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At least 631 records · Page 35Linked to original sources
PubMed1985

Complications and mortality associated with cardiac catheterization in infants under one year: a prospective study.

To evaluate complications and mortality following cardiac catheterization (CC) in patients under one year of age, we prospectively examined 312 CC on 273 patients from the centers in the New England Regional Infant Cardiac Program during a one-year period. Among CC performed on patients less than four months old, the incidence of complications requiring treatment was 12%; for patients 4-12 months, it was 1.5% (p less than 0.02). By pre-CC risk assessment, 13% of CC were high risk, 21% medium risk, and 66% low risk. The incidence of major complications was much greater among the High Risk (30%) compared with Medium Risk (14%) (p less than 0.05) and with Low Risk (4%) (p less than 0.001). The overall mortality rates 24 h, 48 h, and one week after CC were 3.8%, 8.3%, and 13.5%, including patients with inoperable lesions and those having cardiac surgery, while deaths directly attributable to a CC complication were 0, 0.3%, and 0.3%, respectively. We can predict, prior to CC, the high-risk cases where major complications and death are likeliest to occur. The incidence of death from CC-related complications is extremely low in patients under one year of age, compared with death from the underlying lesion or following cardiac surgery.

Age Factors↗
PubMed1984

Iatrogenic central retinal artery embolization: a complication of cardiac catheterization.

A 57-year-old man with a myocardial infarction was subjected to cardiac catheterization as a follow-up study for his heart problem. The catheter, made for one time use only, was reautoclaved and used sometime before catheterizing this man. A small fragment of this catheter dislodged while guiding the parent catheter into coronary vessels with a metallic guide-wire. The fragment traveled getting lodged in the central retinal artery of the right eye leaving the eye with only light perception vision. The catheter fragment could be seen in the central retinal artery at the optic nerve head.

Cardiac Catheterization↗
PubMed1992

Complications of pediatric cardiac catheterization: a 3-year study.

To determine the current risk of pediatric cardiac catheterization, the complications and incidents of all catheterizations performed in a pediatric laboratory between January 1986 and October 1988 were prospectively recorded and compared with results from a 1974 study from the same institution. In the current study 1,037 catheterizations, 885 diagnostic and 152 diagnostic/interventional procedures, were performed in 888 patients (aged 1 day to 27 years, median 15.6 months). There were 15 major complications (1.4%), 70 minor complications (6.8%) and 30 incidents (2.9%). Two patients died as a result of the procedure and two as a result of pericatheterization clinical deterioration caused by the cardiac abnormality. The great majority of complications were successfully treated or were self-limited and the patients had no residua. Of patients with 13 nonfatal major complications and 70 minor complications, residua were evident in 7 patients and 3 without evident residua had the potential for sequelae (0.7% and 0.3% of catheterizations). A comparison of the diagnostic and balloon atrial septostomy cases in the present study with similar cases in the 1974 study shows that the incidence of major complications has decreased from 2.9% to 0.9% (p less than 0.0001); minor complications and incidents have decreased from 11.7% to 7.9% (p less than 0.006) and pericatheterization deaths not attributable to catheterization have decreased from 2.8% to 0.2% (p less than 0.0001). Changes in pericatheterization medical management, patient selection for catheterization and catheterization techniques probably account for these improvements.

Age Factors↗
PubMed1976

On-line computer processing of pressure data from cardiac catheterizations.

A flexible program system for on-line analysis of pressure data from cardiac catheterizations is described. The programs are implemented on an IBM 1800 computer, equipped with remote oscilloscope/keyboard terminals. The current computer system can handle any combination of up to 4 pressure signals. During catheterization, measurement specifications (i.e. calibration levels or sites of pressure recordings) are entered via the keyboard immediately before each recording. As an option the whole expected measurement sequence may be stored on disk before the catheterization starts. This method will minimize the necessary interaction with the computer when the same catheterization procedure is used on several occasions. Changes from the predetermined scheme may, however, be undertaken before each recording to meet with unexpected events that may arise during the catheterization. After computer detection of calibration levels, the recorded signals are digitized during 20 seconds and analysed beat-by-beat. Calculated values are averaged and presented on the terminal oscilloscope in tabular and/or graphic form. The waveform analysis performed by the program system is validated in a statistical comparison between manually and automatically computed values.

Cardiac Catheterization↗
PubMed1991

Outpatient cardiac catheterization: a report of 3,000 cases.

A total of 3000 patients have had cardiac catheterization in the Andreas Gruentzig Cardiovascular Laboratory of the Emory Clinic. The purpose of this presentation is to describe the patient population selected for this procedure and our experience with this group. The concept of catheterization as an outpatient is attractive from the standpoint of cost savings and time conservation. Safety has been questioned. We have found that this technique can be performed safely in carefully selected outpatients. Careful selection attempted to eliminate those with unstable symptoms, recent myocardial infarction, severe diabetes, and renal failure. Small catheters were used to minimize the potential for bleeding. Excellent opacification of vessels was obtained with these catheters. Despite careful screening we found 2.2% had significant left main obstruction, 10.8% had triple-vessel disease, 16.0% had double-vessel disease, and 23.5% had single-vessel disease, and a similar percentage had normal coronary arteriograms. Our patients experienced ventricular fibrillation on five occasions, there were two small cerebral emboli with reversible neurologic defects, two episodes of pulmonary edema, and two episodes of severe allergic reactions. Only three patients had significant groin bleeding at home that required compression of the site. We subsequently did angioplasty on 323 patients, performed cardiac surgery (mostly coronary bypass) on 187 patients, and admitted 18.2% of the entire group. We conclude that this procedure can be done safely in this carefully designed setting and it saves time and offers cost savings. Patient selection is very important to minimize potential emergency situations and complications. The laboratory must be carefully set up and provide a close relationship with a hospital capable of attending to any unexpected emergency.

Ambulatory Care↗
PubMed1983

A method of maintaining thermal homeostasis during cardiac catheterization in newborns.

This device has been designed to maintain thermal homeostasis in newborns undergoing cardiac catheterization. It is easily constructed from materials available in any hospital, and it is safe and effective. It consists of a warming coil and a delivery unit made from Plexiglas which encloses the patient. In addition to maintaining a neutral thermal environment, it allows for the selection of any desired oxygen concentration by simply blending the gas mixture before warming and delivery. Since using this device we have had no problems or complications related to thermal stress during catheterization of the neonate.

Body Temperature Regulation↗
PubMed1983

Value of isometric exercise testing during cardiac catheterization in mitral stenosis.

To examine the value of preoperative isometric exercise testing during cardiac catheterization in patients with mitral stenosis, the isometric handgrip exercise test was performed on 28 patients during preoperative diagnostic catheterization. Eighteen patients who subsequently underwent mitral valve surgery were recatheterized and reevaluated clinically 12 months after operation. Preoperatively, the patients were divided into 2 groups: 16 whose mean mitral valve pressure gradient increased greater than 4 mm Hg during isometric exercise (group A) and 12 whose pressure gradient decreased or increased less than 4 mm Hg (group B). The ejection fraction remained unchanged and the peak systolic pressure/end-systolic volume ratio increased during isometric exercise in group A (p less than 0.001). In group B, the ejection fraction decreased (p less than 0.001) and the peak systolic pressure/end-systolic volume ratio remained unchanged. In the total group, a positive correlation existed between the change in mean mitral valve pressure gradient during isometric exercise and the changes in measures of left ventricular function during exercise. The patients in group A had a significant improvement in both symptoms and in exercise tolerance as determined by symptom-limited bicycle ergometry after surgery. The patients in group B showed minimal or no symptomatic improvement and their exercise tolerance did not improve. The change in mitral valve pressure gradient during isometric exercise appears to reflect the left ventricular response to exercise.

Adult↗
PubMed1985

Combined cardiac catheterization and carotid cineangiography: an analysis of complications.

Two hundred fifty-three patients underwent cardiac catheterization with selective cineangiography of the carotid arteries. Diagnostic angiograms of both the right and left carotid arteries were obtained in 240 patients (95%). Of these, 217 patients (90%) were studied without complication, 18 (8%) had minor complications, and five (2%) had major complications. Four of the five major complications occurred in patients with bilateral carotid atherosclerosis obliterans. Variations of catheterization technique used in an effort to reduce risk are discussed.

Adult↗
PubMed2003

Magnetic resonance--guided cardiac catheterization in a swine model of atrial septal defect.

BACKGROUND: Radiation exposure during cardiac catheterization, limited image planes, and poor soft tissue definition are disadvantages of x-ray fluoroscopy that could be overcome with the use of MRI. This study evaluates the feasibility of real-time MRI (MR fluoroscopy) to guide left and right heart catheterization. METHODS AND RESULTS: Anesthetized pigs (n=7) with defects of the atrial septum were catheterized using venous and arterial access. A prototype active tracking catheter was used to obtain blood pressures and samples from cardiac chambers and great vessels using antegrade, transseptal, and retrograde approaches. MR fluoroscopy was used for catheter steering. Velocity-encoded cine MRI was used to measure pulmonary and aortic blood flow to calculate vascular resistances. Image planes used during catheter manipulation used rapid sequencing to planes directed by the operator to include the tip of the catheter and the chamber to be entered. All areas of interest were effectively entered, and samples were obtained. In the presence of an acute atrial septal defect, a Qp/Qs ratio of 1.3+/-0.2 was measured, and no significant differences in pressure between inferior vena cava, right atrium, and left atrium were found. Pulmonary and aortic flow were 4.9+/-0.6 and 3.7+/-0.4 L/min, and pulmonary and systemic vascular resistance were 312+/-134 and 2006+/-336 dyne x s x cm(-5). CONCLUSIONS: Left and right heart catheterization using MR guidance is feasible. The combination of hemodynamic catheterization data with anatomic and functional MRI may significantly improve the evaluation of patients with congenital heart disease while avoiding radiation exposure.

Animals↗
PubMed1989

Gastrointestinal hemorrhage as a complication of cardiac catheterization.

This report describes three patients who developed the rate complication of gastrointestinal hemorrhage following cardiac catheterization. These cases illustrate the diverse mechanisms by which bleeding may occur. The important predisposing factors appear to be widespread atherosclerosis, prolonged hypotension, and gastrointestinal disease potentially associated with bleeding.

Aged↗
PubMed1975

Cardiac catheterization and selective angiography in infants with a new flow-directed catheter.

Preliminary experience with a new flow-directed pediatric angiography catheter in 35 infants indicates that catheterization of all cardiac chambers and both great vessels can be accomplished without risk of perforation or major arrhythmia. Antegrade access to the aorta from the left ventricle via the foramen ovale reduced the need for retrograde arterial catheterization. The maneuverability of this balloon-tipped catheter coupled with the ability to perform safely selective angiography at any site entered establishes a unique advantage over standard cardiac catheters now in use. The success with this catheter in performing right and left heart studies and the safety in its use promise to significantly reduce the risk of mechanical and angiographic accidents during the intracardiac investigation of critically ill infants with congenital heart disease.

Angiocardiography↗
PubMed1982

Mortality related to cardiac catheterization and angiography.

During a 14-month period, 75 deaths occurring in relation to 53,581 cardiac catheterizations were consecutively and prospectively reported to the Registry Committee of the Society for Cardiac Angiography. Three of the patients died several days after their catheterization from an unrelated cause and are excluded from this analysis. There were 21 patients (group I) who arrived at the laboratory in extremis and whose deaths were expected irrespective of the catheterization. Most of these patients suffered from recent myocardial infarctions and cardiogenic shock, or had complex congenital malformations. In 35 patients (group II), a cardiovascular complication occurring during the catheterization resulted in death. In 16 patients (group III) catheterization seemed uneventful, but death occurred suddenly 10 min to 10 h after the procedure. Of these 16 patients, eight had left main coronary artery obstruction greater than or equal to 90%, five had three-vessel disease all with 90% obstructions, one had 2-vessel disease both with 90% obstructions, and who had critical aortic stenosis. The 51 unexpected deaths (groups II and III) were considered to be causally related to the procedure, a mortality rate of 0.10%. Subsets with an increased mortality rate (M), were patients with: a) left main disease greater than 50% (M = 0.94%); b) ejection fraction less than 30% (M = 0.54%); c) NYHA class III or IV (m = 0.24%); d) age over 60 years (M = 0.23%); or e) three-vessel disease (M = 0.13%). In conclusion, catheterization related mortality occurs mostly in patients with far advanced cardiac disease. Nearly 1/3 of the unexpected deaths occurred suddenly after a seemingly uneventful procedure. Close monitoring after catheterization of patients with similar characteristics (left main disease greater than or equal to 90%, or three-vessel disease all greater than or equal to 90%) might disclose avenues for reducing mortality occurring after catheterization.

Adolescent↗
PubMedDate not supplied

Quantifying and minimizing radiation exposure during pediatric cardiac catheterization.

This study reports findings from evaluations of new technologies to measure radiation exposure during pediatric cardiac catheterization procedures. A strategy of pulsed fluoroscopy and low power settings resulted in significantly lower patient radiation exposure compared to conventional 60 frames/sec, high-power settings during fluoroscopy. During radiofrequency ablation procedures, thyroid and thoracic skin sites outside the direct fluoroscopic field received minimal radiation exposure. Intrathoracic radiation exposure was measured with the use of an esophageal dosimeter. In conclusion, strategies to reduce total radiation exposure should be employed, radiation dose should be measured, and assessment of radiation skin injury should be included in post-catheterization assessment.

Adolescent↗