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PubMed1998

Case of tumor neovascularization demonstrated by cardiac catheterization.

A 46-year-old man presented to his physician with nonspecific abdominal complaints. CT of the abdomen was obtained to investigate his symptoms, which showed significant pericardial effusion. One week after drainage of the pericardial fluid, his symptoms recurred and a transesophageal echo showed a right atrial tumor. Cardiac catheterization demonstrated right coronary artery neovascularization. A nonresectable primary angiosarcoma was found following median sternotomy and biopsy.

Cardiac Catheterization↗

PubMed1998

Pulsed wave and color Doppler echocardiography and cardiac catheterization findings in bilateral pulmonary vein stenosis.

Pulmonary vein stenosis is a rare condition that usually is congenital in origin; it is almost invariably fatal in its bilateral and severe forms. It is often overlooked, however, during clinical examination, routine echocardiography, and even at cardiac catheterization. This report describes the pulsed Doppler, color flow echocardiography, and hemodynamic findings of bilateral pulmonary vein stenosis that accompany ventricular septal defect and atrial septal defect corrected by surgery.

Adult↗

PubMed1995

The use of echocardiography in pediatric interventional cardiac catheterization procedures.

The last decade saw a dramatic change in the management of congenital heart defects. The introduction and development in echocardiography and Doppler modalities enable definitive diagnosis of congenital lesions without cardiac catheterization. At the same time, new therapeutic procedures for congenital defects using the catheter as a channel for different procedures were developed. These therapeutic procedures have replaced cardiac surgery in many types of defects. The new developments in echocardiography and Doppler modalities provide accurate imaging and visualization of the transcatheter devices and brought these two imaging modalities into a close marriage. The use of echocardiography and Doppler in the catheterization laboratory became a must, especially when used in atrial (ASD) and ventricular septal defect (VSD) closure. In this article we will detail the role of echocardiography in the different transcatheter interventional procedures in the catheterization laboratory. Those include atrial septostomy, blade atrial septectomy, balloon dilation, ASD closure, VSD closure, patent ductus anterior closure, and pericardiocentesis.

Cardiac Catheterization↗

PubMed1983

The prognosis for patients with new-onset angina who have undergone cardiac catheterization.

We investigated the prognostic significance of new-onset angina in patients in whom coronary anatomic characteristics were known. New onset angina was defined as angina of less than 3 months duration. Consecutive patients (n = 1727) with significant coronary artery disease (diagnosed at cardiac catheterization) and who had not had a prior myocardial infarction or congestive heart failure were studied. In patients with new-onset angina (n = 329) there was a higher incidence of single-vessel disease (43% vs 27%) and a lower incidence of triple-vessel (23% vs 35%) and left main artery (5% vs 10%) disease compared with patients with chronic angina (n = 1398). Patients were classified by the presence or absence of preinfarction angina (severe and prolonged angina at rest requiring hospitalization to rule out myocardial infarction). In patients treated without surgery and who did not have preinfarction angina, survival at 1 year was 97% for patients with new-onset angina and 98% for those with chronic angina (p = .27). Among patients not treated surgically who did not have preinfarction angina, at 1 year 16% with new-onset angina and 7% with chronic angina had suffered a cardiac event (nonfatal myocardial infarction or death, p = .006). In patients treated surgically who did not have preinfarction angina, survival at 1 year was 96% both for those with new-onset angina and those with chronic angina (p = .99). The risk of an event in patients treated surgically at 1 year was not statistically different in patients with new-onset angina and those with chronic angina (12% vs 11%, p = .27). Survival and event-free rates were lower in patients with preinfarction angina than in patients who did not have it.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed2005

Magnetic resonance imaging changes in a patient with migraine attack and transient global amnesia after cardiac catheterization.

The presence of magnetic resonance imaging (MRI) abnormalities in patients with transient global amnesia has been an interesting phenomenologic finding. Several theories surround the occurrence of this syndrome, but little is known about its true physiopathology. We present a case of transient global amnesia after cardiac catheterization associated with migraine headache and MRI changes compatible with an ischemic insult. A discussion on potential explanations for this finding is made, as well as a review of the pertinent literature.

Amnesia, Transient Global↗

PubMed2001

Evaluation of CoaguChek Pro ACT in cardiac catheterization laboratory.

The objective of this study was to assess the analytical performance of CoaguChek Pro ACT assay versus Hemochron Celite ACT assay concerning activated clotting time (ACT) values and the correlations versus heparin. Enrolled were 158 patients and 101 normal subjects from five cardiac catheterization laboratories (cathlabs). Two different CoaguChek Pro ACT lots were compared to different lots of Hemochron Celite ACT. All sites used arterial blood and one site also used venous blood. Determinations were carried out before and directly after heparinization, and 1-4 h later. Besides the ACT values, hematocrit, platelet counts and factor Xa levels were also determined. The correlations between the Hemochron Celite lots and the two different CoaguChek Pro lots for arterial and venous blood for all sites were good (r=0.88 and 0.84). The agreement between both CoaguChek Pro ACT lots was excellent (r=0.99). The correlations between heparin and CoaguChek Pro ACT were similar to those for the Hemochron Celite lots. There was no influence of the hematocrit and the platelets. The imprecision of the method was very good (CV<6%). This demonstrates that the CoaguChek Pro ACT assay is especially useful for monitoring heparin in cathlabs.

Cardiac Catheterization↗

PubMed2001

Use of fenoldopam for prevention of radiocontrast nephropathy in the cardiac catheterization laboratory: a case series.

Many of the longstanding challenges in interventional cardiology, such as restenosis and thrombosis, have been met. However, radiocontrast-induced nephropathy (RCN) continues to be problematic, particularly as the population of patients who are diagnosed and treated for vascular occlusions in the cardiac catheterization laboratory have become increasingly older and more complex. Introduction of nonionic contrast media has not eliminated this problem. We present the cases of four high risk patients whom we treated with a newly available renal vasodilator, fenoldopam, as a strategy to prevent RCN and its associated morbidity and mortality.

Aged↗

PubMed1998

Factors associated with atrial fibrillation in patients with mitral stenosis: a cardiac catheterization study.

Atrial fibrillation (AF) is frequently found in association with rheumatic mitral valve disease. To study the interrelation of factors contributing to the risk of AF in patients with mitral stenosis, we examined a cardiac catheterization database of a series of 314 patients. Patients with AF were older, 53.4 +/- 6.1 years versus 51.7 +/- 7.2 years (p = 0.03), and had a lower cardiac index, 2.3 +/- 0.6 L/min/m2 versus 2.6 +/- 0.7 L/min/m2 (p = 0.0002), than patients in sinus rhythm at catheterization. The mitral valve area was significantly smaller in patients with AF than in patients in sinus rhythm, 1.2 +/- 0.5 cm2 versus 1.6 +/- 0.7 cm2 (odds ratio 1.40/0.25 cm2 decrease; p = 0.0001) as was mitral valve index. The pressure-AF association with the highest statistical significance was seen with mean right atrial pressure, 10.6 +/- 4.9 mm Hg versus 7.6 +/- 3.8 mm Hg (odds ratio 2.24; p < 0.0001). Other variables with significant positive associations by univariate analysis were pulmonary artery wedge pressure, pulmonary artery mean pressure, and pulmonary resistance. When stepwise logistic multiple regression analysis was performed, the results indicated that both severity of mitral stenosis and increased right atrial pressure were independently associated with AF in this population with mitral stenosis. After adjustment was performed for these variables, age was not independently associated with AF.

Adult↗

PubMed1990

Brachial approach to emergency cardiac catheterization during thrombolytic therapy for acute myocardial infarction. TAMI Study Group.

The use of the brachial approach to acute coronary intervention has not been previously studied. In the course of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials, we used the transbrachial approach to cardiac catheterization with or without angioplasty in 202 of 704 (28.6%) patients. The baseline characteristics of age, sex, risk factors, medical history, time from symptom onset to therapy, and left ventricular function were similar for the 2 different approaches. Time from therapy to coronary angiography was not delayed by the brachial approach compared with the femoral approach: 97.1 +/- 26 min vs. 99.9 +/- 133.8 min, respectively. Chemical patency was established in 78 vs. 73% of patients and technical success with acute PTCA with the brachial approach was 89% vs. 78% with the femoral approach. Clinical outcomes were quite similar with respect to death (6 vs. 6%), reocclusion (10 vs. 14%), and emergency coronary bypass surgery (5 vs. 6%). Baseline hematocrit was 43.9 +/- 4.4 and 43.5 +/- 4.8, respectively with a nadir of 32.9 +/- 5.6 vs. 33.0 +/- 5.4. The need for vascular repair occurred in 1% vs. 3% of patients and retroperitoneal hemorrhage was documented in 1% vs. 1% of patients. This study indicates that in the hands of experienced operators the transbrachial approach to acute coronary intervention in the acute phase of treatment with thrombolytic therapy can be used with equal risks and efficacy as the femoral approach.

Aged↗

PubMed1991

Reduction in injection pain using buffered lidocaine as a local anesthetic before cardiac catheterization.

Previous reports have suggested that pain associated with the injection of lidocaine is related to the acidic pH of the solution. To determine if the addition of a buffering solution to adjust the pH of lidocaine into the physiologic range would reduce pain during injection, we performed a blinded randomized study in patients undergoing cardiac catheterization. Twenty patients were asked to quantify the severity of pain after receiving standard lidocaine in one femoral area and buffered lidocaine in the opposite femoral area. The mean pain score for buffered lidocaine was significantly lower than the mean score for standard lidocaine (2.7 +/- 1.9 vs. 3.8 +/- 2.2, P = 0.03). The pH adjustment of standard lidocaine can be accomplished easily in the catheterization laboratory before injection and results in a reduction of the pain occurring during the infiltration of tissues.

Anesthesia, Local↗

PubMed2003

Prevalence of renovascular abnormality in patients undergoing cardiac catheterization.

OBJECTIVE: To determine the prevalence of renal artery disease and to correlate the underlying risk factors like age, sex, diabetes, hypertension, urea and creatinine in patients who have undergone angiogram for cardiovascular diseases. METHODS: Retrospective analysis of the reports of angiogram of patients who have undergone cardiac catheterization in Vijaya Heart Foundation for cardiovascular diseases. RESULTS: The prevalence of renovascular stenosis is 12.4%. Prevalence of hypertension and diabetes in the group of patients with renovascular stenosis compared with group having coronary artery disease is not statistically significant (p > 0.8). Univariate and multivariate logistic identified age, diabetes, hypertension and urea as independent predicators of renal artery stenosis; while variables like sex and serum creatinine were not associated. CONCLUSION: High prevalence of unsuspected renovascular abnormalities is found in patients who undergo angiography for cardiovascular disease. Factors like age, diabetes, hypertension and urea could be clinical predicators of renal artery stenosis. Hence renal arteries should be visualized routinely in patients undergoing coronary angiogram for cardiovascular disease.

Adolescent↗

PubMed2006

Propensity score analysis of vascular complications after diagnostic cardiac catheterization and percutaneous coronary intervention 1998-2003.

OBJECTIVES: To evaluate the adjusted risk of vascular complications after manual compression and vascular closure devices for femoral artery access site management in a large contemporary cohort, using propensity score analysis. BACKGROUND: Vascular closure devices (VCD) allow early ambulation after cardiac procedures involving femoral artery access, but whether the benefit of use of vascular closure devices (VCD) is offset by reduced safety in contemporary practice remains uncertain. METHODS: Twenty one thousand eight hundred and forty one consecutive diagnostic cardiac catheterization (n = 13,124) and percutaneous coronary intervention procedures (n = 8,717) performed via a femoral access at a single site (WFUBMC) between 1998 and 2003 were evaluated. VCD's were used based on operator preference. Propensity to receive a vascular closure device (VCD) was calculated. The relative incidence of vascular complications was evaluated by logistic regression models, using the propensity score as a covariate. RESULTS: Overall, the unadjusted incidence of any vascular complication was 1.3% for VCD use and 1.4% for manual compression, p = NS. The propensity score-adjusted odds ratio for any vascular complication comparing VCD (n = 8,707) to manual compression (n = 13,034) was 0.86 (0.67-1.11) for all procedures, 0.80 (0.53-1.21) for diagnostic procedure, and 0.90 (0.65-1.26) for interventional procedures. CONCLUSIONS: In this large single-center, contemporary observational study, the risk-adjusted occurrence of vascular complications following VCD use for femoral artery access management is not increased by VCD use. Thus, in the current era, the benefit of VCD use is not offset by reduced safety.

Aged↗

PubMed1985

Validation in dogs of a rapid digital angiographic technique to measure relative coronary blood flow during routine cardiac catheterization.

Assessment of the functional significance of anatomically defined coronary stenoses has been hampered by the lack of clinically applicable techniques of measuring coronary blood flow or flow ratios. A digital angiographic technique is reported that allows rapid analysis of relative regional coronary blood flow during routine cardiac catheterization. This technique was validated in dogs by comparing digital flow ratio estimates with electromagnetic-flow (EMF) ratio measurements. Fourteen open-chest dogs had EMF probes placed on the proximal left anterior descending artery before selective coronary angiography. Electrocardiographically gated images were acquired directly by a digital radiographic system during both baseline blood flow and either contrast or papaverine-induced hyperemia. Dual-parameter functional images were generated using color and intensity coding to represent contrast arrival time and contrast density, respectively. For analysis, myocardial areas of interest were created over the distal perfusion bed of the left anterior descending coronary artery. Mean contrast density/appearance time (CD/AT) values were computer calculated as the mean density divided by the mean arrival time for each. Coronary flow reserve was determined as the ratio of the CD/AT value for a hyperemic image divided by the CD/AT value for the corresponding baseline image. CD/AT ratios correlated well (r = 0.92) with actual EMF ratios (CD/AT Ratio = 0.90 EMF Ratio +0.12, n = 48 ratios). Reproducibility was +/- 13%. Interobserver (r = 0.99) and intraobserver (r = 0.98) variability was excellent. Thus, rapid, accurate and reproducible estimates of relative regional coronary blood flow are possible using digital radiography.

Animals↗

PubMedDate not supplied

Comparison of analgesic/sedative effect of racemic ketamine and S(+)-ketamine during cardiac catheterization in newborns and children.

The hypnotic and analgesic effect of ketamine with maintained spontaneous breathing is used for analgesic/sedative anesthesia without the need of intubation. The intention of this study was to compare the efficacy and side effects of racemic ketamine and its enantiomer S(+)-ketamine during cardiac catheterization in newborns and children. One hundred children (ages 0-11 years) were randomly assigned to groups of equal size. The differences between the racemic ketamine/midazolam and the S(+)-ketamine/midazolam groups were investigated regarding the total dosage of sedative drugs, side effects, and the awakening period. The dosage of S(+)-ketamine (2.28 mg/kg/h) was significantly lower than that needed for racemic ketamine (3.12 mg/kg/h) (p = 0.037) with an analgesic/sedative potency ratio of 1.4:1. Balloon dilatation required significantly higher dosages in both groups (p = 0.043). Significantly more patients were excluded because of ineffective analgesia/sedation or severe side effects in the racemic ketamine group. The awakening period did not show significant differences between the two groups. S(+)-ketamine proved to be a more efficient analgesic/sedative drug in newborns and children. It was shown to be useful in diagnostic and interventional procedures and allows spontaneous breathing. Moderate side effects occurred in both groups; severe side effects seemed to occur more often with the racemic solution.

Analgesics↗

PubMed1978

A conductive catheter to improve patient safety during cardiac catheterization.

A 60 Hz current, as small as 20 microamperemeter (rms) is capable of causing ventricular fibrillation when directly applied to the heart. Significant cost and engineering effort has been spent to construct monitoring equipment which satisfies the safety regulations requiring maximum leakage currents below this value. Patients undergoing cardiac catheterization are particularly at risk from electrical hazards, primarily because catheters are made from nonconductive materials. A conductive catheter should allow externally applied currents to leak through its walls before reaching the catheter tip. A new electrically conductive catheter was compared with a standard nonconductive catheter. Five dogs were studied, with 81 attempts to cause fibrillation. Sixty-hertz voltage between the catheter and an external electrode was increased until fibrillation occurred or 130 V was reached. Eight states were studied in randomized sequence: conductive or nonconductive catheter, guidewire or saline-filled and tip touching wall, or free in left ventricle (verified by fluoroscopy and cineangiography). The saline-filled and conductive catheter was safer in that fibrillation never occurred, while fibrillation nearly always occurred with the nonconductive catheter. A conductive guidewire negates the protection of the conductive catheter. The application of conductive catheters could reduce instrumentation costs in laboratories and intensive care units and improve patient safety.

Animals↗

PubMed2001

[Early deambulation following cardiac catheterization by the use of 6 Fr Angio-Seal, a new hemostatic percutaneous puncture closure device].

INTRODUCTION AND OBJECTIVES: Efficacy of the hemostatic puncture closure 8 Fr Angio-Seal device for percutaneous puncture closure after a catheterism has been previously demonstrated, but the experience provided has been obtained with 8 Fr devices. At present the device has been modified and its size reduced to 6 Fr. In this pilot study we evaluate the efficacy of the new hemostatic 6 Fr Angio-Seal device and its safety when early deambulation post-diagnostic and/or therapeutic catheterization is established. PATIENTS AND METHODS: Prospective study of 150 consecutive patients randomized either for application of the 6 Fr Angio-Seal device (group A; n = 75), in which early ambulation was indicated, or manual compression (group B; n = 75), with ambulation 12 h after cardiac catheterization. Basal data, including clinical and angiographic characteristics and previous treatment with heparin and platelet aggregation inhibitors were similar in both groups. RESULTS: The time of hemostasia was significantly shorter in group A than in group B (118 +/- 210 s in A vs 1320 +/- 370 s in B; p (3/4) 0,001), and with early ambulation (3,1 +/- 0,4 h in A vs 12,3 +/- 3,1 h in B; p (3/4) 0,001) no local complications were observed. CONCLUSIONS: The 6 Fr Angio-Seal hemostatic device diminished the hemostasia time and early ambulation could be achieved. In this pilot study no complications due to early movilization were observed, but the safety of the new hemostatic device after diagnostic or therapeutic catheterizations needs to be evaluated in greater series.

Absorbable Implants↗

PubMed1993

Guidelines for personnel radiation monitoring in the cardiac catheterization laboratory. Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions.

The Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions has devised guidelines to inform catheterization laboratory personnel about appropriate radiation monitoring and protection. A personal monitoring dosimeter must be placed over any radiation protective garments on the collar near the thyroid. A second dosimeter, worn at the waist level under any radiation protective garments, is mandatory for any declared pregnant workers exposed to radiation. This dosimeter is recommended, but not required, for all personnel in the catheterization laboratory. The limit for whole body radiation exposure is stated in terms of the effective dose equivalent (EDE). Different formulas are used for calculating the EDE, depending on the number of dosimeters worn simultaneously by the individual. Finger dosimeters should be worn by personnel whose hands are likely to be directly exposed to the x-ray beam. Initial and periodic training in radiation protection is a part of good laboratory practice.

Cardiac Catheterization↗

PubMed1993

Hemodynamic status in repaired tetralogy of Fallot assessed by Doppler echocardiography and cardiac catheterization. Comparisons with healthy subjects and elucidation of factors associated with cardiorespiratory function.

Thirty-four patients were studied after corrective surgery for tetralogy of Fallot (mean follow-up 10 years) and compared with healthy matched controls. All underwent Doppler echocardiography, spirometry and treadmill exercise test. Post-operative cardiac catheterization had been performed on 26 (76%) of the patients and showed poor hemodynamic results in four (15%). Significant correlations of pressure gradients obtained from catheterization and estimated by Doppler echocardiography were right ventricular to right atrial (r = 0.77), pulmonary outflow (r = 0.75), pure valvular pulmonary outflow (r = 0.94) and diastolic pulmonary pressure gradients (r = 0.53). Pulmonary outflow gradients and right ventricular to right atrial pressure gradients estimated from tricuspid regurgitation jets were significantly increased in the patients. Diastolic pulmonary artery pressure, vital capacity and ventilatory anaerobic threshold were independent factors of maximal oxygen consumption. It is suggested that Doppler-derived diastolic pulmonary artery pressure, lung function studies and exercise testing with assessment of the ventilatory anaerobic threshold should be included in follow-up after repair of Fallot's tetralogy.

Adolescent↗