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PubMed2002

Failure of resting echocardiography and cardiac catheterization to identify pulmonary hypertension in two patients with type I Gaucher disease.

Pulmonary hypertension (PHT) is a complication of Gaucher disease. Screening with echocardiography is recommended for Gaucher patients. Two patients naive to enzyme replacement therapy are presented in whom resting echocardiography revealed no evidence of PHT. One of the patients also had normal pulmonary artery pressures at cardiac catheterization. The diagnosis of PHT was made with open lung biopsy in one patient and dobutamine echocardiography in the other. In both cases, diagnosis of PHT altered patient management. Resting echocardiographic assessment may fail to identify PHT in patients with Gaucher disease.

Adult↗
PubMed1999

The assessment of endothelial function in the cardiac catheterization laboratory in patients with risk factors for atherosclerotic coronary artery disease.

In the last 2 decades the endothelium has emerged as an active modulator of many local and systemic functions. The intact endothelium synthesizes and releases a variety of autocrine and paracrine substances that affect cell growth and proliferation, platelet aggregation and adhesion, inflammatory processes, and vascular tone. The aims of the present review are to present the current technique for the assessment of coronary artery endothelial function in the cardiac catheterization laboratory and to describe the current knowledge regarding risk factor modification on endothelial dysfunction.

Animals↗
PubMed2005

Reproducibility and variability of activated clotting time measurements in the cardiac catheterization laboratory.

The objective of this study was to characterize the reproducibility and variability in the measurement to the activated clotting time (ACT) when performed on two different types of instruments, the HemoTec ACT (Medtronic) and the Hemochron 801 (International Technidyne). The ACT has evolved into the most common point-of-care test used in the cardiac catheterization lab to manage patient heparinization. Since the test has not been standardized, different systems frequently produce different results under the same clinical conditions. Duplicate paired ACT tests (n = 885) from 359 patients were performed on both instruments. Prothrombin times (PT) and activated partial thromboplastin times (aPTT) were also determined on subsets of these same samples (PT = 533; aPTT = 487). The performance and relationships between the two tests were determined using a variety of statistical analytical techniques. The average difference between the ACT devices was only 8 sec, yet more than 60% of the measurements varied by more than 10%. Over one-fourth of measurements varied by more than 20%. The reproducibility to the HemoTec instrument was superior to the Hemochron instrument across the entire range of ACTs measured (mean coefficient of variation 2.4% +/- 3.1% vs. 7.2% +/- 6.1% for HemoTec and Hemochron, respectively; P < 0.00001; range = 65-555 sec). The relationship between the two ACTs was nonlinear. In therapeutic ranges used for interventional procedures (200-350 sec), HemoTec and Hemochron ACTs are not comparable to one another. Statistical comparative analysis indicated that the HemoTec ACT has better overall performance.

Adolescent↗
PubMed1997

Mortality related to diagnostic cardiac catheterization. The importance of left main coronary disease and catheter induced trauma.

BACKGROUND: The mortality of diagnostic catheterization is very low but still exists. Large series have documented left main disease as the most important anatomical risk factor but have not clarified the mechanism. OBJECTIVES: To determine the mortality of diagnostic catheterization in a single high volume centre over a 9 year period and assess any change during this period; to compare this experience with that of larger multicentre surveys; to identify the clinical and anatomical risk factors; to investigate the mechanism of the event; to develop guidelines for prevention METHODS: Cardiac catheterization records were reviewed over a 9 year period and patients dying during or within 24 hours were identified. The clinical and anatomical profile of the patients who died were compared with the overall group to search for independent risk factors. The angiograms of the deaths were reviewed for a mechanism. RESULTS: There were 30 deaths in 42,345 procedures (0.071%). There was no change in the incidence over the 9 years. Left main coronary disease was an overwhelming risk factor (incidence 0.7%, p < .002 compared to all other subgroups) and no other anatomical subgroup including triple vessel disease was at greater risk than the overall group. Dissection of the left main coronary artery by the diagnostic catheter was the mechanism of death in 20 cases (67%) CONCLUSIONS: Left main disease and catheter induced trauma are the most important risk factor for and mechanism of death during diagnostic catheterization and may account for the unchanging incidence. Technical guidelines are described which may reduce this risk.

Adult↗
PubMed1992

[Relationship between signal intensity of blood flow in the pulmonary artery obtained by magnetic resonance imaging and results of right cardiac catheterization in patients with pulmonary disease].

Electrocardiogram-gated spin-echo magnetic resonance (MR) images of the chest were obtained in five normal controls and 35 patients with pulmonary disease (11 chronic obstructive pulmonary disease, 6 pulmonary thromboembolism, 5 primary pulmonary hypertension, 4 interstitial pulmonary disease, 4 pulmonary hypertension with disturbance of portal circulation, and 5 other diseases) who underwent right cardiac catheterization. In transverse images at the level of the right main pulmonary artery (rPA) and sagittal images at the level through the midsternal line and the spinal chord, the signal intensity of blood flow in the rPA was quantitatively evaluated, and the correlations with the MR signal intensity of intravascular flow and the parameters of hemodynamics were studied. In diastole MR images of both normal controls and patients mostly showed a significant signal intensity of flowing blood, but in systole some patients demonstrated significant signals and visible flow images. In systolic MR images, the mean values of hemodynamic parameters (mean pulmonary arterial pressure (mPAP), pulmonary arteriolar resistance (PAR), and cardiac index (CI)) were abnormal in patients with significant signal intensity of flow compared with those in patients without sufficient MR signal. The signal intensity was not correlated with mPAP; however, it significantly increased as PAR increased, and it increased as CI decreased both in diastole and in systole. Especially in systole, there was good correlation between the signal intensity in transverse MR images and CI (r = -0.85, P less than 0.01) and between signal intensity in sagittal MR images and PAR (r = 0.90, P less than 0.01). These results suggest that significant flow signal in the rPA in systole has pathophysiological significance, and signal intensity is considered to be significantly affected by changes of PAR and CI. The signal intensity of blood flow in the rPA on MR images can be used as an index of the severity of right heart failure associated with pulmonary disease. MR imaging is a useful modality to evaluate pulmonary circulation disturbance because of its ability to assess blood flow in the pulmonary artery noninvasively without interference from other structures such as bone and normal lung.

Adult↗
PubMed1993

Inventory management for cardiac catheterization labs: the Princeton-Baptist Medical Center experience.

Several issues must be considered for implementation in order to decrease inventories and make them more manageable. Physician consensus on products, strict vendor control by the department manager, setting and maintaining low par levels, inventorying stock daily, negotiating just-in-time deliveries, conservation-minded staff, and working in concert with central supply and materiel management personnel are steps that when employed correctly can lead to more manageable inventories in cardiac catheterization departments. If these steps are implemented, they will enhance the liquidity of the department and ultimately that of the medical center.

Alabama↗
PubMed1993

Seizures due to lidocaine toxicity in a child during cardiac catheterization.

A 17-month-old boy developed grand mal seizures secondary to lidocaine toxicity during balloon dilatation of a congenital pulmonary valve stenosis. Lidocaine at 38 mg/kg (nine times the recommended maximum dose of 4.5 mg/kg) was administered during a 90-min period in order to optimize local anesthesia. This resulted in toxic serum lidocaine levels (8.7 mg/L; therapeutic range, 1.5-5 mg/L) at the time of seizures. Caution should be exercised with local anesthetics during invasive cardiac catheterizations. Hypercarbia (which lowers the seizure threshold to local anesthetics) should be avoided and the temptation to exceed the maximum recommended dose resisted.

Anesthesia, Local↗