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At least 775 records · Page 43Linked to original sources
PubMed1982

Routine surgical management of brachial artery occlusion after cardiac catheterization.

From 1965 through 1980, 1,108 patients (1.5%) underwent thrombectomy and local arterial reconstruction because of brachial artery occlusion after a total of 73,750 cardiac catheterization procedures performed at the Cleveland Clinic. In a study group of 100 consecutive patients, 91 had simple arteriotomy revision and nine had segmental arterial resection with either axial reanastomosis or a saphenous vein interposition graft. Thirteen patients sustained early recurrent thrombosis after limited arteriotomy revisions, and 11 of these had successful reoperations. Ninety-eight patients were discharged from the hospital with normal distal pulses and no ischemic symptoms. Statistical analysis indicated that women were more likely than men to experience early recurrent thrombosis, and that late ischemic symptoms were most common among women and among those who required reoperations at the time of initial treatment.

Adult↗
PubMed2004

Impact of diabetes mellitus type 2 on in-hospital outcome after cardiac catheterizations in a large cohort of octogenarians.

AIM: To assess the impact of diabetes mellitus type 2 (DM) in 1085 octogenarians on in-hospital outcome after cardiac catheterization (CATH) and/or percutaneous coronary intervention (PCI). METHODS AND RESULTS: We studied 1085 consecutive octogenarians [82.6+/-2.6 years; 401 DM, 684 without DM (non-DM)]. Age, acute myocardial infarctions (DM: 26%, non-DM: 21%) and extent of disease (three-vessel disease, DM: 34%, non-DM: 31%) were similar in both groups. There was a similar percentage of interventions (PCI: DM: 30% vs. non-DM: 29%; bypass surgery: DM: 30% vs. non-DM: 25%) performed in both groups. Thirty-one patients (2.9%) died during hospital stay (DM: 2.2%; non-DM: 3.2%; p=0.46) of whom 16 died (DM: 1.0%; non-DM: 1.9%) during (n=4) or after (n=12) interventions in patients who were already admitted in cardiogenic shock. At the puncture site, 87 complications occurred (DM 6.5% vs. non-DM 6.4%, p=0.87). Stepwise logistic regression analyses identified DM as an independent predictor of adverse events during CATH, but not PCI. Furthermore, DM was not a predictor for vascular complications. CONCLUSIONS: Catheterization-related complication rates are different in diabetic as compared to nondiabetic patients during CATH, but not PCI. Octogenarians should be granted access to an invasive treatment strategy even in the presence of DM.

Aged↗
PubMedDate not supplied

Variability between methods of calculating mitral valve area: simultaneous Doppler echocardiographic and cardiac catheterization studies conducted before and after percutaneous mitral valvuloplasty.

The purpose of this study was to assess the variability of measuring the mitral valve area (MVA) by the cardiac catheterization (Gorlin) method and two Doppler echocardiographic methods, the pressure half-time and continuity equation methods. The determinants of MVA were measured simultaneously before and after percutaneous mitral balloon valvuloplasty (PBMV). Thirty-three patients with severe mitral stenosis underwent simultaneous measurements of MVA by the three methods immediately before and within 15 minutes after PBMV. After combining all data, the correlation between the catheterization and pressure half-time methods was significant (r = 0.65; p < 0.001), as was that between the catheterization and continuity equation methods (r = 0.64; p < 0.001). However, there was a large degree of variability among the measurements with the three techniques. The mean difference between the catheterization and pressure half-time methods of measuring MVA before PBMV was -0.2 +/- 0.4 cm2 and 0.1 +/- 0.3 cm2 between the catheterization and continuity equation methods. This variability was even more marked after PBMV: -0.5 +/- 0.9 cm2 between the catheterization and pressure half-time methods and 0.4 +/- 0.6 cm2 between the catheterization and continuity equation methods. Although previous studies have shown a good correlation between MVA as measured with the catheterization and two Doppler echocardiographic methods, they included a wide range of MVAs. In our study of patients with hemodynamically significant mitral stenosis, there was a large degree of variability between the catheterization and simultaneously performed Doppler echocardiographic methods. The calculated MVA by any method should not be used as the single measure of severity of stenosis.

Adult↗
PubMed1992

Double-blind comparison of the clinical, hemodynamic, and electrocardiographic effects of sodium meglumine ioxaglate or iohexol during diagnostic cardiac catheterization.

The clinical effects and the maximal hemodynamic and electrocardiographic effects of two low-osmolality radiographic contrast media (ioxaglate and iohexol) were directly compared during diagnostic cardiac catheterization in a double-blind, randomized study in 80 patients. Because small changes were expected after injection of both of these agents, sensitive ECG and intracardiac-pressure-monitoring methods were used, and maximal changes, as well as mean changes in variables, were analyzed. Symptoms were absent, mild, or moderate in 67-77% of patients after left ventriculography and in 97-100% of patients after coronary arteriography. After left ventriculography, maximum and minimum left ventricular systolic pressure and end-diastolic pressure, the first derivative of left ventricular pressure (dp/dt), heart rate, were significantly altered over the two-minute observation period but were not different from the preinjection values at two minutes after both agents. Small but significant increases in mean aortic pressure, cardiac output, and pulmonary arterial wedge pressures were seen at two minutes after both agents.

Cardiac Catheterization↗
PubMed1982

Pseudo complications of cardiac catheterization: update.

This prospective study was performed to determine whether complications that occur immediately before or after the time of scheduled catheterization are as much disease-related as procedure-related. During 24 months all complications associated with 1,606 diagnostic cardiac catheterizations were recorded if they occurred from 24 hours before the time the procedure was scheduled to 72 hours later, longer if complications were clearly procedure-related. Pseudo complications are spontaneous medical or surgical incidents that occur during the 24-hour period before catheterization is scheduled to be performed. Procedure-related complications are incidents that occur during or after the catheterization procedure. There were 13 (0.81%) procedure-related complications but not deaths. There were 13 (0.81%) pseudo complications including 4 (0.24%) deaths. All complications were similar in nature except for 3 instances of vascular injury, which were procedure-related. Pseudo complications occur as commonly as procedure-related complications and at times are more severe. Complications occurring before catheterization are related to the underlying disease process and not medical intervention. It is likely that similar disease-caused incidents occur after a catheterization and are not necessarily procedure-related.

Adolescent↗
PubMed1984

Two-dimensional echocardiography and its influence on cardiac catheterization.

Successful management of congenital heart disease requires complete anatomic definition and timely surgical intervention. Preoperative anatomic detail is enhanced by coordination of different imaging disciplines. Precatheterization cardiac ultrasound avoids unnecessary catheter manipulation, excess radiation and reduces contrast volume. Detailed noninvasive imaging, coupled with an understanding of the natural history and surgical alternatives, obviate the need for preoperative cardiac catheterization in selected lesions. Cardiovascular anomalies which, in a well defined set of circumstances, may be exclusively managed by two-dimensional echocardiography include sinus venosus and secundum type interatrial septal defects, severe aortic stenosis in infancy, and hypoplastic left heart syndrome. The "well defined set of circumstances" are particular to each lesion and must include the patient's history, physical examination, electrocardiogram, and chest X-ray. Definitive management of a cardiovascular anomaly entails consideration of the relative superiority and cost benefit advantages of the different imaging disciplines.

Aortic Valve↗
PubMed1976

Irradiation to the thyroid gland at cardiac catheterization and angiocardiography in children.

Irradiation to the thyroid gland was measured during cardiac catheterization in 16 infants and 30 children aged 1 to 13 years. The doses from fluoroscopy, full-scale angiocardiography, and cineradiography were measured separately with thermoluminescent dosimeters and, in addition, the exposure-area product was assessed during fluoroscopy with a transparent ionization chamber. Median value of the absorbed dose to the thyroid from the complete heart investigation was 370 mrad in infants and 260 mrad in children. The highest values and also the greatest range in dosage were observed in infants. The quotient of the thyroid-absorbed dose divided by the integral dose or the dose per exposed film area was also highest in infants, due to anatomical conditions. The absorbed dose to the thyroid during heart catheterization comes almost exclusively from scattered radiation. By appropriate examination technique this dose can be kept within acceptable limits.

Adolescent↗
PubMed2006

Indications for renal arteriography at the time of coronary arteriography: a science advisory from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Councils on Cardiovascular Radiology and Intervention and on Kidney in Cardiovascular Disease.

Atherosclerotic renal artery stenosis is commonly present in patients with clinically manifest atherosclerosis in other vascular beds and is independently associated with increased cardiovascular morbidity and mortality. Screening tests such as renal angiography should be selectively applied to patients at high risk for renal artery stenosis who are potential candidates for revascularization. This multispecialty consensus document describes the rationale for patient selection for screening renal angiography at the time of cardiac catheterization.

Angiography↗
PubMedDate not supplied

Can cardiac catheterization accurately assess the severity of aortic stenosis? An in vitro pulsatile flow study.

An accurate hemodynamic assessment of aortic stenosis has important clinical implications. In clinical practice, cardiac catheterization is often used to assess the severity of aortic stenosis. However, in conducting catheterization, the precise position of the catheter tip is often not known or controlled. From the standpoint of hydrodynamics, the position of the catheter tip may affect pressure measurement due to the complicated flow fields distal to the valve. This fact is particularly true when the diagnosed valve is stenotic. The study was aimed to investigate how the position of the catheter tip in catheterizing aortic stenosis affects pressure measurement. The experiments were conducted in an in vitro pulse duplicator system. Laser flow visualization was used to examine the flow fields in the vicinity of varying degrees of aortic stenosis, and a pressure transducer with a side-hole catheter was used to measure pressures. Minimal variation in transvalvular pressure drop measured along the radial direction was observed for varying degrees of valvular aortic stenosis. This implies that, in catheterization, the placement of the catheter tip along the radial direction does not seem to affect pressure measurement. However, along the axial direction, pressure recovery was observed for all the cases studied. Therefore, within the region of pressure recovery, the position of the catheter tip may affect the pressure drop measurement. This may cause inaccuracy in assessing the severity of aortic stenosis. However, this concern may be overcome by pulling the catheter slightly further downstream, so that the position of the catheter tip is outside of the pressure recovery region.

Adult↗
PubMed1995

Acute embolic carotid occlusion after cardiac catheterization: effect of local intra-arterial urokinase thrombolysis.

A 64-year-old woman developed a severe embolic cerebral attack with total left hemiplegia approximately 30 hours after cardiac catheterization for mitral stenosis. She underwent intra-arterial thrombolysis of the right internal carotid artery four and one-half hours after the onset of neurologic deficit with subsequent recanalization of the occluded vessel and near complete neurologic recovery.

Acute Disease↗
PubMed1998

Current concepts of coronary flow reserve for clinical decision making during cardiac catheterization.

Measurements of coronary flow reserve, once used only for research, have gained wide acceptance as an additional diagnostic approach in the decision-making process of diagnostic cardiac catheterization and coronary interventions. Apart from the noninvasive determination of coronary flow reserve, intracoronary Doppler flow wires have facilitated decision making in the catheterization laboratory. Different techniques, unstandardized procedures, and data from uncomparable patient populations have remained a confounding factor. This review examines current concepts of coronary flow reserve as well as methodologic considerations and pitfalls. Applications of coronary flow reserve for periinterventional assessment are evaluated on the background of practical guidance. According to a detailed examination of arterial structure and function, a normal coronary flow reserve exceeds a value of 3.0. Values below 3.0 suggest involvement of microvascular disease caused by functional or structural alterations. The influences of various factors such as age, hemodynamics, hypercholesterolemia, hypertrophy, hypertension, syndrome X, and coronary artery disease are discussed in relation to the effect on coronary flow reserve. From available information, measurements of coronary flow reserve are an adjunct to current interventional technology to optimize individual patient care. Further efforts should be undertaken to incorporate these new methods into our routine clinical decision making.

Blood Flow Velocity↗
PubMed1980

Hemodynamic effects of nitrous oxide administered during cardiac catheterization.

To assess the effects of nitrous oxide on hemodynamics and left ventricular function in man, 30 patients (24 of whom had coronary artery disease) were studied at the time of cardiac catheterization. Left ventricular peak-systolic pressure and end-diastolic volume showed no significant change during nitrous oxide inhalation. The maximum rate of pressure rise declined slightly, but left ventricular end-diastolic pressure and ejection fraction were unchanged. Heart rate and cardiac index declined modestly. The pressure-rate product and left ventricular minute work index decreased, suggesting a decline in myocardial oxygen requirements. These data suggest that nitrous oxide inhalation does not produce important depression of left ventricular performance. The consistent decrease in the determinants of myocardial oxygen demand suggests that use of this analgesic agent may be helpful in patients with coronary heart disease.

Adolescent↗
PubMed2001

Therapeutic cardiac catheterization for congenital heart disease--a new era in pediatric care.

In recent years, enormous technological advances have occurred that allow intervention for many congenital heart defects in the pediatric cardiac catheterization laboratory. Therapeutic catheterization procedures, including valvuloplasty, angioplasty, stent implantation, coil embolization, and device occlusion, are employed to treat heart defects in infants and children. This report describes these interventional procedures, outcomes, potential complications, and implications for nursing care.

Balloon Occlusion↗
PubMed1990

Diagnosis of unexpected atrial septal defect by inspired hydrogen appearance time in adult patients referred for cardiac catheterization.

Atrial septal defects may have clinical consequences regardless of their size. We evaluated the incidence of clinically unsuspected atrial septal defects in 4,411 consecutive adult patients referred for cardiac catheterization by the previously validated method of inspired hydrogen appearance time. Oximetry was performed only when an abnormally short inspired hydrogen appearance time was measured. Seventy-five patients (1.7%) were discovered to have a left-to-right shunt by this method. The shunting was at the atrial level in 65 patients. Thirty-five of these patients (0.8% of all catheterizations) were not suspected of having any form of congenital heart disease by history, physical examination, chest X-ray, EKG, or echocardiogram. In 19 cases there was no significant oxygen step-up and the diagnosis would have been missed by oximetry. The atrial septum was explored during open heart surgery in 7 patients. Atrial septal defects were detected and closed in all. Four patients had the finding confirmed by echocardiography after the catheterization. Small atrial septal defects are frequently not detected by clinical evaluation, noninvasive testing, or oximetry and are easily detected by the rapid, safe, and accurate method of inspired hydrogen appearance time.

Cardiac Catheterization↗
PubMed1990

Should patients have cardiac catheterization prior to long-term oxygen treatment?

Pulmonary arterial pressure predicts survival in patients with hypoxic chronic obstructive pulmonary disease as does the presence of cor pulmonale. Thus, cardiac catheterization has been performed prior to treatment for long-term oxygen therapy (LTOT) in order to 1) assess the suitability of patients for LTOT, 2) predict survival in patients receiving LTOT and 3) for research in cor pulmonale. In this review I will submit the evidence which suggests that these indications for measurement of pulmonary haemodynamics are not justified, and measurements of arterial blood gas values and assessment of airflow limitation are all that is necessary prior to LTOT.

Cardiac Catheterization↗
PubMed1990

Cardiac catheterization in the patient with history of allergy to local anesthetics.

Patients with a history of allergic reactions to local anesthetic drugs present a difficult problem during evaluation for cardiac catheterization procedures. In the worst cases the procedure may be deferred, or even performed without local anesthesia. In the vast majority of patients an acceptable agent for safe local anesthetic use can be found. Skin testing beginning with very dilute solutions of preservative-free local anesthetic agent may be administered easily. This report describes the practical aspects of skin testing and local anesthetic agent selection in patients with a history of allergic reaction to local anesthetic drugs.

Adult↗
PubMed2002

Arterial complications following cardiac catheterization in children less than 10 kg.

We sought to determine if a higher dose of heparin would reduce arterial complications in patients weighing 10 kg or less undergoing cardiac catheterization to investigate congenital heart disease. Sixty patients were given either 100 (group A) or 150 (group B) IU x kg(-1) of heparin in a double-blinded randomized manner. Initial arterial access was established using a 4F cannula in all patients. Mean activated clotting time measured 20 minutes following heparin administration was significantly lower in group A than in group B (199 versus 251 seconds). Only 3 out of 60 patients (5%) required treatment for loss of femoral pulse. The age, weight, activated clotting time, length of catheterization procedure, time taken to establish arterial access, and the duration of arterial cannulation were comparable between the groups. Weight under 4 kg, age under 1 month, and cannula size larger than 4F were identified as independent risk factors for the development of arterial complications. Arterial access using a 4F cannula is a safe procedure in children weighing 10 kg or less. The incidence of significant arterial complications is low, and they do not appear to be preventable by a higher dose of heparin.

Anticoagulants↗