SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Children who undergo cardiac catheterization present pain management challenges to nurses. In this experimental study, the investigator examined the effect of imagery on children's pain and anxiety during cardiac catheterization. Twenty-four children, aged 9 to 17 years were randomly assigned to a control, presence, or imagery condition. Physiological, psychological, and behavioral data were used to rate children's pain and anxiety during cardiac catheterization. Children in the imagery condition displayed fewer distress behaviors during cardiac catheterization. Children in the presence condition reported the lowest levels of pain. Cortisol elevation over baseline was lowest in the control group, a result consistent with findings in previous studies. Several correlations of interest are reported. Implications for nursing practice and research are discussed.
BACKGROUND: Elevation of cardiac troponin I in the serum is a specific marker for myocardial injury. We measured levels of troponin I in the serum in children before and after cardiac catheterization to determine if this procedure was associated with an increase in levels of troponin. METHODS: We enrolled patients under 21 years of age undergoing cardiac catheterization at our institution. A baseline sample of serum was drawn at the start of the procedure. Repeat samples were obtained immediately after, and six hours subsequent to the procedure. All samples were analyzed for cardiac troponin I using the Abbott AxSYM microparticle immunoassay system. Levels were considered normal (0-0.4 ng/ml) or elevated (>0.4 ng/ml). Patients were excluded if the baseline level was elevated. RESULTS: Levels of cardiac troponin I were elevated in the serum from 11 of 14 (79%) cases immediately after the procedure (p < 0.0001), and in 12 of 14 (86%) six hours later (p < 0.0001). Only 2 patients had recognized complications potentially causing myocardial injury. CONCLUSION: Levels of cardiac troponin I increase in the serum in a high proportion of children after cardiac catheterization. These elevations can be observed immediately, and are maintained for at least six hours. Our study suggests that cardiac catheterization, predominantly intervention, is associated with myocardial injury, even in the absence of complications.
BACKGROUND: Shortening the prenatal disease course of severe aortic and pulmonary stenoses by balloon valvuloplasty may diminish their postnatal expression. The purpose of this study in fetal sheep was to assess the feasibility of fetoscopic and open transumbilical fetal cardiac catheterization guided by fetal transesophageal echocardiography to provide alternative approaches for human fetal cardiac intervention. METHODS AND RESULTS: We studied a total of nine fetal sheep (95 to 103 days of gestation; term = 145 to 150 days) and performed transumbilical fetal cardiac catheterization by a minimally invasive fetoscopic (n = 6) or an open fetal surgical approach (n = 3). Monitored by fetal transesophageal echocardiography, with an 8F or 10F, 10-MHz intravascular ultrasound catheter we placed guidewires and interventional catheters via the umbilical arterial route into the fetal heart. In three of the fetuses, we created supravalvar pulmonary artery stenosis by open fetal cardiac surgery After fetal and maternal recovery, we exteriorized these fetuses and performed open transumbilical fetal cardiac catheterization with successful pulmonary arterial angioplasty in two. Three fetuses survived fetoscopic transumbilical catheterization for 1 or 2 days and died most likely of blood loss after sheath dislodgment (n = 1) or removal (n = 2). By securing the sheath insertion site with a suture, we prevented sheath dislodgment and minimized bleeding during sheath removal in three fetuses. These fetuses then survived fetoscopic transumbilical fetal cardiac catheterization for 1 to 2 weeks before being killed. CONCLUSIONS: This study in fetal sheep demonstrates that fetoscopic and open transumbilical fetal cardiac catheterization are feasible and, guided by fetal transesophageal echocardiography, provide potential alternative approaches for human fetal cardiac intervention.
The experience of cardiac catheterization (CC) has included feelings of uncertainty, stress, fear and anxiety in many patients. However, conflicting findings from previous research have been reported. Chinese patients who undergo CC may experience psychological distress in a different way to other cultures as a result of traditional beliefs. Moreover, little research examining the impact of CC among Hong Kong Chinese has been carried out. Therefore, the aim of the study was to explore relationships between uncertainty, psychological distress and coping strategy in Chinese men after CC, using Mishel's model of uncertainty in illness as a framework. A convenience sample of 27 men hospitalized for cardiac catheterization participated in this study using a descriptive, correlational research design. Ethical approval was obtained from the Ethics Committee of the Medical Faculty at the Chinese University of Hong Kong and from the Executive Committee of the hospital. Participation was on a voluntary basis with patient confidentiality assured. Self-report questionnaires included Chinese versions of Mishel's Uncertainty in Illness Scale (MUIS), the Profile of Mood States (POMS), the State-Trait Anxiety Inventory (STAI) and the Chinese Coping Scale (CCS) for data collection. Data were analysed using the Statistical Package for Social Sciences. High mean scores for uncertainty (mean=101.4, SD=11.49) and variables measuring psychological distress (mood disturbance mean=36.6, SD=33.6, state-anxiety mean=39.1, SD=8.95, trait-anxiety mean=43.7, SD=8.1) among these participants suggest that Hong Kong Chinese men experience uncertainty and psychological distress when undergoing cardiac catheterization. Strong relationships between uncertainty and mood disturbance (r=0.57, P=0.01), trait-anxiety and mood disturbance (r=0.65, P=0.01) and state-anxiety and external coping strategies (r=0.50, P=0.05) were found. These findings suggest that relationships between uncertainty, psychological distress and external coping strategies exist in Chinese men hospitalized for cardiac catheterization. Moreover, these findings may help nurses' design culturally specific interventions for their patients.
The evolution of cardiac catheterization has occurred over at least four centuries. One of the first major steps was the description of the circulation of the blood by William Harvey in 1628. The next milestone was the measurement of arterial pressure by Stephen Hales, one century later. However, the 19th century represented the golden age of cardiovascular physiology, highlighted by the achievements of Carl Ludwig, Etienne-Jules Marey and Claude Bernard, among others. Human cardiac catheterization developed during the 20th century. The first right heart catheterization in a human was performed by Werner Forssmann on himself in 1929. Diagnostic cardiac catheterization was introduced by André Cournand and Dickinson Richards in the early 1940s, and selective coronary angiography was described by Mason Sones in the early 1960s. More recently, with the advent of catheter-based interventions, pioneered by Andreas Gruentzig in the late 1970s, there has been considerable progress in the refinement and expansion of these techniques. Currently, the Sones technique is used only infrequently, and coronary angiography and percutaneous coronary intervention rely mainly on percutaneous femoral and percutaneous radial artery approaches. On the occasion of the 50th anniversary of the Montreal Heart Institute, it seems appropriate to highlight the contribution of this institution in these two areas.
Patients who undergo cardiac catheterization are frequently taking propranolol and are often premedicated with diazepam. Because the intensity of a drug's action is determined by free, or non-protein-bound, levels in plasma, changes in the degree of protein binding may profoundly alter the pharmacologic effect. We examined the effects of heparin on the free levels of propranolol and diazepam in six patients who underwent cardiac catheterization. After heparinization, the free fraction of diazepam increased more than fourfold, from 1.8 +/- 0.1% to 7.9 +/- 1.2% (p < 0.002) and the free levels increased from 2.0 +/- 0.5 to 8.4 +/- 2.2 ng/ml (p < 0.025); the free fraction of propranolol increased from 7.4 +/- 0.9% to 12.5 +/- 1.4% (p < 0.001). The increase in free drug concentration was associated with elevated free fatty acid levels, which rose from 181 +/- 7 micrograms/ml to 596 +/- 119 micrograms/ml (p < 0.02). Increases in the free levels of propranolol and diazepam produced by heparinization during cardiac catheterization may result in increased pharmacolaogic effect, such as excessive sedation or respiratory depression.
The success of noninvasive preoperative evaluation of infants with congenital heart disease using cardiac ultrasound depends not only on diagnostic accuracy, but also on risk of morbidity and mortality as compared with infants who undergo cardiac catheterization. Fifty-six infants (age 10 weeks or younger) with coarctation of the aorta (n = 16), coarctation with ventricular septal defect (n = 12), valvar aortic stenosis (n = 10) or total anomalous pulmonary venous connection (n = 18) were examined. Thirty-one underwent noninvasive preoperative assessment and 25 underwent evaluation including cardiac catheterization. Age, level and duration of support, pH, renal function, mortality, complications of cardiac catheterization and errors of diagnosis were compared. Significant differences between the 2 groups were more frequent preoperative use of prostaglandin E1 and shorter hospital stay in the noninvasively evaluated coarctation group. Of the infants with coarctation and ventricular septal defect, 1 who had cardiac catheterization required renal transplantation and 1 evaluated noninvasively required surgery at age 3 months for mitral stenosis not discovered on preoperative evaluation. One noninvasively evaluated infant with total anomalous pulmonary venous connection had a stenotic communication between the pulmonary venous confluence and the left atrium not detected by ultrasound. Surgery was successful in the latter 2 infants. Noninvasive preoperative diagnosis of some infants with congenital heart disease can be performed without increasing the risk of operative morbidity and mortality. Eliminating cardiac catheterization reduces hospital costs, decreases total numbers of catheterizations performed and influences the structure of training programs.
Since 1979 most of the cardiac catheterizations at the investigators' institution have been performed as outpatient procedures. All cardiac catheterizations performed over a 66-month period were analyzed. A total of 3,071 outpatient cardiac catheterizations (83% of all cardiac catheterizations) were performed. The percutaneous femoral technique was used in 98% of the procedures. Most patients (79%) had both right and left-sided cardiac catheterization and coronary angiography, which showed significant coronary artery disease (70.4%). Only 13.6% of the study results were normal. Thirty-four patients (1.1%) had major complications, including 4 deaths (0.13%). Seventy patients (2.3%) were admitted for observation only. More than 96% of all patients did not have a major complication and were discharged the same day. Thus, outpatient cardiac catheterization can be performed safely, with a potential reduction in hospital costs and better utilization of medical beds.
Cardiac catheterization in children with congenital heart disease or in adults with completely or partially corrected cardiac defects, is a growing field of activity for anaesthesiologists. This requires not only the willingness for interdisciplinary co-operation, but also detailed knowledge about the pathophysiology of congenital heart diseases. In interventional paediatric cardiology significant innovations have occurred during recent years including stenting of a patent ductus arteriosus and of peripheral pulmonary artery stenosis. Furthermore, radiofrequency catheter ablation for recurrent tachyarrhythmia, or resynchronisation therapy with biventricular pacing in the setting of congestive heart failure, or implantation of cardioverter defibrillators are increasingly being employed which require anaesthesia support.
OBJECTIVE: The aim of this study was to compare the anesthetic efficacy of prilocaine infiltration and a eutectic mixture of local anesthetics (EMLA) in cream for femoral vessel catheterization during pediatric cardiac catheterization and to evaluate whether EMLA cream application improves cannulation success. DESIGN: Prospective, randomized clinical trial. SETTING: A university hospital. PARTICIPANTS: Forty American Society of Anesthesiologists class III and IV children scheduled for cardiac catheterization via the femoral route were included. INTERVENTIONS: The children were randomly assigned to 2 groups. The EMLA group (n = 20) had EMLA cream applied to the groin 60 minutes before the procedure, and the control group (n = 20) had prilocaine infiltrated at the site 5 minutes before the procedure. Boluses of intravenous midazolam, 0.1 mg/kg, and/or ketamine, 1 mg/kg, were given to achieve and maintain a predetermined sedation score of 2-3 (0 = deeply sedated, 5 = agitated) throughout the procedure (sedation monitored every 5 minutes). The groups were compared with respect to demographic data, hemodynamic and respiratory parameters/complications, amounts of additional sedative-analgesics required, cannulation time, and cannulation results (first-attempt success [right groin], second-attempt success [left groin], or failure on both attempts). Each group's "overall cannulation success rate" was calculated as the proportion of cases in which cannulation was achieved on the first or second attempt. MEASUREMENTS AND MAIN RESULTS: The demographic data and the group findings for hemodynamic and respiratory parameters/complications, additional amounts of sedative-analgesics needed, cannulation times, and overall cannulation success rate were similar. The mean sedation score during femoral puncture in the EMLA group was significantly lower than that in the control group (3 +/- 1 v 4 +/- 1, respectively, p = 0.001). There were no other significant differences between the groups with respect to sedation scores during the procedure. The respective frequencies of first-attempt cannulation success in the EMLA and control groups were 75% and 45% (p = 0.05). CONCLUSION: The study showed that EMLA cream provides adequate topical anesthesia for femoral vessel cannulation during pediatric cardiac catheterization and may also increase the likelihood of cannulation success. However, use of this cream has no effect on sedative-analgesic requirements or on the risks of hemodynamic and respiratory complications during this procedure.
Cardiac catheterization, once the mainstay of diagnosis in children with congenital heart disease, has become a therapeutic modality for many conditions. Balloon dilatation can now open stenotic valves and vessels, coils and umbrellas can now close unwanted communications, and emboli can be withdrawn without surgical intervention.
In traditional cardiac catheterization laboratories, anatomic images are acquired onto 35-mm cine film and presented in series with related information days, weeks, or months later to an audience of decision-makers. These data are projected onto a convenient light-colored wall or silver screen, while echocardiograms and electrophysiologic data are displayed using small single-user computer monitors. This presentation format is not ideal, because full audience participation is not fostered, image quality may be degraded, and small computer screens can be adequataly visualized only by those individuals immediately in front of them. Modern video multimedia systems now make an ideal data presentation format practical, in which all types of media including digitally acquired angiograms can be displayed in parallel with full annotation, using large diagonal multisync color monitors. This communication discusses how to design a multimedia conference center in which remotely acquired filmless digital images can be displayed and processed together with all other pertinent cardiac multimedia to a large audience.
Cardiac catheterization, originally performed only in hospital settings, is currently undertaken in hospital ambulatory and freestanding settings. Although use of the hospital ambulatory setting is accepted, questions have been raised about the safety and effectiveness of cardiac catheterization when performed in a freestanding setting. Critics have claimed that use of freestanding centers subjects patients to additional risk of complications without affording significant benefits. Proponents maintain that selected cardiac catheterization procedures can be performed in freestanding settings without exposing patients to increased risk. Available data on complication rates indicate that freestanding centers perform catheterizations with morbidity and mortality rates substantially lower than those reported in the literature for inpatient procedures. Although questions have been raised about the validity of these data, they suggest that cardiac catheterization can be performed in a freestanding setting with acceptable safety and effectiveness.
Arterial occlusions after cardiac catheterization are usually treated surgically. We report four patients with femoral thrombosis or distal emboli that developed after cardiac catheterization. Each patient was treated successfully with intravenous streptokinase. Therapy was initiated 1-60 hr after the procedure. The duration of infusion lasted 4-42 hr (mean 27 hr). Pulses were restored 4-19 hr (mean 10 hr) after the beginning of infusion. There was no major hemorrhagic complication, even in patients with very early streptokinase infusion. Thus intravenous streptokinase may be an alternate choice to surgery for arterial occlusions after invasive procedures.
Pediatric cardiac catheterization may be indicated under certain conditions, but is associated with some risk. The purpose of the study was to evaluate the complications associated with diagnostic and interventional catheterization procedures done over an 18-month period in our laboratory. Of the 230 cardiac catheterizations, 204 were solely diagnostic in nature. Eleven percent were interventional catheterizations including aortic and pulmonary valvuloplasties and balloon atrial septostomy. Six percent of the patients constituted grown-up congenital heart disease (GUCH). The median age was 34 months excluding the GUCH group. There was one death below one year of age (0.4% mortality) occurring six hours after the diagnostic catheterization; it was attributed to the underlying disease. There were eight complications (3.4%) that we would consider serious, including atrial flutter, ventricular tachycardia, severe hypercyanotic spell, seizure, transient complete heart block, peripheral vascular injury which resulted in pseudoaneurysm formation of the femoral artery requiring surgical intervention, and transient pulse loss. When catheterization is necessary, it should be carried out as efficiently as possible with awareness of conditions that probably increase the risk of a clinically important event. Although patients undergoing cardiac catheterization are now younger and have more complex cardiac abnormalities, the procedure seems to have become safer when compared to previous literature.
Cardiac catheterization studies performed in research laboratories showed that advanced mitral stenosis is associated with a characteristic dynamic pattern which is reversible by mitral valvulotomy. In the process of the selection of patients for mitral valvulotomy, occasionally there are instances in which a decision cannot be reached on the basis of ordinary clinical methods of examination. In some such cases cardiac catheterization may be of decisive value by demonstrating, or by failing to demonstrate, the dynamic pattern of mitral stenosis. Cases in which this diagnostic procedure is most often helpful are those of mild mitral stenosis and those in which there are combined valvular defects.
Vascular complications after cardiac catheterization are rare and usually occur at the access sites. However, vessels along the tract of the catheter can also be injured, causing bleeding and hematoma formation. We present a 57-year-old male who underwent cardiac catheterization via the radial approach, later developing neck and mediastinal hematoma, which was managed conservatively. This complication has only been reported once in the English literature.