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PubMed1981

Radiation exposure to the pediatric patient during cardiac catheterization and angiocardiography. Emphasis on the thyroid gland.

Thermoluminescent dosimetry was used to measure the radiation exposure to the skin, thyroid and gonads in 50 consecutive pediatric patients undergoing cardiac catheterization and angiocardiography using cine photofluorography. Average exposures were 17.1 R to the skin, 2.3 R to the thyroid and 0.1 R to the gonads. Fluoroscopy accounted for approximately 80% of the skin and thyroid exposure and cine photofluorography for 20-25%. Occasional primary-beam irradiation was the major contributor to gonad exposure. Internal scatter of the incident x-ray beam was primarily responsible for thyroid exposure, so that infants received relatively high exposures; one receiving 7.3 R. The thyroid was not frequently in the primary beam. The significance of high radiation exposure to the thyroid, and in particular its relationship to thyroid carcinoma, are discussed. The results are compared with other series in the literature and relative exposures of cine photofluorography and serial filming are contrasted.

Angiocardiography↗
PubMed2005

[Cardiac catheterization via the right radial artery with a Judkins left catheter. A prospective study].

Radial artery access improves the patient's well-being, permits earlier ambulation and diminishes vascular complications after cardiac catheterization. Using the same catheter to study the left and right coronary arteries may facilitate the technique. In a cohort of 100 patients we prospectively analyzed the possibility of studying both coronary arteries with a Judkins left 3.5 catheter. The variables studied were percentage of successful access, complications, and procedural time from insertion of the guiding catheter to the end of ventriculography. It was possible to catheterize both coronary arteries with the same catheter in 94 cases (94%) with a procedural time of 16.7 (6.8) min. In 6 patients a JR4 catheter was required, in one of them due to severe spasm of the right coronary artery ostium and due to impossibility to catheterize the ostium in the other 5. There were no cases of severe radial artery spasm.

Aged↗
PubMedDate not supplied

Relaxation training and response to cardiac catheterization: a pilot study.

This pilot study evaluated the effects of relaxation-via-letting-go training on patients' state anxiety, observer-reported distress, and self-reported distress during cardiac catheterization. The sample consisted of 30 adults, 15 subjects in the relaxation training group and 15 subjects in the control group. A comparison of the control and relaxation training groups on the demographic variables of age and education, the preintervention variables of state anxiety and worry about the procedure, and number of days in the hospital prior to catheterization showed no differences between the groups. Relaxation training subjects did not indicate less anxiety prior to catheterization nor were they seen as less distressed during the procedure than control subjects. In addition, relaxation subjects did not report having less distress than control subjects.

Adult↗
PubMed2004

Transthoracic access for cardiac catheterization.

Patients who have undergone Fontan palliation for congenital heart disease have limited access to the pulmonary venous atrium. We describe a transthoracic approach to the pulmonary venous atrium for diagnostic and therapeutic cardiac catheterization. A total of 22 patients ranging in age from 14 months to 25 years and weighing 7-68 kg underwent transthoracic catheterization. With the aid of fluoroscopic and angiographic markers, a 20 gauge needle was inserted into the pulmonary venous atrium. A floppy-tipped wire was inserted, and a 4 Fr sheath was placed, upsized as needed. Access to the pulmonary venous atrium was obtained for all patients. Therapeutic procedures were completed for all patients. Transthoracic access to the pulmonary venous atrium in patients who have undergone a Fontan operation is a reliable and rapid mode of access, allowing for complex therapeutic procedures to be performed in the catheterization laboratory, obviating the need for additional open heart surgery.

Adolescent↗
PubMed1994

Endothelin-1 in patients with coronary heart disease undergoing cardiac catheterization.

OBJECTIVES: This study examined the possible association between endothelin and coronary atherosclerosis and evaluated the synthesis and release of endothelin in the presence of various stimuli that occur during cardiac catheterization. BACKGROUND: Circulating endothelin has been reported to be increased in diffuse atherosclerosis and acute myocardial infarction. However, the relation between coronary artery disease and endothelin release remains unclear. METHODS: We measured the plasma and urinary concentrations of endothelin immunoreactivity in 45 patients and 10 healthy control subjects. RESULTS: In group IA (n = 9), simultaneous blood sampling in the coronary sinus and femoral artery during coronary angioplasty of the left anterior descending coronary artery demonstrated no immediate changes in plasma immunoreactive endothelin-1 (ir-ET-1) levels. In 11 patients in group IB undergoing coronary angioplasty of a major artery, we did not detect changes in peripheral plasma concentrations of ir-ET-1 within 24 h, but urinary ir-ET-1 levels increased from 9.2 +/- 2.3 to 18.6 +/- 4.9 pg/mg of creatinine a few hours after coronary angioplasty (mean +/- SEM, p < 0.05). This increase in urinary endothelin excretion persisted 24 h later. Group II patients (n = 12) had coronary angiography without coronary angioplasty. Levels of both plasma and urinary ir-ET-1 did not change during the 24-h follow-up period. There was no relation between the severity of coronary atherosclerosis and the plasma or urinary concentrations of ir-ET-1. Systolic aortic pressure correlated with basal urinary excretion of endothelin (r = 0.54, p = 0.03, n = 15). In group III (n = 13), levels of ir-ET-1 in patients undergoing right heart catheterization without angiography did not differ from those in the control group. CONCLUSIONS: The presence or the severity, or both, of coronary atherosclerosis is not associated with a detectable increase in endothelin release. The diagnostic procedures of catheterization do not modify endothelin concentrations in plasma and urine. Vascular stretch or injury, or both, during coronary angioplasty increases urinary ir-ET-1 levels a few hours after the procedure. This increase persists for at least 24 h but is not detectable by brief sampling of peripheral or coronary sinus blood.

Angioplasty, Balloon, Coronary↗
PubMed2001

Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization.

The angiographic prevalence, clinical predictors, and sensitivity and specificity of a bilateral arm blood pressure differential for predicting proximal left subclavian artery stenosis were established in 492 patients undergoing cardiac catheterization. Seventeen subjects (3.5%) in the overall population and nine subjects (5.3%) with potential surgical coronary disease had proximal left subclavian stenosis. Precatheterization evidence of peripheral vascular disease (PVD) was the only predictor of subclavian stenosis in the overall population (P < 0.001; OR = 7.9; 95% CI = 2.6-24.3) and in patients with potential surgical coronary disease (P = 0.04; OR = 5.4; 95% CI = 1.1-27.2). Both a bilateral blood pressure differential of > 10 mm Hg and of > or =20 mm Hg had a good specificity but a poor sensitivity for predicting left subclavian stenosis. Thus, left subclavian angiography should be performed in patients with surgical coronary disease with either an arm blood pressure differential of > 10 mm Hg or with other precatheterization evidence of PVD. Cathet Cardiovasc Intervent 2001;54:8-11.

Aged↗
PubMed2006

Diagnostic reference levels and effective dose in paediatric cardiac catheterization.

European states within the EEC are required to establish and use diagnostic reference levels (DRLs) in X-ray examinations. However, up to now there have been no DRLs for cardiac catheterization in children, nor as a rule is the effective dose estimated. We have evaluated the dose-area products (DAPs) for three different types of angiocardiography systems over a time span of 8 years. For each system DAP increased in proportion to the body weight (BW) over two orders of magnitude. The proportionality constant decreased over the years. To reduce the broad distribution of DAP the doses for cine acquisition (DAPA) and fluoroscopy (DAPF) were indexed with respect to the total numbers of acquired images (AN) and the total times of fluoroscopy (FT). DAPA/AN is directly proportional to BW with a high correlation (r = 0.896, n = 1346). Likewise, DAPF/FT is proportional to BW from 0.1 kg to 100 kg (r = 0.84, n = 2138). Therefore, by normalizing DAP to BW the growth dependent variation of DAP can be eliminated. There are numerous short examinations with very small total DAPs, which were separated from the group of diagnostic examinations. The mean DAP/BW of this group is 0.41 Gycm2 kg(-1) (90th percentile: 0.81 Gycm2 kg(-1), n = 1106). For interventional procedures in congenital heart diseases DAP/BW is significantly higher (p<0.001) (mean: 0.56 Gycm2 kg(-1), 90th percentile: 1.16 Gycm2 kg(-1), n = 883). There are significant differences between different types of interventional procedures, the mean values being between 0.35 Gycm2 kg(-1) (occlusion of patent ductus botalli, n = 165) and 1.30 Gycm2 kg(-1) (occlusion of ventricular septal defect, n = 32). For patients who are catheterized several times over the years, the cumulative effective dose (E) may reach high values, being especially high for patients with hypoplastic left heart syndrome (typically 11 mSv). E is derived from DAP/BW by use of a constant DAP/BW to E conversion factor, independent of the age of the patient. DAP/BW is appropriate to describe paediatric DRLs and is recommended instead of using mean DAP values for age groups.

Adolescent↗
PubMed1984

Modified Blalock-Taussig shunt operation without cardiac catheterization: two-dimensional echocardiographic preoperative assessment in cyanotic infants.

Between May 1981 and December 1983, 25 infants with cyanotic congenital heart defects underwent 26 Blalock-Taussig shunt operations without cardiac catheterization and angiocardiography. In these infants, the diagnosis was established by 2-dimensional echocardiography (2-D echo) supplemented with clinical findings, chest x-ray and electrocardiography. The right and left pulmonary artery measurements, a prerequisite for a shunt operation, determined by 2-D echo were compared with those at surgery and had an excellent correlation (r = 0.94). No infant died as a consequence of an early shunt failure, and only 1 died of postoperative pyothorax. In conclusion, 2-D echo may eliminate the need for invasive investigation in selected patients undergoing the Blalock-Taussig anastomosis.

Blood Vessel Prosthesis↗
PubMed1990

[Pulmonary perfusion and ventilation scintigraphies before and after cardiac catheterization in infants with congenital heart diseases].

We performed 99mTc-MAA pulmonary perfusion scintigraphies before and after catheterization of 50 infants with congenital heart disease. 81mKr ventilation scintigraphies were also performed in 41 patients. Both right and left heart catheterization (23 patients) and right heart catheterization (27 patients) were performed by Seldinger's method. Pulmonary perfusion scintigraphies showed new perfusion defects in 6 patients (12%) following catheterization. Of six patients, three had ventilation defects. Clinical characteristics, duration of catheterization, hemodynamic variables were not significantly different between patients with and without lung perfusion defects. The lung perfusion defects seemed to be due to pulmonary embolism following cardiac catheterization.

Adolescent↗