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[Cardiac catheterization].
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[Application of cardiac catheterization].
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Cardiac catheterism.
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[Current status of cardiac catheterization].
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[Diagnosis of various forms of pulmonary artery stenosis by cardiac catheterization].
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The reliability of observations at cardiac catheterization.
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Variability in fluoroscopic X-ray exposure in contemporary cardiac catheterization laboratories.
OBJECTIVES: This study sought to assess fluoroscopic exposure rates in contemporary cardiac catheterization laboratories (CCL). BACKGROUND: Increasing attention is being focused on X-ray exposure during diagnostic and therapeutic cardiovascular procedures. METHODS: We measured fluoroscopic exposure rates (R/min) in 41 systems using a standardized methodology (National Electrical Manufacturers Association XR21 phantom). Measurements were obtained at 2 different phantom thicknesses to simulate varying patient body habitus. RESULTS: Fluoroscopic exposure rates under medium (median 3.0 R/min, interquartile range 1.4 R/min) and large (median 12.5 R/min, interquartile range 4.8 R/min) habitus conditions showed substantial variation. Fluoroscopic exposure was associated with simulated patient habitus, X-ray system type, vendor, and geographic region. Under medium habitus conditions, only 25% of systems operated within a zone of lower than average exposure rates and satisfactory image quality; this frequency diminished to 7% under large habitus conditions (p < 0.001). CONCLUSIONS: There is substantial variation (4- to 6-fold) in fluoroscopic exposure rates. This variation was not consistently associated with improved image quality. In the absence of a predictable benefit of higher (or lower) than average exposure rates, CCL quality improvement programs must minimize such potentially harmful variability in X-ray exposure.
Cardiac catheterizations: average inpatient charges, 1998.
In 1998 the average change for an impatient cardiac catheterization (CC)was $12,450 among 13,922 group health insured over age 30. Among the 29 states in which at least 150,CCs were performed, the average total charge ranged from $24,000 in California, which was 93 percent above the U.S. norm, to just over one-third of this total in Iowa ($8,810). The second highest average charge was reported in Texas ($20,140, 62 percent above the norm) and the second lowest was in Maryland ($11,420, 8 percent below). On average, the hospital proportion of the total CC charges accounted for 80 percent but ranged from 86 percent in California to 71 percent in Maryland. Physician fees averaged $2,450 across the country and ranged from $3,830 in Texas (56 percent above in average) to $2,140 in Iowa (13 percent below the norm). Length to stay averaged 3.2 days, with patients in Iowa remaining in the hospital for 5.6 days and those in Washington 2.9 days. Per diem costs averaged $3,850 and were the highest in California, $6,470 (68 percent above the average) and $1,570 in Iowa (59 percent below).
Microcomputer-assisted filing system of cardiac catheterization records using a relational database management system.
To efficiently store and retrieve cardiac catheterization records, we have developed a computer-assisted database, which comprises a 16-bit microcomputer with dual floppy disk drives, a 20 MB random-access memory, hard disk drive, and a line printer. All programmings were accomplished using a relational database management system (R:base 5000, Microrim, Inc.). Data inquiry procedures could be performed with direct operational commands of the system as well as with preprogrammed command files, and final results of searches were printed out with a line printer. The major advantages of the present system described in this report include: (1) the relatively easy and rapid creation of the database, (2) ease of modification of the database structures even after the system design is finished, (3) operational commands in combination with conditional operator(s) are flexible and powerful enough to allow the end user to retrieve data based on various kinds of criteria, (4) a high-level programming language provided by the R:base automates a series of database procedures with relative ease, (5) relational capabilities of the database management system can enhance the possibility of reconstruction of a new data file from a single or several preexisting data files, and (6) the system can be realized at reasonable cost.
Cardiac catheterization is necessary before bidirectional Glenn and Fontan procedures in single ventricle physiology.
There are significant mortality and morbidity in bidirectional Glenn (stage II) and Fontan (stage III) procedures for congenital heart diseases with single ventricle physiology. In order to minimize the mortality and morbidity, the presence or absence of hemodynamic and anatomical abnormalities, such as poor ventricular function, coarctation of the aorta, pulmonary artery distortion, high pulmonary resistance, and abnormal collateral vessels, should be evaluated. Echocardiography and magnetic resonance imaging (MRI) can visualize ventricular size and coarctation of the aorta but may fail to visualize pulmonary artery distortion. Furthermore, cardiac catheterization is needed to measure pulmonary resistance. If the pulmonary resistance is > 3 Wood units/m2 before stage II, the risk for the bidirectional Glenn operation may be high. Abnormal aortopulmonary collateral vessels may develop after the stage II procedure and echocardiography and MRI may not visualize these vessels. Coil embolization may be required to treat these vessels. In conclusion, cardiac catheterization is required to evaluate abnormalities, which may be treated by interventional catheterization, and to reduce mortality and morbidity of stage II and III procedures.
[Cardiac catheterization of neonates and young infants using a flow-directed balloon catheter (author's transl)].
In cardiac catheterization with the Swan-Ganz-flow-directed balloon catheter the aorta or, in transposition of the great arteries, the pulmonary artery was entered from the left ventricle with a special heart catheterization technique in 68 neonates and young infants. In the same way selective aortography was performed in 29 of these patients. This catheterization technique has the following advantages: 1. the complete evaluation of complex cardiac anomalies even in neonates, 2. selective aortography avoiding the retrograde arterial catheterization, 3. reducing the risk of cardiac perforation or myocardial staining due to the contrast injection using the usual semirigid catheters. Balloon rupture or knotting are specific but avoidable complications.
Significance of ventricular tachyarrhythmias complicating cardiac catheterization: a CASS Registry Study.
Ventricular tachycardia and ventricular fibrillation are recognized complications of cardiac catheterization. Despite numerous reports documenting the frequency of these occurrences, their significance has not been systematically examined. Accordingly, the outcome of 108 patients who experienced either ventricular tachycardia or ventricular fibrillation during coronary angiography between 1975 and 1979 in the Coronary Artery Surgery Study (CASS) Registry were examined. There were 20,142 patients analyzed. Patients with ventricular tachyarrhythmias had more objective evidence of left ventricular impairment, clinical heart failure, and ventricular arrhythmia recorded as a clinical symptom. The overall 5-year survival rates were 83% and 88% for patients with and without ventricular tachyarrhythmias, respectively (p = 0.07). When ventricular function, age, gender, angina, and previous myocardial infarction were added in a stepwise Cox survival analysis, the presence of arrhythmias was not significant (p = 0.66). At 5 years, 80% of the medically treated patients and 82% of the surgically treated patients remained alive (p = 0.95). The only statistically significant differences in the patients with ventricular arrhythmias who were treated medically or surgically were age (medically treated patients 52 +/- 10 years, surgical patients 57 +/- 9 years, p = 0.01) and number of diseased vessels (p less than 0.001). In a stepwise Cox survival analysis, functional impairment secondary to congestive heart failure was the only significant covariate to affect survival in the medical and surgical groups (p = 0.0001). Surgical therapy itself was not significant (p = 1.00). The incidence of sudden death during 5 years for patients with and without ventricular tachyarrhythmias during catheterization was 5% and 4%, respectively (p = 0.28).(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiac catheterization and long-term chromosomal damage in children with congenital heart disease.
AIMS: Medical radiological exposure is associated with an additional risk of cancer. Children with repaired congenital heart disease (CHD) are theoretically at a relatively greater cancer risk as the radiological exposure can be intensive in these patients. Chromosomal aberrations test (CA) and micronucleus assay (MN) in peripheral blood lymphocytes are biomarkers of chromosomal damage and intermediate endpoints in carcinogenesis. METHODS AND RESULTS: The frequency of CA and MN was assessed in three groups of patients: Group I, 32 exposed patients (17 males, age=15.5+/-8.3 years) who underwent cardiac procedures employing ionizing radiation (mostly cardiac catheterization) for CHD between 1965 and 2000; Group II, 32 healthy age- and sex-matched subjects (17 males, age=14.1+/-12.3 years), and Group III, 10 newborn non-exposed patients (7 males) with CHD. Exposed patients of Group I had a mean value of 2.9+/-1.4 cardiac catheterization (range 1-5) procedures per person. The mean frequency of CA was higher in the exposed patients (Group I=2.8+/-1.9% vs. Group II=0.7+/-0.7%; vs. Group III=0.8+/-0.8%; P<0.0001). Similarly, the mean values of MN were higher in the exposed patients (Group I =12.3+/-5.1 per thousand vs. Group II=6.0+/-3.8 per thousand; vs. Group III=4.4+/-1.4 per thousand; P<0.0001). CONCLUSION: Cardiac ionizing procedures are associated with a long-lasting mark in the chromosomal damage of exposed children with CHD.
Percutaneous sheath brachial vein cardiac catheterization in children.
During the past ten years we have performed certain phases of cardiac catheterization on 48 children using a modified percutaneous sheath technique to enter a superficial arm vein. Our patients ranged in age from 15 months to 21 years, with a mean age of 10.0 years. The indications for a superior approach most commonly have included electrophysiologic investigations, femoral vein occlusions, and proximal obstructions of the inferior vena cava. The advantages of a percutaneous sheath technique in the superficial brachial veins include the ease of changing catheters frequently during a case and the preservation of the vessel for possible repeat studies. It is not always possible to enter the heart with this technique, owing to sharp angulation of deep venous confluences in the axilla and occasional venous spasm. When successful, this mode of approach is attended by a very low prevalence of complications. There were no deaths, heart or vein perforations, or systemic infections. One patient developed a superficial phlebitis; this was mild and temporally limited. We have not encountered any case of clinically apparent venous thrombosis. When a superior approach for prograde heart catheterization in children is indicated, we have found that our modified percutaneous sheath technique is a simple, safe, and frequently successful alternative to a cutdown approach.
Nursing assessment of patient readiness for ambulation after cardiac catheterization.
Although nurses routinely perform activities that prevent or detect vascular complications following a cardiac catheterization, determining patient readiness for ambulation has received minimal research attention. Educating nurses to determine patient readiness for ambulation is a safe and effective way to promote patient comfort.
[Surgical treatment of peripheral vascular injuries after cardiac catheterization].
OBJECTIVE: Diagnostic and therapeutic cardiac interventions have being performed in expanding numbers during last years. Forty-two cases with peripheral vascular injuries requiring surgical therapy after 64.911 cardiac interventions in our center between 1985 and 2002 were evaluated retrospectively. METHODS: Thirty-three of vascular injuries (78.6%) occurred after angiography/catheterization, and the remaining vascular injuries (21.4%) occurred after angioplasty/stent procedures. There were 12 female (28.6%) and 30 male (71.4%). The mean age was 51.3+/-4.1 years. The localization of the arterial injuries were femoral region in 37 cases (88.1%) and brachial region in 5 cases (11.9%). The complications were recorded as arterial thrombosis in 19 cases, pseudoaneurysm in 14 cases, hematoma in 5 cases, arteriovenous fistula in 2 cases, deformed stent stuck in 2 cases. Arterial injuries were treated by performing embolectomy in 16 cases, embolectomy and saphenous patch plasty in 3 cases, resection of pseudoaneurysm and PTFE patch plasty in 1 case, draining of hematoma and primary repair in 5 cases, primary repair of femoral arteriovenous fistula in 2 cases and removal of the deformed stent from femoral artery in 2 cases. RESULTS: The incidence of vascular complications was significantly higher in brachial interventions when compared with femoral interventions (p<0.0001). The postoperative morbidity was found as 14.3% in our cases. CONCLUSION: The early diagnosis and treatment are very important in peripheral vascular complications after cardiac interventions; otherwise, delay can cause loss of related extremity.
Chromosome damage in infants and children after cardiac catheterization and angiocardiography.
Current diagnostic cardiac studies in infants and children result in longer x-ray exposure times and in more angiocardiograms per patient. Blood samples removed before and immediately after such studies in 20 infants and children have shown chromosome damage in all. The damage was equal to an in vitro absorbed dose in the range of 20 to 50 rads. Since the effect was considerably greater than that calculated from the x-ray exposure dose to the patient, it is concluded that the damage is mainly due to the contrast agent used in angiocardiography. Long-term follow-up studies on such patients are indicated.