheterization on serum lipoprotein and triglyceride levels.

This study determined whether heparin administration and procedures involving heparin significantly affect lipid measurement. Serum lipid and lipoprotein analyses (total cholesterol, triglycerides, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, apolipoprotein B, and apolipoprotein A-I) were performed at baseline and at several time points after (1) intravenous heparin or placebo in 6 healthy volunteers (group 1), (2) cardiac catheterization with heparin in 26 patients (group 2), and (3) peripheral angiography without heparin in 11 patients (group 3). In group 1, after heparinization, triglycerides decreased 50 +/- 12 mg/dl (-57%, p < 0.001 vs baseline and placebo) at 60 minutes. No changes were observed in other lipid or lipoprotein fractions. After cardiac catheterization (group 2), however, decreases were observed not only in triglycerides (58 +/- 26 mg/dl [-40%]), but also in total cholesterol (28 +/- 12 mg/dl [-14%]), LDL cholesterol (19 +/- 22 mg/dl [-15%]), apolipoprotein B (13 +/- 9 mg/dl [-14%]), and apolipoprotein A-I (21 +/- 14 mg/dl [-17%]) (p < 0.001 vs baseline for all), and HDL cholesterol (4 +/- 7 mg/dl [-3%], p = 0.07). With the exception of triglycerides, these values remained significantly decreased for > or = 24 hours. The change in HDL was variable: Whereas most patients had a decrease (n = 24), 2 patients had a dramatic increase (> 100%) after administration of heparin. Similar decreases in total cholesterol, LDL cholesterol, and apolipoproteins B and A-I were observed in group 3 undergoing peripheral angiography without heparin.(ABSTRACT TRUNCATED AT 250 WORDS)

Apolipoproteins↗
PubMed2005

Early diagnosis of stress-induced apical ballooning syndrome based on classic echocardiographic findings and correlation with cardiac catheterization.

Stress-induced apical ballooning has been described as a reversible condition involving the apical left ventricular wall, sparing the base, and causing a ballooning appearance of the left ventricle during systole despite normal coronaries. We are presenting 4 cases of apical ballooning seen at our institution with echocardiographic correlation. Echocardiography showed similar anatomical apical ballooning of the left ventricular apex. The diagnosis of apical ballooning syndrome was suspected based on echocardiography in conjunction with clinical data before cardiac catheterization was performed. In one case, in addition to classic left ventricular apical ballooning, marked right ventricular apical akinesia was present on the initial echocardiographic examination. This makes diagnosis of apical ballooning syndrome most likely in this patient before cardiac catheterization. Therefore, we suggest using echocardiography more often for the early diagnosis of this disease, based on careful anatomic evaluation in conjunction with clinical data. Wall motion analysis should reveal an apical ballooning appearance involving many coronary territories. Furthermore, the additional presence of right ventricular apical akinesia during echocardiographic examination makes the diagnosis of this syndrome more likely.

Aged↗
PubMed1995

Subclavian artery dissection during diagnostic cardiac catheterization: the role of conservative management.

Dissection of the subclavian artery during routine cardiac catheterization while obtaining cannulation to the left internal mammary artery is an unusual complication and to our knowledge has never been reported. Conservative management of this vascular injury can avoid the sequelae of high-risk surgical repairs made difficult by a complex operative exposure. We describe a case in which dissection of the left subclavian artery was treated conservatively with an excellent outcome.

Aged↗
PubMed2002

Chronic radiodermatitis injury after cardiac catheterization.

The authors present two patients in whom chronic radiodermatitis developed after repeated cardiac catheterization and coronary angioplasty procedures, with no indication of malignancy. In one patient, after other therapeutic methods were unsuccessful in alleviating his symptoms, the authors excised the lesion with wide surgical margins and skin grafted the area. The mere purpose was to free the patient from the unrelenting pain and discomfort. In this case, the authors achieved complete success in wound healing but only partial success in pain relief.

Aged↗
PubMed1975

An off-line system for in-time analysis of cardiac catheterization data and for establishment of a cardiological database for retrospective studies.

The system described may be divided in two major parts: (i) automatic analysis of cardiac catheterization data running off-line on a Siemens 305 computer; (ii) storage and retrieval of the results from these analyses and additional data from related departments (thoracic surgery, internal medicine and clinical physiology) in a cardiological database on an IBM 370/155 computer. The first part is described with special regard to (i) operation and control during the phases of data collection, pre-processing, processing and storage of results; (ii) the presentation of the results in a complete and readable form and (iii) the modular design of the software. The results of an evaluation of the computer methods versus manual methods are also presented. The second part has been described with regard to the type of data entered in the cardiological database. The structure of the database and the programs used for storage and retrieval have not been described in detail in the present publication.

Analog-Digital Conversion↗
PubMed2006

Complex regional pain syndrome after transradial cardiac catheterization.

Complex regional pain syndrome (CRPS) is a disease with unclear pathophysiology. The condition is characterized by pain, soft tissue change, vasomotor change, and even psychosocial disturbance. It may affect the upper more than the lower extremities, and the distal more than the proximal. The trigger factors include carpal tunnel release, Dupuytren's repair, tendon release procedures, knee surgery, crush injury, ankle arthrodesis, amputation, and hip arthroplasty. Rarely, it has been associated with stroke, mastectomy, pregnancy, and osteogenesis imperfecta. Herein, we present a rare case of a patient who was diagnosed with CRPS after transradial cardiac catheterization. CRPS was first diagnosed due to hand swelling, allodynia, paresthesia, and the limited range of motion of interphalangeal, metacarpophalangeal, and wrist joints, with the preceding factor of transradial cardiac catheterization, and was then confirmed by a three-phase bone scan. After intensive physical therapy with hydrotherapy, manual soft tissue release, and occupational therapy for the hand function, there was much improvement in range of motion and hand function. There was no allodynia or painful sensation in the follow-up. After training, the functional status of this patient was adequate for daily activity.

Aged↗