Science.gov

Sample records for cardiac catheterization techniques

  1. Cardiac catheterization

    MedlinePlus

    Catheterization - cardiac; Heart catheterization; Angina - cardiac catheterization; CAD - cardiac catheterization; Coronary artery disease - cardiac catheterization; Heart valve - cardiac catheterization; Heart failure - ...

  2. Cardiac catheterization - discharge

    MedlinePlus

    Catheterization - cardiac - discharge; Heart catheterization - discharge: Catheterization - cardiac; Heart catheterization; Angina - cardiac catheterization discharge; CAD - cardiac catheterization discharge; Coronary artery disease - cardiac catheterization ...

  3. What Is Cardiac Catheterization?

    MedlinePlus

    ... of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & ... arteries is called coronary heart disease (CHD) or coronary artery disease. Doctors also can use ultrasound during cardiac catheterization ...

  4. Cardiac Catheterization (For Kids)

    MedlinePlus

    ... done during a cardiac catheterization include: closing small holes inside the heart repairing leaky or narrow heart ... bandage. It's normal for the site to be black and blue, red, or slightly swollen for a ...

  5. Cardiac Catheterization (For Teens)

    MedlinePlus

    ... a person will have only a small puncture hole where the catheter was put in. Doctors usually ... done using a cardiac catheterization, including: closing small holes inside the heart repairing leaky or narrow heart ...

  6. The history of cardiac catheterization.

    PubMed

    Bourassa, Martial G

    2005-10-01

    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.

  7. The ALARA concept in pediatric cardiac catheterization: techniques and tactics for managing radiation dose.

    PubMed

    Justino, Henri

    2006-09-01

    The cardiac catheterization laboratory plays an important role in the management of children with congenital heart disease by not only enabling diagnosis but, in many cases, providing definitive therapy. The goal of the ALARA (As Low as Reasonably Achievable) concept as it applies to cardiac catheterization is to provide maximal diagnostic and therapeutic benefit while requiring the lowest possible radiation dose. A number of specific challenges unique to the setting of pediatric cardiac catheterization, such as higher heart rates, smaller cardiovascular structures, smaller body size, and wider variety of unusual anatomic variants with the potential need for relatively lengthy and complex studies, result in relatively high radiation doses (to the patient and, consequently, to laboratory personnel). In addition, the improved survival of patients with complex anatomy (e.g., palliated single ventricle anatomies) implies that many such children with chronic cardiac disease require frequent catheterizations within the first few years of life. These factors, coupled with the increased radiosensitivity of children and a longer lifespan ahead of them in which to possibly develop radiation-related sequelae, converge to create potentially ominous consequences. Attention to basic rules of radiation safety is, therefore, of tremendous importance in the pediatric cardiac catheterization laboratory. This review focuses on the importance of adequate planning of the study, optimizing image formation, management of fluoroscopy and cine angiography parameters, and the use of certain equipment features that might allow the cardiologist to lower the radiation dose without sacrificing image quality.

  8. Anomalous Coronary Arteries and Myocardial Bridges: Risk Stratification in Children Using Novel Cardiac Catheterization Techniques.

    PubMed

    Agrawal, Hitesh; Molossi, Silvana; Alam, Mahboob; Sexson-Tejtel, S Kristen; Mery, Carlos M; McKenzie, E Dean; Fraser, Charles D; Qureshi, Athar M

    2017-03-01

    The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children's Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions. Out of the 131 patients followed by the CAP between 12/12-4/16, 8 (6%) patients underwent 9 cath investigations at median age 13.1 (2.6-18.7) years and median weight 49.5 (11.4-142.7) kg. Six patients presented with cardiac signs/symptoms. Four patients had myocardial bridges of the left anterior descending (LAD) coronary artery, 2 patients had isolated AAOCA, and 2 patients had an anomalous left coronary artery (LCA) with an intramyocardial course of the LAD. SCA was performed in all patients. FFR was positive in 4/6 patients: IVUS showed >70% intraluminal narrowing in 3/5 patients. One patient had hemodynamic instability that reversed with catheter removal from the coronary ostium. Based on the catheterization data obtained, findings were reassuring in three patients, surgery was performed in three patients, and two patients are being medically managed/restricted from competitive sports. In our small cohort of patients, we demonstrated that IVUS and FFR can safely be performed in children and may help to risk stratify some patients with AAOCA and myocardial bridges.

  9. [Interventional cardiac catheterization in congenital heart disease].

    PubMed

    Godart, François; Houeijeh, Ali

    2017-05-01

    Interventional cardiac catheterization has a major place in the management of congenital heart disease. Since the Rashkind atrioseptostomy in mid-1960s, many techniques have been developed. For some, it is necessary to close a cardiac or extracardiac shunt using occluder (double disc system, plug, coil…): closure of atrial septal defect, ventricular septal defect or patent arterial duct. For others, it is necessary to treat a valvular or vascular stenosis using a balloon catheter: dilatation of the pulmonary or the aortic valve, dilatation of aortic coarctation. For vascular stenosis, balloon angioplasty may be associated with stent implantation. Moreover, since more than 10 years, valve implantation can be performed: initially for pulmonic valve (the Melody™ valve from Medtronic or the Sapien™ valve from Edwards Lifesciences); but probably, most of the valves in the future could be implanted using appropriate tools and hybrid techniques combining cardiac catheterization and surgery. All these techniques were developed because of progress in fluoroscopy, and more recently association of different imaging techniques (echocardiography, MRI and CT) provides more information about the true anatomy. Interventional cardiac catheterization will continue to increase with use of new tools as 3D printing, tissue engineering and nano-techniques. It seems that from correction with open-heart surgery, many lesions could be repaired in future by hybrid techniques without opening the heart. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. What to Expect during Cardiac Catheterization

    MedlinePlus

    ... education Cardiac catheterization is a test during which flexible tubes called catheters are inserted into the heart ... from excess x-rays; and D, video display screens, used to review the x-ray images. Once ...

  11. [Iatrogenic vascular lesions after cardiac catheterization].

    PubMed

    Manuel-Rimbau, E; Lozano, P; Gómez, A; Bethencourt, A; Gómez, F T

    1998-09-01

    The increase in vascular complications after cardiac catheterizations is rising due to the increase in the total number of these procedures. The purpose of this report is to determine the incidence of this complication and to identify the variables which are related to the presence of vascular complications which required surgical repair. Retrospective review of the 3,723 cardiac catheterizations made by the interventional cardiology department during a period between June 1992 to August 1996. Thirty two vascular complications were detected (0.9%), which required surgical reparation. There was no statistical difference in age, sex, presence of vascular risk factors, cardiac indication for catheterization and vascular approach between those patients who had a vascular complication and those who did not. The presence of obesity [RR: 2.5, IC 95% (1.2-5)], use of catheter sheath, superior or equal to 8F [RR: 0.3, IC 95% (0.14-0.62)] and use of systemic anticoagulation [RR: 4.8, IC 95% (2.1-10.8)], increase the risk of vascular complications. Two patients died (6.2%) due to cardiac complications and there were minor complications in 23% after surgical repair. Vascular complications after cardiac catheterization continue to be a significant problem. There are several variables which influence the presentation of vascular complications. Continued surveillance of cardiac catheterization complications is necessary to minimize problems and improve results.

  12. Cardiac catheterization in the early post-operative period after congenital cardiac surgery.

    PubMed

    Nicholson, George T; Kim, Dennis W; Vincent, Robert N; Kogon, Brian E; Miller, Bruce E; Petit, Christopher J

    2014-12-01

    This study sought to demonstrate that early cardiac catheterization, whether used solely as a diagnostic modality or for the use of transcatheter interventional techniques, can be used effectively and with an acceptable risk in the post-operative period. Cardiac catheterization offers important treatment for patients with congenital heart disease. Early post-operative cardiac catheterization is often necessary to diagnose and treat residual anatomic defects. Experience with interventional catheterization to address post-operative concerns is limited. This was a retrospective cohort study. The medical and catheterization data of pediatric patients who underwent a cardiac catheterization ≤30 days after congenital heart surgery between November 2004 and July 2013 were reviewed. Patients who underwent right heart catheterization and endomyocardial biopsy after heart transplantation were excluded. A total of 219 catheterizations (91 interventional procedures, 128 noninterventional catheterizations) were performed on 193 patients. Sixty-five interventions (71.43%) were dilations, either balloon angioplasty or stent implantation. There was no difference in survival to hospital discharge between those who underwent an interventional versus noninterventional catheterization (p = 0.93). One-year post-operative survival was comparable between those who underwent an intervention (66%) versus diagnostic (71%) catheterization (p = 0.58). There was no difference in the incidence of major or minor complications between the interventional and diagnostic catheterization cohorts (p = 0.21). Cardiac catheterization, including transcatheter interventions, can be performed safely in the immediate post-operative period after congenital heart surgery. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Cardiac catheterization is underutilized after in-hospital cardiac arrest.

    PubMed

    Merchant, Raina M; Abella, Benjamin S; Khan, Monica; Huang, Kuang-Ning; Beiser, David G; Neumar, Robert W; Carr, Brendan G; Becker, Lance B; Vanden Hoek, Terry L

    2008-12-01

    Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival. Using a billing database we retrospectively identified cases with an ICD-9 code of cardiac arrest (427.5) or VF (427.41). Discharge summaries were reviewed to identify in-hospital VF arrests. Rates of catheterization on the day of arrest were determined by identifying billing charges. Unadjusted analyses were performed using Chi-square, and adjusted analyses were performed using logistic regression. One hundred and ten in-hospital VF arrest survivors were included in the analysis. Cardiac catheterization was performed immediately or within 1 day of arrest in 27% (30/110) of patients and of these patients, 57% (17/30) successfully received percutaneous coronary intervention. Of those who received cardiac catheterization the indication for the procedure was STEMI or new left bundle branch block (LBBB) in 43% (13/30). Therefore, in the absence of standard ECG data suggesting acute myocardial infarction, 57% (17/30) received angiography. Patients receiving cardiac catheterization were more likely to survive than those who did not receive catheterization (80% vs. 54%, p<.05). In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI or new LBBB. Cardiac catheterization was associated with improved survival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization.

  14. Cardiac catheterization laboratory imaging quality assurance program.

    PubMed

    Wondrow, M A; Laskey, W K; Hildner, F J; Cusma, J; Holmes, D R

    2001-01-01

    With the recent approval of the National Electrical Manufacturers Association (NEMA) standard for "Characteristics of and Test Procedures for a Phantom to Benchmark Cardiac Fluoroscopic and Photographic Performance," comprehensive cardiac image assurance control programs are now possible. This standard was developed by a joint NEMA/Society for Cardiac Angiography and Interventions (SCA&I) working group of imaging manufacturers and cardiology society professionals over the past 4 years. This article details a cardiac catheterization laboratory image quality assurance and control program that includes the new standard along with current regulatory requirements for cardiac imaging. Because of the recent proliferation of digital imaging equipment, quality assurance for cardiac imaging fluoroscopy and digital imaging are critical. Included are the previous works recommended by the American College of Cardiology (ACC) and American Heart Association (AHA), Society for Cardiac Angiographers and Interventions (SCA&I), and authors of previous image quality subjects.

  15. Video x-ray progressive scanning: new technique for decreasing x-ray exposure without decreasing image quality during cardiac catheterization

    SciTech Connect

    Holmes, D.R. Jr.; Bove, A.A.; Wondrow, M.A.; Gray, J.E.

    1986-05-01

    A newly developed video x-ray progressive scanning system improves image quality, decreases radiation exposure, and can be added to any pulsed fluoroscopic x-ray system using a video display without major system modifications. With use of progressive video scanning, the radiation entrance exposure rate measured with a vascular phantom was decreased by 32 to 53% in comparison with a conventional fluoroscopic x-ray system. In addition to this substantial decrease in radiation exposure, the quality of the image was improved because of less motion blur and artifact. Progressive video scanning has the potential for widespread application to all pulsed fluoroscopic x-ray systems. Use of this technique should make cardiac catheterization procedures and all other fluoroscopic procedures safer for the patient and the involved medical and paramedical staff.

  16. Radiation dosage during pediatric diagnostic or interventional cardiac catheterizations using the "air gap technique" and an aggressive "as low as reasonably achievable" radiation reduction protocol in patients weighing <20 kg.

    PubMed

    Osei, Frank A; Hayman, Joshua; Sutton, Nicole J; Pass, Robert H

    2016-01-01

    Cardiac catheterizations expose both the patient and staff to the risks of ionizing radiation. Studies using the "air gap" technique (AGT) in various radiological procedures indicate that its use leads to reduction in radiation exposure but there are no data on its use for pediatric cardiac catheterization. The aim of this study was to retrospectively review the radiation exposure data for children weighing <20 kg during cardiac catheterizations using AGT and an "as low as reasonably achievable (ALARA)" radiation reduction protocol. All patients weighing <20 kg who underwent cardiac catheterization at the Children's Hospital at Montefiore (CHAM), New York, the United States from 05/2011 to 10/2013 were included. Transplant patients who underwent routine endomyocardial biopsy and those who had surgical procedures at the time of the catheterizations were excluded. The ALARA protocol was used in concert with AGT with the flat panel detector positioned 110 cm from the patient. Demographics, procedural data, and patient radiation exposure levels were collected and analyzed. One-hundred and twenty-seven patients underwent 151 procedures within the study period. The median age was 1.2 years (range: 1 day to 7.9 years) and median weight was 8.8 kg (range: 1.9-19.7). Eighty-nine (59%) of the procedures were interventional. The median total fluoro time was 13 min [interquartile range (IQR) 7.3-21.8]. The median total air Kerma (K) product was 55.6 mGy (IQR 17.6-94.2) and dose area product (DAP) was 189 Gym2 (IQR 62.6-425.5). Use of a novel ALARA and AGT protocol for cardiac catheterizations in children markedly reduced radiation exposure to levels far below recently reported values. AGT: Air gap technique, ALARA: As low as reasonably achievable.

  17. Iatrogenic Claudication from a Vascular Closure Device after Cardiac Catheterization

    PubMed Central

    Hermann, Luke; Chow, Evelyn; Duvall, W. Lane

    2010-01-01

    We report a case of iatrogenic claudication as a result of a misplaced percutaneous arterial closure device (PACD) used to obtain hemostasis after cardiac catheterization. The patient presented one week after his procedure with complaints suggestive of right lower extremity claudication. Computed tomographic angiography demonstrated a near total occlusion of the right common femoral artery from a PACD implemented during the cardiac catheterization. The use of PACD’s to obtain rapid hemostasis is estimated to occur in half of all cardiac catheterizations. Ischemic complications as a result of these devices must be considered when evaluating post procedural patients with extremity complaints. PMID:21293776

  18. Radiation Dose Estimation for Pediatric Patients Undergoing Cardiac Catheterization

    NASA Astrophysics Data System (ADS)

    Wang, Chu

    correction factors for the MOSFET organ dose measurements in the following studies. Minor angular dependence (< +/-20% at all angles tested, < +/-10% at clinically relevant angles in cardiac catheterization) was observed. Second, the cardiac dose for common fluoroscopic imaging techniques for pediatric patients in the two age groups was measured. Imaging technique settings with variations of individual key imaging parameters were tested to observe the quantitative effect of imaging optimization or lack thereof. Along with each measurement, the two standard system output indices, the Air Kerma (AK) and Dose-Area Product (DAP), were also recorded and compared to the measured cardiac and skin doses -- the lack of correlation between the indices and the organ doses shed light to the substantial limitation of the indices in representing patient radiation dose, at least within the scope of this dissertation. Third, the effective dose (ED) for Posterior-Anterior and Lateral fluoroscopic imaging techniques for pediatric patients in the two age groups was determined. In addition, the dosimetric effect of removing the anti-scatter grid was studied, for which a factor-of-two ED rate reduction was observed for the imaging techniques. The Clinical Component involved analytical research to develop a validated retrospective cardiac dose reconstruction formulation and to propose the new Optimization Index which evaluates the level of optimization of the clinician's imaging usage during a procedure; and small sample group of actual procedures were used to demonstrate applicability of these formulations. In its entirety, the research represents a first-of-its-kind comprehensive approach in radiation dosimetry for pediatric cardiac catheterization; and separately, it is also modular enough that each individual section can serve as study templates for small-scale dosimetric studies of similar purposes. The data collected and algorithmic formulations developed can be of use in areas of

  19. Superselective catheterization technique in hepatic angiography

    SciTech Connect

    Chuang, V.P.; Soo, C.S.; Carrasco, C.H.; Wallace, S.

    1983-10-01

    The techniques for superselective catheterization of hepatic artery are described. The catheters have five major configurations in various sizes: (1) simple curve, (2) reverse curve, (3) double curve, (4) modified double curve, and (5) hepatic and splenic curves. Since the celiac artery may be directed caudad, horizontally, or cephalad, the techniques vary accordingly. The basic approach of the system described is to tailor the catheter to fit the vascular anatomy. These various techniques have produced a 95% success rate in the hepatic artery catheterization of 1000 patients.

  20. Radiation dose to the pediatric cardiac catheterization and intervention patient.

    PubMed

    Chida, Koichi; Ohno, Tadayuki; Kakizaki, Shuhei; Takegawa, Mika; Yuuki, Hiroko; Nakada, Mitsuru; Takahashi, Shoki; Zuguchi, Masayuki

    2010-11-01

    The radiation dose from cardiac catheterization is particularly relevant when treating children because of their greater radiosensitivity compared with adults. Moreover, cardiac catheterization is being used increasingly for interventional radiology procedures, possibly resulting in higher patient radiation doses. This article reports the radiation doses and related factors, such as fluoroscopy time, for children who underwent cardiac catheterization and children who underwent other interventional radiology procedures. We evaluated 239 consecutive patients who underwent cardiac catheterization (n = 205) or another interventional radiology procedure (n = 34) for which the dose-area product (DAP) was measured. The number of cine runs and fluoroscopic time for each procedure and the body mass index and body weight of each patient were recorded. We also used the double product combined with body weight, which is the weight- fluoroscopic time product. The average DAP ± SD of cardiac catheterization and of an interventional radiology procedure was 1,702.6 ± 2,110.1 cGy × cm² and 2,242.2 ± 2,509.4 cGy × cm², respectively. The average fluoroscopic time ± SD of cardiac catheterization and of an interventional radiology procedure was 24.1 ± 16.8 minutes and 37.2 ± 20.0 minutes. For children who underwent cardiac catheterization and those who underwent an interventional radiology procedure, a strong correlation was seen between the DAP and weight-fluoroscopic time product (cardiac catheterization, r = 0.906; interventional radiology procedure, r = 0.885) and a good correlation was detected between the DAP and weight (r = 0.819 and 0.895, respectively). There was a good correlation between the DAP and weight and between DAP and weight-fluoroscopic time product for children who underwent cardiac catheterization or an interventional radiology procedure. Therefore, body weight is important for determining radiation dose to children undergoing cardiac catheterization or

  1. Patient radiation exposure during pediatric cardiac catheterization

    SciTech Connect

    Fellows, K.E.; Leibovic, S.J.

    1983-08-01

    Exposure air product (EAP) and center field entrance exposure (free-in-air) were measured in seventeen pediatric patients undergoing cardiac catheterization. Exposures were recorded separately for biplane fluoroscopy and cine angiocardiography using flat-plate ionization chambers. In the posterior-anterior (PA) projections, median EAP was 425 Roentgen-square centimeter (R-cm/sup 2/), with a range of 90.5-3,882 R-cm/sup 2/; 29-35% of this exposure occurred during cine filming. In the lateral projection, median EAP was 276 R-cm/sup 2/ (range 117-1,173); 52-59% of this exposure was due to cine filming. Median center field entrance exposure in the PA view was 7.86 Roentgens (R) with a range 2.16-73.9 of and in the lateral projection 7.39 R (range 2.64-24.6). As much as 25% of the exposure from the entire examination was contributed by manual ''test'' exposures to set cine radiographic kVp. We recommend use of testing circuits, which determine cine radiographic factors automatically and thus should lower levels of exposure.

  2. Cardiac catheterization in children with pulmonary hypertensive vascular disease.

    PubMed

    Bobhate, Prashant; Guo, Long; Jain, Shreepal; Haugen, Richard; Coe, James Y; Cave, Dominic; Rutledge, Jennifer; Adatia, Ian

    2015-04-01

    The risks associated with cardiac catheterization in children with pulmonary hypertension (PH) are increased compared with adults. We reviewed retrospectively all clinical data in children with PH [mean pulmonary artery pressure (mean PAp) ≥25 mmHg and pulmonary vascular resistance index (PVRI) ≥3 Wood units m(2)] undergoing cardiac catheterization between 2009 and 2014. Our strategy included a team approach, minimal catheter manipulation and sildenafil administration prior to extubation. Adverse events occurring within 48 h were noted. Seventy-five patients (36 males), median age 4 years (0.3-17) and median weight 14.6 kg (2.6-77 kg), underwent 97 cardiac catheterizations. Diagnoses included idiopathic or heritable pulmonary arterial hypertension (PAH) (29 %), PAH associated with congenital heart disease (52 %), left heart disease (5 %) and lung disease (14 %). Mean PAp was 43 ± 19 mmHg; mean PVRI was 9.7 ± 6 Wood units m(2). There were no deaths or serious arrhythmias. No patient required cardiac massage. Three patients who suffered adverse events had suprasystemic PAp (3/3), heritable PAH (2/3), decreased right ventricular function (3/3), and pulmonary artery capacitance index <1 ml/mmHg/m(2) (3/3) and were treatment naïve (3/3). No patient undergoing follow-up cardiac catheterization suffered a complication. In 45 % of cases, the data acquired from the follow-up cardiac catheterization resulted in an alteration of therapy. Three percent of children with PH undergoing cardiac catheterization suffered adverse events. However, there were no intra or post procedural deaths and no one required cardiac massage or cardioversion. Follow-up cardiac catheterization in patients receiving pulmonary hypertensive targeted therapy is safe and provides useful information.

  3. Catheterization.

    ERIC Educational Resources Information Center

    Lewis, Mary Bell; Moseley, James L.

    This module is designed to teach the fundamentals of clean intermittent urinary catheterization for the disabled child, particularly in the school setting. The text includes information on proper hand washing techniques, the supplies needed, suggested settings, and the preparations required before and after the catheter is inserted into the…

  4. Multimodality 3-Dimensional Image Integration for Congenital Cardiac Catheterization

    PubMed Central

    2014-01-01

    Cardiac catheterization procedures for patients with congenital and structural heart disease are becoming more complex. New imaging strategies involving integration of 3-dimensional images from rotational angiography, magnetic resonance imaging (MRI), computerized tomography (CT), and transesophageal echocardiography (TEE) are employed to facilitate these procedures. We discuss the current use of these new 3D imaging technologies and their advantages and challenges when used to guide complex diagnostic and interventional catheterization procedures in patients with congenital heart disease. PMID:25114757

  5. Development of a charge adjustment model for cardiac catheterization.

    PubMed

    Brennan, Andrew; Gauvreau, Kimberlee; Connor, Jean; O'Connell, Cheryl; David, Sthuthi; Almodovar, Melvin; DiNardo, James; Banka, Puja; Mayer, John E; Marshall, Audrey C; Bergersen, Lisa

    2015-02-01

    A methodology that would allow for comparison of charges across institutions has not been developed for catheterization in congenital heart disease. A single institution catheterization database with prospectively collected case characteristics was linked to hospital charges related and limited to an episode of care in the catheterization laboratory for fiscal years 2008-2010. Catheterization charge categories (CCC) were developed to group types of catheterization procedures using a combination of empiric data and expert consensus. A multivariable model with outcome charges was created using CCC and additional patient and procedural characteristics. In 3 fiscal years, 3,839 cases were available for analysis. Forty catheterization procedure types were categorized into 7 CCC yielding a grouper variable with an R (2) explanatory value of 72.6%. In the final CCC, the largest proportion of cases was in CCC 2 (34%), which included diagnostic cases without intervention. Biopsy cases were isolated in CCC 1 (12%), and percutaneous pulmonary valve placement alone made up CCC 7 (2%). The final model included CCC, number of interventions, and cardiac diagnosis (R (2) = 74.2%). Additionally, current financial metrics such as APR-DRG severity of illness and case mix index demonstrated a lack of correlation with CCC. We have developed a catheterization procedure type financial grouper that accounts for the diverse case population encountered in catheterization for congenital heart disease. CCC and our multivariable model could be used to understand financial characteristics of a population at a single point in time, longitudinally, and to compare populations.

  6. Cardiac catheterization laboratory management: the fundamentals.

    PubMed

    Newell, Amy

    2012-01-01

    Increasingly, imaging administrators are gaining oversight for the cardiac cath lab as part of imaging services. Significant daily challenges include physician and staff demands, as well as patients who in many cases require higher acuity care. Along with strategic program driven responsibilities, the management role is complex. Critical elements that are the major impacts on cath lab management, as well as the overall success of a cardiac and vascular program, include program quality, patient safety, operational efficiency including inventory management, and customer service. It is critically important to have a well-qualified cath lab manager who acts as a leader by example, a mentor and motivator of the team, and an expert in the organization's processes and procedures. Such qualities will result in a streamlined cath lab with outstanding results.

  7. Cardiac catheterization laboratory inpatient forecast tool: a prospective evaluation.

    PubMed

    Toerper, Matthew F; Flanagan, Eleni; Siddiqui, Sauleh; Appelbaum, Jeff; Kasper, Edward K; Levin, Scott

    2016-04-01

    To develop and prospectively evaluate a web-based tool that forecasts the daily bed need for admissions from the cardiac catheterization laboratory using routinely available clinical data within electronic medical records (EMRs). The forecast model was derived using a 13-month retrospective cohort of 6384 catheterization patients. Predictor variables such as demographics, scheduled procedures, and clinical indicators mined from free-text notes were input to a multivariable logistic regression model that predicted the probability of inpatient admission. The model was embedded into a web-based application connected to the local EMR system and used to support bed management decisions. After implementation, the tool was prospectively evaluated for accuracy on a 13-month test cohort of 7029 catheterization patients. The forecast model predicted admission with an area under the receiver operating characteristic curve of 0.722. Daily aggregate forecasts were accurate to within one bed for 70.3% of days and within three beds for 97.5% of days during the prospective evaluation period. The web-based application housing the forecast model was used by cardiology providers in practice to estimate daily admissions from the catheterization laboratory. The forecast model identified older age, male gender, invasive procedures, coronary artery bypass grafts, and a history of congestive heart failure as qualities indicating a patient was at increased risk for admission. Diagnostic procedures and less acute clinical indicators decreased patients' risk of admission. Despite the site-specific limitations of the model, these findings were supported by the literature. Data-driven predictive analytics may be used to accurately forecast daily demand for inpatient beds for cardiac catheterization patients. Connecting these analytics to EMR data sources has the potential to provide advanced operational decision support. © The Author 2015. Published by Oxford University Press on behalf of the

  8. Routine preoperative cardiac catheterization necessary before repair of secundum and sinus venosus atrial septal defects

    SciTech Connect

    Freed, M.D.; Nadas, A.S.; Norwood, W.I.; Castaneda, A.R.

    1984-08-01

    Between January 1976 and July 1983, 217 patients with atrial septal defect underwent surgical repair at Children's Hospital. Thirty with a primum atrial septal defect and 26 who underwent cardiac catheterization elsewhere before being seen were excluded from analysis. Of the 161 remaining patients, 52 (31%) underwent preoperative cardiac catheterization, 38 because the physical examination was considered atypical for a secundum atrial septal defect and 14 because of a preexisting routine indication. One hundred nine (69%) underwent surgery without catheterization, with the attending cardiologist relying on clinical examination alone in 5, additional technetium radionuclide angiocardiography in 5, M-mode echocardiography in 13 and two-dimensional echocardiography in 43; both M-mode echocardiography and radionuclide angiography were performed in 24 and two-dimensional echocardiography and radionuclide angiography in 19. Since 1976, there has been a trend toward a reduction in the use of catheterization and use of one rather than two noninvasive or semiinvasive techniques for the detection of atrial defects. Of the 52 patients who underwent catheterization, the correct anatomic diagnosis was made before catheterization in 47 (90%). Two patients with a sinus venosus defect and one each with a sinus venosus defect plus partial anomalous pulmonary venous connection, partial anomalous pulmonary venous connection without an atrial septal defect and a sinoseptal defect were missed. Of 109 patients without catheterization, a correct morphologic diagnosis was made before surgery in 92 (84%). Nine patients with a sinus venosus defect, three with sinus venous defect and partial anomolous pulmonary venous connection, four with partial anomalous pulmonary venous return without an atrial septal defect and one with a secundum defect were incorrectly diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Thrombolytic therapy in acute cerebral infarction complicating diagnostic cardiac catheterization.

    PubMed

    Chen, Yu-Wei; Sim, Ming-Ming; Smith, Eric E

    2006-10-01

    Diagnostic and interventional percutaneous coronary catheterization is associated with stroke. Many of such strokes are asymptomatic, but some are devastating. Once the diagnosis of acute cerebral infarction is confirmed, thrombolytic therapy should be administrated within the time window of 3 hours. We report a 61-year-old woman who suffered from an acute cerebral infarction during diagnostic cardiac catheterization for unstable angina, which manifested as sudden onset of global aphasia, right hemiplegia and gaze preponderance to the left side. Computed tomography of the head performed immediately after recognition of the symptoms showed a hyperdense middle cerebral artery (MCA) sign. Following prompt recognition and diagnosis, intravenous thrombolytic therapy was administered 2 hours after symptom onset. The patient had a favorable outcome. Initially, National Institutes of Health Stroke Scale score was 21, and 24 hours later it improved to 9. The hyperdense MCA lesion had resolved on the 24-hour follow-up scan. This case illustrates the clinical benefit of thrombolytic therapy in the setting of acute stroke associated with cardiac catheterization.

  10. Ambulatory anesthesia for the cardiac catheterization and electrophysiology laboratories.

    PubMed

    Roberts, J Devin

    2014-06-01

    The cardiac catheterization laboratory (CCL) and electrophysiology laboratory (EPL) environments present unique clinical challenges. These challenges include unfamiliar work areas and staff, limited space with physical barriers separating the patient from the care provider, remote locations, and procedures with rare but potentially catastrophic clinical complications. Ambulatory anesthesiologists must familiarize themselves with these new surroundings and practice vigilant preoperative planning and continual communication with the proceduralist and team. In the future, the need for anesthesiologists in the CCL and EPL will continue to grow as procedures increase in complexity and duration. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. The frequency of cardiac arrests in patients with congenital heart disease undergoing cardiac catheterization.

    PubMed

    Odegard, Kirsten C; Bergersen, Lisa; Thiagarajan, Ravi; Clark, Laura; Shukla, Avinash; Wypij, David; Laussen, Peter C

    2014-01-01

    Cardiac catheterization for patients with congenital heart disease has shifted from diagnostic to predominantly interventional procedures because of advances in catheter-based technologies. Children undergoing therapeutic catheterization may be at higher risk of adverse events, and the purpose of our study was to determine the incidence of cardiac arrest (CA) in patients with congenital heart disease undergoing cardiac catheterization at a large pediatric tertiary referral center. All CAs from January 2004 through December 2009 occurring in the cardiac catheterization laboratory were reviewed. A CA was defined as an event in which cessation of circulation required chest compressions. Procedure, patient, practitioner, and system-related factors were examined. Over the study period, during 7289 catheterization procedures, 70 procedures were associated with a CA (0.96 [99% confidence interval, 0.7-1.3] per 100 procedures); 48 events (69%) were successfully resuscitated to a perfusing rhythm, 18 events (26%) resulted in need for extracorporeal membrane oxygenation, and 4 events (6%) resulted in unsuccessful resuscitation. Sudden onset of cardiac arrhythmia led to CA during 38 events (54%). The duration of resuscitation after CA was ≤11 minutes in 71%. Occurrence of CA was associated with interventional procedures (P < 0.001) and younger age (P < 0.001). A change in systems for scheduling and communication of cases was associated with a significant reduction in the incidence of CA (1.5% vs 0.7%; P = 0.002). The incidence of CA in children undergoing cardiac catheterization is high compared with pediatric noncardiac surgery. Procedural and system factors were associated with occurrence of CA in this cohort. These issues highlight the need for close communication, anticipation, and preparation.

  12. Spanish Cardiac Catheterization and Coronary Intervention Registry. 23rd official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2013).

    PubMed

    García del Blanco, Bruno; Hernández Hernández, Felipe; Rumoroso Cuevas, José Ramón; Trillo Nouche, Ramiro

    2014-12-01

    The Working Group on Cardiac Catheterization and Interventional Cardiology presents its yearly report on the data from the registry of the activity in Spain corresponding to 2013. The centers introduce their data online voluntarily and the information is analyzed by the Steering Committee of the Working Group on Cardiac Catheterization. In 2013, 104 hospitals sent their data (72 public centers and 32 private). In all, 136 715 diagnostic studies were performed (120 358 coronary angiograms), with a slight decrease with respect to 2012, a reduction that was also observed in the rate, which was 2944 diagnostic studies per million population. A total of 65 912 interventional procedures were carried out during a phase of stability, for a rate of 1419 interventions per million population. Other techniques included the implantation of 99 417 stents and 1384 biodegradable intracoronary devices (64% of them drug-eluting devices). There were 18 337 procedures in acute myocardial infarction, for an increase of 7% with respect to 2012 and representing 27.8% of all the percutaneous coronary interventions. Radial access was the approach used in 71% of the diagnostic procedures and in 65% of the interventional procedures. The performance of renal denervation has nearly doubled with respect to 2012. For the first time, more than 1000 transcatheter aortic valve implantation procedures were carried out in 1 year, although the frequency increased only slightly (23%). There continued to be a slight increase in the activity in cardiac catheterization in association with ST-segment elevation myocardial infarction, whereas, with the exception of recently introduced, highly specific procedures, the use of the remainder of the procedures, among them transcatheter aortic valve implantation, leveled off. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  13. [Surgery in children with atrial septal defects without cardiac catheterization].

    PubMed

    Velázquez-Rosas, S J; Santamaría-Díaz, H; Gómez-Gómez, M; Alba-Espinosa, C; Maulen-Radovan, X; Palacios-Macedo, X

    1988-01-01

    We describe the results of surgical repair of atrial septal defects in 36 children who did not undergo pre-op cardiac catheterization. These cases were seen at the Hospital de Cardiologia y Neumología Dr. Luis Méndez del Centro Médico Nacional. There were 24 (67%) females and twelve (33%) males. The mean age was 6.4 +/- 2.4 years with a range from three to thirteen. All cases had auscultatory findings typical of atrial septal defect. Five patients with associated tricuspid murmur (chest film showed grade I cardiomegaly in 21 (58.3 per cent), grade II cardiomegaly in fifteen (41.7 percent). Pulmonary artery shadow was normal in 24 (66.6 percent) and increased in twelve (33.3%). Pulmonary blood flow was increased in all of them. Electrocardiogram showed sinus rhythm in 35 (97.2%). In one instance left atrial rhythm; all EKGs demonstrated right axis deviation, complete right bundle branch block and right ventricular hypertrophy with diastolic overload. Only three had right atrial hypertrophy. The M-mode echocardiogram showed right ventricular dilatation in all and paradoxically septal motion in 26 (72.2%). Two-dimensional echo with the subxiphoid view allowed direct visualization of the defect in all cases. We performed contrast echocardiogram in eight cases and Doppler echocardiogram in six of them. Cardiac surgery findings were ostium secundum atrial septal defect in 34 (94.4%). Two of them also had partial anomalous venous connection. All had uneventful recovery. We conclude that in typical atrial septal defects operative repair is feasible without prior cardiac catheterization.

  14. Assessment of coronary blood flow in the cardiac catheterization laboratory.

    PubMed

    Blair, John E A; Ricciardi, Mark J

    2014-06-01

    Coronary blood flow is tightly autoregulated but is subject to epicardial and microvascular obstruction, primarily owing to coronary atherosclerosis. Because coronary flow limitation underlies ischemic heart disease, an understanding of coronary physiology is paramount. Measurement of coronary blood flow, once relegated to the research laboratory is now easily performed in the cardiac catheterization laboratory. In particular, the measurement of fractional flow reserve has been extensively studied and is an important adjunct to clinical decision making. Measurement of coronary flow informs clinicians of prognosis, guides revascularization therapy, and forms the basis of ongoing research in treatment of complex myocardial disease processes. Newer methods of assessing coronary flow measurements are undergoing validation for clinical use and should further enhance our ability to assess the importance of coronary flow in clinical disease.

  15. Life-threatening Rupture of a Femoral Pseudoaneurysm after Cardiac Catheterization

    PubMed Central

    Petrou, Emmanouil; Malakos, Ioannis; Kampanarou, Stamatina; Doulas, Nikolaos; Voudris, Vassilis

    2016-01-01

    A pseudoaneurysm refers to a defect in the arterial wall, allowing communication of arterial blood with the adjacent extra-luminal space. Pseudoaneurysms result from traumatic arterial injury. With the increasing utilization of percutaneous arterial interventions, iatrogenic arterial injury has become the predominant cause of pseudoaneurysm formation. Rupture of the pseudoaneurysm comprises a vascular emergency. Clinical suspicion and imaging techniques are the cornerstones of timely diagnosis and appropriate management of the condition. Herein, we report the case of a 69 year-old woman who suffered a life-threatening profunda femoral artery pseudoaneurysm rupture after a routine cardiac catheterization, that was treated surgically. PMID:27733869

  16. Transradial Approach for Cardiac Catheterization: The New Frontier of Coronary Intervention

    MedlinePlus

    Transradial approach for cardiac catheterization: The new frontier of coronary intervention Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. All rights reserved.

  17. Using central venous catheter for suprapubic catheterization in cardiac surgery.

    PubMed

    Bilehjani, Eissa; Fakhari, Solmaz

    2017-01-01

    Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC) suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2-3 attempts).

  18. Pharmacotherapy in the cardiac catheterization laboratory: evolution and recent developments

    PubMed Central

    Thind, Guramrinder S; Parida, Raunak; Gupta, Nishant

    2014-01-01

    Many recent innovations have been made in developing new antiplatelet and anticoagulant drugs in the last few years, with a total of nine new antithrombotic drugs approved by the Food and Drug Administration after the year 2000. This has revolutionized the medical therapy given to manage acute coronary syndrome and support cardiac catheterization. The concept of dual antiplatelet therapy has been emphasized, and clopidogrel has emerged as the most-popular second antiplatelet drug after aspirin. Newer P2Y12 inhibitors like prasugrel and ticagrelor have been extensively studied and compared to clopidogrel. The role of glycoprotein (Gp) IIb/IIIa inhibitors is being redefined. Other alternatives to unfractionated heparin have become available, of which enoxaparin and bivalirudin have been studied the most. Apart from these, many more drugs with novel therapeutic targets are being studied and are currently under development. In this review, current evidence on these drugs is presented and analyzed in a way that would facilitate decision making for the clinician. For this analysis, various high-impact clinical trials, pharmacological studies, meta-analyses, and reviews were accessed through the MEDLINE database. Adopting a unique interdisciplinary approach, an attempt has been made to integrate pharmacological and clinical evidence to better understand and appreciate the pros and cons of each of these classes of drugs. PMID:25364258

  19. Diagnostic reference levels and effective dose in paediatric cardiac catheterization.

    PubMed

    Onnasch, D G W; Schröder, F K; Fischer, G; Kramer, H-H

    2007-03-01

    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

  20. Spanish Cardiac Catheterization and Coronary Intervention Registry. 24th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2014).

    PubMed

    García Del Blanco, Bruno; Hernández Hernández, Felipe; Rumoroso Cuevas, José Ramón; Trillo Nouche, Ramiro

    2015-12-01

    The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the data from the registry of the activity in Spain in 2014. Data were voluntarily provided by participating centers. The information was introduced online and was analyzed by the Steering Committee of the Working Group on Cardiac Catheterization and Interventional Cardiology. Data were reported by 106 hospitals. A total of 140 461 diagnostic procedures (125 484 coronary angiograms) were performed, representing a rate of 3014 diagnostic studies per million population. This year, the number of percutaneous coronary interventions increased to 67 611, giving a rate of 1447 interventions per million population. A total of 94 458 stents were implanted, including 64 057 drug-eluting stents and 2424 biodegradable intracoronary devices. Of the total number of percutaneous coronary interventions, 17 825 were in acute myocardial infarction, representing 26.4% of all coronary interventions. A radial approach was used in 74% of diagnostic procedures and in 70.4% of interventional procedures. The use of renal denervation decreased, whereas over 125 mitral leak closures were performed. Transcatheter aortic valve implantation procedures exceeded 1300 implantations per year, a 27% increase from 2013. The registry for 2014 shows a slight increase in coronary disease activity despite no increase in the management of ST-segment elevation myocardial infarction. Drug-eluting intracoronary devices now comprise over 70% of all intracoronary devices. A continual increase is only seen in certain structural interventional techniques, such as transcatheter aortic valve implantation and perivalvular leak closure. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  1. The psychological effects of a videotape educational intervention on cardiac catheterization patients.

    PubMed

    Chair, Sek Ying; Chau, Mei Yi; Sit, Janet Wing Hung; Wong, Eliza Mei Ling; Chan, Aileen Wai Kiu

    2012-02-01

    Coronary artery disease (CAD) is one of the leading causes of death and morbidity worldwide, and cardiac catheterization plays an essential role in its diagnostic evaluation. This quasi-experimental study examined the effectiveness of an educational intervention with the use of videotape and pamphlet among the Chinese patient undergoing the cardiac catheterization, and explored the relationship between anxiety, uncertainty, and other psychological variables. One hundred and thirty two Chinese patients of diagnosed or suspected CAD preparing for the first-time catheterization were recruited. Anxiety level (the Chinese State Anxiety Inventory) and uncertainty (the Chinese version of Mishel Uncertainty in Illness Scale) were measured before the intervention and within 2 hours before receiving cardiac catheterization; while patients' satisfaction and perceived knowledge gain were measured at 20-24 hours after it. The mean age of the participants was 61.3 and 64.8% of them were male. The findings indicated that the use of videotape to prepare patients for the cardiac catheterization is effective in reducing the level of anxiety (p < 0.001) and the uncertainty (p < 0.001), as the patients experienced higher satisfaction and knowledge level after the educational intervention. Therefore, videotape education is suggested for cardiac catheterization care on top of the usual pamphlet education.

  2. What is the appropriate "dress code" for the cardiac catheterization laboratory?

    PubMed

    Leaman, D M; Zelis, R F

    1983-01-01

    In order to determine the effect of the manner of dress by personnel and observers on cardiac catheterization-related infections, a retrospective survey was undertaken of 107,203 catheterization procedures done during the calendar year prior to this survey. An analysis of 55,976 cutdowns and 53,578 percutaneous procedures was performed (some subjects had both procedures performed). A total of 379 infections in 109,554 entrance sites were reported for an overall incidence of infection of 0.35%. There were 33 infections at the percutaneous site (incidence = 0.06%) and 346 at the cutdown site (incidence = 0.62%). The manner of dress of personnel not involved with catheter manipulation and of the observers had no relationship to the incidence of infection when the percutaneous technique was used. When cutdowns were performed, there was a lower incidence of infection in those laboratories where all personnel and observers were required to wear a mask, cap, and gown (17,311 cutdowns, 83 infections, 0.48% infection rate) than in those laboratories where none of these was required (15,170 cutdowns, 109 infections, 0.72% infection rate) (P less than 0.025). Laboratories which did 150 or less cutdowns/year had more infections than those laboratories performing more than 150/year (P less than 0.0001). Our data suggest that the risk of infection from cardiac catheterization is more closely correlated with the volume of studies done in the laboratory than in the manner of dress of the laboratory personnel and visitors in the laboratory. However, the wearing of full "sanitary clothing" will help decrease the infection rate in cutdowns.

  3. Cardiac Catheterization in Pediatric Patients Supported by Extracorporeal Membrane Oxygenation: A 15-Year Experience.

    PubMed

    Boscamp, Nicholas S; Turner, Mariel E; Crystal, Matthew; Anderson, Brett; Vincent, Julie A; Torres, Alejandro J

    2017-02-01

    Cardiac catheterization is commonly performed in patients being supported by extracorporeal membrane oxygenation (ECMO). We aimed to evaluate the safety, benefit, and outcomes of catheterization in pediatric patients supported by ECMO. Retrospective review of cardiac catheterizations performed in patients ≤18 years of age while on ECMO at a large tertiary care center between January 2000 and May 2015. A total of 55 catheterizations were performed on 51 patients during 53 unique ECMO courses. Indications for ECMO include ventricular dysfunction (22), cardiac arrest (20), inability to wean from cardiopulmonary bypass (7), and persistent cyanosis (4). Catheterizations included purely diagnostic studies (11), atrial septostomies (34), stenting of vessels or surgical shunts (6), adjustment of a stent (1), coil embolization (1), and endomyocardial biopsy (1). Septostomy was elective in 58.8% of cases (20) and emergent in 41.2% (14). Forty-six catheterizations had either surgical or catheter intervention during the same or subsequent study (83.6%). High severity complications occurred in three patients (5.6%), including one death due to hemothorax after pulmonary artery stent placement. There were no complications during patient transport. In total, 38 out of 53 (71.7%) ECMO courses resulted in decannulation, 29 (54.7%) patients survived to discharge from the hospital, and 25 (47.2%) were alive at follow-up. Cardiac catheterization can be safely performed on patients supported by ECMO. Cardiac catheterization is a critical tool in the early recognition, diagnosis, and direct treatment of hemodynamic/anatomic abnormalities in patients supported by ECMO.

  4. Using central venous catheter for suprapubic catheterization in cardiac surgery

    PubMed Central

    Bilehjani, Eissa; Fakhari, Solmaz

    2017-01-01

    Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC) suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2–3 attempts). PMID:28116283

  5. A Review of the Effects of Sedation on Thermoregulation: Insights for the Cardiac Catheterization Laboratory.

    PubMed

    Conway, Aaron

    2016-06-01

    To examine the effects that the sedative and analgesic medications commonly used in the cardiac catheterization laboratory have on thermoregulation. A structured review strategy was used. MEDLINE and CINAHL were searched for published studies, and reference lists of retrieved studies were scrutinized for further studies. Data were extracted using a standardized extraction tool. A total of nine studies examined the effect that sedative and analgesic medications have on thermoregulation. Midazolam has minimal impact on thermoregulation, whereas opioids, dexmedetomidine, and propofol markedly decrease vasoconstriction and shivering thresholds. Patients who receive sedation in the cardiac catheterization laboratory may be at risk of hypothermia because of the use of medications that impair thermoregulation. Further research is required to identify the prevalence of unplanned hypothermia during sedation in the cardiac catheterization laboratory. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  6. Acute ischemic stroke after cardiac catheterization: the protamine low-dose recombinant tissue plasminogen activator pathway.

    PubMed

    Guevara, Carlos; Quijada, Alonso; Rosas, Carolina; Bulatova, Katya; Lara, Hugo; Nieto, Elena; Morales, Marcelo

    2016-05-20

    Intravenous thrombolysis is the preferred treatment for acute ischemic stroke; however, it remains unestablished in the area of cardiac catheterization. We report three patients with acute ischemic stroke after cardiac catheterization. After reversing the anticoagulant effect of unfractionated heparin with protamine, all of the patients were successfully off-label thrombolyzed with reduced doses of intravenous recombinant tissue plasminogen activator (0.6 mg/kg). This dose was preferred to reduce the risk of symptomatic cerebral or systemic bleeding. The sequential pathway of protamine recombinant tissue plasminogen activator at reduced doses may be safer for reducing intracranial or systemic bleeding events, whereas remaining efficacious for the treatment of acute ischemic stroke after cardiac catheterization.

  7. Bradycardia during Transradial Cardiac Catheterization due to Catheter Manipulation: Resolved by Catheter Removal

    PubMed Central

    Kumar, Vishesh; Stys, Adam

    2017-01-01

    Purpose. To report the resolution of bradycardia encountered during transradial cardiac catheterization through the catheter pullback technique in two cases. Case Report. A 62-year-old male and an 81-year-old male underwent coronary angiogram to evaluate for coronary artery disease and as a result of positive stress test, respectively. Upon engagement of the FL 3.5 catheter into the ascending aorta through the transradial approach, the first case developed bradycardia with a heart rate of 39 beats per minute. The second case developed profound bradycardia with a heart rate of 25 beats per minute upon insertion of the 5 Fr FL 3.5 catheter near the right brachiocephalic trunk through the right radial access. Conclusion. Bradycardia can be subsided by removal of the catheter during catheter manipulation in patients undergoing transradial coronary angiogram if there is a suspicion of excessive stretching of aortic arch receptors and/or carotid sinus receptors. PMID:28348915

  8. The anesthetic management of children with pulmonary hypertension in the cardiac catheterization laboratory.

    PubMed

    Twite, Mark D; Friesen, Robert H

    2014-03-01

    Children need cardiac catheterization to establish the diagnosis and monitor the response to treatment when undergoing drug therapy for the treatment of pulmonary arterial hypertension (PAH). Children with PAH receiving general anesthesia for cardiac catheterization procedures are at significantly increased risk of perioperative complications in comparison with other children. The most acute life-threatening complication is a pulmonary hypertensive crisis. It is essential that the anesthesiologist caring for these children understands the pathophysiology of the disease, how anesthetic medications may affect the patient's hemodynamics, and how to manage an acute pulmonary hypertensive crisis.

  9. Direct measurement of a patient's entrance skin dose during pediatric cardiac catheterization

    PubMed Central

    Sun, Lue; Mizuno, Yusuke; Iwamoto, Mari; Goto, Takahisa; Koguchi, Yasuhiro; Miyamoto, Yuka; Tsuboi, Koji; Chida, Koichi; Moritake, Takashi

    2014-01-01

    Children with complex congenital heart diseases often require repeated cardiac catheterization; however, children are more radiosensitive than adults. Therefore, radiation-induced carcinogenesis is an important consideration for children who undergo those procedures. We measured entrance skin doses (ESDs) using radio-photoluminescence dosimeter (RPLD) chips during cardiac catheterization for 15 pediatric patients (median age, 1.92 years; males, n = 9; females, n = 6) with cardiac diseases. Four RPLD chips were placed on the patient's posterior and right side of the chest. Correlations between maximum ESD and dose–area products (DAP), total number of frames, total fluoroscopic time, number of cine runs, cumulative dose at the interventional reference point (IRP), body weight, chest thickness, and height were analyzed. The maximum ESD was 80 ± 59 (mean ± standard deviation) mGy. Maximum ESD closely correlated with both DAP (r = 0.78) and cumulative dose at the IRP (r = 0.82). Maximum ESD for coiling and ballooning tended to be higher than that for ablation, balloon atrial septostomy, and diagnostic procedures. In conclusion, we directly measured ESD using RPLD chips and found that maximum ESD could be estimated in real-time using angiographic parameters, such as DAP and cumulative dose at the IRP. Children requiring repeated catheterizations would be exposed to high radiation levels throughout their lives, although treatment influences radiation dose. Therefore, the radiation dose associated with individual cardiac catheterizations should be analyzed, and the effects of radiation throughout the lives of such patients should be followed. PMID:24968708

  10. Estimation of Organ and Effective Doses for Neonate and Infant Diagnostic Cardiac Catheterizations.

    PubMed

    Kawasaki, Toshio; Fujii, Keisuke; Akahane, Keiichi

    2015-09-01

    Radiation exposure to neonates and infants during cardiac catheterizations is an important issue. Smaller patient size and higher heart rate in these patients result in a greater need for magnification modes and higher frame rates, all of which contribute to a significant increase in radiation doses. The aims of our study were to evaluate organ and effective doses for neonates and infants during diagnostic cardiac catheterizations on the basis of in-phantom dosimetry and conversion factors from dose-area product (DAP) to the effective dose. Organ doses for 0- and 1-year-old children during diagnostic cardiac catheterizations were measured by radiophotoluminescence glass dosimeters implanted in neonate and infant anthropomorphic phantoms. The effective doses were evaluated according to recommendations of the International Commission on Radiologic Protection (ICRP) publication 103. The mean effective doses evaluated according to ICRP 103 were 7.7 mSv (range, 0.1-18.4 mSv) for a neonate and 7.3 mSv (range, 1.9-18.6 mSv) for an infant. Conversion factors from DAP to the effective dose were 2.2 and 4.0 in posteroanterior and lateral cine angiography, respectively, for a neonate and 1.4 and 2.7 in posteroanterior and lateral cine angiography, respectively, for an infant. The dose data and conversion factors evaluated in this study could be useful for the estimation of radiation exposure in neonates and infants during diagnostic cardiac catheterization.

  11. Radiation Dose Reduction during Radial Cardiac Catheterization: Evaluation of a Dedicated Radial Angiography Absorption Shielding Drape.

    PubMed

    Ertel, Andrew; Nadelson, Jeffrey; Shroff, Adhir R; Sweis, Ranya; Ferrera, Dean; Vidovich, Mladen I

    2012-01-01

    Objectives. Radiation scatter protection shield drapes have been designed with the goal of decreasing radiation dose to the operators during transfemoral catheterization. We sought to investigate the impact on operator radiation exposure of various shielding drapes specifically designed for the radial approach. Background. Radial access for cardiac catheterization has increased due to improved patient comfort and decreased bleeding complications. There are concerns for increased radiation exposure to patients and operators. Methods. Radiation doses to a simulated operator were measured with a RadCal Dosimeter in the cardiac catheterization laboratory. The mock patient was a 97.5 kg fission product phantom. Three lead-free drape designs were studied. The drapes were placed just proximal to the right wrist and extended medially to phantom's trunk. Simulated diagnostic coronary angiography included 6 minutes of fluoroscopy time and 32 seconds of cineangiography time at 4 standard angulated views (8 s each), both 15 frames/s. ANOVA with Bonferroni correction was used for statistical analysis. Results. All drape designs led to substantial reductions in operator radiation exposure compared to control (P < 0.0001). The greatest decrease in radiation exposure (72%) was with the L-shaped design. Conclusions. Dedicated radial shielding drapes decrease radiation exposure to the operator by up to 72% during simulated cardiac catheterization.

  12. Mentored simulation training improves procedural skills in cardiac catheterization: a randomized, controlled pilot study.

    PubMed

    Bagai, Akshay; O'Brien, Sean; Al Lawati, Hatim; Goyal, Prateek; Ball, Warren; Grantcharov, Teodor; Fam, Neil

    2012-10-01

    Despite valuable supplemental training resources for surgical skill acquisition, utility of virtual reality simulators to improve skills relevant to performing cardiac catheterization has not been evaluated. Post baseline cardiac catheterization performance assessment, 27 cardiology trainees were randomized to either mentored training on a virtual reality simulator (n=12) or no simulator training (control; n=15). Cardiac catheterization performance was reassessed 1 week post baseline assessment. Performance scores at 1 week were compared with baseline within each group, and change in score from baseline to 1 week was compared between groups. Linear regression modeling was performed to assess the effect of simulator training as a function of baseline performance. Technical performance improved postintervention in the simulator group (24 versus 18; P=0.008) and changed marginally in the control group (20 versus 18; P=0.054). Improvement in technical performance was greater in the simulator group (6 versus 1; P=0.04). Global performance improved postintervention in both groups (simulator, 24 versus 17, P=0.01; control, 20 versus 18, P=0.02), with a trend toward greater improvement in the simulator group (5 versus 2; P=0.11). Lower scores at baseline were associated with larger differences in postintervention scores between the simulator and control groups (technical performance, P=0.0006; global performance, P<0.0001). Skills required to perform cardiac catheterization can be learned via mentored simulation training and are transferable to actual procedures in the catheterization laboratory. Less proficient operators derive greater benefit from simulator training than more proficient operators.

  13. Measures to reduce radiation in a modern cardiac catheterization laboratory.

    PubMed

    Agarwal, Shikhar; Parashar, Akhil; Ellis, Stephen G; Heupler, Frederick A; Lau, Evan; Tuzcu, E Murat; Kapadia, Samir R

    2014-08-01

    X-ray use in the catheterization laboratory is guided by the principle of as low as reasonably achievable. In accordance with this principle, we reduced the default fluoroscopic frame rate from 10 to 7.5 frames/s and increased the emphasis on the use of low-dose acquisition starting January 1, 2013. We aimed to study the impact of these measures on the total air kerma during diagnostic catheterization (DC) and percutaneous interventions (PCI). Propensity matching based on age, sex, body surface area, total fluoroscopy time, and total acquisition time was used to select matched patients for 2012 and 2013, further stratified by DC or PCI. The total air kerma was subsequently compared between 2012 and 2013, separately for DC and PCI. Median total air kerma during DC in 2013 was 625 mGy, which was significantly lower than the corresponding values in 2012 (median, 798 mGy; P<0.001). Similarly, median total air kerma during PCI in 2013 was 1675 mGy, which was significantly less than corresponding values in 2012 (median 2463 mGy, P<0.001). On comparison of air kerma rates between corresponding projections in 2 years, we observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates in 2013, after institution of radiation reduction measures in all projections. With reduction in the default fluoroscopic frame rate and a greater use of low-dose acquisition, there has been a marked reduction in the total air kerma and air kerma rates for DC and PCI. © 2014 American Heart Association, Inc.

  14. SU-E-P-10: Imaging in the Cardiac Catheterization Lab - Technologies and Clinical Applications

    SciTech Connect

    Fetterly, K

    2014-06-01

    Purpose: Diagnosis and treatment of cardiovascular disease in the cardiac catheterization laboratory is often aided by a multitude of imaging technologies. The purpose of this work is to highlight the contributions to patient care offered by the various imaging systems used during cardiovascular interventional procedures. Methods: Imaging technologies used in the cardiac catheterization lab were characterized by their fundamental technology and by the clinical applications for which they are used. Whether the modality is external to the patient, intravascular, or intracavity was specified. Specific clinical procedures for which multiple modalities are routinely used will be highlighted. Results: X-ray imaging modalities include fluoroscopy/angiography and angiography CT. Ultrasound imaging is performed with external, trans-esophageal echocardiography (TEE), and intravascular (IVUS) transducers. Intravascular infrared optical coherence tomography (IVOCT) is used to assess vessel endothelium. Relatively large (>0.5 mm) anatomical structures are imaged with x-ray and ultrasound. IVUS and IVOCT provide high resolution images of vessel walls. Cardiac CT and MRI images are used to plan complex cardiovascular interventions. Advanced applications are used to spatially and temporally merge images from different technologies. Diagnosis and treatment of coronary artery disease frequently utilizes angiography and intra-vascular imaging, and treatment of complex structural heart conditions routinely includes use of multiple imaging modalities. Conclusion: There are several imaging modalities which are routinely used in the cardiac catheterization laboratory to diagnose and treat both coronary artery and structural heart disease. Multiple modalities are frequently used to enhance the quality and safety of procedures. The cardiac catheterization laboratory includes many opportunities for medical physicists to contribute substantially toward advancing patient care.

  15. Influence of the timing of cardiac catheterization and amount of contrast media on acute renal failure after cardiac surgery.

    PubMed

    Sadeghi, Mohsen Mirmohammad; Gharipour, Mojgan; Nilforoush, Peiman; Shamsolkotabi, Hamid; Sadeghi, Hamid Mirmohammad; Kiani, Amjad; Sadeghi, Pouya Mirmohammad; Farahmand, Niloufar

    2011-04-01

    There is limited data about the influence of timing of cardiac surgery in relation to diagnostic angiography and/or the impact of the amount of contrast media used during angiography on the occurance of acute renal failure (ARF). Therefore, in the present study the effect of the time interval between diagnostic angiography and cardiac surgery and also the amount of contrast media used during the diagnostic procedure on the incidence of ARF after cardiac surgery was investigated. Data of 1177 patients who underwent different types of cardiac surgeries after cardiac catheterization were prospectively examined. The influence of time interval between cardiac catheterization and surgery as well as the amount of contrast agent on postoperative ARF were assessed using multivariable logistic regression. The patients who progressed to ARF were more likely to have received a higher dose of contrast agent compared to the mean dose. However, the time interval between cardiac surgery and last catheterization was not significantly different between the patients with and without ARF (p = 0.05). Overall, postoperative peak creatinine was highest on day 0, then decreased and remained significantly unchanged after this period. Overall prevalence of acute renal failure during follow-up period had a changeable trend and had the highest rates in days 1 (53.57%) and 6 (52.17%) after surgery. Combined coronary bypass and valve surgery were the strongest predictor of postoperative ARF (OR: 4.976, CI = 1.613-15.355 and p = 0.002), followed by intra-aortic balloon pump insertion (OR: 6.890, CI = 1.482-32.032 and p = 0.009) and usage of higher doses of contrast media agent (OR: 1.446, CI = 1.033-2.025 and p = 0.031). Minimizing the amount of contrast agent has a potential role in reducing the incidence of postoperative ARF in patients undergoing cardiac surgery, but delaying cardiac surgery after exposure to these agents might not have this protective effect.

  16. A Radiation Dose Reduction Technology to Improve Patient Safety During Cardiac Catheterization Interventions.

    PubMed

    Bracken, John A; Mauti, Maria; Kim, Michael S; Messenger, John C; Carroll, John D

    2015-10-01

    A novel radiation dose reduction technology was evaluated in a cardiac catheterization laboratory during routine clinical care to determine if it could reduce radiation dose to patients undergoing coronary angiography and percutaneous coronary intervention. These results were compared to patients undergoing similar procedures in a cardiac catheterization laboratory without this technology. There is a safety priority in clinical care to reduce X-ray radiation dose to patients in order to lower the risk of deterministic and stochastic effects. Dose reduction technologies must be verified in clinical settings to prove if they reduce X-ray radiation dose and to what extent. Radiation dose data and procedure characteristics of 268 consecutive patients were collected and analyzed from a cardiac catheterization laboratory with dose reduction technology installed (referred to as Lab A, n = 135) and from a cardiac catheterization laboratory without this technology (referred as Lab B, n = 133). For diagnostic procedures, the median total dose-area product in Lab A was reduced by 46% (P < 0.0001) compared to Lab B, with no differences in terms of body mass index (P = 0.180), total fluoroscopy times (P = 1), number of acquired images (P = 0.920), and contrast medium (P = 0.660). For interventional procedures, the median total dose-area product in Lab A was reduced by 34% (P = 0.015) compared to Lab B, with no differences in terms of body mass index (P = 0.665), total fluoroscopy times (P = 0.765), number of acquired images (P = 0.923), and contrast medium (P = 0.969). This new dose reduction technology significantly reduces X-ray radiation dose without affecting fluoroscopy time, number of images, and contrast medium used during diagnostic and interventional coronary procedures. © 2015, Wiley Periodicals, Inc.

  17. Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease.

    PubMed

    Lin, C Huie; Hegde, Sanjeet; Marshall, Audrey C; Porras, Diego; Gauvreau, Kimberlee; Balzer, David T; Beekman, Robert H; Torres, Alejandro; Vincent, Julie A; Moore, John W; Holzer, Ralf; Armsby, Laurie; Bergersen, Lisa

    2014-01-01

    Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133-3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8-2.4 %], whereas mortality was 0.28 % (95 % CI 0.18-0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age <1 year [odd ratio (OR) 1.9, 95 % CI 1.4-2.7, p < 0.001], hemodynamic vulnerability (OR 1.6, 95 % CI 1.1-2.3, p < 0.01), and procedure risk (category 3: OR 2.3, 95 % CI 1.3-4.1; category 4: OR 4.2, 95 % CI 2.4-7.4) were predictors of life-threatening events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.

  18. Mechanical Cardiopulmonary Resuscitation In and On the Way to the Cardiac Catheterization Laboratory.

    PubMed

    William, Preethi; Rao, Prashant; Kanakadandi, Uday B; Asencio, Alejandro; Kern, Karl B

    2016-05-25

    Cardiac arrest, though not common during coronary angiography, is increasingly occurring in the catheterization laboratory because of the expanding complexity of percutaneous interventions (PCI) and the patient population being treated. Manual chest compression in the cath lab is not easily performed, often interrupted, and can result in the provider experiencing excessive radiation exposure. Mechanical cardiopulmonary resuscitation (CPR) provides unique advantages over manual performance of chest compression for treating cardiac arrest in the cardiac cath lab. Such advantages include the potential for uninterrupted chest compressions, less radiation exposure, better quality chest compressions, and less crowded conditions around the catheterization table, allowing more attention to ongoing PCI efforts during CPR. Out-of-hospital cardiac arrest patients not responding to standard ACLS therapy can be transported to the hospital while mechanical CPR is being performed to provide safe and continuous chest compressions en route. Once at the hospital, advanced circulatory support can be instituted during ongoing mechanical CPR. This article summarizes the epidemiology, pathophysiology and nature of cardiac arrest in the cardiac cath lab and discusses the mechanics of CPR and defibrillation in that setting. It also reviews the various types of mechanical CPR and their potential roles in and on the way to the laboratory. (Circ J 2016; 80: 1292-1299).

  19. Anxiety reduction in patients undergoing cardiac catheterization following massage and guided imagery.

    PubMed

    Armstrong, Karen; Dixon, Simon; May, Sara; Patricolo, Gail Elliott

    2014-11-01

    This study aimed to evaluate the effectiveness of massage with or without guided imagery in reducing anxiety prior to cardiac catheterization. A total of 55 inpatients and outpatients received massage, guided imagery, or massage with guided imagery prior to cardiac catheterization. Self-reported anxiety levels and blood pressure (BP) and heart rate (HR) were evaluated in participants and a matched comparison group. Massage with and without guided imagery resulted in significant reductions in self-reported anxiety (p < 0.0001). Patients receiving intervention had lower diastolic BP and HR vs. the comparison group (p < 0.0001 and p < 0.05). Massage with or without guided imagery immediately reduced self-reported anxiety. This pilot study has certain limitations: a non-randomized, convenience sample and a matched control group that was created retrospectively. However, the study indicates a benefit to providing massage or massage with guided imagery prior to anxiety-inducing medical procedures such as cardiac catheterization. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States.

    PubMed

    Ghelani, Sunil J; Glatz, Andrew C; David, Sthuthi; Leahy, Ryan; Hirsch, Russel; Armsby, Laurie B; Trucco, Sara M; Holzer, Ralf J; Bergersen, Lisa

    2014-09-01

    The aim of this study was to define age-stratified, procedure-specific benchmark radiation dose levels during interventional catheterization for congenital heart disease. There is a paucity of published literature with regard to radiation dose levels during catheterization for congenital heart disease. Obtaining benchmark radiation data is essential for assessing the impact of quality improvement initiatives for radiation safety. Data were obtained retrospectively from 7 laboratories participating in the Congenital Cardiac Catheterization Project on Outcomes collaborative. Total air kerma, dose area product, and total fluoroscopy time were obtained for the following procedures: 1) patent ductus arteriosus closure; 2) atrial septal defect closure; 3) pulmonary valvuloplasty; 4) aortic valvuloplasty; 5) treatment of coarctation of aorta; and 6) transcatheter pulmonary valve placement. Between January 2009 and July 2013, 2,713 cases were identified. Radiation dose benchmarks are presented including median, 75th percentile, and 95th percentile. Radiation doses varied widely between age groups and procedure types. Radiation exposure was lowest in patent ductus arteriosus closure and highest in transcatheter pulmonary valve placement. Total fluoroscopy time was a poor marker of radiation exposure and did not correlate well with total air kerma and dose area product. This study presents age-stratified radiation dose values for 6 common congenital heart interventional catheterization procedures. Fluoroscopy time alone is not an adequate measure for monitoring radiation exposure. These values will be used as baseline for measuring the effectiveness of future quality improvement activities by the Congenital Cardiac Catheterization Project on Outcomes collaborative. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. Technique for retrieval of a knotted and entrapped guide wire after central venous catheterization.

    PubMed

    Yong, Yao Pey; Abisi, Said; Whitaker, Simon; Braithwaite, Bruce

    2013-04-01

    Central venous catheterization is a common procedure performed in the critically ill patient. The complication associated with this invasive procedure is well established. However, complication related to the guide wire is rare. We present a case of knotted and entrapped guide wire following central venous catheterization using the Seldinger method and technique to retrieve it nonoperatively.

  2. [Transradial percutaneous approach for cardiac catheterization in patients with previous brachial artery cutdown].

    PubMed

    Magariños, Eduardo; Solioz, Germán; Cermesoni, Gabriel; Koretzky, Martín; Carnevalini, Mariana; González, Daniel

    2013-01-01

    The percutaneous punction of the radial artery for catheterization procedures has gained acceptance lately. This was a consequence of achieving results similar to the femoral approach, with the benefits of a lower rate of complications and increased comfort for the patients post procedure. Recently it has gained an additional impulse with the better prognosis obtained in acute coronary syndromes. In this trial we have evaluated if the feasibility, results and advantages related with the use of the radial artery percutaneous approach to perform catheterization procedures, continues when used in patients who have had a previous brachial artery cutdown. Out of a total of 1356 percutaneous radial accesses, 53 were in patients with previous brachial artery cutdown. Through this access 71 catheterization procedures were performed, achieving access success in 96.2% (51/53) of the punctions. Once the access success was obtained, 93.6% (44/47) of the diagnostic procedures and 100% (24/24) of the therapeutics procedures were successful. During hospitalization, in this group of patients, no major adverse cardiac events occurred and there was a 1.4% (1/71) rate of minor events. At seven days follow up, no new complications were recorded. Although this is a small group, we believe that it is enough to show that percutaneous punctions of the radial artery to perform catheterization procedures, in patients with previous brachial artery cutdown, are feasible, allowing high access and procedure success rates, with a low frequency of complications.

  3. Radiation exposure of pediatric patients and physicians during cardiac catheterization and balloon pulmonary valvuloplasty.

    PubMed

    Wu, J R; Huang, T Y; Wu, D K; Hsu, P C; Weng, P S

    1991-07-15

    Thermoluminescent dosimeters were applied to various areas of 61 pediatric patients and physicians to measure radiation doses during routine cardiac catheterization and during 4 cases of balloon pulmonary valvuloplasty. Radiation doses were measured during chest roentgenography, fluoroscopy and cineangiography. Average skin dose to the chest was 121 microGy during chest x-ray, 5,182 microGy during catheterization and 641 mGy during valvuloplasty. For the eyes, thyroid and gonads of the patients, the exposure during routine catheterization was equal to 0.4, 6 and 0.2 chest x-rays, respectively. Radiation dose of the operator was 3 microGy for the eyes and 6 miCroGy in the thyroid. About 56% of the operator's dose could be reduced by thyroid shields, and 80% by lead aprons. The assistant received only 1 microGy outside the thyroid shield. Therefore, we have concluded that the patients' dose during routine catheterization is largely based on our experimental results, but the dose is acceptable based on the risk factor analysis. The skin dose to the right lateral chest of the patient during valvuloplasty is extremely high, perhaps as high as the equivalent of 1,000 chest x-rays. Besides the clinical benefits of valvuloplasty, the long-term radiation-related hazards to the patient should be carefully monitored.

  4. Occupational Health Risks in Cardiac Catheterization Laboratory Workers.

    PubMed

    Andreassi, Maria Grazia; Piccaluga, Emanuela; Guagliumi, Giulio; Del Greco, Maurizio; Gaita, Fiorenzo; Picano, Eugenio

    2016-04-01

    Orthopedic strain and radiation exposure are recognized risk factors in personnel staff performing fluoroscopically guided cardiovascular procedures. However, the potential occupational health effects are still unclear. The purpose of this study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure. We used a self-administered questionnaire to collect demographic information, work-related information, lifestyle-confounding factors, all current medications, and health status. A total number of 746 questionnaires were properly filled comprising 466 exposed staff (281 males; 44±9 years) and 280 unexposed subjects (179 males; 43±7years). Exposed personnel included 218 interventional cardiologists and electrophysiologists (168 males; 46±9 years); 191 nurses (76 males; 42±7 years), and 57 technicians (37 males; 40±12 years) working for a median of 10 years (quartiles: 5-24 years). Skin lesions (P=0.002), orthopedic illness (P<0.001), cataract (P=0.003), hypertension (P=0.02), and hypercholesterolemia (P<0.001) were all significantly higher in exposed versus nonexposed group, with a clear gradient unfavorable for physicians over technicians and nurses and for longer history of work (>16 years). In highly exposed physicians, adjusted odds ratio ranged from 1.7 for hypertension (95% confidence interval: 1-3; P=0.05), 2.9 for hypercholesterolemia (95% confidence interval: 1-5; P=0.004), 4.5 for cancer (95% confidence interval: 0.9-25; P=0.06), to 9 for cataract (95% confidence interval: 2-41; P=0.004). Health problems are more frequently observed in workers performing fluoroscopically guided cardiovascular procedures than in unexposed controls, raising the need to spread the culture of safety in the cath laboratory. © 2016 American Heart Association, Inc.

  5. Sex, socioeconomic status, access to cardiac catheterization, and outcomes for acute coronary syndromes in the context of universal healthcare coverage.

    PubMed

    Fabreau, Gabriel E; Leung, Alexander A; Southern, Danielle A; Knudtson, Merrill L; McWilliams, J Michael; Ayanian, John Z; Ghali, William A

    2014-07-01

    Sex and neighborhood socioeconomic status (nSES) may independently affect the care and outcomes of acute coronary syndrome, partly through barriers in timely access to cardiac catheterization. We sought to determine whether sex modifies the association between nSES and the receipt of cardiac catheterization and mortality after an acute coronary syndrome in a universal healthcare system. We studied 14 012 patients with acute coronary syndrome admitted to cardiology services between April 18, 2004, and December 31, 2011, in Southern Alberta, Canada. We used multivariable logistic regression to compare the odds of cardiac catheterization within 2 and 30 days of admission and the odds of 30-day and 1-year mortality for men and women by quintile of neighborhood median household income. Significant relationships between nSES and the receipt of cardiac catheterization and mortality after acute coronary syndrome were detected for women but not men. When examined by nSES, each incremental decrease in neighborhood income quintile for women was associated with a 6% lower odds of receiving cardiac catheterization within 30 days (P=0.01) and a 14% higher odds of 30-day mortality (P=0.03). For men, each decrease in neighborhood income quintile was associated with a 2% lower odds of receiving catheterization within 30 days (P=0.10) and a 5% higher odds of 30-day mortality (P=0.36). Associations between nSES and receipt of cardiac catheterization and 30-day mortality were noted for women but not men in a universal healthcare system. Care protocols designed to improve equity of access to care and outcomes are required, especially for low-income women. © 2014 American Heart Association, Inc.

  6. Medicolegal characteristics of cardiac catheterization litigation in the United States, 1985 to 2009.

    PubMed

    Kim, Candice; Vidovich, Mladen I

    2013-11-15

    There are few assessments of patterns of medicolegal cases involving cardiac catheterizations. This descriptive study reviews the patterns of liability and medical outcomes involving cardiac catheterization litigation from the LexisNexis Academic database and the Physician Insurers Association of America registry. From 1985 to 2009, the Physician Insurers Association of America registry documented 1,361 closed coronary angiography claims. The cardiovascular disease specialty was involved in 699 with other specialties involved in the remaining cases. Of the 1,361 closed claims, 301 (22%) resulted in payments to the plaintiff (average indemnity of $230,987). The most common alleged error was for improper performance (35.4%; average indemnity of $255,542). The alleged error with the highest average indemnity of $270,916 was errors in diagnosis. Not performing an indicated procedure had the highest ratio of paid to closed claims (41%) with an average indemnity of $246,988. In regard to the severity of injury, death was the most common outcome (44%). The highest ratio of paid to total closed claims (43%) was for grave injuries (highest average indemnity of $555,625). Of the 116 LexisNexis cases, litigation against physicians occurred in 90.5% of cases with judgments in favor of the patients in 29.5%. When death was the outcome (31% of cases), physicians were highly likely to be sued (97%) and the judgment was more likely in the plaintiffs' favor (44%). In conclusion, in litigation related to cardiac catheterizations, most cases are due to medical malpractice and physicians are sued in a high percentage of cases. Cardiologists should recognize these patterns of litigation as these may impact and improve processes of care.

  7. Effects of oral premedication on cognitive status of elderly patients undergoing cardiac catheterization

    PubMed Central

    Ashraf, Javed M; Schweiger, Marc; Vallurupalli, Neelima; Bellantonio, Sandra; Cook, James R

    2015-01-01

    Background Sedatives and analgesics are often administered to achieve conscious sedation for diagnostic and therapeutic procedures. Appropriate concerns have been raised regarding post procedure delirium related to peri-procedural medication in the elderly. The objective of this study was to investigate the effect of premedication on new onset delirium and procedural care in elderly patients. Methods Patients ≥ 70 years old and scheduled for elective cardiac catheterization were randomly assigned to receive either oral diphenhydramine and diazepam (25 mg/5 mg) or no premedication. All patients underwent a mini mental state exam and delirium assessment using confusion assessment method prior to the procedure and repeated at 4 h after the procedure and prior to discharge. Patients' cooperation during the procedure and ease of post-procedure were measured using Visual Analog Scale (VAS). The degree of alertness was assessed immediately on arrival to the floor, and twice hourly afterwards using Observer's Assessment of Alertness/Sedation Scale (OAA/S). Results A total of 93 patients were enrolled. The mean age was 77 years, and 47 patients received premedication prior to the procedure. None of the patients in either group developed delirium. Patients' cooperation and the ease of procedure was greater and pain medication requirement less both during and after the procedure in the pre-medicated group (P < 0.05 for both). Nurses reported an improvement with patient management in the pre-medicated group (P = 0.08). Conclusions In conclusion, premedication did not cause delirium in elderly patients undergoing cardiac catheterization. The reduced pain medication requirement, perceived procedural ease and post procedure management favors premedication in elderly patients undergoing cardiac catheterization. PMID:26089850

  8. An algorithm for use of prasugrel (effient) in patients undergoing cardiac catheterization and percutaneous coronary intervention.

    PubMed

    Marchini, Julio; Morrow, David; Resnic, Frederic; Manica, Andre; Kirshenbaum, James; Cannon, Christopher; Croce, Kevin

    2010-12-01

    An algorithm for use of Prasugrel (Effient) in patients undergoing cardiac catheterization and percutaneous coronary intervention at the Brigham and Women's Hospital is presented. Our algorithm, which is in the process of being implemented, is consistent with published and generally accepted standards of care and is based on data from the pivotal Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38, which compared clopidogrel with prasugrel in acute coronary syndrome patients undergoing percutaneous coronary intervention. Areas of focus include analysis of the benefit of prasugrel over clopidogrel in acute coronary syndrome patients and appropriate selection of patients for prasugrel treatment.

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

    PubMed

    Long, T A

    1993-08-01

    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.

  10. Spanish Cardiac Catheterization and Coronary Intervention Registry. 25th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2015).

    PubMed

    Jiménez-Quevedo, Pilar; Serrador, Ana; Pérez de Prado, Armando; Pan, Manuel

    2016-12-01

    The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the data from the registry of the activity in 2015. All Spanish hospitals with catheterization laboratories were invited to voluntarily contribute their activity data. The information was collected online and analyzed mostly by an independent company. In 2015, 106 centers participated in the national register; 73 of these centers are public. A total of 145 836 diagnostic studies were conducted, among which 128 669 were coronary angiograms. These figures are higher than in previous years. The Spanish average of total diagnoses per million population was 3127. The number of coronary interventional procedures was very similar (67 671), although there was a slight increase in the complexity of coronary interventions: 7% in multivessel treatment and 8% in unprotected left main trunk treatment. A total of 98 043 stents were implanted, of which 74 684 were drug-eluting stents. A total of 18 418 interventional procedures were performed in the acute myocardial infarction setting, of which 81.9% were primary angioplasties. The radial approach was used in 73.3% of the diagnostic procedures and in 76.1% of interventional ones. The number of transcatheter aortic valve implantations continued to increase (1586), as well as the number of left atrial appendage closures (331). An increase in diagnostic and therapeutic procedures in acute myocardial infarction was reported in 2015. The use of the radial approach and drug-eluting stents also increased in therapeutic procedures. The progressive increase in structural procedures seen in previous years continued. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  11. Relationship of beam angulation and radiation exposure in the cardiac catheterization laboratory.

    PubMed

    Agarwal, Shikhar; Parashar, Akhil; Bajaj, Navkaranbir Singh; Khan, Imran; Ahmad, Imran; Heupler, Fredrick A; Bunte, Matthew; Modi, Dhruv K; Tuzcu, E Murat; Kapadia, Samir R

    2014-05-01

    The aim of this study was to analyze the relationship between beam angulation and air kerma in a modern cardiac catheterization laboratory. Recent reports have identified the merits of reducing radiation scatter, an important determinant of radiation dose in the catheterization laboratory. Radiation scatter is poorly characterized in the context of catheterization laboratories using modern digital equipment. Understanding the principles of dosimetry may reduce the radiation exposure to patients, providers, and medical staff. Prospectively captured radiation data were extracted from a database of 1,975 diagnostic catheterizations (DCs) and 755 percutaneous coronary interventions (PCIs), which included 138,342 fluoroscopic and 35,440 acquisition (cine) sequences. Fluoroscopy and acquisition modes were categorized into tertiles based on the total air kerma measured at a standard reference point. Radiation maps were modeled according to the relative proportion of exposure in each projection. Median air kerma during DCs and PCIs was 677 and 2,188 mGy, respectively. Fluoroscopy contributed to 66.3% of total dose during PCIs compared with 39.7% during DCs (p < 0.001). Fluoroscopy was more sensitive to changes in angulation with a rapid increase in total air kerma on small increases in beam angulation. Complex spatial maps were created to study the impact of angulation and other covariates on total air kerma. Besides beam angulation, body surface area was the strongest predictor of the total air kerma. This study uniquely describes radiation dosimetry using contemporary equipment in a real-world setting. Extreme angulations were associated with high air kerma values. Fluoroscopy compared with acquisition was more sensitive to changes in angulation, with relatively larger increases in total air kerma with small increases in steepness of the angulation. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Radial Artery Catheterization

    MedlinePlus

    ... of the radial artery for cardiac catheterization procedures. Advantages of Radial Artery Catheterization Any catheter placement into ... walk, and eat immediately. This is a particular advantage for patients with back problems because there is ...

  13. Spanish cardiac catheterization and coronary intervention registry. 22nd official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2012).

    PubMed

    García Del Blanco, Bruno; Rumoroso Cuevas, Jose Ramón; Hernández Hernández, Felipe; Trillo Nouche, Ramiro

    2013-11-01

    The Working Group on Cardiac Catheterization and Interventional Cardiology presents the yearly report on the data collected for the Spanish registry. Institutions provided their data voluntarily (online) and the information was analyzed by the Working Group's Steering Committee. Data were provided by 109 hospitals (71 public and 38 private) that mainly treat adults. There were 136,912 diagnostic procedures, 120, 441 of which were coronary angiograms, slightly fewer than the year before, with a rate of 2979 diagnostic studies per million population. Percutaneous coronary interventions increased slightly to 65,909 procedures, for a rate of 1434 interventions per million population. Of the 99,110 stents implanted, 62% were drug-eluting stents. In all, 17,125 coronary interventions were carried out during the acute phase of myocardial infarction, 10.5% more than in 2011, representing 25.9% of the total number of coronary interventions. The most frequently performed intervention for adult congenital heart disease was atrial septal defect closure (292 procedures). The use of percutaneous mitral valvuloplasty continued to decline (258 procedures) and percutaneous aortic valve implantations increased by only 10% in 2012. In 2012, the only increase in hemodynamic activity occurred in the field of ST-elevation myocardial infarction, and the increasing trend had slowed for percutaneous aortic valve implantation and other procedures affecting structure. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  14. Soluble CD40 Ligand in Aspirin-Treated Patients Undergoing Cardiac Catheterization

    PubMed Central

    Gremmel, Thomas; Frelinger, Andrew L.; Michelson, Alan D.

    2015-01-01

    Plasma soluble CD40 ligand (sCD40L) is mainly generated by cleavage of CD40L from the surface of activated platelets, and therefore considered a platelet activation marker. Although the predictive value of sCD40L for ischemic events has been demonstrated in patients with acute coronary syndromes (ACS), studies on the association of sCD40L with cardiovascular outcomes in lower risk populations yielded heterogeneous results. We therefore sought to investigate factors influencing sCD40L levels, and the predictive value of sCD40L for long-term ischemic events in unselected, aspirin-treated patients undergoing cardiac catheterization. sCD40L was determined by a commercially available enzyme-linked immunosorbent assay in 682 consecutive patients undergoing cardiac catheterization. Two-year follow-up data were obtained from 562 patients. Dual antiplatelet therapy with aspirin and clopidogrel was associated with significantly lower levels of sCD40L and lower platelet surface expressions of P-selectin and activated GPIIb/IIIa compared to aspirin monotherapy (all p≤0.01). Hypertension was linked to lower plasma concentrations of sCD40L, whereas female sex, increasing high-sensitivity C-reactive protein, and hematocrit were associated with higher sCD40L concentrations (all p<0.05). sCD40L levels were similar in patients without and with the primary endpoint in the overall study population (p = 0.4). Likewise, sCD40L levels did not differ significantly between patients without and with the secondary endpoints (both p≥0.4). Similar results were obtained when only patients with angiographically-proven coronary artery disease (n = 459), stent implantation (n = 205) or ACS (n = 125) were analyzed. The adjustment for differences in patient characteristics by multivariate regression analyses did not change the results. ROC curve analyses did not reveal cut-off values for sCD40L for the prediction of the primary or secondary endpoints. In conclusion, plasma sCD40L levels are

  15. Risk of cancer associated with cardiac catheterization procedures during childhood: a cohort study in France

    PubMed Central

    2013-01-01

    Background Radiation can be used effectively for diagnosis and medical treatment, but it can also cause cancers later on. Children with congenital heart disease frequently undergo cardiac catheterization procedures for diagnostic or treatment purposes. Despite the clear clinical benefit to the patient, the complexity of these procedures may result in high cumulative radiation exposure. Given children’s greater sensitivity to radiation and the longer life span during which radiation health effects can develop, an epidemiological cohort study is being launched in France to evaluate the risks of leukaemia and solid cancers in this specific population. Methods/design The study population will include all children who have undergone at least one cardiac catheterization procedure since 2000 and were under 10 years old and permanent residents of France at the time of the procedure. Electronically stored patient records from the departments of paediatric cardiology of the French national network for complex congenital heart diseases (M3C) are being searched to identify the children to be included. The minimum dataset will comprise: identification of the subject (file number in the centre or department, full name, sex, date and place of birth), and characteristics of the intervention (date, underlying disease, type of procedure, technical details, such as fluoroscopy time and dose area product, (DAP), which are needed to reconstruct the doses received by each child). The cohort will be followed up through linkage with the two French paediatric cancer registries, which have recorded all cases of childhood leukaemia and solid cancers in France since 1990 and 2000, respectively. Radiation exposure will be estimated retrospectively for each child. 4500 children with catherizations between 2000 and 2011 have been already included in the cohort, and recruitment is ongoing at the national level. The study is expected to finally include a total of 8000 children. Discussion This

  16. A new technique for long time catheterization of sacral epidural canal in rabbits.

    PubMed

    Erkin, Yüksel; Aydın, Zeynep; Taşdöğen, Aydın; Karcı, Ayşe

    2013-01-01

    In this study we aimed to develop a simple and practical technique for chronic sacral epidural catheterization of rabbits. We included ten rabbits weighing 2-2.5 kg in the study. After anesthesia and analgesia, we placed an epidural catheter by a 2 cm longitudinal skin incision in the tail above the sacral hiatus region. We confirmed localization by giving 1% lidocaine (leveling sensory loss and motor function loss of the lower extremity). The catheter was carried forward through a subcutaneous tunnel and fixed at the neck. Chronic caudal epidural catheter placement was succesful in all rabbits. The catheters stayed in place effectively for ten days. We encountered no catheter complications during this period. The localization of the catheter was reconfirmed by 1% lidocaine on the last day. After animals killing, we performed a laminectomy and verified localization of the catheter in the epidural space. Various methods for catheterization of the epidural space in animal models exist in the literature. Epidural catheterization of rabbits can be accomplished by atlanto-occipital, lumbar or caudal routes by amputation of the tail. Intrathecal and epidural catheterization techniques defined in the literature necessitate surgical skill and knowledge of surgical procedures like laminectomy and tail amputation. Our technique does not require substantial surgical skill, anatomical integrity is preserved and malposition of the catheter is not encountered. In conclusion, we suggest that our simple and easily applicable new epidural catheterization technique can be used as a model in experimental animal studies.

  17. Ultrasound-guided central venous catheterization: A review of the relevant anatomy, technique, complications, and anatomical variations.

    PubMed

    Hoffman, Taryn; Du Plessis, Maira; Prekupec, Matthew P; Gielecki, Jerzy; Zurada, Anna; Shane Tubbs, R; Loukas, Marios

    2017-03-01

    Central venous catheterization is a commonly used and important intervention. Despite its regular use it is still associated with a high incidence of complications especially infection and catheter tip embolization. Addition of ultrasound guidance to the technique has shown great improvement to the time and number of attempts for successful catheterization. The preference of vein depends greatly on the situation; subclavian vein is the preferred method overall but internal jugular vein is preferred in patients undergoing cardiac or thoracic surgery. This is especially true for pediatric patients in whom femoral vein catheterization is still preferred despite it carrying a higher risk than other locales. Addition of ultrasound guidance greatly reduces the incidence of arterial puncture and subsequent hematoma formation regardless of location. This is because it allows for visualization of anatomical variation prior to intervention and continual visualization of the needle during the placement. It is noteworthy however, that addition of ultrasound does not prevent complications such as catheter tip embolization as this may occur even with perfect placement. The value of ultrasound usage is undisputable since all studies assessing the difference between it and landmark based methods showed preferable outcome. Reduction of time and number of attempts is sufficient argument to make ultrasound guidance standard practice. Clin. Anat. 30:237-250, 2017. © 2017 Wiley Periodicals, Inc.

  18. Effect of music therapy with emotional-approach coping on preprocedural anxiety in cardiac catheterization: a randomized controlled trial.

    PubMed

    Ghetti, Claire M

    2013-01-01

    Individuals undergoing cardiac catheterization are likely to experience elevated anxiety periprocedurally, with highest anxiety levels occurring immediately prior to the procedure. Elevated anxiety has the potential to negatively impact these individuals psychologically and physiologically in ways that may influence the subsequent procedure. This study evaluated the use of music therapy, with a specific emphasis on emotional-approach coping, immediately prior to cardiac catheterization to impact periprocedural outcomes. The randomized, pretest/posttest control group design consisted of two experimental groups--the Music Therapy with Emotional-Approach Coping group [MT/EAC] (n = 13), and a talk-based Emotional-Approach Coping group (n = 14), compared with a standard care Control group (n = 10). MT/EAC led to improved positive affective states in adults awaiting elective cardiac catheterization, whereas a talk-based emphasis on emotional-approach coping or standard care did not. All groups demonstrated a significant overall decrease in negative affect. The MT/EAC group demonstrated a statistically significant, but not clinically significant, increase in systolic blood pressure most likely due to active engagement in music making. The MT/EAC group trended toward shortest procedure length and least amount of anxiolytic required during the procedure, while the EAC group trended toward least amount of analgesic required during the procedure, but these differences were not statistically significant. Actively engaging in a session of music therapy with an emphasis on emotional-approach coping can improve the well-being of adults awaiting cardiac catheterization procedures.

  19. Cardiac catheterization in patients with unstable angina. Recent onset vs crescendo pattern.

    PubMed

    Plotnik, G D; Fisher, M L; Carliner, N H; Becker, L C

    1980-08-08

    Among patients with unstable angina pectoris, those with crescendo angina seem to be at high risk for death and myocardial infarction. We reviewed the clinical, arteriographic, and hemodynamic findings in 218 consecutive catheterized patients with unstable angina. Unstable angina was defined as ischemic cardiac pain at rest associated with transient ECG changes but no evidence for acute myocardial infarction. Patients were divided into two groups according to the duration of symptoms: 134 patients with crescendo angina (new, or increasing, rest pain with previous ischemic symptoms present for more than three months) and 84 with recent onset angina (symptoms present for less than three months). Compared with patients with recent onset symptoms, patients with crescendo angina had more extensive coronary disease and lower ejection fractions, which may explain their poor prognosis.

  20. Feasible induction of coronary artery vasospasm occurred during cardiac catheterization in a microminipig

    PubMed Central

    MATSUKURA, Suchitra; NAKAMURA, Yuji; OHARA, Hiroshi; CAO, Xin; WADA, Takeshi; IZUMI-NAKASEKO, Hiroko; ANDO, Kentaro; AKASAKA, Yoshikiyo; SUGIYAMA, Atsushi

    2016-01-01

    A 14 month-old intact microminipig, weighing 8 kg, showed ST-segment elevation in A-B lead electrocardiogram during cardiac catheterization followed by ventricular tachycardia, which degenerated into ventricular fibrillation. Although a direct current defibrillation of 360 J was applied, ventricular tachycardia re-occurred for another 2 times and the direct defibrillation was repeated. After returning to normal sinus rhythm, a marked ST-segment elevation was still observed on leads II, III and aVF together with a remarkable decrease in contractility of inferior wall. The heart was excised for precise macroscopic and histological examinations, but there was no dissection, embolus or thrombus in the coronary arteries. These findings suggest that right coronary artery vasospasm could have caused the ischemic attack, leading to lethal arrhythmias. PMID:26806564

  1. An Algorithm for use of Prasugrel (Effient) in Patients Undergoing Cardiac Catheterization and Percutaneous Coronary Intervention

    PubMed Central

    Marchini, Julio; Morrow, David; Resnic, Frederic; Manica, Andre; Kirshenbaum, James; Cannon, Christopher; Croce, Kevin

    2011-01-01

    An algorithm for use of Prasugrel (Effient) in patients undergoing cardiac catheterization and percutaneous coronary intervention (PCI) at the Brigham and Women’s Hospital is presented. Our algorithm, which is in the process of being implemented, is consistent with published and generally accepted standards of care and is based on data from the pivotal Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38, which compared clopidogrel to prasugrel in acute coronary syndrome (ACS) patients undergoing PCI. Areas of focus include analysis of the benefit of prasugrel over clopidogrel in ACS patients and appropriate selection of patients for prasugrel treatment. PMID:21119336

  2. Mycotic Saccular Abdominal Aortic Aneurysm in an Infant after Cardiac Catheterization: A Case Report.

    PubMed

    Benrashid, Ehsan; McCoy, Christopher C; Rice, Henry E; Shortell, Cynthia K; Cox, Mitchell W

    2015-10-01

    Abdominal aortic aneurysms (AAAs) are a rare entity in the pediatric population. Children with mycotic (infectious) AAA in particular are at risk of life-threatening rupture due to their rapid expansion coupled with aortic wall thinning and deterioration. Here, we present the case of a 10-month-old infant with prior 2-staged repair for hypoplastic left heart syndrome that was incidentally discovered to have a mycotic AAA on abdominal ultrasound (US) for evaluation of renovascular hypertension. Before the time of evaluation with US, the infant had developed methicillin-resistant Staphylococcus aureus bacteremia 3 days after cardiac catheterization with percutaneous thoracic aortic balloon angioplasty. She had normal aortic contours on contrasted computed tomography scan of the abdomen approximately 2 weeks before the aforementioned US evaluation. This infant subsequently underwent open aneurysmorrhaphy with cryopreserved vein patch angioplasty with resolution of her aneurysmal segment. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    SciTech Connect

    Martin, E.C.; Olson, A.P.; Steeg, C.N.; Casarella, W.J.

    1981-07-01

    Thermoluminescent dosimetry was used to measure the radiation exposure to the skin, thyroid and gonads in 50 consecutive pediatric patients undergoing cardiac catheterization and angiocariography 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 to 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.

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

    SciTech Connect

    Martin, E.C.; Olson, A.P.; Steeg, C.N.; Casarella, W.J.

    1981-07-01

    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.

  5. Radiation dosage during pediatric diagnostic or interventional cardiac catheterizations using the “air gap technique” and an aggressive “as low as reasonably achievable” radiation reduction protocol in patients weighing <20 kg

    PubMed Central

    Osei, Frank A; Hayman, Joshua; Sutton, Nicole J; Pass, Robert H

    2016-01-01

    Background: Cardiac catheterizations expose both the patient and staff to the risks of ionizing radiation. Studies using the “air gap” technique (AGT) in various radiological procedures indicate that its use leads to reduction in radiation exposure but there are no data on its use for pediatric cardiac catheterization. The aim of this study was to retrospectively review the radiation exposure data for children weighing <20 kg during cardiac catheterizations using AGT and an “as low as reasonably achievable (ALARA)” radiation reduction protocol. Patients and Methods: All patients weighing <20 kg who underwent cardiac catheterization at the Children's Hospital at Montefiore (CHAM), New York, the United States from 05/2011 to 10/2013 were included. Transplant patients who underwent routine endomyocardial biopsy and those who had surgical procedures at the time of the catheterizations were excluded. The ALARA protocol was used in concert with AGT with the flat panel detector positioned 110 cm from the patient. Demographics, procedural data, and patient radiation exposure levels were collected and analyzed. Results: One-hundred and twenty-seven patients underwent 151 procedures within the study period. The median age was 1.2 years (range: 1 day to 7.9 years) and median weight was 8.8 kg (range: 1.9-19.7). Eighty-nine (59%) of the procedures were interventional. The median total fluoro time was 13 min [interquartile range (IQR) 7.3-21.8]. The median total air Kerma (K) product was 55.6 mGy (IQR 17.6-94.2) and dose area product (DAP) was 189 Gym2 (IQR 62.6-425.5). Conclusion: Use of a novel ALARA and AGT protocol for cardiac catheterizations in children markedly reduced radiation exposure to levels far below recently reported values. Abbreviations: AGT: Air gap technique, ALARA: As low as reasonably achievable. PMID:27011686

  6. Paraplegia following cervical epidural catheterization using loss of resistance technique with air: a case report.

    PubMed

    Chae, Yun Jeong; Han, Kyung Ream; Park, Hyung Bae; Kim, Chan; Nam, Si Gweon

    2016-02-01

    We report a case of paraplegia without neurologic deficit of upper extremities following cervical epidural catheterization using air during the loss of resistance technique. A 41-year-old woman diagnosed with complex regional pain syndrome had upper and lower extremity pain. A thoracic epidural lead was inserted for a trial spinal cord stimulation for treating lower extremity pain and cervical epidural catheterization was performed for treating upper extremity pain. Rapidly progressive paraplegia developed six hours after cervical epidural catheterization. Spine CT revealed air entrapment in multiple thoracic intervertebral foraminal spaces and surrounding epidural space without obvious spinal cord compression before the decompressive operation, which disappeared one day after the decompressive operation. Her paraplegia symptoms were normalized immediately after the operation. The presumed cause of paraplegia was transient interruption of blood supply to the spinal cord through the segmental radiculomedullary arteries feeding the spinal cord at the thoracic level of the intervertebral foramen caused by the air.

  7. Cardiac catheterization in the dialysis population in 2012: we know more, but much remains unknown.

    PubMed

    Costa, Salvatore P; Jayne, John E; Friedman, Scott E; Lentine, Krista L

    2012-05-01

    Chronic kidney disease is now widely accepted as an independent risk factor for coronary disease and the dialysis population may represent the highest risk subgroup. Among all dialysis patients, a cardiac cause of mortality has been estimated at 40%. In addition, prior studies have demonstrated that when cardiac catheterization is obtained in a consecutive series of asymptomatic diabetic patients on dialysis the rates of coronary disease can approach 50%. However, the ability to define the problem continues to be greater than the ability to treat or prevent it. Coronary revascularization strategies have limitations in the general population which are amplified in the dialysis population. The ability to accurately diagnose an acute coronary syndrome is more difficult, clinical outcomes have a smaller margin of benefit, and technical challenges result in higher complication rates. Recent data demonstrate an inverse relationship between glomerular filtration rate and the risk of presenting with an acute myocardial infarction rather than unstable angina suggesting that patients with CKD may have a unique pathophysiologic profile that is more prone to plaque rupture. However, these "vulnerable" plaques typically are associated with stenoses <50% prior to rupture and are thus poor targets for revascularization and perhaps best treated with medical therapy. Although the benefits of revascularization may continue to outweigh the risks in the context of acute coronary syndromes, preventive strategies would have to overcome the lower margin of benefit and higher complication rates. © 2012 Wiley Periodicals, Inc.

  8. Radiation dose reduction in the cardiac catheterization laboratory utilizing a novel protocol.

    PubMed

    Wassef, Anthony W A; Hiebert, Brett; Ravandi, Amir; Ducas, John; Minhas, Kunal; Vo, Minh; Kass, Malek; Parmar, Gurpreet; Hussain, Farrukh

    2014-05-01

    This study reports the results a novel radiation reduction protocol (RRP) system for coronary angiography and interventional procedures and the determinants of radiation dose. The cardiac catheterization laboratory is an important source of radiation and should be kept in good working order with dose-reduction and monitoring capabilities. All diagnostic coronary angiograms and percutaneous coronary interventions from a single catheterization laboratory were analyzed 2 months before and after RRP implementation. The primary outcome was the relative dose reduction at the interventional reference point. Separate analyses were done for conventional 15 frames/s (FPS) and at reduced 7.5 FPS post-RRP groups. A total of 605 patients underwent coronary angiography (309 before RRP and 296 after RRP), with 129 (42%) and 122 (41%) undergoing percutaneous coronary interventions before and after RRP, respectively. With RRP, a 48% dose reduction (1.07 ± 0.05 Gy vs. 0.56 ± 0.03 Gy, p < 0.0001) was obtained, 35% with 15 FPS RRP (0.70 ± 0.05 Gy, p < 0.0001) and 62% with 7.5 FPS RRP (0.41 ± 0.03 Gy, p < 0.001). Similar dose reductions for diagnostic angiograms and percutaneous coronary interventions were noted. There was no change in the number of stents placed or vessels intervened on. Increased dose was associated with male sex, radial approach, increasing body mass index, cine runs, and frame rates. Using a multivariable model, a 48% relative risk with RRP (p < 0.001), 44% with 15 FPS RRP and 68% with 7.5 FPS RRP was obtained. We demonstrate a highly significant 48.5% adjusted radiation dose reduction using a novel algorithm, which needs strong consideration among interventional cardiology practice. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. Music for anxiety reduction in patients undergoing cardiac catheterization: A systematic review and meta-analysis of randomized controlled trials.

    PubMed

    Jayakar, Jai P; Alter, David A

    2017-08-01

    Medical diagnostic procedures, such as cardiac catheterization, can cause significant patient anxiety. Patient anxiety can have negative implications for compliance with healthcare visits, medical tests, and treatments. Music interventions may have a role in reducing anxiety related to cardiac catheterization procedures. To perform a comprehensive systematic review and meta-analysis evaluating whether musical interventions reduce anxiety in patients undergoing cardiac catheterization. MEDLINE, EMBASE, CENTRAL, AMED, and PsychINFO from inception to May 2015. Reference lists of included articles were further hand searched for additional eligible studies. Randomized controlled trials evaluating the effectiveness of music interventions for anxiety reduction in patients undergoing cardiac catheterization. Data on trial design, baseline characteristics and outcomes was extracted using a data extraction table. Study quality and risk of bias were assessed using the JADAD scale. The main outcome was the effectiveness of music interventions in reducing anxiety in this patient population. Meta-analysis was pursued using data from studies that had used the Spielberger state anxiety inventory (STAI-S) to measure anxiety reduction. Other outcomes qualitatively reported include the use of anxiolytic medications and effect on physiological parameters such as blood pressure and heart rate. A total of 15 studies were found to be eligible for inclusion (14 published trials and one conference abstract) in this review. Two-thirds of these studies showed statistically significant reduction in measures of patient anxiety or well-being with musical interventions. Meta-analysis included six studies (n = 695) and showed statistically significant reduction in mean STAI-S scores with music (-3.95 points; 95% confidence -5.53 and -2.37; p value less than 0.005). In conclusion, music is a safe and easily administered intervention that can be used for anxiety reduction among patients

  10. Effect of pulsed progressive fluoroscopy on reduction of radiation dose in the cardiac catheterization laboratory

    SciTech Connect

    Holmes, D.R. Jr.; Wondrow, M.A.; Gray, J.E.; Vetter, R.J.; Fellows, J.L.; Julsrud, P.R. )

    1990-01-01

    The increased application of therapeutic interventional cardiology procedures is associated with increased radiation exposure to physicians, patients and technical personnel. New advances in imaging techniques have the potential for reducing radiation exposure. A progressive scanning video system with a standard vascular phantom has been shown to decrease entrance radiation exposure. The effect of this system on reducing actual radiation exposure to physicians and technicians was assessed from 1984 through 1987. During this time, progressive fluoroscopy was added sequentially to all four adult catheterization laboratories; no changes in shielding procedures were made. During this time, the case load per physician increased by 63% and the number of percutaneous transluminal coronary angioplasty procedures (a high radiation procedure) increased by 244%. Despite these increases in both case load and higher radiation procedures, the average radiation exposure per physician declined by 37%. During the same time, the radiation exposure for technicians decreased by 35%. Pulsed progressive fluoroscopy is effective for reducing radiation exposure to catheterization laboratory physicians and technical staff.

  11. Progression of isolated aortic stenosis: analysis of 29 patients having more than 1 cardiac catheterization.

    PubMed

    Nestico, P F; DePace, N L; Kimbiris, D; Hakki, A H; Khanderia, B; Iskandrian, A S; Segal, B

    1983-11-01

    Factors related to progression of nonrheumatic aortic stenosis (AS) were analyzed in 29 adult patients who underwent serial hemodynamic studies over a mean of 71 months. AS was congenital in 8 patients and degenerative in 21. The patients were divided into 2 groups on the basis of the change in aortic valve area between the 2 studies. Twelve patients had a greater than or equal to 25% reduction in aortic valve area (Group I) and 17 patients had less than 25% decrease in aortic valve area (Group II). There were no significant differences between the 2 groups in age, interval between studies, cardiac output, left ventricular end-diastolic pressure, left ventricular peak systolic pressure and origin of AS (congenital or degenerative). Group I patients had significantly larger initial aortic valve areas than did Group II patients (1.3 +/- 0.9 cm2 versus 0.8 +/- 0.4 cm2, p = 0.02). Also, the initial peak transaortic pressure gradients were lower in Group I than in Group II (27 +/- 19 versus 58 +/- 38 mm Hg, p = 0.01). Group I patients had a significantly greater increase in pressure gradient and a greater reduction in cardiac output than did Group II patients (24 +/- 21 mm Hg in Group I versus -0.1 +/- 24.5 mm Hg in Group II, p = 0.01, and -1.0 +/- 1.3 liters/min in Group I versus 0.10 +/- 1.4 liters/min in Group II, p = 0.03). Thus, AS progressed in 41% of a selected group of patients who underwent repeated cardiac catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. A home-based exercise program for children with congenital heart disease following interventional cardiac catheterization: study protocol for a randomized controlled trial.

    PubMed

    Du, Qing; Salem, Yasser; Liu, Hao Howe; Zhou, Xuan; Chen, Sun; Chen, Nan; Yang, Xiaoyan; Liang, Juping; Sun, Kun

    2017-01-23

    Cardiac catheterization has opened an innovative treatment field for cardiac disease; this treatment is becoming the most popular approach for pediatric congenital heart disease (CHD) and has led to a significant growth in the number of children with cardiac catheterization. Unfortunately, based on evidence, it has been demonstrated that the majority of children with CHD are at an increased risk of "non-cardiac" problems. Effective exercise therapy could improve their functional status significantly. As studies identifying the efficacy of exercise therapy are rare in this field, the aims of this study are to (1) identify the efficacy of a home-based exercise program to improve the motor function of children with CHD with cardiac catheterization, (2) reduce parental anxiety and parenting burden, and (3) improve the quality of life for parents whose children are diagnosed with CHD with cardiac catheterization through the program. A total of 300 children who will perform a cardiac catheterization will be randomly assigned to two groups: a home-based intervention group and a control group. The home-based intervention group will carry out a home-based exercise program, and the control group will receive only home-based exercise education. Assessments will be undertaken before catheterization and at 1, 3, and 6 months after catheterization. Motor ability quotients will be assessed as the primary outcomes. The modified Ross score, cardiac function, speed of sound at the tibia, functional independence of the children, anxiety, quality of life, and caregiver burden of their parents or the main caregivers will be the secondary outcome measurements. The proposed prospective randomized controlled trial will evaluate the efficiency of a home-based exercise program for children with CHD with cardiac catheterization. We anticipate that the home-based exercise program may represent a valuable and efficient intervention for children with CHD and their families. http

  13. Cardiac catheterization in children with pulmonary hypertensive vascular disease: consensus statement from the Pulmonary Vascular Research Institute, Pediatric and Congenital Heart Disease Task Forces.

    PubMed

    Del Cerro, Maria Jesus; Moledina, Shahin; Haworth, Sheila G; Ivy, Dunbar; Al Dabbagh, Maha; Banjar, Hanaa; Diaz, Gabriel; Heath-Freudenthal, Alexandria; Galal, Ahmed Nasser; Humpl, Tilman; Kulkarni, Snehal; Lopes, Antonio; Mocumbi, Ana Olga; Puri, G D; Rossouw, Beyra; Harikrishnan, S; Saxena, Anita; Udo, Patience; Caicedo, Lina; Tamimi, Omar; Adatia, Ian

    2016-03-01

    Cardiac catheterization is important in the diagnosis and risk stratification of pulmonary hypertensive vascular disease (PHVD) in children. Acute vasoreactivity testing provides key information about management, prognosis, therapeutic strategies, and efficacy. Data obtained at cardiac catheterization continue to play an important role in determining the surgical options for children with congenital heart disease and clinical evidence of increased pulmonary vascular resistance. The Pediatric and Congenital Heart Disease Task Forces of the Pulmonary Vascular Research Institute met to develop a consensus statement regarding indications for, conduct of, acute vasoreactivity testing with, and pitfalls and risks of cardiac catheterization in children with PHVD. This document contains the essentials of those discussions to provide a rationale for the hemodynamic assessment by cardiac catheterization of children with PHVD.

  14. Cardiac catheterization in children with pulmonary hypertensive vascular disease: consensus statement from the Pulmonary Vascular Research Institute, Pediatric and Congenital Heart Disease Task Forces

    PubMed Central

    del Cerro, Maria Jesus; Moledina, Shahin; Haworth, Sheila G.; Ivy, Dunbar; Al Dabbagh, Maha; Banjar, Hanaa; Diaz, Gabriel; Heath-Freudenthal, Alexandria; Galal, Ahmed Nasser; Humpl, Tilman; Kulkarni, Snehal; Lopes, Antonio; Mocumbi, Ana Olga; Puri, G. D.; Rossouw, Beyra; Harikrishnan, S.; Saxena, Anita; Udo, Patience; Caicedo, Lina; Tamimi, Omar

    2016-01-01

    Abstract Cardiac catheterization is important in the diagnosis and risk stratification of pulmonary hypertensive vascular disease (PHVD) in children. Acute vasoreactivity testing provides key information about management, prognosis, therapeutic strategies, and efficacy. Data obtained at cardiac catheterization continue to play an important role in determining the surgical options for children with congenital heart disease and clinical evidence of increased pulmonary vascular resistance. The Pediatric and Congenital Heart Disease Task Forces of the Pulmonary Vascular Research Institute met to develop a consensus statement regarding indications for, conduct of, acute vasoreactivity testing with, and pitfalls and risks of cardiac catheterization in children with PHVD. This document contains the essentials of those discussions to provide a rationale for the hemodynamic assessment by cardiac catheterization of children with PHVD. PMID:27076908

  15. Technical note: rapid, large-volume resuscitation at resuscitative thoracotomy by intra-cardiac catheterization

    PubMed Central

    Cawich, Shamir O; Naraynsingh, Vijay

    2016-01-01

    An emergency thoracotomy may be life-saving by achieving four goals: (i) releasing cardiac tamponade, (ii) controlling haemorrhage, (iii) allowing access for internal cardiac massage and (iv) clamping the descending aorta to isolate circulation to the upper torso in damage control surgery. We theorize that a new goal should be achieving rapid, large-volume fluid resuscitation and we describe a technique to achieve this. PMID:27887010

  16. Adjusting for Risk Associated with Pediatric and Congenital Cardiac Catheterization: A Report from the NCDR® IMPACT™ Registry

    PubMed Central

    Jayaram, Natalie; Beekman, Robert H.; Benson, Lee; Holzer, Ralf; Jenkins, Kathy; Kennedy, Kevin F.; Martin, Gerard R.; Moore, John W.; Ringel, Richard; Rome, Jonathan; Spertus, John A.; Vincent, Robert; Bergersen, Lisa

    2016-01-01

    Background As US healthcare increasingly focuses upon outcomes as a means for quantifying quality, there is a growing demand for risk models that can account for the variability of patients treated at different hospitals so that equitable comparisons between institutions can be made. We sought to apply aspects of prior risk-standardization methodology in order to begin development of a risk-standardization tool for the NCDR® IMPACT™ (Improving Pediatric and Adult Congenital Treatment) Registry. Methods and Results Using IMPACT, all patients undergoing diagnostic or interventional cardiac catheterization between January 2011 and March 2013 were identified. Multivariable hierarchical logistic regression was used to identify patient and procedural characteristics predictive of experiencing a major adverse event following cardiac catheterization. A total of 19,608 cardiac catheterizations were performed between January 2011 and March 2013. Amongst all cases, a major adverse event occurred in 378 (1.9%) of all cases. After multivariable adjustment, eight variables were identified as critical for risk-standardization: patient age, renal insufficiency, single-ventricle physiology, procedure-type risk group, low systemic saturation, low mixed venous saturation, elevated systemic ventricular end diastolic pressure, and elevated main pulmonary artery pressures. The model had good discrimination (C-statistic of 0.70), confirmed by bootstrap validation (validation C-statistic of 0.69). Conclusions Using prior risk-standardization efforts as a foundation, we developed and internally validated a model to predict the occurrence of a major adverse event following cardiac catheterization for congenital heart disease. Future efforts should be directed towards further refinement of the model variables within this large, multicenter dataset. PMID:26481778

  17. Three-dimensional magnetic resonance imaging overlay to assist with percutaneous transhepatic access at the time of cardiac catheterization

    PubMed Central

    Whiteside, Wendy; Christensen, Jason; Zampi, Jeffrey D

    2015-01-01

    Multimodality image overlay is increasingly used for complex interventional procedures in the cardiac catheterization lab. We report a case in which three-dimensional magnetic resonance imaging (3D MRI) overlay onto live fluoroscopic imaging was utilized to safely obtain transhepatic access in a 12-year-old patient with prune belly syndrome, complex and distorted abdominal anatomy, and a vascular mass within the liver. PMID:26085770

  18. [Application of ultrasonography in central venous catheterization; access sites and procedure techniques].

    PubMed

    Czyzewska, Dorota; Ustymowicz, Andrzej; Klukowski, Mark

    2016-08-05

    Central venous catheterization is commonly performed in clinical practice. Traditional procedural technique is based on anatomical landmarks, but is associated with a high risk of failure and complications. To decrease their incidence European and American societies recommend application of ultrasonography. Preliminary ultrasonographic examination allows for assessment of local anatomical relations as well as vessel morphology (diameter, patency), while real-time ultrasonography increases chances of successful needle insertion. This paper presents the most common venous access sites and procedure techniques.

  19. Cost-volume-profit analysis and expected benefit of health services: a study of cardiac catheterization services.

    PubMed

    Younis, Mustafa Z; Jabr, Samer; Smith, Pamela C; Al-Hajeri, Maha; Hartmann, Michael

    2011-01-01

    Academic research investigating health care costs in the Palestinian region is limited. Therefore, this study examines the costs of the cardiac catheterization unit of one of the largest hospitals in Palestine. We focus on costs of a cardiac catheterization unit and the increasing number of deaths over the past decade in the region due to cardiovascular diseases (CVDs). We employ cost-volume-profit (CVP) analysis to determine the unit's break-even point (BEP), and investigate expected benefits (EBs) of Palestinian government subsidies to the unit. Findings indicate variable costs represent 56 percent of the hospital's total costs. Based on the three functions of the cardiac catheterization unit, results also indicate that the number of patients receiving services exceed the break-even point in each function, despite the unit receiving a government subsidy. Our findings, although based on one hospital, will permit hospital management to realize the importance of unit costs in order to make informed financial decisions. The use of break-even analysis will allow area managers to plan minimum production capacity for the organization. The economic benefits for patients and the government from the unit may encourage government officials to focus efforts on increasing future subsidies to the hospital.

  20. Cancer mortality following cardiac catheterization: a preliminary follow-up study on 4,891 irradiated children

    SciTech Connect

    Spengler, R.F.; Cook, D.H.; Clarke, E.A.; Olley, P.M.; Newman, A.M.

    1983-02-01

    A retrospective cohort study was conducted on the risk of radiation-induced cancer mortality following cardiac catheterization. The study included 4,891 children with congenital heart disease who were assessed by cardiac catheterization during 1946 to 1968 at The Hospital for Sick Children, Toronto. The cohort was matched against the Ontario cancer death file from 1950 to 1975. The average period of follow-up was 13 years and more than 66,000 person-years have been accrued from the cohort. No deaths from breast cancer or thyroid cancer were identified. Five cancer deaths were observed and compared with 4.8 expected deaths based on Ontario cancer death rates. The five cancer deaths resulted from three leukemias, one Wilms' tumor, and one unspecified nervous system tumor. The preliminary findings did not demonstrate a significant leukemia risk arising from diagnostic cardiac catheterizations. Continued follow-up of this cohort is required to evaluate the risk of breast and thyroid cancers which can occur more than 20 years following radiation exposure.

  1. Cancer mortality following cardiac catheterization: a preliminary follow-up study on 4,891 irradiated children

    SciTech Connect

    Spengler, R.F.; Cook, D.H.; Clarke, E.A.; Olley, P.M.; Newman, A.M.

    1983-02-01

    A retrospective cohort study was conducted on the risk of radiation-induced cancer mortality following cardiac catheterization. The study included 4,891 children with congenital heart disease who were assessed by cardiac catheterization during 1946 to 1968 at The Hospital for Sick Children, Toronto. The cohort was matched against the Ontario cancer death file from 1950 to 1975. The average period of follow-up was 13 years and more than 66,000 person-years have been accrued from the cohort. No deaths from breast cancer or thyroid cancer were identified. Five cancer deaths were observed and compared with 4.8 expected deaths based on Ontario cancer death rates. The five cancer deaths resulted from three leukemias, one Wilms tumor, and one unspecified nervous system tumor. The preliminary findings did not demonstrate a significant leukemia risk arising from diagnostic cardiac catheterizations. Continued follow-up of this cohort is required to evaluate the risk of breast and thyroid cancers which can occur more than 20 years following radiation exposure.

  2. Novel miniature mobile cardiac catheterization laboratory for critical cardiovascular disease following natural disasters: a feasibility study.

    PubMed

    Han, Ya-ling; Liang, Zhuo; Yao, Tian-ming; Sun, Jing-yang; Liang, Ming; Huo, Yu; Wang, Geng; Wang, Xiao-zeng; Liang, Yan-chun; Meng, Wei-hong

    2012-03-01

    Natural disasters have been frequent in recent years. Effective treatment of patients with cardiovascular disease following natural disasters is an unsolved problem. We aimed to develop a novel miniature mobile cardiac catheterization laboratory (Mini Mobile Cath Lab) to provide emergency interventional services for patients with critical cardiovascular disease following natural disasters. A feasibility study was performed by testing the Mini Mobile Cath Lab on dogs with ST-elevation myocardial infarction (STEMI) model in a hypothetical natural-disaster-stricken area. The Mini Mobile Cath Lab was transported to the hypothetical natural-disaster-stricken area by truck. Coronary angiography and primary percutaneous coronary intervention (PCI) were performed on six dogs with STEMI model. The transportation and transformation of the Mini Mobile Cath Lab were monitored and its functioning was evaluated through the results of animal experiments. The Mini Mobile Cath Lab could be transported by truck at an average speed of 80 km/h on mountain roads during daytime in the winter, under conditions of light snow (-15°C to -20°C/-68°F to -59°F). The average time required to prepare the Mini Mobile Cath Lab after transportation, in a wetland area, was 30 minutes. Coronary angiography, and primary PCI were performed successfully. This preliminary feasibility study of the use of the Mini Mobile Cath Lab for emergency interventional treatment of dogs with STEMI indicated that it may perform well in the rescue of critical cardiovascular disease following natural disasters.

  3. Calibration of Kodak EDR2 film for patient skin dose assessment in cardiac catheterization procedures

    NASA Astrophysics Data System (ADS)

    Morrell, Rachel E.; Rogers, Andy

    2004-12-01

    Kodak EDR2 film has been calibrated across the range of exposure conditions encountered in our cardiac catheterization laboratory. Its dose-response function has been successfully modelled, up to the saturation point of 1 Gy. The most important factor affecting film sensitivity is the use of beam filtration. Spectral filtration and kVp together account for a variation in dose per optical density of -10% to +25%, at 160 mGy. The use of a dynamic wedge filter may cause doses to be underestimated by up to 6%. The film is relatively insensitive to variations in batch, field size, exposure rate, time to processing and day-to-day fluctuations in processor performance. Overall uncertainty in the calibration is estimated to be -20% to +40%, at 160 mGy. However, the uncertainty increases at higher doses, as the curve saturates. Artefacts were seen on a number of films, due to faults in the light-proofing of the film packets.

  4. Electrocardiograhic findings resulting in inappropriate cardiac catheterization laboratory activation for ST-segment elevation myocardial infarction

    PubMed Central

    Shamim, Shariq; McCrary, Justin; Wayne, Lori; Gratton, Matthew

    2014-01-01

    Background Prompt reperfusion has been shown to improve outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with a goal of culprit vessel patency in <90 minutes. This requires a coordinated approach between the emergency medical services (EMS), emergency department (ED) and interventional cardiology. The urgency of this process can contribute to inappropriate cardiac catheterization laboratory (CCL) activations. Objectives One of the major determinants of inappropriate activations has been misinterpretation of the electrocardiogram (ECG) in the patient with acute chest pain. Methods We report the ECG findings for all CCL activations over an 18-month period after the inception of a STEMI program at our institution. Results There were a total of 139 activations with 77 having a STEMI diagnosis confirmed and 62 activations where there was no STEMI. The inappropriate activations resulted from a combination of atypical symptoms and misinterpretation of the ECG (45% due to anterior ST-segment elevation) on patient presentation. The electrocardiographic abnormalities were particularly problematic in African-Americans with left ventricular hypertrophy. Conclusions In this single-center, prospective observational study, nearly half of the inappropriate STEMI activations were due to the misinterpretation of anterior ST-segment elevation and this finding was commonly seen in African-Americans with left ventricular hypertrophy. PMID:25009790

  5. Microcomputer-assisted filing system of cardiac catheterization records using a relational database management system.

    PubMed

    Mohri, M; Kikuchi, Y; Sagara, T; Sugihara, M

    1988-03-01

    To efficiently store and retrieve cardiac catheterization records, we have developed a computer-assisted database, which comprises a 16-bit microcomputer with dual floppy disk drives, a 20 MB random-access memory, hard disk drive, and a line printer. All programmings were accomplished using a relational database management system (R:base 5000, Microrim, Inc.). Data inquiry procedures could be performed with direct operational commands of the system as well as with preprogrammed command files, and final results of searches were printed out with a line printer. The major advantages of the present system described in this report include: (1) the relatively easy and rapid creation of the database, (2) ease of modification of the database structures even after the system design is finished, (3) operational commands in combination with conditional operator(s) are flexible and powerful enough to allow the end user to retrieve data based on various kinds of criteria, (4) a high-level programming language provided by the R:base automates a series of database procedures with relative ease, (5) relational capabilities of the database management system can enhance the possibility of reconstruction of a new data file from a single or several preexisting data files, and (6) the system can be realized at reasonable cost.

  6. Educational Video Intervention Effects on Periprocedural Anxiety Levels Among Cardiac Catheterization Patients: A Randomized Clinical Trial.

    PubMed

    Ayasrah, Shahnaz Mohammed; Ahmad, Muayyad M

    2016-01-01

    To explore the effectiveness of an educational video intervention in lowering periprocedural anxiety among Jordanian patients hospitalized for cardiac catheterization (CATH). There are many potential reasons of anxiety related to CATH including involvement of the heart and the actual test procedure. A randomized controlled trial took place in a specialized heart institute in Jordan. The sample size was 186 patients who had undergone CATH procedure. Patients anxiety levels were measured by physiological parameters of anxiety (blood pressure, heart rate, and respiratory rate) and by the Spielberger State Anxiety Inventory (SAI). After video education, there was a significant difference in periprocedural perceived anxiety between the groups: preprocedural anxiety levels (M = 39.03, SD = 5.70) for the experimental group versus (M = 49.34, SD = 6.00) for the control, p < .001, and postprocedural perceived anxiety for the experimental group (M = 29.18, SD = 5.42) versus (M = 41.73, SD = 5.41) for the control. Providing an educational video intervention about CATH may effectively decrease periprocedural anxiety levels.

  7. Randomized controlled trial on the impact of music therapy during cardiac catheterization on reactive hyperemia index and patient satisfaction: the Functional Change in Endothelium After Cardiac Catheterization, With and Without Music Therapy (FEAT) study.

    PubMed

    Ripley, Lindsay; Christopoulos, Georgios; Michael, Tesfaldet T; Alomar, Mohammed; Rangan, Bavana V; Roesle, Michele; Kotsia, Anna; Banerjee, Subhash; Brilakis, Emmanouil S

    2014-09-01

    To determine the impact of music intervention on endothelial function, hemodynamics, and patient anxiety before, during, and after cardiac catheterization. The effect of music therapy during cardiac catheterization on endothelial function and patient satisfaction has received limited study. Seventy patients undergoing elective cardiac catheterization were randomized to music therapy (n=36) or no music therapy (n=34). Peripheral arterial tonometry was performed before and after catheterization. A 6 item (24-point scale) questionnaire evaluating patient anxiety and discomfort levels was also administered after the procedure. Both study groups had similar baseline characteristics, fluoroscopy time, and contrast administration. Reactive hyperemia index (RHI) change was 0.14 ± 0.72 in the music group and 0.30 ± 0.58 in the control group (P=.35). Systolic and diastolic blood pressure (BP) changes did not significantly differ between the two groups (systolic BP change -3.3 ± 17.3 mm Hg vs -2.3 ± 19.4 mm Hg; P=.83 and diastolic BP change -1.9 ± 12.2 mm Hg vs. 2.0 ± 13.4 mm Hg; P=.23). Heart rate changes were also comparable between the two groups (-1 ± 6 beats/ min vs -1 ± 7 beats/min; P=.22). Patient satisfaction questionnaire measurements were found to be similar in patients with and without music therapy (8 [7-11] vs 9 [8-12]; P=.36). In this study, music intervention did not elicit a vasodilator response, did not lower blood pressure or heart rate, and did not relieve anxiety or stress discomfort in patients who underwent coronary angiography.

  8. DIAGNOSTIC CARDIAC CATHETERIZATION USING THE MEDRAD AVANTA FLUID MANAGEMENT SYSTEM AS COMPARED TO THE TRADITIONAL MANUAL INJECTION METHOD

    SciTech Connect

    Winniford, Michael D

    2013-02-08

    Nearly 4 million patient procedures performed annually in US cardiac catheterization laboratories utilize contrast media to achieve vessel opacification. The amount of contrast media used is variable and depends on the complexity of the procedure, the method of contrast delivery as well as the skill-level of the operator. Since the total amount of contrast used for each procedure can have both patient safety and economic implications, it is essential for cardiologists to have the ability to control contrast delivery such that optimal angiographic image quality is achieved using the least amount of contrast. Although the complication rate associated with cardiac catheterization remains low, the most common serious complication, contrast-induced nephropathy (CIN), is associated with poor prognosis and a high mortality rate. Numerous interventional strategies for preventing and reducing the severity of CIN have demonstrated varying degrees of clinical benefit, but none has been shown to reliably prevent this serious complication. To date, the most effective approach for reducing the risk of CIN is to properly hydrate the patient and to minimize the amount of contrast media administered. Automated injection systems are intended for use in virtually all cardiac catheterization procedures and have numerous features which can provide potential advantages over traditional methods. With automated injection technology the operator is able to control and precisely monitor contrast delivery. Additionally, the MEDRAD Avanta Fluid Management Injection System utilizes a sterile contrast reservoir which eliminates the need to discard unused contrast in individual opened containers following each procedure. Considering that an average of 50% of opened contrast media is wasted using manual injection methods, this savings can provide a substantial economic benefit. Automated systems also facilitate the use of smaller (5 French) catheter sizes. Precise flow control and the use of

  9. Impact of lean six sigma process improvement methodology on cardiac catheterization laboratory efficiency.

    PubMed

    Agarwal, Shikhar; Gallo, Justin J; Parashar, Akhil; Agarwal, Kanika K; Ellis, Stephen G; Khot, Umesh N; Spooner, Robin; Murat Tuzcu, Emin; Kapadia, Samir R

    2016-03-01

    Operational inefficiencies are ubiquitous in several healthcare processes. To improve the operational efficiency of our catheterization laboratory (Cath Lab), we implemented a lean six sigma process improvement initiative, starting in June 2010. We aimed to study the impact of lean six sigma implementation on improving the efficiency and the patient throughput in our Cath Lab. All elective and urgent cardiac catheterization procedures including diagnostic coronary angiography, percutaneous coronary interventions, structural interventions and peripheral interventions performed between June 2009 and December 2012 were included in the study. Performance metrics utilized for analysis included turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start and manual sheath-pulls inside the Cath Lab. After implementation of lean six sigma in the Cath Lab, we observed a significant improvement in turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab. The percentage of cases with optimal turn-time increased from 43.6% in 2009 to 56.6% in 2012 (p-trend<0.001). Similarly, the percentage of cases with an aggregate on-time start increased from 41.7% in 2009 to 62.8% in 2012 (p-trend<0.001). In addition, the percentage of manual sheath-pulls performed in the Cath Lab decreased from 60.7% in 2009 to 22.7% in 2012 (p-trend<0.001). The current longitudinal study illustrates the impact of successful implementation of a well-known process improvement initiative, lean six sigma, on improving and sustaining efficiency of our Cath Lab operation. After the successful implementation of this continuous quality improvement initiative, there was a significant improvement in the selected performance metrics namely turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab. Copyright © 2016

  10. Effects of therapeutic touch on anxiety, vital signs, and cardiac dysrhythmia in a sample of Iranian women undergoing cardiac catheterization: a quasi-experimental study.

    PubMed

    Zolfaghari, Mitra; Eybpoosh, Sana; Hazrati, Maryam

    2012-12-01

    To investigate the effects of Therapeutic Touch (TT) on anxiety, vital signs, and cardiac dysrhythmia in women undergoing cardiac catheterization. It was a quasi-experimental study. The participants had no history of hallucination, anxiety, or other psychological problems. Participants had to be conscious and have attained at least sixth-grade literacy level. Participants were randomly assigned into an intervention group (n = 23; received 10-15 minutes TT), a placebo group (n = 23; received 10-15 minutes simulated touch), and a control group (n = 23; did not receive any therapy). Data were collected using Spielberger's anxiety test, cardiac dysrhythmia checklist, and vital signs recording sheet. Statistical analyses were considered to be significant at α = .05 levels. Sixty-nine women ranging in age from 35 to 65 years participated. TT significantly decreased state anxiety p < 0.0001 but not trait anxiety (p = .88), decreased the incidence of all cardiac dysrhythmias p < 0.0001 except premature ventricular contraction (p = .01), and regulated vital signs p < 0.0001 in the intervention group versus placebo and control group. TT is an effective approach for managing state anxiety, regulating vital signs, and decreasing the incidence of cardiac dysrhythmia during stressful situations, such as cardiac catheterization, in Iranian cardiac patients.

  11. [Spanish Registry on Cardiac Catheterization Interventions. 11th official report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001)].

    PubMed

    Hernández, José M; Goicolea, Javier; Durán, Juan M; Augé, José M

    2002-11-01

    The results of the Spanish Registry of the Working Group on cardiac catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001) are presented. One-hundred-and-three centers contributed data, all the cardiac catheterization laboratories in Spain; 97 centers performed mainly adult catheterization and 6 carried out only pediatric procedures. In 2001, 95,430 diagnostic catheterization procedures were performed, with 79,607 coronary angiograms, representing a total increase of 8.4% over 2000. The population-adjusted incidence was 1947 coronary angiograms per 106 inhabitants. Coronary interventions increased by 15.4% compared with 2000, with a total of 31,290 procedures and an incidence of coronary interventions of 761 per 106 inhabitants. Coronary stents were the most frequently used devices with 39,356 implanted in 2001, and increase of 33.4% over 2000. Stenting accounted for 88.2% of procedures. Direct stenting was done in 11,280 procedures (40.9%). IIb-IIIa glycoprotein inhibitors were given in 7,012 procedures (22.4%). Multivessel percutaneous coronary interventions were performed in 8,445 cases (27%) and interventions were performed ad hoc during diagnostic study in 23,144 cases (74 %).A total of 3,845 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, an increase of 22.9% over 2000 and 12.3% of all interventional procedures. Among non-coronary interventions, atrial septal defect closure was performed more often (161 cases, a 60% increase over 2000). Pediatric interventions increased by 15.4% (from 817 to 943 cases).Lastly, we would like to underline the high rate of reporting by laboratories, which allowed the Registry to compile data that are highly representative of hemodynamic interventions in Spain.

  12. Determining geographic areas and populations with timely access to cardiac catheterization facilities for acute myocardial infarction care in Alberta, Canada

    PubMed Central

    Patel, Alka B; Waters, Nigel M; Ghali, William A

    2007-01-01

    Background This study uses geographic information systems (GIS) as a tool to evaluate and visualize the general accessibility of areas within the province of Alberta (Canada) to cardiac catheterization facilities. Current American and European guidelines suggest performing catheterization within 90 minutes of the first medical contact. For this reason, this study evaluates the populated places that are within a 90 minute transfer time to a city with a catheterization facility. The three modes of transport considered in this study are ground ambulance, rotary wing air ambulance and fixed wing air ambulance. Methods Reference data from the Alberta Chart of Call were interpolated into continuous travel time surfaces. These continuous surfaces allowed for the delineation of isochrones: lines that connect areas of equal time. Using Dissemination Area (DA) centroids to represent the adult population, the population numbers were extracted from the isochrones using Statistics Canada census data. Results By extracting the adult population from within isochrones for each emergency transport mode analyzed, it was found that roughly 70% of the adult population of Alberta had access within 90 minutes to catheterization facilities by ground, roughly 66% of the adult population had access by rotary wing air ambulance and that no population had access within 90 minutes using the fixed wing air ambulance. An overall understanding of the nature of air vs. ground emergency travel was also uncovered; zones were revealed where the use of one mode would be faster than the others for reaching a facility. Conclusion Catheter intervention for acute myocardial infarction is a time sensitive procedure. This study revealed that although a relatively small area of the province had access within the 90 minute time constraint, this area represented a large proportion of the population. Within Alberta, fixed wing air ambulance is not an effective means of transporting patients to a

  13. Retroperitoneal bleeding after cardiac catheterization: a 7-year descriptive single-center experience.

    PubMed

    Eisen, Alon; Kornowski, Ran; Vaduganathan, Muthiah; Lev, Eli; Vaknin-Assa, Hana; Bental, Tamir; Orvin, Katia; Brosh, David; Rechavia, Eldad; Battler, Alexander; Assali, Abid

    2013-01-01

    Retroperitoneal bleeding (RPB) is an unusual but potentially fatal vascular complication occurring after cardiac catheterization (CC). Contemporary data of RPB in the era of dual antiplatelet therapy and vascular closure devices are lacking. We retrospectively examined all RPB cases that occurred after CC in the Rabin Medical Center between the years 2005 and 2011. Of 26,487 patients who underwent CC, a total of 48 patients (mean age 60.9 ± 13.8 years, 52.1% female) with RPB were identified (0.18%). The indication for CC was acute coronary syndrome (43.7%), myocardial infarction (35.4%), stable angina pectoris (8.3%), hemodynamic studies for valvular heart disease (10.4%) and others (2.1%). Coronary intervention was performed in 34 patients (70.9%) and a vascular closure device (VCD) was used in 16 patients (33.3%). Seventy-seven percent of patients were treated with clopidogrel, 20.8% with glycoprotein IIb-IIIa inhibitors and 85.4% with anticoagulation during CC. Median time to diagnosis of bleeding was 9.0 h, while the median time to bleeding differed between patients with and without a VCD (12 vs. 5 h, respectively). The clinical presentation of RPB was hemorrhagic shock in 39.6% of patients and 50.0% required at least one blood transfusion. Patients were managed either with conservative treatment (79.2%), angiography stenting (14.6%) or vascular surgery (6.2%). A total of 3 patients died during hospitalization, of which RPB was the etiology in 2 (4.2%). RPB which is a rare complication of CC is associated with younger age and female gender, as compared to patients without RPB. Onset of bleeding can be delayed in patients with VCDs. With careful and early diagnosis, most patients with RPB after CC can be managed conservatively. Copyright © 2013 S. Karger AG, Basel.

  14. Cardiac catheterization: impact of face and neck shielding on new estimates of effective dose.

    PubMed

    von Boetticher, Heiner; Lachmund, Jörn; Hoffmann, Wolfgang

    2009-12-01

    Optimization of radiation protection devices for the operator is achieved by minimizing the effective dose (E) on the basis of the recommendations of Publications 60 and 103 of the International Commission on Radiological Protection (ICRP). Radiation exposure dosimetry was performed with thermoluminescence dosimeters using one Alderson phantom in the patient position and a second one in the typical position of the operator. Various types of protective clothing as well as fixed leaded shieldings (table mounted shielding and overhead suspended shields) were considered calculating E. Shielding factors for protective equipment can readily be misinterpreted referring to the reduction of the effective dose because fixed protective barriers as well as radiation protection clothing are shielding only parts of the body. With the ICRP 103 approach relative to the exposure without lead protection, a lead apron of 0.35 or 0.5 mm thickness reduces E to 14.4 or 12.3%, respectively; by using an additional thyroid collar, these values are reduced to 9.7 or 7.5%. A thyroid collar reduces the effective dose by more than an increase of the lead equivalency of the existing apron. Wearing an apron of 0.5 mm lead-equivalent with a thyroid collar and using an additional side shield, E decreases to 6.8%. Using both a fixed side and face shield decreases E to 2.0%. For protective garments including thyroid protection, the values of the effective dose in cardiac catheterization are 47-106% higher with ICRP 103 than with ICRP 60 recommendations. This is essentially caused by the introduction of new factors for organs in the head and neck region in ICRP 103.

  15. Anatomical variations affect radial artery spasm and procedural achievement of transradial cardiac catheterization.

    PubMed

    Numasawa, Yohei; Kawamura, Akio; Kohsaka, Shun; Takahashi, Masashi; Endo, Ayaka; Arai, Takahide; Ohno, Yohei; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi

    2014-01-01

    Transradial cardiac catheterization (TRCC) has unique technical challenges such as access difficulty related to anatomical variations and/or radial artery (RA) spasm. We sought to evaluate the incidence of anatomical variations of the RA and whether they would affect RA spasm and procedural achievement of TRCC. A total of 744 consecutive patients who underwent TRCC were analyzed by routine radial arteriography. Anatomical variations were defined as abnormal origin of the RA and/or radioulnar loop and/or tortuous configuration. RA spasm was defined as >75 % stenosis at first radial arteriography. Overall, anatomical variations were noted in 68 patients (9.1 %), including 39 cases of abnormal origin (5.2 %), 11 cases of radioulnar loop (1.5 %), and 42 cases of tortuous configuration (5.6 %). Transradial procedures failed in 26 patients (3.5 %), and more frequently in patients with anatomical variation than in those with normal anatomy (23.5 % vs 1.5 %, P < 0.001). Importantly, on multivariate analysis the presence of anatomical variation was a distinct predictor of transradial procedure failure (odds ratio (OR) 17.80; 95 % CI 7.55-43.73; P < 0.001). RA spasm was observed in 83 patients (11.2 %), and more frequently in patients with anatomical variation than in those with normal anatomy (35.3 % vs 8.7 %, P < 0.001). Anatomical variation (OR 4.74; 95 % CI 2.61-8.47; P < 0.001) and female gender (OR 2.23; 95 % CI 1.01-4.73; P = 0.041) were distinct predictors of RA spasm. Anatomical variations were observed in 9.1 % of the patients, and strongly correlated with RA spasm and procedural achievement of TRCC.

  16. Frequency and factors associated with inappropriate for intervention cardiac catheterization laboratory activation.

    PubMed

    Patel, Apurva; Parikh, Roosha; Poddar, Kanhaiya L; Ellis, Stephen G; Tuzcu, E Murat; Kapadia, Samir R

    2016-06-01

    Current guidelines emphasize timely coronary intervention with a door to balloon time of ≤90min for favorable survival impact after STEMI. Efforts to achieve these targets may result in unnecessary emergent angiography for inappropriate activations. Evaluate the frequency, trend and factors which are significantly associated with inappropriate for intervention cardiac catheterization laboratory (CCL) activation. We analyzed 1764 consecutive emergent CCL activation for possible ST segment elevation myocardial infarction (STEMI) between 7/2005 and 8/2013. Inappropriate for intervention activation was defined as negative STEMI (incorrect diagnosis: insignificant coronary lesion, not requiring any intervention) and inappropriate patients (true STEMI but poor CCL candidacy). Inappropriate for intervention CCL activation occurred in 317 patients (17.9%): 292 incorrect diagnosis (negative STEMI diagnosis), 25 inappropriate patients, with no difference in the frequency based on time of the day (18.6% regular hours vs. 17.6% off-hours, p=0.6). On multivariable analysis, female gender (OR 1.9 [1.2-3.0]), African American race (OR 1.9[1.3-2.7]), and prior coronary artery bypass graft surgery (OR 3.6 [2.3-5.5]) were significantly associated with incorrect diagnosis (negative STEMI diagnosis) (all p<0.005) and hyperlipidemia (OR 0.2 [0.1-0.3]), tobacco use (OR 0.2 [0.1-0.3]), and stroke/TIA (OR 0.2 [0.1-0.4]) had a significant inverse association (all p<0.001). ST Elevation with no reciprocal depression and pericarditis/myocarditis were the most common ECG finding and etiology respectively. Inappropriate for intervention CCL activation is not uncommon and should be closely monitored to maximize resource utilization. Females, African American patients with few or no risk factors and patients presenting ST elevation but no reciprocal depression constitute a population that may require attention. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Radiation safety in the cardiac catheterization lab: A time series quality improvement initiative.

    PubMed

    Abuzeid, Wael; Abunassar, Joseph; Leis, Jerome A; Tang, Vicky; Wong, Brian; Ko, Dennis T; Wijeysundera, Harindra C

    Interventional cardiologists have one of the highest annual radiation exposures yet systems of care that promote radiation safety in cardiac catheterization labs are lacking. This study sought to reduce the frequency of radiation exposure, for PCI procedures, above 1.5Gy in labs utilizing a Phillips system at our local institution by 40%, over a 12-month period. We performed a time series study to assess the impact of different interventions on the frequency of radiation exposure above 1.5Gy. Process measures were percent of procedures where collimation and magnification were used and percent of completion of online educational modules. Balancing measures were the mean number of cases performed and mean fluoroscopy time. Information sessions, online modules, policies and posters were implemented followed by the introduction of a new lab with a novel software (AlluraClarity©) to reduce radiation dose. There was a significant reduction (91%, p<0.05) in the frequency of radiation exposure above 1.5Gy after utilizing a novel software (AlluraClarity©) in a new Phillips lab. Process measures of use of collimation (95.0% to 98.0%), use of magnification (20.0% to 14.0%) and completion of online modules (62%) helped track implementation. The mean number of cases performed and mean fluoroscopy time did not change significantly. While educational strategies had limited impact on reducing radiation exposure, implementing a novel software system provided the most effective means of reducing radiation exposure. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  18. Significance of serum enzyme changes after cardiac catheterization and selective coronary arteriography.

    PubMed Central

    Hori, M; Inoue, M; Fukui, S; Furukawa, T; Abe, H

    1976-01-01

    The serum creatine kinase (CK), aspartate transaminase (AST), lactic dehydrogenase (LD) and alpha-hydroxybutyric dehydrogenase (HBD) were determined before and 3, 6, 18, and 36 hours after cardiac catheterization and angiocardiography in 56 consecutive patients with ischaemic heart disease. Five of these patients whose serum enzyme levels were higher than normal before the procedure were excluded from the study. Forty-one of the remaining 51 patients had left ventriculography and also selective coronary arteriography. In these 41 patients (groups 1 and 2--see below), the mean serum CK levels increased after the procedure to exceed the upper limit of normal at every study interval. The mean serum AST, LD, and HBD levels generally remained within the normal range at all study intervals, though serum AST increased abnormally in 9 of the 41 patients (22%) and serum LD and HBD each increased above the normal limit in 2 of 41 patients (4.9%). In 24 patients (group 1) whose coronary arteriograms showed insignificant coronary narrowing (less than 75%) in any of the three major coronary arteries, the increase in serum CK was significantly higher than in 17 patients (group 2) with greater than 75% narrowings in at least one of the three major coronary arteries. However, the degree of serum CK elevation observed during the postangiographic period was much lower than that in another group of 30 consecutive patients with acute myocardial infarction. In 10 patients (group 3) who had the same procedure as groups 1 and 2 except without the selective coronary arteriography, the serum enzyme levels showed no noticeable increase after the procedure. The difference in postangiographic serum CK elevation between patients with and without selective coronary arteriography and the difference between group 1 (without significant coronory narrowing) and group 2 (with significant narrowing) strongly suggest that the raised serum CK levels represent some form of myocardial damage caused by

  19. Significance of serum enzyme changes after cardiac catheterization and selective coronary arteriography.

    PubMed

    Hori, M; Inoue, M; Fukui, S; Furukawa, T; Abe, H

    1976-01-01

    The serum creatine kinase (CK), aspartate transaminase (AST), lactic dehydrogenase (LD) and alpha-hydroxybutyric dehydrogenase (HBD) were determined before and 3, 6, 18, and 36 hours after cardiac catheterization and angiocardiography in 56 consecutive patients with ischaemic heart disease. Five of these patients whose serum enzyme levels were higher than normal before the procedure were excluded from the study. Forty-one of the remaining 51 patients had left ventriculography and also selective coronary arteriography. In these 41 patients (groups 1 and 2--see below), the mean serum CK levels increased after the procedure to exceed the upper limit of normal at every study interval. The mean serum AST, LD, and HBD levels generally remained within the normal range at all study intervals, though serum AST increased abnormally in 9 of the 41 patients (22%) and serum LD and HBD each increased above the normal limit in 2 of 41 patients (4.9%). In 24 patients (group 1) whose coronary arteriograms showed insignificant coronary narrowing (less than 75%) in any of the three major coronary arteries, the increase in serum CK was significantly higher than in 17 patients (group 2) with greater than 75% narrowings in at least one of the three major coronary arteries. However, the degree of serum CK elevation observed during the postangiographic period was much lower than that in another group of 30 consecutive patients with acute myocardial infarction. In 10 patients (group 3) who had the same procedure as groups 1 and 2 except without the selective coronary arteriography, the serum enzyme levels showed no noticeable increase after the procedure. The difference in postangiographic serum CK elevation between patients with and without selective coronary arteriography and the difference between group 1 (without significant coronory narrowing) and group 2 (with significant narrowing) strongly suggest that the raised serum CK levels represent some form of myocardial damage caused by

  20. Building hospital management capacity to improve patient flow for cardiac catheterization at a cardiovascular hospital in Egypt.

    PubMed

    Wong, Rex; Hathi, Sejal; Linnander, Erika L; El Banna, Adel; El Maraghi, Mohamed; El Din, Randah Zain; Ahmed, Ashraf; Hafez, Abdel Rahman; Allam, Adel A; Krumholz, Harlan M; Bradley, Elizabeth H

    2012-04-01

    Quality improvement (QI) has been shown to be effective in improving hospital care in high-income countries, but evidence of its use in low- and middle-income countries has been limited to date. The impact of a QI intervention to reduce patient waiting time and overcrowding for cardiac catheterization-the subset of procedures associated with the most severe bottlenecks in patient flow at the National Heart Institute in Cairo-was investigated. A pre-post intervention study was conducted to examine the impact of a new scheduling system on patient waiting time and overcrowdedness for cardiac catheterization. The sample consisted of 628 consecutive patients in the pre-intervention period (July-August 2009) and 1,607 in the postintervention period (September-November 2010). The intervention was associated with significant reductions in waiting time and patient crowdedness. On average, total patient waiting time from arrival to beginning the catheterization procedure decreased from 208 minutes to 180 minutes (13% decrease, p < .001). Time between arrival at registration and admission to inpatient ward unit decreased from 33 minutes to 24 minutes (27% decrease, p < .001). Patient waiting time immediately prior to the catheterization laboratory procedure decreased from 79 minutes to 58 minutes (27% decrease, p < .001). The percentage of patients arriving between 7:00 A.M. and 9:00 A.M. decreased from 88% to 44% (50% decrease, p < .001), reducing patient crowding. With little financial investment, the patient scheduling system significantly reduced waiting time and crowdedness in a resource-limited setting. The capacity-building effort enabled the hospital to sustain the scheduling system and data collection after the Egyptian revolution and departure of the mentoring team in January 2011.

  1. Referrals in acute coronary events for CARdiac catheterization: The RACE CAR trial.

    PubMed

    Kreatsoulas, Catherine; Sloane, Debi; Pogue, Janice; Velianou, James L; Anand, Sonia S

    2010-10-01

    Women with acute coronary syndromes have lower rates of cardiac catheterization (CC) than men. To determine whether sex⁄gender, age, risk level and patient preference influence physician decision making to refer patients for CC. Twelve clinical scenarios controlling for sex⁄gender, age (55 or 75 years of age), Thrombolysis in Myocardial Infarction risk score (low, moderate or high) and patient preference for CC (agreeable or refused⁄no preference expressed) were designed. Scenarios were administered to specialists across Canada using a web-based computerized survey instrument. Questions were standardized using a five-point Likert scale ranging from 1 (very unlikely to benefit from CC) to 5 (very likely to benefit from CC). Outcomes were assessed using a two-tailed mixed linear regression model. Of 237 scenarios, physicians rated men as more likely to benefit from CC than women (mean [± SE] 4.44±0.07 versus 4.25±0.07, P=0.03), adjusted for age, risk and patient preference. Low-risk men were perceived to benefit more than low-risk women (4.20±0.13 versus 3.54±0.14, P<0.01), and low-risk younger patients were perceived to benefit more than low-risk older patients (4.52±0.17 versus 3.22±0.16, P<0.01). Regardless of risk, patients who agreed to CC were perceived as more likely to benefit from CC than patients who were disagreeable or made no comment at all (5.0±0.23, 3.67±0.21, 2.95±0.14, respectively, P<0.01). Canadian specialists' decisions to refer patients for CC appear to be influenced by sex⁄gender, age and patient preference in clinical scenarios in which cardiac risk is held constant. Future investigation of possible age and sex⁄gender biases as proxies for risk is warranted.

  2. Predicting patient volume in cardiac catheterization laboratory to improve resource management.

    PubMed

    Liu, Jianhua; Santangelo, Jennifer; James, Randy; Watters, Coyt D; Orsini, Anthony; Mekhjian, Hagop; Kamal, Jyoti

    2008-11-06

    Using historical data within the Information Warehouse of the Ohio State University Medical Center, prediction on daily patient volume to catheterization laboratory was attempted to facilitate resource management and planning.

  3. Validation of cardiac output using real-time measurement of oxygen consumption during cardiac catheterization in children under 3 years of age.

    PubMed

    Seckeler, Michael D; Hirsch, Russel; Beekman, Robert H; Goldstein, Bryan H

    2014-01-01

    To validate a method for determination of cardiac index (CI) using real-time measurement of oxygen consumption (VO2 ) in young children undergoing cardiac catheterization. Retrospective review comparing thermodilution cardiac index (TDCI) to CI calculated by the Fick equation using real-time measured VO2 (RT-VO2 ) and VO2 derived from 2 published predictive equations. Paired t-test and Bland-Altman analysis were used to compare TDCI to Fick CI. A survey to ascertain pediatric cardiac catheterization practices regarding VO2 determination was also conducted. Quaternary care children's hospital cardiac catheterization laboratory. Children <3 years old with structurally normal hearts undergoing cardiac catheterization under general anesthesia with at least one set of contemporaneous TDCI and RT-VO2 measurements. Thirty-six paired measurements of TDCI and RT-VO2 were made in 27 patients over a 2-year period. Indications for catheterization included congenital diaphragmatic hernia postrepair (n = 13), heart disease post-orthotopic heart transplant (n = 13), and suspected cardiomyopathy (n = 1). Mean age was 21.5 ± 8 months; median weight was 9.9 kg (IQR 8.57, 12.2). RT-VO2 was higher than VO2 predicted by the LaFarge equation (190 ± 31 vs. 173.8 ± 12.8 mL/min/m(2), P < .001), but there was no difference between TDCI and Fick CI calculated using VO2 from any method. Bland-Altman analysis showed excellent agreement between TDCI and Fick CI using RT-VO2 and VO2 predicted by the Lundell equation; Fick CI using VO2 predicted by the LaFarge equation showed fair agreement with TDCI. In children <3 years with a structurally normal heart, RT-VO2 generates highly accurate determinations of Fick CI as compared with TDCI. Additionally, in this population, VO2 derived from the LaFarge and Lundell equations generates accurate Fick CI compared with TDCI. Future studies are needed to identify factors associated with inaccurate VO2 generated from these predictive equations. © 2013

  4. Achievable radiation reduction during pediatric cardiac catheterization: How low can we go?

    PubMed

    Borik, Sharon; Devadas, Sunder; Mroczek, Dariusz; Lee, Kyong Jin; Chaturvedi, Rajiv; Benson, Lee N

    2015-11-01

    To assess the effectiveness of radiation-reduction measures implemented during pediatric catheterization, and provide data on the radiation doses for common interventional and diagnostic procedures, indexed to body weight. Ionizing radiation exposure must be minimized to "as low as reasonably achievable," by instituting radiation-limiting techniques and knowledge of expected radiation exposure. Radiation-reduction measures included pulsed-fluoroscopy at 7.5 pulses/second (0.032-0.045 µGy/pulse), an air-gap magnification technique for children<20 kg, operator awareness, and additional exposure reduction techniques through projection optimization. Radiation doses for procedures performed between 2007 through 2014 were retrospectively reviewed, including dose area product (DAP) and DAP/kg of body weight for 25 procedural types. Median doses were compared with those previously published from other large centers and multi-institutional databases and assessed for changes over time. Reviewed were 5,196 cases, which included 2,819 interventional, 710 endomyocardial biopsies and 1,667 diagnostic studies, documenting a significant difference in exposure between various procedures and body weights. The absolute exposure was significantly greater in larger children (e.g., for ductal closure median DAP/kg: 17 µGy*m2/kg 10-20 kg children vs. 37 µGy*m2 /kg for those>30 kg, P<0.001). Dose exposure using radiation-reduction techniques were the lowest reported in the literature for all procedure types compared (e.g. median DAP for pulmonary valvuloplasty 163 µGy*m2 vs. 405 to 1,230 µGy*m2 reported by 3 large centers). Reduction of fluoroscopy acquisition to 7.5 pulses/second nearly halved radiation exposure (P<0.001). Implementing a radiation dose reduction and awareness program can lead to documented reduction in exposure, across a variety of procedures performed by multiple operators. © 2015 Wiley Periodicals, Inc.

  5. Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization

    SciTech Connect

    Kaul, S.; Lilly, D.R.; Gascho, J.A.; Watson, D.D.; Gibson, R.S.; Oliner, C.A.; Ryan, J.M.; Beller, G.A.

    1988-04-01

    The goal of this study was to determine the prognostic utility of the exercise thallium-201 stress test in ambulatory patients with chest pain who were also referred for cardiac catheterization. Accordingly, 4 to 8 year (mean +/- 1SD, 4.6 +/- 2.6 years) follow-up data were obtained for all but one of 383 patients who underwent both exercise thallium-201 stress testing and cardiac catheterization from 1978 to 1981. Eighty-three patients had a revascularization procedure performed within 3 months of testing and were excluded from analysis. Of the remaining 299 patients, 210 had no events and 89 had events (41 deaths, nine nonfatal myocardial infarctions, and 39 revascularization procedures greater than or equal to 3 months after testing). When all clinical, exercise, thallium-201, and catheterization variables were analyzed by Cox regression analysis, the number of diseased vessels (when defined as greater than or equal to 50% luminal diameter narrowing) was the single most important predictor of future cardiac events (chi 2 = 38.1) followed by the number of segments demonstrating redistribution on delayed thallium-201 images (chi 2 = 16.3), except in the case of nonfatal myocardial infarction, for which redistribution was the most important predictor of future events. When coronary artery disease was defined as 70% or greater luminal diameter narrowing, the number of diseased vessels significantly (p less than .01) lost its power to predict events (chi 2 = 14.5). Other variables found to independently predict future events included change in heart rate from rest to exercise (chi 2 = 13.0), ST segment depression on exercise (chi 2 = 13.0), occurrence of ventricular arrhythmias on exercise (chi 2 = 5.9), and beta-blocker therapy (chi 2 = 4.3).

  6. Measurement of oxygen consumption in children undergoing cardiac catheterization: comparison between mass spectrometry and the breath-by-breath method.

    PubMed

    Guo, Long; Cui, Yong; Pharis, Scott; Walsh, Mark; Atallah, Joseph; Tan, Meng-Wei; Rutledge, Jennifer; Coe, J Y; Adatia, Ian

    2014-06-01

    Accurate measurement of oxygen consumption (VO2) is important to precise calculation of blood flow using the Fick equation. This study aimed to validate the breath-by-breath method (BBBM) of measuring oxygen consumption VO2 compared with respiratory mass spectroscopy (MS) for intubated children during cardiac catheterization. The study used MS and BBBM to measure VO2 continuously and simultaneously for 10 min in consecutive anesthetized children undergoing cardiac catheterization who were intubated with a cuffed endotracheal tube, ventilated mechanically, and hemodynamically stable, with normal body temperature. From 26 patients, 520 data points were obtained. The mean VO2 was 94.5 ml/min (95 % confidence interval [CI] 65.7-123.3 ml/min) as measured by MS and 91.4 ml/min (95 % CI 64.9-117.9 ml/min) as measured by BBBM. The mean difference in VO2 measurements between MS and BBBM (3.1 ml/min; 95 % CI -1.7 to +7.9 ml/min) was not significant (p = 0.19). The MS and BBBM VO2 measurements were highly correlated (R (2) = 0.98; P < 0.0001). Bland-Altman analysis showed good correspondence between MS and BBBM, with a mean difference of -3.01 and 95 % limits of agreement ranging from -26.2 to +20.0. The mean VO2 indexed to body surface area did not differ significantly between MS and BBBM (3.4 ml/min m(2); 95 % CI -1.4 to 8.2; p = 0.162). The mean difference and limits of agreement were -3.8 ml/min m(2) (range, -19.9 to 26.7). Both MS and BBBM may be used to measure VO2 in anesthetized intubated children undergoing cardiac catheterization. The two methods demonstrated excellent agreement. However, BBBM may be more suited to clinical use with children.

  7. X-ray dose from pediatric cardiac catheterization: a comparison of materials and methods for measurement or calculation.

    PubMed

    Herron, Brent; Strain, John; Fagan, Thomas; Wright, Linda; Shockley, Heather

    2010-11-01

    Pediatric cardiac catheterization procedures have the potential to transmit high X-ray doses, which may lead to acute effects or latent skin reactions. Direct measurement of radiation dose was facilitated using nanodot dosimeters and radiochromic film. Direct measurement results were compared with vendor-listed dosimetry and calculation using phantom data. Vendor-listed data demonstrated a wide discrepancy with measured data, whereas the calculation reproducibly overestimated the actual dose. A simple formula was derived to calculate the dose using fluoroscopy time, cine frame quantity and average cine mA in a biplane environment.

  8. EMS activation of the cardiac catheterization laboratory is associated with process improvements in the care of myocardial infarction patients.

    PubMed

    Cone, David C; Lee, Christopher H; Van Gelder, Carin

    2013-01-01

    Prior data from our institution suggested that our paramedics can accurately interpret ST-segment elevation myocardial infarction (STEMI) on prehospital 12-lead electrocardiograms (ECGs), and that activation of the cardiac catheterization laboratory by paramedics immediately upon diagnosing STEMI at the scene could potentially decrease door-to-balloon (D2B) times. A "field activation" protocol was thus initiated in May 2010. This study examined D2B times and compliance with the national 90-minute D2B performance benchmark in the first 14 months. Hypothesis. We hypothesized that D2B times would be shorter, and 90-minute compliance better, when the catheterization laboratory was activated by emergency medical services (EMS), compared with when either EMS failed to activate the catheterization laboratory or when the STEMI patient arrived by means other than EMS. For this prospective, observational study, EMS and hospital data were reviewed for consecutive STEMI patients at a single hospital between May 2010 and July 2011. Patients were categorized as: 1) EMS field activations, 2) patients transported by EMS without EMS catheterization laboratory activation (e.g., ambulance from outside our area, paramedic missed STEMI/protocol violation), or 3) walk-in STEMI patient. Data were manipulated in Excel, means with standard deviations (SDs) and 95% confidence intervals (95% CIs) were determined, and analysis of variance (ANOVA) with Dunnett's correction was used to compare groups. There were 38 EMS field activations, 47 nonactivation EMS STEMI arrivals, and 28 walk-in STEMI patients. The mean (±SD) D2B times were 37 (±17), 87 (±40), and 80 (±23) minutes, respectively. D2B time was better for the EMS field activations than for either nonactivation EMS transports (difference of means 35.3 min, 95% CI 22.3-48.3 min, p < 0.001) or walk-in patients (difference of means 37.0 min, 95% CI 21.8-52.2 min, p < 0.001). Compliance with the 90-minute D2B benchmark was 100%, 72%, and

  9. Quantitative Impact of Cardiovascular Risk Factors and Vascular Closure Devices on the Femoral Artery after Repeat Cardiac Catheterization

    PubMed Central

    Tiroch, Klaus A.; Matheny, Michael E.; Resnic, Frederic S.

    2010-01-01

    Background We evaluated the exact quantitative long-term impact of repeated catheterizations, vascular closure devices (VCDs) and cardiovascular risk factors on the femoral artery after cardiac catheterization. Methods A total of 2,102 available femoral angiograms from 827 consecutive patients were analyzed using caliper-based quantitative vascular analysis (QVA). These patients underwent coronary interventions between 01/2005-04/2007, and had at least one additional catheterization procedure through the ipsilateral femoral access site from 12/2001 until 01/2008. Multivariate analysis was performed to control for confounding variables. The primary outcome was change in artery size. Results The average punctured artery diameter was 6.5mm±2.1mm. The average time between first case and last follow-up was 349 days. There was no significant change of the punctured artery size over time after the index procedure (P=0.15) and no change associated with the use of VCDs (P=0.25) after multivariate analysis. Smaller arteries were associated with female gender (−1.22mm, P<0.0001), presence of angiographic peripheral vascular disease (PVD, −1.19mm, P<0.0001), and current (−0.48mm, P=0.001) or former (−0.23mm, P=0.01) smoking status, while previous statin therapy was associated with an increase in artery size (+0.47mm, P<0.0001). VCDs were used less often compared to manual compression in cases preceding the first detection of angiographic PVD (P<0.001). Conclusion VCDs are not associated with a change in the artery size or progression of PVD. Overall, there is no change in vessel size over time after repeat catheterizations, with a decrease in vessel size associated with current and former smoking, and an increase with previous statin therapy. PMID:20102878

  10. [Does NMR provide information complementary to cardiac catheterization in aortic coarctation?].

    PubMed

    Godart, F; Beregi, J P; Rey, C; Louvegny, S; Desmoucelles, F; Nicol, L; Vaksmann, G; Brevière, G M; Francart, C

    1998-05-01

    The results of magnetic resonance imaging (MRI) in the investigation of coarctation of the aorta were assessed and compared with those of cardiac catheterisation. This was a retrospective study of a series of 24 patients aged 14 +/- 4 years with a coarctation treated and documented by MRI. The investigation was performed with a high field 1.5 tesla (Vision, Siemens) system. Twenty-one children underwent comparative retrograde cardiac catheterisation with angiography and measurement of the peak-to-peak pressure gradient across the isthmus. No significant difference in the measurements of the aorta in MRI spin echo, gradient echo and retrograde aortic angiography were observed. On the other hand, there was a slight correlation between the degree of stenosis measured by MRI and the peak-to-peak haemodynamic gradient (r = 0.40). Seven patients had a loss of signal at the level of the aortic isthmus on MRI angiography which correlated with the haemodynamic gradient (p = 0.04). The authors conclude that MRI is a reliable non-invasive technique of investigating coarctations of the aorta. It gives accurate morphological data concerning the stenosis and blood flow. MRI should be part of the investigations of coarctation of the aorta, especially in poor indication to be able to correct it or consider the results of angioplasty or surgical correction.

  11. Preventive effect of oral nicorandil on contrast-induced nephropathy in patients with renal insufficiency undergoing elective cardiac catheterization.

    PubMed

    Fan, Yanming; Wei, Qingmin; Cai, Junna; Shi, Yongtang; Zhang, Youliang; Yao, Limei; Wang, Xiaogang; Lin, Shupo; Li, Yilin; Lv, Jing; Zhou, Bin; Du, Ruijuan

    2016-11-01

    This study aims to investigate the preventive effect of oral nicorandil on contrast-induced nephropathy (CIN) in patients with renal insufficiency undergoing elective cardiac catheterization. A total of 240 patients with an estimated glomerular filtration rate (eGFR) of 60 mL/min or less, who were undergoing elective cardiac catheterization, were randomly assigned to nicorandil group (n = 120, 10 mg nicorandil, three times daily from 2 days before to 3 days after procedure) or control group (n = 120, matching placebo as the same method). The primary endpoint was the incidence of CIN defined as 25 % increase in serum creatinine (SCr) from baseline or 44 μmol/L (0.5 mg/dL) increase in absolute value within 72 h after exposure to contrast medium. The secondary endpoints were: (1) the changes of SCr, Cystatin-C (Cys-C) and eGFR within 72 h; (2) major adverse events (MACE) occurring within 30 days. Baseline characteristics of the patients in the two groups were similar. The incidence of CIN was significantly lower in nicorandil group compared with control group (6.67 vs. 17.5 %, P = 0.017). Compared with the control group, nicorandil group tended to have a lower SCr and Cys-C levels as well as a higher eGFR at 48 h after the procedure (all P < 0.05). There was no difference about the incidence of MACE within 30 days between nicorandil group and control group (4.16 vs. 5.83 %, P = 0.767). Multivariate logistic analysis showed that nicorandil was an independent protective factor against CIN (OR = 0.260, 95 % CI = 0.1-0.676, P = 0.006). Therefore, we concluded that oral nicorandil was associated with a decline in the incidence of CIN in patients with renal insufficiency undergoing elective cardiac catheterization.

  12. Prediction of contrast-induced nephropathy by the serum creatinine level on the day following cardiac catheterization.

    PubMed

    Watanabe, Makoto; Saito, Yoshihiko; Aonuma, Kazutaka; Hirayama, Atsushi; Tamaki, Nagara; Tsutsui, Hiroyuki; Murohara, Toyoaki; Ogawa, Hisao; Akasaka, Takashi; Yoshimura, Michihiro; Sato, Akira; Takayama, Tadateru; Sakakibara, Mamoru; Suzuki, Susumu; Ishigami, Kenichi; Onoue, Kenji

    2016-11-01

    The majority of patients who undergo coronary arteriography are discharged from the hospital on the day of the procedure or on the following day. The aim of this study is to investigate whether the change in serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) on the day following cardiac catheterization can predict the development of contrast-induced nephropathy (CIN). This is a multicenter prospective observational study, which consists of 860 patients who underwent cardiac catheterization. We measured SCr and eGFR before cardiac catheterization, on the following day, and 48-72h post-procedure. Definition of CIN is changes in SCr ≥0.5mg/dL or ≥25% from baseline 48-72h after contrast exposure. CIN occurred in 40 patients. SCr levels significantly increased from a baseline of 1.55±1.08mg/dL to 1.79±1.26mg/dL on the following day in patients with CIN (p<0.0001), but significantly decreased from a baseline of 1.21±0.65mg/dL to 1.18±0.61mg/dL on the following day in those without CIN (p<0.0001). eGFR significantly decreased from a baseline of 47.3±28.3mL/min/1.73m(2) to 40.6±26.7mL/min/1.73m(2) on the following day in patients with CIN (p<0.0001), but significantly increased from a baseline of 53.1±22.0mg/dL to 53.6±21.2mg/dL on the following day in those without CIN (p=0.0236). Receiver operating characteristic curve analysis indicated that SCr change ≥0.1mg/dL [area under the curve (AUC)=0.852, sensitivity 72.5%, specificity 86.1%] and eGFR change ≤-1.1mL/min/1.73m(2) (AUC=0.789, sensitivity 85.0%, specificity 64.9%) were the best cut-off values for predicting CIN. Multivariate logistic regression showed that a change in SCr ≥0.1mg/dL [odds ratio (OR), 29.3; 95% confidence interval (CI), 10.8-96.2] and change in eGFR ≤-1.1mL/min/1.73m(2) (OR, 69.7; 95% CI, 13.3-952) were powerful independent predictors of CIN. Changes in SCr and eGFR on the day following cardiac catheterization predict the development of CIN. Copyright © 2016

  13. Reduction of operator radiation dose by a pelvic lead shield during cardiac catheterization by radial access: comparison with femoral access.

    PubMed

    Lange, Helmut W; von Boetticher, Heiner

    2012-04-01

    This study sought to determine the efficacy of patient pelvic lead shielding for the reduction of operator radiation exposure during cardiac catheterization via the radial access in comparison with the femoral access. Cardiac catheterization via the radial access is associated with significantly increased radiation dose to the patient and the operator. Improvements in radiation protection are needed to minimize this drawback. Pelvic lead shielding has the potential to reduce operator radiation dose. We randomly assigned 210 patients undergoing elective coronary angiography by the same operator to a radial and femoral access with and without pelvic lead shielding of the patient. Operator radiation dose was measured by a radiation dosimeter attached to the outside breast pocket of the lead apron. For radial access, operator dose decreased from 20.9 ± 13.8 μSv to 9.0 ± 5.4 μSv, p < 0.0001 with pelvic lead shielding. For femoral access, it decreased from 15.3 ± 10.4 μSv to 2.9 ± 2.7 μSv, p < 0.0001. Pelvic lead shielding significantly decreased the dose-area product-normalized operator dose (operator dose divided by the dose-area product) by the same amount for radial and femoral access (0.94 ± 0.28 to 0.39 ± 0.19 μSv × Gy(-1) × cm(-2) and 0.70 ± 0.26 to 0.16 ± 0.13 μSv × Gy(-1) × cm(-2), respectively). Pelvic lead shielding is highly effective in reducing operator radiation exposure for radial as well as femoral procedures. However, despite its use, radial access remains associated with a higher operator radiation dose. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Baseline Hemodynamics and Response to Contrast Media During Diagnostic Cardiac Catheterization Predict Adverse Events in Heart Failure Patients.

    PubMed

    Denardo, Scott J; Vock, David M; Schmalfuss, Carsten M; Young, Gregory D; Tcheng, James E; O'Connor, Christopher M

    2016-07-01

    Contrast media administered during cardiac catheterization can affect hemodynamic variables. However, little is documented about the effects of contrast on hemodynamics in heart failure patients or the prognostic value of baseline and changes in hemodynamics for predicting subsequent adverse events. In this prospective study of 150 heart failure patients, we measured hemodynamics at baseline and after administration of iodixanol or iopamidol contrast. One-year Kaplan-Meier estimates of adverse event-free survival (death, heart failure hospitalization, and rehospitalization) were generated, grouping patients by baseline measures of pulmonary capillary wedge pressure (PCWP) and cardiac index (CI), and by changes in those measures after contrast administration. We used Cox proportional hazards modeling to assess sequentially adding baseline PCWP and change in CI to 5 validated risk models (Seattle Heart Failure Score, ESCAPE [Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness], CHARM [Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity], CORONA [Controlled Rosuvastatin Multinational Trial in Heart Failure], and MAGGIC [Meta-Analysis Global Group in Chronic Heart Failure]). Median contrast volume was 109 mL. Both contrast media caused similarly small but statistically significant changes in most hemodynamic variables. There were 39 adverse events (26.0%). Adverse event rates increased using the composite metric of baseline PCWP and change in CI (P<0.01); elevated baseline PCWP and decreased CI after contrast correlated with the poorest prognosis. Adding both baseline PCWP and change in CI to the 5 risk models universally improved their predictive value (P≤0.02). In heart failure patients, the administration of contrast causes small but significant changes in hemodynamics. Calculating baseline PCWP with change in CI after contrast predicts adverse events and increases the predictive value of

  15. [Closure of the patent ductus arteriosus by means of cardiac catheterization].

    PubMed

    Szatmári, A; Németh, J; Környei, L; Palik, I; Hartyánszky, I; Lozsádi, K

    1998-05-24

    Authors report their results with transcatheter closure of patent arterial duct during a period of 1 year. Thirty patients underwent the procedure at the mean age of 5.22 yrs (range 5 mos-22.3 yrs) and mean bodyweight of 19.1 kg (range 5.8-73 kg). There were 9 males and 21 females. The diagnosis of the patent arterial duct was established by physical examination and noninvasive techniques. The procedures were attempted in all patients above 5 kg bodyweight with patent arterial duct and normal pulmonary artery pressure, irrespective of the shunt-size. All procedures were performed under general anesthesia in one session with the diagnostic cardiac catheterisation. Transcatheter closure was successful in 29 patients. In one patient the device embolized into the left pulmonary artery, snaring was unsuccessful, surgical closure of the patent duct and removal of the device took place uneventfully. Control aortography 15 minutes after the coil placement showed insignificant residual shunt through the patent duct in 8 patients (27%), while echocardiography at 1 month proved complete closure in all. The patients were followed by noninvasive methods. No mortality was observed. Authors emphasize the low risk and cost-effectiveness of the procedure. They stress the importance of the patients selection. Authors applied the technique for the first time and introduced it to the regular patient-care practice in Hungary.

  16. Technical note: a technique for ear vein catheterization in group-housed sows.

    PubMed

    Phillips, C E; Li, Y Z; Johnston, L J; Goplen, A E; Shurson, G C

    2012-02-01

    No methods have been published for repeated blood sampling via an ear vein in group-housed sows. Therefore, the objective of this study was to develop a minimally invasive technique for the insertion of an ear vein catheter for repeated blood sampling in group-housed peripartum sows while minimizing any impact on production performance. Thirty-three multiparous pregnant sows were used including 18 catheterized sows and 15 control sows. In a group-farrowing barn, sows (8/room) shared a communal area and farrowed in individual, free-access pens. Treatment sows were anesthetized, and 1 ear was prepared aseptically 2 to 4 d before their expected farrowing date. A sterile needle was inserted into the largest and straightest portion of the vein, and the catheter, which was medical-grade microbore tubing, was inserted through the needle at least 24 cm. The needle was withdrawn, and the catheter was fixed into position and sutured to the ear. A blunt-end probe point cannula was glued onto the distal end of the catheter, and an adaptor injection cap with male Luer lock was placed on the end. The catheter was coiled and placed in a protective purse, which was cemented directly to the skin on the back of the shoulders. The catheter was flushed with heparinized saline to ensure patency. Once sows were able to stand, an elastic bandage was wrapped around the neck and upper body of the sow to hold the protective purse and exposed catheter in position. Blood samples were collected every 24 h, and catheters were flushed with heparinized saline after each collection. Fourteen of the 18 insertions were successful, and 11 of those remained functional for 4 d or more. Differences were not observed in reproductive performance between catheterized and noncatheterized sows.

  17. Cardiac imaging of congenital heart diseases during interventional procedures continues to evolve: Pros and cons of the main techniques.

    PubMed

    Hascoët, Sebastien; Warin-Fresse, Karine; Baruteau, Alban-Elouen; Hadeed, Khaled; Karsenty, Clement; Petit, Jérôme; Guérin, Patrice; Fraisse, Alain; Acar, Philippe

    2016-02-01

    Cardiac catheterization has contributed to the progress made in the management of patients with congenital heart disease (CHD). First, it allowed clarification of the diagnostic assessment of CHD, by offering a better understanding of normal cardiac physiology and the pathophysiology and anatomy of complex malformations. Then, it became an alternative to surgery and a major component of the therapeutic approach for some CHD lesions. Nowadays, techniques have evolved and cardiac catheterization is widely used to percutaneously close intracardiac shunts, to relieve obstructive valvar or vessel lesions, and for transcatheter valve replacement. Accurate imaging is mandatory to guide these procedures. Cardiac imaging during catheterization of CHD must provide accurate images of lesions, surrounding cardiac structures, medical devices and tools used to deliver them. Cardiac imaging has to be 'real-time' with an excellent temporal resolution to ensure 'eyes-hands' synchronization and 'device-target area' accurate positioning. In this comprehensive review, we provide an overview of conventional cardiac imaging tools used in the catheterization laboratory in daily practice, as well as the effect of recent evolution and future imaging modalities.

  18. Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization

    SciTech Connect

    Kaul, S.; Finkelstein, D.M.; Homma, S.; Leavitt, M.; Okada, R.D.; Boucher, C.A.

    1988-07-01

    The purpose of this study was to determine the prognostic utility of quantitative exercise thallium-201 imaging and compare it with that of cardiac catheterization in ambulatory patients. Accordingly, long-term (4 to 9 years) follow-up was obtained in 293 patients who underwent both tests for the evaluation of chest pain: 89 had undergone coronary artery bypass graft surgery within 3 months of testing and were excluded from analysis, 119 experienced no cardiac events and 91 had an event (death in 20, nonfatal myocardial infarction in 21 and coronary artery bypass operations performed greater than 3 months after cardiac catheterization in 50). When all variables were analyzed using Cox regression analysis, the quantitatively assessed lung/heart ratio of thallium-201 activity was the most important predictor of a future cardiac event (chi 2 = 40.21). Other significant predictors were the number of diseased vessels (chi 2 = 17.11), patient gender (chi 2 = 9.43) and change in heart rate from rest to exercise (chi 2 = 4.19). Whereas the number of diseased vessels was an important independent predictor of cardiac events, it did not add significantly to the overall ability of the exercise thallium-201 test to predict events. Furthermore, information obtained from thallium-201 imaging alone was marginally superior to that obtained from cardiac catheterization alone (p = 0.04) and significantly superior to that obtained from exercise testing alone (p = 0.02) in determining the occurrence of events. In addition, unlike the exercise thallium-201 test, which could predict the occurrence of all categories of events, catheterization data were not able to predict the occurrence of nonfatal myocardial infarction. The exclusion of bypass surgery and previous myocardial infarction did not alter the results.

  19. Transcatheter aortic valve replacement: establishing a comprehensive program model for hybrid cardiac catheterization laboratories in the Department of Veterans Affairs.

    PubMed

    Speiser, Bernadette; Dutra-Brice, Cynthia

    2014-01-01

    Aortic valve disease, especially aortic stenosis, becomes progressively debilitating and carries a high mortality risk if it is categorized as severe and symptomatic (J Thorac Cardiovas Surg. 2012;144(3):e29-e84). In the past, the only treatment for aortic stenosis was surgical aortic valve replacement. Surgical treatment may require several hours of cardioplegia, and if the patient has comorbidities, such as renal failure or chronic obstructive pulmonary disease, their operative mortality percentage increases.In 2011, the US Food and Drug Administration approved the use of a transcatheter aortic valve replacement (TAVR) procedure for patients who were deemed high risk or inoperative for the routine surgical aortic valve replacement surgery. More than 20, 000 TAVRs have been performed in patients worldwide since 2002 when Dr Alain Cribier performed the first-in-man TAVR (Arch Cardiovasc Dis. 2012;105(3):145-152). The Edwards Lifesciences SAPIEN XT valve and the Medtronic CoreValve are commercially available.The clinical findings and economic statistic have supported the expansion of the TAVR procedure. However, there has been considerable controversy over where the procedure is to occur and who is directly responsible for directing the TAVR care. This debate has identified barriers to the implementation of a TAVR program. The operating rooms and a cardiac catheterization laboratory are underprepared for the hybrid valve replacement therapy. Because of the barriers identified, the Department of Veterans Affairs determined a need for a systematic approach to review the programs that applied for this structural heart disease program. A centralized team was developed to ensure room readiness and staff competency. The use of the Health Failure Mode and Effects Analysis can define high-risk clinical processes and conduct a hazard analysis. Worksheets can show potential failure modes and their probabilities, along with actions and outcome measures, team collaboration

  20. Amiodarone administered for cardiac resuscitation does not alter the integrity of noncontrast cerebral computed tomography performed on neurologically symptomatic patients before therapeutic cardiac catheterization.

    PubMed

    Ptak, Thomas; Novelline, Robert A

    2003-01-01

    Recent revisions of the advanced cardiac life support guidelines support the use of amiodarone in treating acute cardiac arrhythmia. Chemically, amiodarone has two atoms of iodine per molecule (39.3% wt/wt). We propose that at antiarrhythmic doses as prescribed by advanced cardiac life support guidelines, enhancement resulting from the bound amiodarone iodine is not significantly different from routine noncontrasted screening cerebral computed tomography (CT) studies. Six patients presenting to the our emergency department with successful resuscitation after cardiac arrhythmia were identified before obtaining a screening CT scan and subsequent transfer to the cardiac catheterization laboratory for intervention. The total dose of amiodarone (bolus + drip) was calculated up to the moment of the CT scan. Subjects were age and gender matched with two control subjects. Hematocrit value and CT density measurements in the pons, putamen, centrum semiovale, and cerebral venous blood pool were recorded. Paired t test and linear regression analyses were performed. Amiodarone dose and hematocrit were used as covariates in the regression model to correct for altered density as a result of relative anemia. Mean density in the blood pool was increased in the amiodarone subjects in both the univariate and regression models. Although the mean density difference of 3 HU was statistically significant, it is not likely detectable by the eye. All other brain area measurements showed nonsignificant differences in mean density for both the univariate analysis and regression model. Amiodarone administered at doses recommended by the American Heart Association for treatment of cardiac arrhythmia does not interfere with interpretation of the precatheterization noncontrasted screening cerebral CT scan.

  1. Comparative study between the effects of dexmedetomidine and propofol on cerebral oxygenation during sedation at pediatric cardiac catheterization

    PubMed Central

    Cetin, Murat; Birbicer, Handan; Hallioglu, Olgu; Orekeci, Gulhan

    2016-01-01

    Introduction: Nowadays, assessment of brain oxygen saturation, which is simply appliable and noninvasive method, can provide the anesthesia plans to be optimized according to the needs of the brain, which is the main target organ. Brain may be exposed to hypoxia due to supply-demand imbalance of oxygen not only in general anesthesia procedures but also in sedation practices. The aim of the study is to compare the effects of dexmedetomidine and propofol which are widely used agents for pediatric catheterization procedures on brain oxygen saturation using Fore-Sight. Material and Methods: A total of 44 patients undergoing diagnostic cardiac catheterization between 1 and 18 years old were included in the study. All patients, who were randomly divided into two groups, had ASA physical status I-II. In Group Propofol (Group P, n = 22), induction of sedation was made by midazolam (0.5 mg,iv) + propofol (1m/kg,iv), and in Group Dexmedetomidine (Group D, n = 22), induction of sedation was made by midazolam (0.5 mg,iv) +dexmedetomidine (1mcg/kg, iv). Throughout the sedation, cerebral tissue oxygen saturation (SctO2) was recorded by Fore-Sight in addition to routine monitoring. Results: There were no statistically significant differences between the groups in terms of demographic data, hemodynamic data and sedation scores. On other hand, statistically significant decreases in cerebral tissue oxygen saturation were detected especially at 5th and 10th minutes, in Group D, while cerebral oxygenation level did not decrease in Group P. Though, statistically significant difference was determined between two groups in terms of cerebral oxygen saturation, the obtained data was not interpreted as cerebral desaturation. Conclusion: As a conclusion, there was a statistically significant but clinically insignificant decrease in cerebral tissue oxygen saturation in dexmedetomidine group compared to propofol group. Although it does not seem to be important in hemodynamic stabilization, we

  2. Comparative study between the effects of dexmedetomidine and propofol on cerebral oxygenation during sedation at pediatric cardiac catheterization.

    PubMed

    Cetin, Murat; Birbicer, Handan; Hallioglu, Olgu; Orekeci, Gulhan

    2016-01-01

    Nowadays, assessment of brain oxygen saturation, which is simply appliable and noninvasive method, can provide the anesthesia plans to be optimized according to the needs of the brain, which is the main target organ. Brain may be exposed to hypoxia due to supply-demand imbalance of oxygen not only in general anesthesia procedures but also in sedation practices. The aim of the study is to compare the effects of dexmedetomidine and propofol which are widely used agents for pediatric catheterization procedures on brain oxygen saturation using Fore-Sight. A total of 44 patients undergoing diagnostic cardiac catheterization between 1 and 18 years old were included in the study. All patients, who were randomly divided into two groups, had ASA physical status I-II. In Group Propofol (Group P, n = 22),induction of sedation was made by midazolam (0.5 mg,iv) + propofol (1m/kg,iv), and in Group Dexmedetomidine (Group D, n = 22), induction of sedation was made by midazolam (0.5 mg,iv) +dexmedetomidine (1mcg/kg, iv). Throughout the sedation, cerebral tissue oxygen saturation (SctO 2 ) was recorded by Fore-Sight in addition to routine monitoring. There were no statistically significant differences between the groups in terms of demographic data, hemodynamic data and sedation scores. On other hand, statistically significant decreases in cerebral tissue oxygen saturation were detected especially at 5th and 10th minutes, in Group D, while cerebral oxygenation level did not decrease in Group P. Though, statistically significant difference was determined between two groups in terms of cerebral oxygen saturation, the obtained data was not interpreted as cerebral desaturation. As a conclusion, there was a statistically significant but clinically insignificant decrease in cerebral tissue oxygen saturation in dexmedetomidine group compared to propofol group. Although it does not seem to be important in hemodynamic stabilization, we assume that may cause problems for clinically unstable

  3. Silent cerebral infarct after cardiac catheterization as detected by diffusion weighted Magnetic Resonance Imaging: a randomized comparison of radial and femoral arterial approaches

    PubMed Central

    Hamon, Michèle; Burzotta, Francesco; Oppenheim, Catherine; Morello, Rémy; Viader, Fausto; Hamon, Martial

    2007-01-01

    Background and objective Cerebral microembolism detected by transcranial Doppler (TCD) occurs systematically during cardiac catheterization, but its clinical relevance, remains unknown. Studies suggest that asymptomatic embolic cerebral infarction detectable by diffusion-weighted (DW) MRI might exist after percutaneous cardiac interventions with a frequency as high as 15 to 22% of cases. We have set up, for the first time, a prospective multicenter trial to assess the rate of silent cerebral infarction after cardiac catheterization and to compare the impact of the arterial access site, comparing radial and femoral access, on this phenomenon. Study design This prospective study will be performed in patients with severe aortic valve stenosis. To assess the occurrence of cerebral infarction, all patients will undergo cerebral DW-MRI and neurological assessment within 24 hours before, and 48 hours after cardiac catheterization and retrograde catheterization of the aortic valve. Randomization for the access site will be performed before coronary angiography. A subgroup will be monitored by transcranial power M-mode Doppler during cardiac catheterization to observe cerebral blood flow and track emboli. Neuropsychological tests will also be recorded in a subgroup of patients before and after the interventional procedures to assess the impact of silent brain injury on potential cognitive decline. The primary end-point of the study is a direct comparison of ischemic cerebral lesions as detected by serial cerebral DW-MRI between patients explored by radial access and patients explored by femoral access. Secondary end-points include comparison of neuropsychological test performance and number of microembolism signals observed in the two groups. Implications Using serial DW-MRI, silent cerebral infarction rate will be defined and the potential influence of vascular access site will be evaluated. Silent cerebral infarction might be a major concern during cardiac catheterization

  4. Acute Hemodynamic Changes After Rapid Intravenous Bolus Dosing of Dexmedetomidine in Pediatric Heart Transplant Patients Undergoing Routine Cardiac Catheterization

    PubMed Central

    Jooste, EH; Muhly, WT; Ibinson, JW; Suresh, T; Damian, D; Phadke, A; Callahan, P; Miller, S; Feingold, B; Lichtenstein, SE; Cain, JG; Chrysostomou, C; Davis, PJ

    2011-01-01

    Introduction Dexmedetomidine is a highly selective α2-adrenoceptor agonist with sedative, anxiolytic and analgesic properties that has minimal effects on respiratory drive. Its sedative and hypotensive effects are mediated via central α2A and imidazoline type 1 receptors while activation of peripheral α2B–adrenoceptors result in an increase in arterial blood pressure and systemic vascular resistance (SVR). In this randomized, prospective, clinical study we attempted to quantify the short-term hemodynamic effects resulting from a rapid IV bolus administration of dexmedetomidine in pediatric cardiac transplant patients. Methods Twelve patients, aged ≤10 years of age, weighing ≤40kg, presenting for routine surveillance of right and left heart cardiac catheterization after cardiac transplantation were enrolled. After an inhaled or IV induction, the tracheas were intubated and anesthesia was maintained with 1 minimum alveolar concentration of isoflurane in room air, fentanyl (1mcg/kg) and rocuronium (1mg/kg). At the completion of the planned cardiac catheterization, 100% oxygen was administered. After recording a set of baseline values that included heart rate (HR), systolic blood pressure, diastolic blood pressure, central venous pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure and thermodilution-based cardiac output, a rapid IV dexmedetomidine bolus of either 0.25mcg/kg or 0.5mcg/kg was administered over 5 seconds. The hemodynamic measurements were repeated at 1 min and 5 mins. Results There were 6 patients in each group. Investigation suggested that systolic blood pressure, diastolic blood pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure and systemic vascular resistance all increased at 1 minute after rapid IV bolus for both doses, and decreased significantly to near baseline for both doses by 5 minutes. The transient increase

  5. Changing Trends in, and Characteristics Associated With, Not Undergoing Cardiac Catheterization in Elderly Patients Hospitalized with ST-segment Elevation Acute Myocardial Infarction

    PubMed Central

    Tisminetzky, Mayra; Erskine, Nathaniel; Chen, Han-Yang; Gore, Joel; Gurwitz, Jerry; Yarzebski, Jorge; Joffe, Samuel; Shaw, Peter; Goldberg, Robert

    2015-01-01

    Objectives Little data existaboutthe magnitude and characteristics ofelderly patientswho are hospitalized foran ST-segment elevation acute myocardial infarction (STEMI)who do not undergo cardiac catheterization and/ora percutaneous coronary intervention (PCI).Our study objectives were to describe decade long trends (1999-2009)in the rates of not undergoingcardiaccatheterizationand PCI among patients>65 years old presenting with an STEMI and factors associated with not undergoing these procedures. Design Observational study. Setting Population-based study. Participants 960residents of theWorcester (MA) metropolitan area 65 years and older who were hospitalized for an STEMI in 6 biennial periods between 1999 and 2009 at all 11central MA medical centers. Measurements Analyses were conducted to examine the characteristics of patients who did not undergo cardiac catheterization overall, and further stratified into 2 age strata (65-74 years and >75 years) Results Between 1999and 2009, dramatic declines (from 59.4% to 7.5%)were observed in the proportion ofolder patients who did not undergo cardiac catheterization at all greater Worcester hospitalsThese declines were observed in patients65-74 yearsold (58.4%to6.7%) as well as in patients 75 years and older(69.4% to13.5%).The proportion of patients not receiving a PCI after undergoing a cardiac catheterization decreased from 36.6% (in 1999) to 6.5% (in 2009). Women, patients with a prior MI, those with do not resuscitate orders, and patients withvarious comorbidities were less likely to have undergone these procedures thanrespective comparison groups. Conclusion Older patients who develop an STEMI are increasingly likely to undergo cardiac catheterizationand a PCI but several high risk groups remain less likely to undergo these procedures. PMID:25940950

  6. Novel Three-Dimensional Image Fusion Software to Facilitate Guidance of Complex Cardiac Catheterization : 3D image fusion for interventions in CHD.

    PubMed

    Goreczny, Sebastian; Dryzek, Pawel; Morgan, Gareth J; Lukaszewski, Maciej; Moll, Jadwiga A; Moszura, Tomasz

    2017-08-01

    We report initial experience with novel three-dimensional (3D) image fusion software for guidance of transcatheter interventions in congenital heart disease. Developments in fusion imaging have facilitated the integration of 3D roadmaps from computed tomography or magnetic resonance imaging datasets. The latest software allows live fusion of two-dimensional (2D) fluoroscopy with pre-registered 3D roadmaps. We reviewed all cardiac catheterizations guided with this software (Philips VesselNavigator). Pre-catheterization imaging and catheterization data were collected focusing on fusion of 3D roadmap, intervention guidance, contrast and radiation exposure. From 09/2015 until 06/2016, VesselNavigator was applied in 34 patients for guidance (n = 28) or planning (n = 6) of cardiac catheterization. In all 28 patients successful 2D-3D registration was performed. Bony structures combined with the cardiovascular silhouette were used for fusion in 26 patients (93%), calcifications in 9 (32%), previously implanted devices in 8 (29%) and low-volume contrast injection in 7 patients (25%). Accurate initial 3D roadmap alignment was achieved in 25 patients (89%). Six patients (22%) required realignment during the procedure due to distortion of the anatomy after introduction of stiff equipment. Overall, VesselNavigator was applied successfully in 27 patients (96%) without any complications related to 3D image overlay. VesselNavigator was useful in guidance of nearly all of cardiac catheterizations. The combination of anatomical markers and low-volume contrast injections allowed reliable 2D-3D registration in the vast majority of patients.

  7. Percutaneous Transhepatic Catheterization of the Portal Vein: A Combined CT- and Fluoroscopy-Guided Technique

    SciTech Connect

    Weimar, Bernd; Rauber, Klaus; Brendel, Mathias D.; Bretzel, Reinhard G.; Rau, Wigbert S.

    1999-07-15

    Combined CT- and fluoroscopy-guided transhepatic portal vein catheterization was performed in 44 patients selected for pancreatic islet cell transplantation. The method allowed catheterization with a single puncture attempt in 39 patients. In four patients two attempts and in one patient four attempts were necessary. One minor hematoma of the liver capsule occurred that required no further treatment. Compared with other methods the average number of puncture attempts was reduced.

  8. Incidence of Mechanical Complications of Central Venous Catheterization Using Landmark Technique: Do Not Try More Than 3 Times.

    PubMed

    Calvache, Jose-Andres; Rodríguez, Maria-Virginia; Trochez, Adolfo; Klimek, Markus; Stolker, Robert-Jan; Lesaffre, Emmanuel

    2016-07-01

    Central venous catheterization is a standard procedure in intensive care therapy. In developing countries, this intervention is frequently performed by physicians in training and without the availability of ultrasound guidance. Purpose of this study was to determine the incidence and potential risk factors for mechanical complications during central venous catheterization in an intensive care setting performed by a mixed group of practitioners without the use of adjunct ultrasound. Prospective observational cohort study in a university teaching hospital. Three hundred critically ill patients requiring their first central venous catheter insertion were enrolled. All patients were observed for 24 hours for mechanical complications (pneumothorax, hemothorax, arterial puncture, incorrect tip position, cardiac dysrhythmia, and/or subcutaneous hematoma). Potential associations with mechanical complications were adjusted using multivariable analysis. Main outcome was the cumulative incidence of mechanical complications. The incidence of mechanical complications was 17% (n = 51). After covariate adjustment, the number of punctures was significantly related to mechanical complications. Compared with 1 puncture, 3 or more attempts were significantly associated with mechanical complications (odds ratio 3.62 [95% confidence interval 1.34-9.8]; P = .011). Experience of the operator was not associated with mechanical complications. The incidence of mechanical complications is affected by the number of punctures performed. After adjustment, the risk increases substantially with more than 3 attempts. Limiting the number of attempts, appropriate supervision and the use of ultrasound guidance when available are recommended for the further reduction in mechanical complications of central venous catheterization. © The Author(s) 2014.

  9. Simulation-based training for nurses in sterile techniques during central vein catheterization.

    PubMed

    Gerolemou, Louis; Fidellaga, Amelita; Rose, Keith; Cooper, Scott; Venturanza, Majella; Aqeel, Adnan; Han, Qifa; Jones, James; Shapiro, Janet; Khouli, Hassan

    2014-01-01

    The effectiveness of simulation-based training of critical care nurses in sterile techniques has not been determined. To evaluate the effectiveness of simulation-based training of critical care nurses to use sterile techniques during central vein catheterization and the effect of such training on infection rates. A prospective controlled study with 12-month observational follow-up to assess the rate of catheter-related bloodstream infections in a 23-bed medical, surgical, neurological critical care unit. Forty-six critical care nurses completed assessment and training in sterile technique skills in the simulation laboratory. Performance scores at baseline were poor: median scores in each category ranging from 0 to 2 out of a maximum score of 4 and a median total score of 7 out of a maximum score of 24. After simulation-based training, nurses' median scores in each ST category and their total scores improved significantly, with the median total score increasing to 23 (P < .01; median difference, 15; 95% CI, 14-16). After completion of the simulation-based training intervention, the mean infection rate in the unit was reduced by 85% from 2.61 to 0.4 infections per 1000 catheter-days (P = .02). The incidence rate-ratio derived from the Poisson regression (0.15; 95% CI, 0.03-0.78) indicates an 85% reduction in the incidence of catheter-related bloodstream infections in the unit after the intervention. Simulation-based training of critical care nurses in sterile technique is an important component in the strategy to reduce the occurrence of such infections and promote patient safety.

  10. Reduction in Radiation Dose in a Pediatric Cardiac Catheterization Lab Using the Philips AlluraClarity X-ray System.

    PubMed

    Sullivan, Patrick M; Harrison, David; Badran, Sarah; Takao, Cheryl M; Ing, Frank F

    2017-08-02

    The objective of this study was to compare radiation doses and imaging quality using Philips AlluraClarity (Philips Healthcare, Best, The Netherlands) X-ray system and an older generation reference system. AlluraClarity is a new generation fluoroscopy system designed to reduce radiation without compromising image quality, but reports of its use in pediatric patients are limited. Dose area products (DAP, mGy cm(2)) and DAP/kg were compared in patients catheterized using Allura Xper and AlluraClarity systems over a year of use for each. Randomly selected studies from each system were assessed for image quality. The 430 patients imaged with Clarity were larger than the 332 imaged with Xper (median BSA: 0.74 vs. 0.64 m(2), p = 0.06), and median total fluoroscopic times (TFT) were similar (15.8 vs. 16.1 min, p = 0.37). Median DAPs were 8661 mGy cm(2) (IQR: 18,300 mGy cm(2)) and 4523 mGy cm(2) (IQR: 11,596 mGy cm(2)) with Xper and Clarity, respectively (p < 0.001). There was a reduction in median DAP in all procedure categories. After adjustment for BSA, TFT, and procedure type, using Clarity was associated with a 57.5% (95% CI 51.5-62.8%, p < 0.001) reduction in DAP for all procedures. Reductions did not significantly differ by weight (<10 kg, 10-40 kg, ≥ 40 kg). There was an adjusted percent reduction in DAP for each procedure category ranging from 39.0% (95% CI 25.6-50.1%, p < 0.001) for cardiac biopsies with or without coronary angiography to 67.6% (95% CI 61.2-72.8%, p < 0.001) for device occlusions. Mean overall imaging quality scores (4.3 ± 0.8 with Clarity vs. 4.4 ± 0.6 with Xper, p = 0.62) and scores based on specific quality parameters were similar in the two groups. Use of AlluraClarity substantially reduced radiation doses compared to the older generation reference system without compromising imaging quality in a pediatric cardiac catheterization lab.

  11. Frequencies of micronucleated reticulocytes, a dosimeter of DNA double-strand breaks, in infants receiving computed tomography or cardiac catheterization.

    PubMed

    Khattab, Mona; Walker, Dale M; Albertini, Richard J; Nicklas, Janice A; Lundblad, Lennart K A; Vacek, Pamela M; Walker, Vernon E

    2017-08-01

    The use of computed tomography (CT scans) has increased dramatically in recent decades, raising questions about the long-term safety of CT-emitted x-rays especially in infants who are more sensitive to radiation-induced effects. Cancer risk estimates for CT scans typically are extrapolated from models; therefore, new approaches measuring actual DNA damage are needed for improved estimations. Hence, changes in a dosimeter of DNA double-strand breaks, micronucleated reticulocytes (MN-RETs) measured by flow cytometry, were investigated in mice and infants exposed to CT scans. In male C57BL/6N mice (6-8 weeks-of-age), there was a dose-related increase in MN-RETs in blood samples collected 48h after CT scans delivering targeted exposures of 1-130 cGy x-rays (n=5-10/group, r=0.994, p=0.01), with significant increases occurring at exposure levels as low as 0.83 cGy x-rays compared to control mice (p=0.002). In paired blood specimens from infants with no history of a prior CT scan, there was no difference in MN-RET frequencies found 2h before (mean, 0.10±0.07%) versus 48h after (mean, 0.11±0.05%) a scheduled CT scan/cardiac catheterization. However, in infants having prior CT scan(s), MN-RET frequencies measured at 48h after a scheduled CT scan (mean=0.22±0.12%) were significantly higher than paired baseline values (mean, 0.17±0.07%; p=0.032). Increases in baseline (r=0.722, p<0.001) and 48-h post exposure (r=0.682, p<0.001) levels of MN-RETs in infants with a history of prior CT scans were significantly correlated with the number of previous CT scans. These preliminary findings suggest that prior CT scans increase the cellular responses to subsequent CT exposures. Thus, further investigation is needed to characterize the potential cancer risk from single versus repeated CT scans or cardiac catheterizations in infants. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Balloon valvuloplasty as destination therapy in elderly with severe aortic stenosis: a cardiac catheterization study

    PubMed Central

    Kamperidis, Vasileios; Hadjimiltiades, Stavros; Ziakas, Antonios; Sianos, Georgios; Kazinakis, Georgios; Giannakoulas, George; Mouratoglou, Sophia-Anastasia; Sarafidou, Athanasia; Ventoulis, Ioannis; Efthimiadis, Georgios K; Parcharidis, Georgios; Karvounis, Haralambos

    2015-01-01

    Background In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty (BAV) and invasive hemodynamic evaluation of aortic stenosis (AS). The current report aimed to study the invasive hemodynamics of severe AS patients treated with BAV as destination therapy and to identify factors associated with better hemodynamic outcome and prognosis. Methods From 2009 to 2012, 63 high risk elderly patients were treated with BAV as destination therapy for symptomatic severe AS and were all prospectively included in the study. Their hemodynamics were invasively evaluated during catheterization, pre- and post-BAV at the same session. All Post-BAV patients were regularly followed-up. Results The patients (82 ± 6 years, 52% male) had post-BAV aortic valve area index (AVAi) significantly increased and mean pressure gradient (MPG) significantly reduced. During the follow-up of 0.9 (maximum 3.3) years, those with post-BAV AVAi < 0.6 cm2/m2 compared with the AVAi ≥ 0.6 cm2/m2 group had significantly higher mortality (60% vs. 28%, log-rank P = 0.02), even after adjusting for age, gender, atrial fibrillation, chronic kidney disease, diabetes mellitus, coronary artery disease and EuroSCORE [HR: 5.58, 95% confidence interval (CI): 1.62−19.20, P = 0.006]. The only independent predictor of moderate AS post-BAV was the pre-BAV AVAi increase by 0.1cm2/m2 (OR: 3.81, 95% CI: 1.33−10.89, P = 0.01). Pre-BAV AVAi ≥ 0.39 cm2/m2 could predict with sensitivity 84% and specificity 70% the post-BAV hemodynamic outcome. Conclusions BAV as destination therapy for severe AS offered immediate and significant hemodynamic improvement. The survival was significantly better when a moderate degree of AS was present. PMID:26089844

  13. Assessment of DNA double-strand breaks induced by intravascular iodinated contrast media following in vitro irradiation and in vivo, during paediatric cardiac catheterization.

    PubMed

    Gould, Richard; McFadden, Sonyia L; Horn, Simon; Prise, Kevin M; Doyle, Philip; Hughes, Ciara M

    2016-01-01

    Paediatric cardiac catheterizations may result in the administration of substantial amounts of iodinated contrast media and ionizing radiation. The aim of this work was to investigate the effect of iodinated contrast media in combination with in vitro and in vivo X-ray radiation on lymphocyte DNA. Six concentrations of iodine (15, 17.5, 30, 35, 45, and 52.5 mg of iodine per mL blood) represented volumes of iodinated contrast media used in the clinical setting. Blood obtained from healthy volunteers was mixed with iodinated contrast media and exposed to radiation doses commonly used in paediatric cardiac catheterizations (0 mGy, 70 mGy, 140 mGy, 250 mGy and 450 mGy). Control samples contained no iodine. For in vivo experimentation, pre and post blood samples were collected from children undergoing cardiac catheterization, receiving iodine concentrations of up to 51 mg of iodine per mL blood and radiation doses of up to 400 mGy. Fluorescence microscopy was performed to assess γH2AX-foci induction, which corresponded to the number of DNA double-strand breaks. The presence of iodine in vitro resulted in significant increases of DNA double-strand breaks beyond that induced by radiation for ≥ 17.5 mg/mL iodine to blood. The in vivo effects of contrast media on children undergoing cardiac catheterization resulted in a 19% increase in DNA double-strand breaks in children receiving an average concentration of 19 mg/mL iodine to blood. A larger investigation is required to provide further information of the potential benefit of lowering the amount of iodinated contrast media received during X-ray radiation investigations.

  14. Ultrasound-guided femoral arterial access in pediatric cardiac catheterizations: A prospective evaluation of the prevalence, risk factors, and mechanism for acute loss of arterial pulse.

    PubMed

    Alexander, John; Yohannan, Thomas; Abutineh, Iman; Agrawal, Vijaykumar; Lloyd, Hannah; Zurakowski, David; Waller, B Rush; Sathanandam, Shyam

    2016-12-01

    The objectives of this study were to describe the prevalence, mechanisms, and identify risk factors for acute loss of arterial pulse (LOP) in children who had ultrasound-guided femoral arterial access (UGFAA) during cardiac catheterization. LOP is a known complication in children following femoral arterial (FA) access for cardiac catheterization. The prevalence of LOP requiring treatment ranges between 4% and 8%. A prospective study was performed including 486 cardiac catheterizations using UGFAA in children ≤18 years over a 3 years period. Ultrasound and Doppler evaluations were performed prior to and at the end of the procedure. LOP was identified in 33 cases (6.8%) with 23 (4.7%) requiring treatment. For children ≤6 months, the prevalence of LOP requiring treatment was 13.6%. FA diameter <3 mm was the only significant independent predictor for LOP (OR: 8.44, 95% CI: 2.07-34.5, P < 0.001). Smaller patient size, number of access attempts, time required for access, operator experience, sheath size, and length of procedure were not found to be significant predictors. Children with LOP had a greater percentage decrease in vessel diameter (median 62% vs 18%, P < 0.001) compared to those without LOP. FA thrombus was diagnosed only in 9 patients (27% of those with LOP). The prevalence of LOP requiring treatment is 4.7% when UGFAA is used during pediatric cardiac catheterizations. Arterial spasm was more common than thrombus as a cause of LOP. FA diameter <3 mm was the only independent predictor for LOP in this carefully designed prospective study. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  15. Factors Influencing ACT After Intravenous Bolus Administration of 100 IU/kg of Unfractionated Heparin During Cardiac Catheterization in Children.

    PubMed

    Muster, Ileana; Haas, Thorsten; Quandt, Daniel; Kretschmar, Oliver; Knirsch, Walter

    2016-01-01

    Anticoagulation using intravenous bolus administration of unfractionated heparin (UFH) aims to prevent thromboembolic complications in children undergoing cardiac catheterization (CC). Optimal UFH dosage is needed to reduce bleeding complications. We analyzed the effect of bolus UFH on activated clotting time (ACT) in children undergoing CC focusing on age-dependent, anesthesia-related, or disease-related influencing factors. This retrospective single-center study of 183 pediatric patients receiving UFH during CC analyzed ACT measured at the end of CC. After bolus administration of 100 IU UFH/kg body weight, ACT values between 105 and 488 seconds were reached. Seventy-two percent were within target level of 160 to 240 seconds. Age-dependent differences were not obtained ( P = .407). The ACT values were lower due to hemodilution (total fluid and crystalloid administration during CC, both P < .001), with premedication of acetylsalicylic acid ( P = .014) and low-molecular-weight heparin ( P = .049). Arterial thrombosis (3.85%), venous thrombosis (0.55%), and bleeding (1.65%) following CC did not correlate with ACT values but occurred more frequently in children between 1 month and 1 year of age (91%). In conclusion, with a bolus of 100 IU UFH/kg, an ACT target level of 160 to 240 seconds can be achieved during CC in children in 72%, which is influenced by hemodilution and anticoagulant and antiplatelet premedication but not by age.

  16. The influence of patient size on dose conversion coefficients: a hybrid phantom study for adult cardiac catheterization

    NASA Astrophysics Data System (ADS)

    Johnson, Perry; Lee, Choonsik; Johnson, Kevin; Siragusa, Daniel; Bolch, Wesley E.

    2009-06-01

    In this study, the influence of patient size on organ and effective dose conversion coefficients (DCCs) was investigated for a representative interventional fluoroscopic procedure—cardiac catheterization. The study was performed using hybrid phantoms representing an underweight, average and overweight American adult male. Reference body sizes were determined using the NHANES III database and parameterized based on standing height and total body mass. Organ and effective dose conversion coefficients were calculated for anterior-posterior, posterior-anterior, left anterior oblique and right anterior oblique projections using the Monte Carlo code MCNPX 2.5.0 with the metric dose area product being used as the normalization factor. Results show body size to have a clear influence on DCCs which increased noticeably when body size decreased. It was also shown that if patient size is neglected when choosing a DCC, the organ and effective dose will be underestimated to an underweight patient and will be overestimated to an underweight patient, with errors as large as 113% for certain projections. Results were further compared with those published for a KTMAN-2 Korean patient-specific tomographic phantom. The published DCCs aligned best with the hybrid phantom which most closely matched in overall body size. These results highlighted the need for and the advantages of phantom-patient matching, and it is recommended that hybrid phantoms be used to create a more diverse library of patient-dependent anthropomorphic phantoms for medical dose reconstruction.

  17. Numbness after Transradial Cardiac Catheterization: the Results from a Nerve Conduction Study of the Superficial Radial Nerve

    PubMed Central

    Jang, Ho-Jun; Kim, Ji-Young; Han, Jae Deok; Lee, Hyun Jong; Kim, Je Sang; Park, Jin Sik; Choi, Rak Kyeong; Choi, Young Jin; Shim, Won-Heum; Kwon, Sung Woo

    2016-01-01

    Background and Objectives Numbness on the hand occurs infrequently after a transradial cardiac catheterization (TRC). The symptom resembles that of neuropathy. We, therefore, investigated the prevalence, the predicting factors and the presence of neurological abnormalities of numbness, using a nerve conduction study (NCS). Subjects and Methods From April to December 2013, all patients who underwent a TRC were prospectively enrolled. From among these, the patients who experienced numbness on the ipsilateral hand were instructed to describe their symptoms using a visual analogue scale; subsequently, NCSs were performed on these patients. Results Of the total 479 patients in the study sample, numbness occurred in nine (1.8%) following the procedure. The NCS was performed for eight out of the nine patients, four (50%) of which had an abnormal NCS result at the superficial radial nerve. A larger sheath and history of myocardial infarction (p=0.14 and 0.08 respectively) tended towards the occurrence of numbness; however, only the use of size 7 French sheaths was an independent predictor for the occurrence of numbness (odds ratio: 5.50, 95% confidence interval: 1.06-28.58, p=0.042). The symptoms disappeared for all patients but one, within four months. Conclusion A transient injury of the superficial radial nerve could be one reason for numbness after a TRC. A large sheath size was an independent predictor of numbness; therefore, large sized sheaths should be used with caution when performing a TRC. PMID:27014346

  18. Adverse events rates and risk factors in adults undergoing cardiac catheterization at pediatric hospitals--results from the C3PO.

    PubMed

    Learn, Christopher P; Holzer, Ralf J; Daniels, Curt J; Torres, Alejandro J; Vincent, Julie A; Moore, John W; Armsby, Laurie B; Landzberg, Michael J; Bergersen, Lisa

    2013-05-01

    Determine the frequency and risk factors for adverse events (AE) for adults undergoing cardiac catheterization at pediatric hospitals. Adult catheterization AE rates at pediatric hospitals are not well understood. The Congenital Cardiac Catheterization Project on Outcomes (C3PO) collects data on all catheterizations at eight pediatric institutions. Adult (≥ 18 years) case characteristics and AE were reviewed and compared with those of pediatric (<18 years) cases. Cases were classified into procedure risk categories from 1 to 4 based on highest risk procedure/intervention performed. AE were categorized by level of severity. Using a multivariate model for high severity AE (HSAE), standardized AE rates (SAER) were calculated by dividing the observed rates of HSAE by the expected rates. 2,061 cases (15% of total) were performed on adults and 11,422 cases (85%) were performed on children. Adults less frequently underwent high-risk procedure category cases than children (19% vs. 30%). AE occurred in 10% of adult cases and 13% of pediatric cases (P < 0.001). HSAE occurred in 4% of adult and 5% of pediatric cases (P = 0.006). Procedure-type risk category (Category 2, 3, 4 OR = 4.8, 6.0, 12.9) and systemic ventricle end diastolic pressure ≥ 18 mm Hg (OR 3.1) were associated with HSAE, c statistic 0.751. There were no statistically significant differences in SAER among institutions. Adults undergoing catheterization at pediatric hospitals encountered AE less frequently than children did. The congenital heart disease adjustment for risk method for adults with congenital heart disease is a new tool for assessing procedural risk in adult patients. Copyright © 2013 Wiley Periodicals, Inc.

  19. A comparison of cardiac output by thoracic impedance and direct fick in children with congenital heart disease undergoing diagnostic cardiac catheterization.

    PubMed

    Taylor, Katherine; La Rotta, Gustavo; McCrindle, Brian W; Manlhiot, Cedric; Redington, Andrew; Holtby, Helen

    2011-10-01

    To evaluate the measurement of cardiac output (CO) using continuous electrical bioimpedance cardiography (Physioflow; Neumedx, Philadelphia, PA) (CO(PF)) with a simultaneous direct Fick measurement (CO(FICK)) in children with congenital heart disease. A prospective cohort study comparing 2 methods of measurement of CO. A quaternary university-affiliated pediatric hospital. Children undergoing cardiac catheterization for clinical care. The Physioflow measured continuous real time CO in 15-second epochs and simultaneous measurement of cardiac output by direct Fick (with mass spectrometry to assess VO(2)) were acquired. Sixty-five patients were recruited, and data from 56 (25 males) were adequate for analysis. The median age at study was 3.5 years (range, 0.4-16.6 years), and the median body surface area was 0.62 m(2) (range, 0.31-1.71). There were 25 of 56 (45%) with univentricular physiology. A total of 19,228 Physioflow data points were available for the analysis of which 14,569 (76%) were valid; 96% of the invalid measurements were identified as artifacts by the device. The average cardiac index of valid measurements was 3.09 ± 0.72 L/min/m(2). Compared with the Fick CO, the mean bias was -0.09 L/min, but the 95% limits of agreement were -3.20 to +3.01 L/min/m(2). Consequently, only 20 of 56 (36%) of measurements were within 20%, and 31 of 56 (55%) of measurements were within 30% of each other. Compared with measurements made by direct Fick, CO measured using the Physioflow device was unreliable in anesthetized children with congenital heart disease. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. Feasibility of clinical pharmacist-led CYP2C19 genotyping for patients receiving non-emergent cardiac catheterization in an integrated health system

    PubMed Central

    2017-01-01

    Objective: To assess the feasibility of clinical pharmacist-led CYP2C19 genotype-guided P2Y12 inhibitor antiplatelet drug therapy recommendations to cardiologists in an outpatient cardiology practice. Methods: This was a prospective, open-labeled, single-arm study conducted in an integrated healthcare delivery system between March 1, 2013 and January 23, 2014. Patients requiring non-emergent cardiac catheterization were included. A clinical pharmacist provided interpretation and recommendations from genotyping results. The feasibility of implementing CYP2C19 genotype-guided antiplatelet therapy was assessed by the: 1) percentage of patients approached who consented to CYP2C19 genotyping, 2) percentage of patients with CYP2C19 genotyping results available prior to cardiac catheterization, and 3) percentage of clinical pharmacist CYP2C19 genotype-based antiplatelet recommendations accepted by cardiologists. Results: Of the 43 patients identified for potential recruitment, 22 of these were eligible for study enrollment and 6 (27%) patients consented and received CYP2C19 genotyping. All patients had genotyping results available prior to catheterization and all clinical pharmacists’ antiplatelet therapy recommendations were accepted by the patients’ cardiologists. Three patients had the CYP2C19 wild-type (*1/*1) genotype and the clinical pharmacist recommended clopidogrel therapy. CYP2C19 variant genotypes (i.e., *1/*2, *1/*17, and *2/*17) were found in the other three patients; alternative antiplatelet therapy was recommended for the patient with the *1/*2 genotype, while clopidogrel was recommended for those with *1/*17 and *2/*17 genotypes. Conclusion: A relatively small proportion of patients undergoing non-emergent cardiac catheterization consented to pharmacogenetic testing; however, their cardiologists were receptive to clinical pharmacists conducting such testing and providing corresponding pharmacotherapy recommendations. Future studies should identify

  1. Complexity of cardiac signals for predicting changes in alpha-waves after stress in patients undergoing cardiac catheterization

    NASA Astrophysics Data System (ADS)

    Chiu, Hung-Chih; Lin, Yen-Hung; Lo, Men-Tzung; Tang, Sung-Chun; Wang, Tzung-Dau; Lu, Hung-Chun; Ho, Yi-Lwun; Ma, Hsi-Pin; Peng, Chung-Kang

    2015-08-01

    The hierarchical interaction between electrical signals of the brain and heart is not fully understood. We hypothesized that the complexity of cardiac electrical activity can be used to predict changes in encephalic electricity after stress. Most methods for analyzing the interaction between the heart rate variability (HRV) and electroencephalography (EEG) require a computation-intensive mathematical model. To overcome these limitations and increase the predictive accuracy of human relaxing states, we developed a method to test our hypothesis. In addition to routine linear analysis, multiscale entropy and detrended fluctuation analysis of the HRV were used to quantify nonstationary and nonlinear dynamic changes in the heart rate time series. Short-time Fourier transform was applied to quantify the power of EEG. The clinical, HRV, and EEG parameters of postcatheterization EEG alpha waves were analyzed using change-score analysis and generalized additive models. In conclusion, the complexity of cardiac electrical signals can be used to predict EEG changes after stress.

  2. Complexity of cardiac signals for predicting changes in alpha-waves after stress in patients undergoing cardiac catheterization.

    PubMed

    Chiu, Hung-Chih; Lin, Yen-Hung; Lo, Men-Tzung; Tang, Sung-Chun; Wang, Tzung-Dau; Lu, Hung-Chun; Ho, Yi-Lwun; Ma, Hsi-Pin; Peng, Chung-Kang

    2015-08-19

    The hierarchical interaction between electrical signals of the brain and heart is not fully understood. We hypothesized that the complexity of cardiac electrical activity can be used to predict changes in encephalic electricity after stress. Most methods for analyzing the interaction between the heart rate variability (HRV) and electroencephalography (EEG) require a computation-intensive mathematical model. To overcome these limitations and increase the predictive accuracy of human relaxing states, we developed a method to test our hypothesis. In addition to routine linear analysis, multiscale entropy and detrended fluctuation analysis of the HRV were used to quantify nonstationary and nonlinear dynamic changes in the heart rate time series. Short-time Fourier transform was applied to quantify the power of EEG. The clinical, HRV, and EEG parameters of postcatheterization EEG alpha waves were analyzed using change-score analysis and generalized additive models. In conclusion, the complexity of cardiac electrical signals can be used to predict EEG changes after stress.

  3. Complexity of cardiac signals for predicting changes in alpha-waves after stress in patients undergoing cardiac catheterization

    PubMed Central

    Chiu, Hung-Chih; Lin, Yen-Hung; Lo, Men-Tzung; Tang, Sung-Chun; Wang, Tzung-Dau; Lu, Hung-Chun; Ho, Yi-Lwun; Ma, Hsi-Pin; Peng, Chung-Kang

    2015-01-01

    The hierarchical interaction between electrical signals of the brain and heart is not fully understood. We hypothesized that the complexity of cardiac electrical activity can be used to predict changes in encephalic electricity after stress. Most methods for analyzing the interaction between the heart rate variability (HRV) and electroencephalography (EEG) require a computation-intensive mathematical model. To overcome these limitations and increase the predictive accuracy of human relaxing states, we developed a method to test our hypothesis. In addition to routine linear analysis, multiscale entropy and detrended fluctuation analysis of the HRV were used to quantify nonstationary and nonlinear dynamic changes in the heart rate time series. Short-time Fourier transform was applied to quantify the power of EEG. The clinical, HRV, and EEG parameters of postcatheterization EEG alpha waves were analyzed using change-score analysis and generalized additive models. In conclusion, the complexity of cardiac electrical signals can be used to predict EEG changes after stress. PMID:26286628

  4. Reducing bed rest time from five to three hours does not increase complications after cardiac catheterization: the THREE CATH Trial 1

    PubMed Central

    Matte, Roselene; Hilário, Thamires de Souza; Reich, Rejane; Aliti, Graziella Badin; Rabelo-Silva, Eneida Rejane

    2016-01-01

    Abstract Objective: to compare the incidence of vascular complications in patients undergoing transfemoral cardiac catheterization with a 6F introducer sheath followed by 3-hour versus 5-hour rest. Methods: randomized clinical trial. Subjects in the intervention group (IG) ambulated 3 hours after sheath removal, versus 5 hours in the control group (CG). All patients remained in the catheterization laboratory for 5 hours and were assessed hourly, and were contacted 24, 48, and 72 h after hospital discharge. Results: the sample comprised 367 patients in the IG and 363 in the GC. During cath lab stay, hematoma was the most common complication in both groups, occurring in 12 (3%) IG and 13 (4%) CG subjects (P=0.87). Bleeding occurred in 4 (1%) IG and 6 (2%) CG subjects (P=0.51), and vasovagal reaction in 5 (1.4%) IG and 4 (1.1%) CG subjects (P=0.75). At 24-h, 48-h, and 72-h bruising was the most commonly reported complication in both groups. None of the comparisons revealed any significant between-group differences. Conclusion: the results of this trial show that reducing bed rest time to 3 hours after elective cardiac catheterization is safe and does not increase complications as compared with a 5-hour rest. ClinicalTrials.gov Identifier: NCT-01740856 PMID:27463113

  5. Is the addition of dexmedetomidine to a ketamine-propofol combination in pediatric cardiac catheterization sedation useful?

    PubMed

    Ülgey, Ayşe; Aksu, Recep; Bicer, Cihangir; Akin, Aynur; Altuntaş, Resul; Esmaoğlu, Aliye; Baykan, Ali; Boyaci, Adem

    2012-06-01

    Pediatric patients undergoing cardiac catheterization usually need deep sedation. In this study, 60 children were randomly allocated to receive sedation with either a ketamine-propofol combination (KP group, n = 30) or a ketamine-propofol-dexmedetomidine combination (KPD group, n = 30). Both groups received 1 mg/kg of ketamine and 1 mg/kg of propofol for induction of sedation, and the KPD group received an additional 1 μg/kg of dexmedetomidine infusion during 5 min for induction of sedation and a maintenance infusion of 0.5 μg/kg/h. In both groups, 0.2 mg/kg of propofol was administered as a bolus to maintain a Ramsey sedation score (RSS) greater than 4 throughout the procedure. None of the patients in either group required intubation. In the KP group, one patient required mask ventilation. The chin-lift maneuver needed to be performed for eight patients in the KP group and one patient in the KPD group (p < 0.05). Adding dexmedetomidine to the ketamine-propofol combination decreased movement during the procedures. The heart rate in the KPD group was significantly lower after induction of sedation and throughout the procedure (p < 0.05). No significant differences in systolic blood pressure, diastolic blood pressure, or respiration rates were found between the two groups (p > 0.05). The mean recovery time was longer in the KP group (5.86 vs 3.13 min; p < 0.05). Adding dexmedetomidine to a ketamine-propofol combination led to a reduced need for airway intervention and to decreased movement during local anesthetic infiltration and throughout the procedure. The recovery time was shorter and hemodynamic stability good in the KPD group.

  6. Fast catheter segmentation from echocardiographic sequences based on segmentation from corresponding X-ray fluoroscopy for cardiac catheterization interventions.

    PubMed

    Wu, Xianliang; Housden, James; Ma, YingLiang; Razavi, Benjamin; Rhode, Kawal; Rueckert, Daniel

    2015-04-01

    Echocardiography is a potential alternative to X-ray fluoroscopy in cardiac catheterization given its richness in soft tissue information and its lack of ionizing radiation. However, its small field of view and acoustic artifacts make direct automatic segmentation of the catheters very challenging. In this study, a fast catheter segmentation framework for echocardiographic imaging guided by the segmentation of corresponding X-ray fluoroscopic imaging is proposed. The complete framework consists of: 1) catheter initialization in the first X-ray frame; 2) catheter tracking in the rest of the X-ray sequence; 3) fast registration of corresponding X-ray and ultrasound frames; and 4) catheter segmentation in ultrasound images guided by the results of both X-ray tracking and fast registration. The main contributions include: 1) a Kalman filter-based growing strategy with more clinical data evalution; 2) a SURF detector applied in a constrained search space for catheter segmentation in ultrasound images; 3) a two layer hierarchical graph model to integrate and smooth catheter fragments into a complete catheter; and 4) the integration of these components into a system for clinical applications. This framework is evaluated on five sequences of porcine data and four sequences of patient data comprising more than 3000 X-ray frames and more than 1000 ultrasound frames. The results show that our algorithm is able to track the catheter in ultrasound images at 1.3 s per frame, with an error of less than 2 mm. However, although this may satisfy the accuracy for visualization purposes and is also fast, the algorithm still needs to be further accelerated for real-time clinical applications.

  7. Effect of prehospital cardiac catheterization lab activation on door-to-balloon time, mortality, and false-positive activation.

    PubMed

    Squire, Benjamin T; Tamayo-Sarver, Joshua H; Rashi, Paula; Koenig, William; Niemann, James T

    2014-01-01

    Reperfusion of ST elevation myocardial infarction (STEMI) is most effective when performed early. Notification of the cardiac catheterization laboratory (cath lab) prior to hospital arrival based on paramedic-performed ECGs has been proposed as a strategy to decrease time to reperfusion and mortality. The purpose of this study was to compare the effects of cath lab activation prior to patient arrival versus activation after arrival at the emergency department (ED). We performed a retrospective cohort study (n = 1933 cases) using Los Angeles County STEMI database from May 1, 2008 through August 31, 2009. The database includes patients arriving at a STEMI Receiving Center (SRC) by ambulance who were diagnosed with STEMI either before or after hospital arrival. We compared the cohort of patients with prehospital cath lab activation to those activated from the ED within 5 minutes of first ED ECG. Outcomes measured were mortality, door-to-balloon time, percent door-to-balloon time <90 min, and percentage of false-positive activations. Prehospital cath lab activations had mean door-to-balloon times 14 minutes shorter (95% CI 11-17), in-hospital mortality 1.5% higher (95% CI -1.0-5.2), and false-positive activation 7.8%, (95% CI 2.7-13.3) higher than ED activation. For prehospital activation, 93% (95% CI 91-94%) met a door-to-balloon target of 90 minutes versus 85% (95% CI 80-88%) for ED activations. Prehospital cath lab activation based on the prehospital ECG was associated with decreased door-to-balloon times but did not affect hospital mortality. False-positive activation was common and occurred more often with prehospital STEMI diagnosis.

  8. X-ray magnetic resonance fusion modality may reduce radiation exposure and contrast dose in diagnostic cardiac catheterization of congenital heart disease.

    PubMed

    Abu Hazeem, Anas A; Dori, Yoav; Whitehead, Kevin K; Harris, Matthew A; Fogel, Mark A; Gillespie, Matthew J; Rome, Jonathan J; Glatz, Andrew C

    2014-11-01

    Radiation exposure in the pediatric population may increase the risk of future malignancy. Children with congenital heart disease who often undergo repeated catheterizations are at risk. One possible strategy to reduce radiation is to use X-ray Magnetic Resonance Fusion (XMRF) to facilitate cardiac catheterization. Catheterization data of patients who underwent diagnostic XMRF procedures between January 1, 2009 and February 1, 2012 were reviewed. Cases were matched 1:1 to contemporary controls who did not undergo XMRF based on weight and diagnosis and were compared in radiation exposure, contrast dose, and procedural and anesthesia times. Forty-four matched pairs were included. Baseline demographics were similar in both groups. Patients in the XMRF group had lower indices of radiation exposure measured by fluoroscopy time (14 vs. 16.4 vs. P = 0.047), dose-area product from fluoroscopy (513.2 vs. 589.1 µGy·m(2) , P = 0.042), total dose-area product (625.8 vs. 995.2 µGy·m(2) , P = 0.027), and total air kerma dose (94.5 vs. 153.8 mGy, P = 0.017). There was also a significant reduction in contrast dose (2 vs. 3.3 cc/kg, P <0.001). Procedural time tended to be shorter in the XMRF group but anesthesia time was significantly longer. Select diagnostic cardiac catheterization cases that utilized XMRF used less radiation and contrast than similar cases where XMRF was not used. Future work is needed to determine whether similar benefits can be extended to other types of diagnostic and complex interventional procedures. © 2014 Wiley Periodicals, Inc.

  9. Online PC-based integration of digital intracoronary ultrasound images into angiographic images during cardiac catheterization.

    PubMed

    Sievers, Burkhard; Böse, Dirk; Sack, Stefan; Philipp, Sebastian; Wieneke, Heinrich; Erbel, Raimund

    2008-08-18

    In recent years, intravascular ultrasound (IVUS) has evolved as an important adjunct to angiography, providing insights that are significantly altering conventional paradigms in diagnosis and therapy. However, major drawbacks in the use of IVUS relied on the fact that a heavy console had to be moved from lab to lab, and extensive time for set up and image analysis. This additional time and the decrease in patients' through-put has not been applicable in clinical practice for many labs. Our manuscript concerns a novel PC-based platform for IVUS that enables the online intergration of digital intracoronary ultrasound images into angiographic images. This new technique offers remote operation, multiple control devices and custom viewing options. The PC-based platform enables IVUS images to be viewed simultaneously from multiple vantage points in the lab, and allows for multiple user interfaces.

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

    PubMed

    Díaz De La Llera, L S; Fournier Andray, J A

    2001-12-01

    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. 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. 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. 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.

  11. Initial experience with pre-activation of the cardiac catheterization lab and emergency room bypass for patients with ST-elevation myocardial infarction in Halifax, Nova Scotia.

    PubMed

    Bata, Adil; Quraishi, Ata Ur Rehman; Love, Michael; Title, Lawrence; Beydoun, Hussein; Lee, Tony; Nadeem, Najaf; Kidwai, Bakhtiar; Kells, Catherine; Curran, Helen

    2016-11-01

    To determine whether pre-activation of the cardiac catheterization lab by Emergency Health Services (EHS) with a single call system in the field was associated with reduced time to reperfusion in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Consecutive STEMI patients identified by EHS and subsequently taken to the Queen Elizabeth II Health Sciences Center (QEIIHSC) for PPCI between February 1, 2011 and January 30, 2013 were examined. Patients who had pre-activation of the catheterization lab from the field (pre-act group) after the acquisition of the LifeNet® system (Physio Control, Redmond Washington) were compared to those who had usual activation (routine group) prior to the acquisition of the LifeNet® system, for outcomes including treatment timeline data and mortality. 271 patients were included in the analysis, 149 patients in the pre-act group and 122 patients in the routine group. Door-to-device (DTD) times of less than 90min were achieved more frequently in the Pre-act group (91.9% vs. 62.2%; P<0.001). DTD time was shorter in the Pre-act group (48min IQR: 38 to 63min vs. 78min IQR: 64-101min; p=0.001) as was first medical contact-to-device (FMCTD) time (91min IQR: 78 to 106min vs. 115min IQR: 90 to 139min; P<0.001). False activation of the catheterization lab was infrequent (1.3%). Implementation of catheterization lab pre-activation using the LifeNet® system was associated with more efficient reperfusion times as measured by reduced FMCTD and DTD times without excess false activation rates. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Cardiac Catheterization (For Kids)

    MedlinePlus

    ... lets the doctors see the vessels, valves, and chambers of your heart more clearly. X-rays will ... taking blood samples from blood vessels and heart chambers removing heart tissue for a biopsy performing operations ...

  13. Cardiac Catheterization (For Teens)

    MedlinePlus

    ... heart to beat irregularly removing blood clots performing angioplasties (a procedure to widen a narrowed blood vessel) or valvuloplasties (a procedure to open a narrowed heart valve) by inflating tiny balloons in blood vessels or heart valves to increase ...

  14. Cardiac Catheterization (For Parents)

    MedlinePlus

    ... Child Has a Heart Defect Arrhythmias Heart and Circulatory System Congenital Heart Defects The Heart Heart Disease Getting ... Arrhythmias EKG (Video) Atrial Septal Defect Heart and Circulatory System Contact Us Print Resources Send to a friend ...

  15. Cardiac Catheterization (For Parents)

    MedlinePlus

    ... Child Has a Heart Defect Arrhythmias Heart and Circulatory System Congenital Heart Defects The Heart Heart Disease Getting ... Arrhythmias EKG (Video) Atrial Septal Defect Heart and Circulatory System Contact Us Print Resources Send to a Friend ...

  16. A Randomized Controlled Comparison of the Internal Jugular Vein and the Subclavian Vein as Access Sites for Central Venous Catheterization in Pediatric Cardiac Surgery.

    PubMed

    Camkiran Firat, Aynur; Zeyneloglu, Pinar; Ozkan, Murat; Pirat, Arash

    2016-09-01

    To compare internal jugular vein and subclavian vein access for central venous catheterization in terms of success rate and complications. A 1:1 randomized controlled trial. Baskent University Medical Center. Pediatric patients scheduled for cardiac surgery. Two hundred and eighty children undergoing central venous catheterization were randomly allocated to the internal jugular vein or subclavian vein group during a period of 18 months. The primary outcome was the first-attempt success rate of central venous catheterization through either approach. The secondary outcomes were the rates of infectious and mechanical complications. The central venous catheterization success rate at the first attempt was not significantly different between the subclavian vein (69%) and internal jugular vein (64%) groups (p = 0.448). However, the overall success rate was significantly higher through the subclavian vein (91%) than the internal jugular vein (82%) (p = 0.037). The overall frequency of mechanical complications was not significantly different between the internal jugular vein (25%) and subclavian vein (31%) (p = 0.456). However, the rate of arterial puncture was significantly higher with internal jugular vein (8% vs 2%; p = 0.03) and that of catheter malposition was significantly higher with subclavian vein (17% vs 1%; p < 0.001). The rates per 1,000 catheter days for both positive catheter-tip cultures (26.1% vs 3.6%; p < 0.001) and central-line bloodstream infection (6.9 vs 0; p < 0.001) were significantly higher with internal jugular vein. There were no significant differences between the groups in the length of ICU and hospital stays or in-hospital mortality rates (p > 0.05 for all). Central venous catheterization through the internal jugular vein and subclavian vein was not significantly different in terms of success at the first attempt. Although the types of mechanical complications were different, the overall rate was similar between internal jugular vein and

  17. Male catheterization.

    PubMed

    Hadfield-Law, L

    2001-10-01

    The insertion of catheters into male emergency patients is fairly common practice and is associated with a worryingly high rate of infection. Everyday pressures within the department, along with the added stress of resuscitation can result in inappropriately trained or skilled staff undertaking this procedure. The issue of gender and whether female nurses should catheterize male patients may also affect this vulnerable group of patients. Acquiring the psychomotor skills of inserting a urethral catheter is only one part of preparation for practice. Emergency nurses must know when and when not to resort to catheterization. Choosing the type and size of catheter requires careful judgment. What will you do if insertion proves difficult? Prevention of infection is of paramount importance and there are an increasing number of evidence-based sources of information, which are crucial to formulating procedures and informing every day practice. In the pressured surroundings of A&E departments, it is easy to ignore the vulnerability of men requiring catheterization, both from a physical and psychological point of view. Making the effort to explain the procedure, listen to questions and concerns and record relevant details in the notes, will take only a few extra moments. There is no doubt that urinary catheterization is not without complications. It is associated with significant morbidity and occasionally, mortality.

  18. The Mercy unique device identifier demonstration project: Implementing point of use product identification in the cardiac catheterization laboratories of a regional health system.

    PubMed

    Drozda, Joseph P; Dudley, Curtis; Helmering, Paul; Roach, James; Hutchison, Lisa

    2016-06-01

    Mercy, a 4 state health system, conducted an FDA-sponsored demonstration whereby prototype unique device identifiers (UDIs) of coronary stents were implemented in its electronic information systems for safety surveillance and research. To accomplish this, a multi-disciplinary team implemented a point of use barcode scanning inventory management system in all 5 Mercy cardiac catheterization laboratories. The system's potential for improving inventory management and tracking Cath Lab supplies was felt to be sufficiently compelling for system deployment outside of the context of the demonstration. Further, it was felt to be useful for all Cath Lab renewable supplies and not just coronary stents. Benefits included preventing procedure delays, lowering costs, and increasing revenue. Finally, the system is extensible to all implanted medical devices and generalizable to most hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Safety and tolerability of iopromide in patients undergoing cardiac catheterization: real-world multicenter experience with 17,513 patients from the TRUST trial.

    PubMed

    Chen, Ji-Yan; Liu, Yong; Zhou, Ying-Ling; Tan, Ning; Zhang, Bin; Chen, Ping-Yan; Chen, Li-Bing

    2015-10-01

    To assess the incidence of and risk factors for acute adverse drug reactions (ADRs) (occurring within 1 h) following iopromide administration in cardiac catheterization in Chinese 'real-world' practice. Acute ADRs following iopromide administration during coronary angiography or percutaneous coronary intervention (PCI) have not been systematically evaluated in China. TRUST was a prospective, multicenter, observational study conducted at 63 centers in China. Patients received iopromide (300 or 370 mgI/mL) during coronary angiography or PCI (n = 17,513). Acute ADRs occurred in 66 patients (0.38%); ADRs were mild in 58 patients (0.33%) and severe in two patients (0.01%). Most acute ADRs manifested as allergy-like symptoms such as nausea/vomiting [39 patients (0.22%)] and/or rash [15 patients (0.09%)]. The rate of acute ADRs was lower among patients who received premedication (6/3349; 0.18 %) than those who did not (60/14,164; 0.42%; p = 0.0379), and among those who did receive pre-procedural hydration (10/7993; 0.13%) compared with those who did not (56/9520; 0.59%; p < 0.0001). Age <50 years, left main coronary disease and history of ADRs to contrast media increased the risk of ADRs, while premedication with corticosteroids, pre-procedural hydration and contrast volume <100 mL versus ≥100 mL reduced the risk. Contrast quality was rated as 'Excellent' in 99.1% of patients. The incidence of acute ADRs was very low with iopromide in cardiac catheterization in China. The risk of acute ADRs increased in patients <50 years and in those with a history of ADRs to contrast media. Premedication with corticosteroids and pre-procedural hydration may prevent acute ADRs in at-risk patients.

  20. Invasive treatment of non-ST-segment elevation acute coronary syndrome: cardiac catheterization/revascularization for all?

    PubMed

    Swahn, Eva; Alfredsson, Joakim

    2014-03-01

    Patients admitted to hospital with symptoms and signs of non-ST-segment elevation acute coronary syndromes have different risk profiles and are in need of an individualized approach that takes into consideration not only age and sex but also comorbidities such as diabetes, renal failure, hypertension, heart failure, peripheral artery disease, earlier revascularization, etc. According to evidence-based medicine and as documented in current guidelines, there is currently evidence for early catheterization and, if feasible, revascularization in high-risk patients, especially in men. Nevertheless, because of a lack of definitive evidence, there is uncertainty about treating women in the same way. Because women are usually older and have more comorbidities, they are frailer and revascularization should be indicated with greater caution. There is no evidence that catheterization as such is worse for women than for men; however, for both men and women with low risk, a less invasive approach, such as coronary computed tomography angiography, could be considered as a first diagnostic tool. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  1. Transient left bundle branch block induced by left-sided cardiac catheterization in patients without pre-existing conduction abnormalities.

    PubMed

    Shimamoto, T; Nakata, Y; Sumiyoshi, M; Ogura, S; Takaya, J; Sakurai, H; Yamaguchi, H

    1998-02-01

    A traumatic left bundle branch block (LBBB) is uncommon in a patient with intact atrioventricular conduction. Three of our patients developed LBBB during a left-sided catheterization. Two patients suffered from angina pectoris and the other had an abdominal aneurysm. Two of them had a history of hypertension. None of the patients had ever shown any conduction abnormalities before the catheterization. The electrocardiogram just before the examination was normal in all 3 patients. LBBB was observed when a catheter was introduced into the left ventricle, and lasted 2--4 min without significant change in heart rates. Examination revealed no significant stenosis proximal to the first septal perforator and normal left ventricular contraction in all patients. One patient developed permanent LBBB 14 months later. Catheter-induced LBBB may occur easily with certain anatomical characteristics of the left bundle branch or the distal His bundle, with or without some concealed damage to the conduction system. It is important to keep this complication in mind and to pay adequate attention to patients' electrocardiograms as well as their angiographical findings, especially in those with pre-existing right bundle branch block.

  2. Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review.

    PubMed

    Cornette, J; Laker, S; Jeffery, B; Lombaard, H; Alberts, A; Rizopoulos, D; Roos-Hesselink, J W; Pattinson, R C

    2017-01-01

    Most severe pregnancy complications are characterized by profound hemodynamic disturbances, thus there is a need for validated hemodynamic monitoring systems for pregnant women. Pulmonary artery catheterization (PAC) using thermodilution is the clinical gold standard for the measurement of cardiac output (CO), however this reference method is rarely performed owing to its invasive nature. Transthoracic echocardiography (TTE) allows non-invasive determination of CO. We aimed to validate TTE against PAC for the determination of CO in severely ill pregnant women. This study consisted of a meta-analysis combining data from a prospective study and a systematic review. The prospective arm was conducted in Pretoria, South Africa, in 2003. Women with severe pregnancy complications requiring invasive monitoring with PAC according to contemporary guidelines were included. TTE was performed within 15 min of PAC and the investigator was blinded to the PAC measurements. Comparative measurements were extracted from similar studies retrieved from a systematic review of the literature and added to a database. Simultaneous CO measurements by TTE and PAC were compared. Agreement between methods was assessed using Bland-Altman statistics and intraclass correlation coefficients (ICC). Thirty-four comparative measurements were included in the meta-analysis. Mean CO values obtained by PAC and TTE were 7.39 L/min and 7.18 L/min, respectively. The bias was 0.21 L/min with lower and upper limits of agreement of -1.18 L/min and 1.60 L/min, percentage error was 19.1%, and ICC between the two methods was 0.94. CO measurements by TTE show excellent agreement with those obtained by PAC in pregnant women. Given its non-invasive nature and availability, TTE could be considered as a reference for the validation of other CO techniques in pregnant women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Las complicaciones del embarazo más graves se caracterizan por trastornos hemodin

  3. Update on cardiac imaging techniques 2013.

    PubMed

    García-Orta, Rocío; Mahía-Casado, Patricia; Gómez de Diego, José J; Barba-Cosials, Joaquín; Rodriguez-Palomares, José F; Aguadé-Bruix, Santiago; Candell-Riera, Jaume

    2014-02-01

    Cardiac imaging is a cornerstone of diagnosis in heart conditions, and an essential tool for assessing prognosis and establishing treatment decisions. This year, echocardiography stands out as a guide in interventional procedures and in choosing the size of the prosthesis. It is also proving to be a valuable technique in low-flow, low-gradient aortic stenosis. Three-dimensional echocardiography is advancing our knowledge of cardiac anatomy and valvular measurements. The parameters indicating tissue deformation have predictive power in valve disease and in the follow-up of drug-induced cardiotoxicity. Single-photon emission computed tomography and positron emission tomography are proving useful in ischemic heart disease and in the diagnosis of cardiac inflammation and infections. The role of computed tomography has been strengthened in noninvasive coronary angiography, the emergency room management of chest pain, assessment of chronic occlusions, and morphologic study of coronary plaque. Cardiac magnetic resonance imaging remains the gold standard for tissue characterization in ischemic heart disease and cardiomyopathies, and is assuming a greater role in stress studies and in the assessment of myocardial viability. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  4. SCAI/CCAS/SPA expert consensus statement for anesthesia and sedation practice: Recommendations for patients undergoing diagnostic and therapeutic procedures in the pediatric and congenital cardiac catheterization laboratory.

    PubMed

    Odegard, Kirsten C; Vincent, Robert; Baijal, Rahul; Daves, SuAnne; Gray, Robert; Javois, Alex; Love, Barry; Moore, Phil; Nykanen, David; Riegger, Lori; Walker, Scott G; Wilson, Elizabeth C

    2016-11-15

    Current practice of sedation and anesthesia for patients undergoing pediatric congenital cardiac catheterization laboratory (PCCCL) procedures is known to vary among institutions, a multi-society expert panel with representatives from the Congenital Heart Disease Council of the Society for Cardiovascular Angiography and Interventions (SCAI), the Society for Pediatric Anesthesia (SPA) and the Congenital Cardiac Anesthesia Society (CCAS) was convened to evaluate the types of sedation and personnel necessary for procedures performed in the PCCCL. The goal of this panel was to provide practitioners and institutions performing these procedures with guidance consistent with national standards and to provide clinicians and institutions with consensus-based recommendations and the supporting references to encourage their application in quality improvement programs. Recommendations can neither encompass all clinical circumstances nor replace the judgment of individual clinicians in the management of each patient. The science of medicine is rooted in evidence, and the art of medicine is based on the application of this evidence to the individual patient. This expert consensus statement has adhered to these principles for optimal management of patients requiring sedation and anesthesia. What follows are recommendations for patient monitoring in the PCCCL regardless of whether minimal or no sedation is being used or general anesthesia is being provided by an anesthesiologist. © 2016 Wiley Periodicals Inc.

  5. Giant splenic artery aneurysm: managed in the cardiovascular catheterization laboratory using the modified neck remodeling technique.

    PubMed

    Pappy, Reji; Sech, Candice; Hennebry, Thomas A

    2010-10-01

    We report the first case of coil embolization using the "modified neck remodeling technique" in the management of a splenic artery aneurysm. This technique was feasible due to the unique and complex anatomy of the aneurysm. This condition has been largely treated by vascular surgeons and interventional radiologists; however, this patient was referred to the interventional cardiologists for endovascular coiling. © 2010 Wiley-Liss, Inc.

  6. Assessment of the efficacy of phentolamine to prevent radial artery spasm during cardiac catheterization procedures: a randomized study comparing phentolamine vs. verapamil.

    PubMed

    Ruiz-Salmerón, Rafael J; Mora, Ramón; Masotti, Mónica; Betriu, Amadeo

    2005-10-01

    The objective of this study was to evaluate phentolamine as radial artery spasmolytic in transradial catheterization procedures. Radial artery spasm is a relatively frequent complication during transradial approach, causing patient discomfort or even making it impossible to continue the procedure. As radial artery spasm is mediated by the stimulation of alpha-adrenoreceptors, the use of the alpha-blocker phentolamine could make sense as spasmolytic. We designed a randomized double-blind study to compare phentolamine vs. verapamil, the standard spasmolytic agent. Five hundred patients (250 in each arm) submitted to a transradial cardiac catheterization were consecutively included and randomly assigned to receive 2.5 mg of verapamil or 2.5 mg of phentolamine after sheath insertion. Both vasodilator agents induced a significant radial artery diameter increase (from 2.22 +/- 0.53 to 2.48 +/- 0.57 mm, P < 0.001 for verapamil, and from 2.20 +/- 0.53 to 2.45 +/- 0.53 mm, P < 0.001 for phentolamine). However, verapamil was more efficacious to prevent radial artery spasm (13.2% compared with 23.2% in phentolamine-treated patients; P = 0.004). Follow-up (20 +/- 18 days) evaluation of the radial artery patency by plestismography and pulse oximetry showed no differences between the two groups in the rate of radial occlusion (3.0% vs. 3.2% in verapamil and phentolamine treated patients, respectively). Phentolamine was an effective radial vasodilator agent, although it showed less ability to prevent radial artery spasm than verapamil. Radial artery occlusion rate was almost identical for both vasodilators. Thus, phentolamine could be a valid alternative to verapamil as a radial artery spasmolytic agent.

  7. [Heart catheterization in Mexico. Results of the 1996 census of heart catheterization services by the Mexican Society of Cardiology].

    PubMed

    Gaspar H, J; Guadalajara Boo, J F; de la Llata Romero, M

    1996-01-01

    The findings of the 1996 Cardiac Catheterization Laboratory Survey of the Sociedad Mexicana de Cardiología are presented. There are 52 cardiac catheterization laboratory departments distributed in 16 cities of which Mexico City has 20, Guadalajara 6 and Monterrey 5. Ninety-six percent are in hospitals where heart surgery can be performed and 8 (17%) have a training program in cardiac catheterization. Only two (3.8%) are exclusively dedicated to pediatric cardiac catheterization. In 1995, 19,214 diagnostic procedures and 2,429 PTCAs were done. A total of 270 physicians were reported to have privileges to perform cardiac catheterization. The geographical distribution of the cath labs, procedure volumes and number of physicians performing catheterization are discussed.

  8. Update on cardiac imaging techniques 2014.

    PubMed

    Mahía-Casado, Patricia; García-Orta, Rocío; Gómez de Diego, José J; Barba-Cosials, Joaquín; Rodríguez-Palomares, José F; Aguadé-Bruix, Santiago

    2015-02-01

    In this article, we review the contributions of the most important imaging techniques used in cardiology, reported in 2014. Echocardiography remains the cornerstone for diagnosing and monitoring valvular heart disease, and there has been a continuing effort to improve quantification of this condition and obtain prognostic parameters for follow-up. The study of regional myocardial function is anchored in the diagnosis of subclinical ventricular dysfunction, and 3-dimensional transesophageal echocardiography has become the perfect ally in interventional procedures for structural heart disease. Cardiac magnetic resonance imaging and cardiac computed tomography are the focus of most publications on cardiac imaging in ischemic heart disease, reflecting their consolidated use in clinical practice. Nuclear medicine excels in the study of myocardial viability after interventional treatment of acute coronary syndromes and its performance is validated in the diagnosis of ischemic heart disease. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  9. SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista).

    PubMed

    Iliescu, Cezar A; Grines, Cindy L; Herrmann, Joerg; Yang, Eric H; Cilingiroglu, Mehmet; Charitakis, Konstantinos; Hakeem, Abdul; Toutouzas, Konstantinos P; Leesar, Massoud A; Marmagkiolis, Konstantinos

    2016-04-01

    In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.

  10. SCAI expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (Endorsed by the Cardiological Society of India, and Sociedad Latino Americana de Cardiologıa Intervencionista).

    PubMed

    Iliescu, Cezar; Grines, Cindy L; Herrmann, Joerg; Yang, Eric H; Cilingiroglu, Mehmet; Charitakis, Konstantinos; Hakeem, Abdul; Toutouzas, Konstantinos; Leesar, Massoud A; Marmagkiolis, Konstantinos

    2016-04-01

    In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.

  11. [Ultrasound-guided peripheral catheterization].

    PubMed

    Salleras-Duran, Laia; Fuentes-Pumarola, Concepció

    2016-01-01

    Peripheral catheterization is a technique that can be difficult in some patients. Some studies have recently described the use of ultrasound to guide the venous catheterization. To describe the success rate, time required, complications of ultrasound-guided peripheral venous catheterization. and patients and professionals satisfaction The search was performed in databases (Medline-PubMed, Cochrane Library, CINAHL and Cuiden Plus) for studies published about ultrasound-guided peripheral venous catheterization performed on patients that provided results on the success of the technique, complications, time used, patient satisfaction and the type of professional who performed the technique. A total of 21 studies were included. Most of them get a higher success rate 80% in the catheterization ecoguide and time it is not higher than the traditional technique. The Technical complications analyzed were arterial puncture rates and lower nerve 10%. In all studies measuring and comparing patient satisfaction in the art ecoguide is greater. Various professional groups perform the technique. The use of ultrasound for peripheral pipes has a high success rate, complications are rare and the time used is similar to that of the traditional technique. The technique of inserting catheters through ultrasound may be learned by any professional group performing venipuncture. Finally, it gets underscores the high patient satisfaction with the use of this technique. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  12. Performance of medical residents in sterile techniques during central vein catheterization: randomized trial of efficacy of simulation-based training.

    PubMed

    Khouli, Hassan; Jahnes, Katherine; Shapiro, Janet; Rose, Keith; Mathew, Joseph; Gohil, Amit; Han, Qifa; Sotelo, Andre; Jones, James; Aqeel, Adnan; Eden, Edward; Fried, Ethan

    2011-01-01

    Catheter-related bloodstream infection (CRBSI) is a preventable cause of a potentially lethal ICU infection. The optimal method to teach health-care providers correct sterile techniques during central vein catheterization (CVC) remains unclear. We randomly assigned second- and third-year internal medicine residents trained by a traditional apprenticeship model to simulation-based plus video training or video training alone from December 2007 to January 2008, with a follow-up period to examine CRBSI ending in July 2009. During the follow-up period, a simulation-based training program in sterile techniques during CVC was implemented in the medical ICU (MICU). A surgical ICU (SICU) where no residents received study interventions was used for comparison. The primary outcome measures were median residents' scores in sterile techniques and rates of CRBSI per 1,000 catheter-days. Of the 47 enrolled residents, 24 were randomly assigned to the simulation-based plus video training group and 23 to the video training group. Median baseline scores in both groups were equally poor: 12.5 to 13 (52%-54%) out of maximum score of 24 (P = .95; median difference, 0; 95% CI, 0.2-2.0). After training, median score was significantly higher for the simulation-based plus video training group: 22 (92%) vs 18 (75%) for the video training group (P < .001; median difference, 4; 95% CI, 3-6). During the follow-up period, there was a significantly lower rate of CRBSI in the MICU (1.0 per 1,000 catheter-days) compared with the SICU (3.4 per 1,000 catheter-days) (P = .03). The incidence rate ratio derived from the Poisson regression (0.30; 95% CI, 0.10-0.91) indicated there was a 70% reduction in the incidence of CRBSI in the postintervention MICU compared with the preintervention MICU and the postintervention SICU. Simulation-based training in sterile techniques during CVC is superior to traditional training or video training alone and is associated with decreased rate of CRBSI. Simulation

  13. Single-blind and Double-blind Randomized Controlled Trials of Palmtherapy®, an Alternative Medical Approach, for Anxiety before Cardiac Catheterization

    PubMed Central

    Jafari, Jamal; Podberezsky, Anna; David, Tamar; Reizin, Leonardo; Benjamin, Jonathan

    2008-01-01

    Alternative medicine is widely used, but lacks consensus regarding its amenability to scientific investigation. Anxiety increases morbidity and mortality in ischemic heart disease. We performed two studies of Palmtherapy®, an alternative treatment, for anxiety before cardiac catheterization. In the first study, patients were randomized to receive pressure at particular points on the palm, or at incorrect locations, for about 50 min, while the therapist conversed with them. In the second study, the conversation was conducted by a second, ‘blind’ investigator. In both studies, patients and nurses, all blind to treatment assignment, completed visual analog scale and National Institute of Mental Health measures of anxiety, respectively. Twenty-three subjects completed study 1, and 17 completed study 2. In study 1, palm therapy was superior to sham therapy for both outcome measures. In study 2, palm therapy was superior for self-reported anxiety, but not for nurses’ assessments of anxiety. Future studies should attempt to separate possible mechanistic effects of Palmtherapy® from therapist-related variables. Whether alternative medicine deserves to be studied at all remains controversial. Palmtherapy® may offer anxiolytic benefit without the harm attributable to drugs. PMID:18317556

  14. [4th report of German Association of Cardiologists in private practice (BNK) on quality assurance in cardiac catheterization and coronary intervention 1999-2002].

    PubMed

    Levenson, Benny; Albrecht, Alexander; Göhring, Stefan; Haerer, Winfried; Herholz, Harald; Kaltenbach, Martin; Reifart, Nicolaus; Sauer, Gregor; Silber, Sigmund; Troger, Bernhard

    2003-06-01

    The Society of German Cardiologists in private practice (BNK) reports about its project on quality assurance in invasive cardiology (QuIK). Results of a computerized data collection and analysis of cardiac catheterizations and interventions in the years 1999-2002 are presented. These results are compared with other registries. The QuIK-project is done voluntarily by 70% of the society's cardiologists who perform invasive methods. A total of 225,562 diagnostic and 64,895 interventional procedures are documented over the 4 years. Patient characteristics and procedural data kept unchanged. Complication rates were low (< 2%), MACE < 0.5%. There was a rising number of patients referred with acute myocardial infarction. Less time was used to complete procedures from 1 year to another. Two out of three of the centers underwent a monitoring/auditing process in 2002. The desirable post-interventional follow-up after discharge in all cases appears to be impossible to fulfill under the given economical circumstances.

  15. [5th Report of the German Association of Cardiologists in Private Practice (BNK) on Quality Assurance in Cardiac Catheterization and Coronary Intervention 2003-2005].

    PubMed

    Levenson, B; Albrecht, A; Göhring, St; Haerer, W; Herholz, H; Reifart, N; Sauer, G; Troger, B

    2007-02-01

    On behalf of the German Association of Cardiologists in Private Practice (BNK) the Steering Committee of the QuIK Registry reports on the results of the voluntary quality assurance in invasive cardiology in 2003-2005 and compares it to other data collections. In 2005 more than 70% of diagnostic (LHK) and 78% of therapeutic (PCI) cardiac catheterization procedures in private practice were entered into the registry. Altogether 229,462 LHK and 64,818 PCI were documented over the 3 years. In the reported period age of patients, percentage of acute coronary syndromes and three-vessel coronary artery disease increased in LHK as well as in PCI while consumption of contrast media and fluoroscopy time decreased. By implemented possibility of follow-up, a high rate of external auditing (monitoring) and certification QuIK remains a worldwide unique quality assurance project in cardiology. On a stable data basis over 10 years the QuIK Registry enables the implementation of quality indicators for future quality assurance purposes.

  16. Virtual-Reality Simulator System for Double Interventional Cardiac Catheterization Using Fractional-Order Vascular Access Tracker and Haptic Force Producer

    PubMed Central

    Chen, Guan-Chun; Lin, Chia-Hung; Li, Chien-Ming; Hsieh, Kai-Sheng; Du, Yi-Chun; Chen, Tainsong

    2015-01-01

    This study proposes virtual-reality (VR) simulator system for double interventional cardiac catheterization (ICC) using fractional-order vascular access tracker and haptic force producer. An endoscope or a catheter for diagnosis and surgery of cardiovascular disease has been commonly used in minimally invasive surgery. It needs specific skills and experiences for young surgeons or postgraduate year (PGY) students to operate a Berman catheter and a pigtail catheter in the inside of the human body and requires avoiding damaging vessels. To improve the training in inserting catheters, a double-catheter mechanism is designed for the ICC procedures. A fractional-order vascular access tracker is used to trace the senior surgeons' consoled trajectories and transmit the frictional feedback and visual feedback during the insertion of catheters. Based on the clinical feeling through the aortic arch, vein into the ventricle, or tortuous blood vessels, haptic force producer is used to mock the elasticity of the vessel wall using voice coil motors (VCMs). The VR establishment with surgeons' consoled vessel trajectories and hand feeling is achieved, and the experimental results show the effectiveness for the double ICC procedures. PMID:26171419

  17. Virtual-Reality Simulator System for Double Interventional Cardiac Catheterization Using Fractional-Order Vascular Access Tracker and Haptic Force Producer.

    PubMed

    Chen, Guan-Chun; Lin, Chia-Hung; Li, Chien-Ming; Hsieh, Kai-Sheng; Du, Yi-Chun; Chen, Tainsong

    2015-01-01

    This study proposes virtual-reality (VR) simulator system for double interventional cardiac catheterization (ICC) using fractional-order vascular access tracker and haptic force producer. An endoscope or a catheter for diagnosis and surgery of cardiovascular disease has been commonly used in minimally invasive surgery. It needs specific skills and experiences for young surgeons or postgraduate year (PGY) students to operate a Berman catheter and a pigtail catheter in the inside of the human body and requires avoiding damaging vessels. To improve the training in inserting catheters, a double-catheter mechanism is designed for the ICC procedures. A fractional-order vascular access tracker is used to trace the senior surgeons' consoled trajectories and transmit the frictional feedback and visual feedback during the insertion of catheters. Based on the clinical feeling through the aortic arch, vein into the ventricle, or tortuous blood vessels, haptic force producer is used to mock the elasticity of the vessel wall using voice coil motors (VCMs). The VR establishment with surgeons' consoled vessel trajectories and hand feeling is achieved, and the experimental results show the effectiveness for the double ICC procedures.

  18. A novel technique for ultrasound-guided central venous catheterization under short-axis out-of-plane approach: "stepwise flashing with triangulation".

    PubMed

    Horiuchi, Toshinori; Okuda, Chie; Kurita, Naoko; Yamaguchi, Ayako; Kitagawa, Kazuhiko; Takeda, Masafumi; Sha, Keiichi; Nagahata, Toshihiro

    2017-06-20

    In ultrasound-guided central venous catheterization, there is no standard technique either for the needle tip visualization or for the adequate needle angle and entry to the skin with short-axis view under out-of-plane technique. In the present study, we propose a novel technique named "stepwise flashing with triangulation", and the efficacy of this technique is assessed. Before and after a didactic session in which the technique was explained, 12 novice residents were asked to position the needle tip on or into the imitation vessels and to avoid deeper penetration by using an agar tissue phantom with ultrasound guidance. "Stepwise flashing" technique was for stepwise visualization of the needle tip, and "triangulation" technique was for adequate needle angle and entry to the skin. After the session, the success rate was increased and a deeper penetration rate was decreased. This technique will help us to facilitate vascular access and to avoid complications in clinical settings.

  19. Bringing measurement and management science to the cath laboratory: the National Cardiovascular Data Registry (ACC-NCDR) and the Cardiac Catheterization Laboratory Continuous Quality Improvement Toolkit (ACC-CathKIT).

    PubMed

    Dehmer, Gregory J; Elma, MaryAnne; Hewitt, Kathleen; Brindis, Ralph G

    2004-01-01

    Diagnostic cardiac catheterization and percutaneous coronary interventions are widely performed for the evaluation and treatment of patients with cardiac disease. Because of high utilization, cost, and complication rates, invasive cardiac procedures are closely monitored and frequently measured using national benchmark databases and public reports. Before decision makers can accept these data and reports as accurate, it is necessary that the measurement process be performed correctly. However, collecting and measuring data is only the first step and does not automatically lead to improvements in quality. For an improvement to occur, a continuous quality improvement effort must exist to transform data into improved outcomes for patients. Recognizing the need to supply healthcare providers with methods and standards for measurement reporting and tools to assist facilities in the development of effective continuous quality improvement efforts, the American College of Cardiology developed the National Cardiovascular Data Registry (ACC-NCDR). Subsequently, the American College of Cardiology Foundation, in cooperation with the Society for Cardiovascular Angiography and Interventions, the American College of Cardiovascular Administrators, and several other professional organizations, developed the ACC-Cardiac Catheterization Laboratory Continuous Quality Improvement Toolkit (ACC-CathKIT). The development and usefulness of these products is described in this paper.

  20. Urine culture - catheterized specimen

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/003752.htm Urine culture - catheterized specimen To use the sharing features on this page, please enable JavaScript. Catheterized specimen urine culture is a laboratory test that looks for germs ...

  1. Self catheterization - female

    MedlinePlus

    ... bladder. You have signs of infection (a burning sensation when you urinate, fever, fatigue, or chills). Alternative Names Clean intermittent catheterization - female; CIC - female Images Bladder catheterization, female References Cepedes RD, Gerboc JL. Other therapies for storage ...

  2. Multicenter long-term validation of a minicourse in radiation-reducing techniques in the catheterization laboratory.

    PubMed

    Kuon, Eberhard; Weitmann, Kerstin; Hoffmann, Wolfgang; Dörr, Marcus; Hummel, Astrid; Riad, Alexander; Busch, Mathias C; Felix, Stephan B; Empen, Klaus

    2015-02-01

    Patient radiation exposure in invasive cardiology is considerable. We aimed to investigate, in a multicenter field study, the long-term efficacy of an educational 90-minute workshop in cardiac invasive techniques with reduced irradiation. Before and at a median period of 2.5 months and 2.0 years after the minicourse (periods I, II, and III, respectively) at 5 German cardiac centers, 18 interventionalists documented various radiation parameters for 10 coronary angiographies. The median patient dose area product (DAP) for periods I, II, and III amounted to 26.6, 12.2, and 9.6 Gy × cm(2), respectively. The short-term and long-term effects were related to shorter median fluoroscopy times (180, 138, and 114 seconds), fewer radiographic frames (745, 553, and 417) because of fewer (11, 11, and 10) and shorter (64, 52, and 44 frames/run) runs, consistent collimation, and restriction to an adequate image quality; both radiographic DAP/frame (27.7, 17.3, and 18.4 mGy × cm(2)) and fluoroscopic DAP/second (26.6, 12.9, and 14.9 mGy × cm(2)) decreased significantly. Multivariate analysis over time indicated increasing efficacy of the minicourse itself (-55% and -64%) and minor influence of interventionist experience (-4% and -3% per 1,000 coronary angiographies, performed lifelong until the minicourse and until period III). In conclusion, autonomous self-surveillance of various dose parameters and feedback on individual radiation safety efforts supported the efficacy of a 90-minute course program toward long-lasting and ongoing patient dose reduction.

  3. Optimization techniques in cardiac resynchronization therapy.

    PubMed

    Fischer, Avi

    2009-07-01

    Cardiac resynchronization therapy improves symptoms and cardiac function, as well as reduces mortality in patients with progressive congestive heart failure, reduced left ventricular ejection fraction and a left bundle branch block on the surface electrocardiogram. As many as 30% of patients fail to have an adequate response. The interplay between the atrioventricular delay and the contribution of a properly timed atrial contraction to ventricular filling along with a properly timed sequence of activation of the right and left ventricular is crucial to maximizing the benefits of cardiac resynchronization therapy devices.

  4. Evaluation of the occupational X-rays dose of the medical staff in a cardiac catheterization laboratory using an acrylic phantom and semiconductor dosimeter.

    PubMed

    Pan, Lung Fa; Kittipayak, Samrit; Yen, Shan Lin; Pan, Lung Kwang; Lin, Cheng Hsun

    2016-01-01

    The occupational X-rays doses of medical staff in a cardiac catheterization laboratory were evaluated. Four customized acrylic phantoms were used to simulate a patient, medical doctor, assistant, and radiologist to evaluate the in-situ X-rays exposure dose using semiconductor dosimeters. The exposure dose was measured under three scenarios that were preset to imply: no shielding, moderate shielding and complete shielding for the medical staff in the laboratory. The doses were applied by changing the dose area product (DAP) from 11,000 to 500,000mGy·cm(2) in 14 increments. The estimated annual occupational doses for doctors, assistants and radiologists in scenarios I, II, and III were: I) 35.03, 7.78, 1.95; II) 1.95, 0.78, 0.06; and III) 0.19, 0.10, 0.05cSv, respectively. The derived linear regression line of the exposure dose with respect to the DAP were extrapolated to obtain the minimum detectable level (MDL) of DAP for triggering the staff dosimeters. Accordingly, the minimum annual dose was estimated as 0.05cSv. Additional shielding provided measurable protection to the staff. The protective clothing used in scenarios II and III can reduce the original dose from scenario I to ∼3% (scenario II) and ∼0.5% (scenario III). The annual occupational dose also changed with the various X-rays energy settings. The annual dose increased to 126% when the preset X-rays energy was changed from 70 to 100kVp. The semiconductor dosimeter proved to be an adequate tool for measuring low doses and low dose rates under these circumstances. The dose can be reduce of I) 35.03, 7.78, 1.95; to II) 1.95, 0.78, 0.06 (∼3%); or III) 0.19, 0.10, 0.05 (∼0.5%)cSv, respectively according to different protective scenarios.

  5. Cardiac MDCT in children: CT technology overview and interpretation.

    PubMed

    Goo, Hyun Woo

    2011-09-01

    Cardiac multidetector computed tomography (MDCT) for congenital heart disease is a useful, rapid, and noninvasive imaging technique bridging the gaps between echocardiography, cardiac catheterization, and cardiac MRI. Fast scan speed and greater anatomic coverage, combined with flexible ECG-synchronized scans and a low radiation dose, are critical for improving the image quality of cardiac MDCT and minimizing patient risk. Current MDCT techniques can accurately evaluate extracardiac great vessels, lungs, and airways, as well as coronary arteries and intracardiac structures. Radiologists who perform cardiac MDCT in children should be familiarized with optimal cardiac computed tomography (CT) scan techniques and characteristic cardiac CT scan imaging findings. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Cardiac gene therapy: optimization of gene delivery techniques in vivo.

    PubMed

    Katz, Michael G; Swain, JaBaris D; White, Jennifer D; Low, David; Stedman, Hansell; Bridges, Charles R

    2010-04-01

    Vector-mediated cardiac gene therapy holds tremendous promise as a translatable platform technology for treating many cardiovascular diseases. The ideal technique is one that is efficient and practical, allowing for global cardiac gene expression, while minimizing collateral expression in other organs. Here we survey the available in vivo vector-mediated cardiac gene delivery methods--including transcutaneous, intravascular, intramuscular, and cardiopulmonary bypass techniques--with consideration of the relative merits and deficiencies of each. Review of available techniques suggests that an optimal method for vector-mediated gene delivery to the large animal myocardium would ideally employ retrograde and/or anterograde transcoronary gene delivery,extended vector residence time in the coronary circulation, an increased myocardial transcapillary gradient using physical methods, increased endothelial permeability with pharmacological agents, minimal collateral gene expression by isolation of the cardiac circulation from the systemic, and have low immunogenicity.

  7. Family presence in the congenital catheterization laboratory.

    PubMed

    Heitschmidt, Mary

    2015-01-01

    Evidence suggests that family presence as an option during invasive procedures may provide a comforting presence to the patient and may not be notable disruptive to the health care team. Little research has explored family presence during cardiac procedures. This is the first documented report of family presence in the congenital cardiac catheterization lab (CCCL). The purpose of this article is to review the course for implementing a family presence program in the CCCL. The Iowa Model of Evidence-Based practice guided this process which included the development of a written policy of family presence in the CCCL at two academic medical centers. Successful family presence in the catheterization lab must include: written guidelines, involvement of all staff, family presence offered as an option, and preparation of the patient and family for the catheterization experience as well as emergency procedures. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. [Subclavian vein catheterization].

    PubMed

    Felsch, G; Richter, G

    1975-08-15

    On the basis of experiences with more than 500 catherizations of the subclavian vein, which were performed partly infraclavicularly, partly supraclavicularly, the two methods were critically estimated and compared with regard to their effectivity and complications. The range of indications is enlarged from the access through the veins for taking blood samples and the infusion therapy over the measurement of the central venous blood pressure to the floating catheterization, temporary external pacemaker stimulation and emergency dialysis. The mastering of the two techniques of puncture provides a high measure of security for the emergency case. On the assumption of an approach secundum artem and knowing and taking into consideration the possibilities of complication, which are particularly referred to, the two ways seem to be approximately of the same value.

  9. Cardiac Gene Therapy: Optimization of Gene Delivery Techniques In Vivo

    PubMed Central

    Katz, Michael G.; Swain, JaBaris D.; White, Jennifer D.; Low, David; Stedman, Hansell

    2010-01-01

    Abstract Vector-mediated cardiac gene therapy holds tremendous promise as a translatable platform technology for treating many cardiovascular diseases. The ideal technique is one that is efficient and practical, allowing for global cardiac gene expression, while minimizing collateral expression in other organs. Here we survey the available in vivo vector-mediated cardiac gene delivery methods—including transcutaneous, intravascular, intramuscular, and cardiopulmonary bypass techniques—with consideration of the relative merits and deficiencies of each. Review of available techniques suggests that an optimal method for vector-mediated gene delivery to the large animal myocardium would ideally employ retrograde and/or anterograde transcoronary gene delivery,extended vector residence time in the coronary circulation, an increased myocardial transcapillary gradient using physical methods, increased endothelial permeability with pharmacological agents, minimal collateral gene expression by isolation of the cardiac circulation from the systemic, and have low immunogenicity. PMID:19947886

  10. Cardiac Gene Delivery in Large Animal Models: Antegrade Techniques.

    PubMed

    Watanabe, Shin; Leonardson, Lauren; Hajjar, Roger J; Ishikawa, Kiyotake

    2017-01-01

    Percutaneous antegrade coronary injection is among the least invasive cardiac selective gene delivery methods. However, transduction efficiency is quite low with a simple bolus antegrade injection. In order to improve the transduction efficiency using antegrade delivery, several additional approaches have been proposed.In this chapter, we briefly discuss important elements associated with intracoronary delivery methods and present protocols for three different catheter-based antegrade delivery techniques in a preclinical large animal model. Despite the lower transduction efficacy relative to more invasive delivery techniques, antegrade techniques have the advantage of being clinically well established and having safer profiles which is important when treating patients with cardiac disease.

  11. A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States: a report from the CathPCI Registry of the National Cardiovascular Data Registry, 2010 through June 2011.

    PubMed

    Dehmer, Gregory J; Weaver, Douglas; Roe, Matthew T; Milford-Beland, Sarah; Fitzgerald, Susan; Hermann, Anthony; Messenger, John; Moussa, Issam; Garratt, Kirk; Rumsfeld, John; Brindis, Ralph G

    2012-11-13

    This study sought to provide a report to the public of data from the CathPCI Registry of the National Cardiovascular Data Registry. The CathPCI Registry collects data from approximately 85% of the cardiac catheterization laboratories in the United States. Data were summarized for 6 consecutive calendar quarters beginning January 1, 2010, and ending June 30, 2011. This report includes 1,110,150 patients undergoing only diagnostic cardiac catheterization and 941,248 undergoing percutaneous coronary intervention (PCI). Some notable findings include, for example, that on-site cardiac surgery was not available in 83% of facilities performing fewer than 200 PCIs annually, with these facilities representing 32.6% of the facilities reporting, but performing only 12.4% of the PCIs in this data sample. Patients 65 years of age or older represented 38.7% of those undergoing PCI, with 12.3% being 80 years of age or older. Almost 80% of PCI patients were overweight (body mass index ≥25 kg/m(2)), 80% had dyslipidemia, and 27.6% were current or recent smokers. Among patients undergoing elective PCI, 52% underwent a stress study before the procedure, with stress myocardial perfusion being used most frequently. Calcium scores and coronary computed tomography angiography were used very infrequently (<3%) before diagnostic or PCI procedures. Radial artery access was used in 8.3% of diagnostic and 6.9% of PCI procedures. Primary PCI was performed with a median door-to-balloon time of 64.5 min for nontransfer patients and 121 min for transfer patients. In-hospital risk-adjusted mortality in ST-segment elevation myocardial infarction patients was 5.2% in this sample. Data from the CathPCI Registry provide a contemporary view of the current practice of invasive cardiology in the United States. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Fallopian Tube Catheterization

    PubMed Central

    Thurmond, Amy Suzanne

    2013-01-01

    Fallopian tube catheterization is used for treatment of infertility caused by proximal tubal occlusion, and has replaced surgical treatment for this condition. More recently, fallopian tube catheterization has been used for tubal sterilization. Interventional radiologists tested numerous methods for tubal occlusion using the rabbit as an animal model. As a result, a tubal device has recently been Food and Drug Administration approved for permanent sterilization using hysteroscopic guidance; it can also be placed fluoroscopically by fallopian tube catheterization as an “off-label” procedure. This is a 5-year continuation and update on a procedure that has been done by interventional radiologists for 25 years; history of the development of fallopian tube catheterization in women has been published in detail in this journal. Highlighted in this article will be description of the basic components needed for fallopian tube catheterization. PMID:24436565

  13. [Cardiac computed tomography: new applications of an evolving technique].

    PubMed

    Martín, María; Corros, Cecilia; Calvo, Juan; Mesa, Alicia; García-Campos, Ana; Rodríguez, María Luisa; Barreiro, Manuel; Rozado, José; Colunga, Santiago; de la Hera, Jesús M; Morís, César; Luyando, Luis H

    2015-01-01

    During the last years we have witnessed an increasing development of imaging techniques applied in Cardiology. Among them, cardiac computed tomography is an emerging and evolving technique. With the current possibility of very low radiation studies, the applications have expanded and go further coronariography In the present article we review the technical developments of cardiac computed tomography and its new applications. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  14. [Correlation of the transaortic gradient determined with doppler echocardiography versus catheterization in patients with aortic stenosis].

    PubMed

    Illescas, J; Enciso, R; Vidrio, M; de la Torre, N; Baduí, E

    1991-01-01

    The purpose of this report is to evaluate the reliability of a non-invasive estimation of a transaortic gradient in patients with valvular aortic stenosis by doppler echocardiography. We compared the transvalvular gradients obtained by cardiac catheterization (invasive) versus the estimation by non-invasive technique such as continuous-wave doppler in 30 consecutive patients with valvular aortic stenosis. When compared the peak velocity (Vmax) of the aortic jet versus the gradient obtained by cardiac catheterization we found a correlation coefficient (r) of 0.83 and when compared the gradient obtained by both methods we found an r value of 0.85. These results show that the calculations of aortic gradient by echo-doppler, are reliable. Besides this method allowed us to establish the correct diagnosis and to follow up these patients.

  15. Swan Ganz catheterization (image)

    MedlinePlus

    Right heart catheterization involves the passage of a catheter (a thin flexible tube) into the right side of the heart to obtain diagnostic information about the heart and for continuous monitoring of heart function in critically ill ...

  16. Bladder catheterization, male (image)

    MedlinePlus

    ... kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.

  17. Left heart catheterization

    MedlinePlus

    Catheterization - left heart ... to help guide the catheters up into your heart and arteries. Dye (sometimes called "contrast") will be ... in the blood vessels that lead to your heart. The catheter is then moved through the aortic ...

  18. Teaching children and young people intermittent self-catheterization.

    PubMed

    Bray, Lucy; Sanders, Caroline

    2007-06-01

    The need to catheterize through the urethra can begin at any age and stage of development in a child's life and may involve different strategies for teaching. Intermittent self-catheterization, as a self-management technique, can be of benefit both physically and psychologically to children and young people. Educational strategies are available to aid health care providers in teaching children and young people self-intermittent catheterization. Use of innovative techniques and resources may assist the practitioner in teaching self-catheterization successfully to this challenging population.

  19. [Field 6. Safety practices for haemodynamic procedures (administration of vasoactive drugs, vascular and cardiac catheterization). French-speaking Society of Intensive Care. French Society of Anesthesia and Resuscitation].

    PubMed

    Monnet, X; Lefrant, J-Y; Teboul, J-L

    2008-10-01

    Arterial and central venous catheterizations and their use for continuous infusion of vasoactive drugs could lead to serious adverses events that could be life threatening. The incidence of human errors related patient adverses events could be decreased by the uses of algorithms and procedures. Concerning the continuous infusion of vasoactive drugs, the name of drug and its concentration should be clearly notified. The use of modern pump and noncompliant pipe could reduce the frequency bolus infusion and their related haemodynamic alterations. Reasonable procedure could reduce the arterial and central venous catheters related complications. Subclavian and radial sites should be preferred for central venous and arterial catheter insertion, respectively. The use of real time echographic guidance could facilitate the catheter insertion. These catheters should be removed when they are not indicated. Concerning the pulmonary artery catheter, the balloon tip should be inflated with visual control of the pulmonary artery pressure. Its removal is recommended within the first five days.

  20. Aggressive Measures To Decrease Door To Balloon Time And Incidence Of Unnecessary Cardiac Catheterization: Potential Risks And Role of Quality Improvement

    PubMed Central

    Fanari, Zaher; Abraham, Niksad; Kolm, Paul; Doorey, Jennifer; Herman, Angela; Hoban, Angela; Reddy, Vivek; Hammami, Sumaya; Leonovich, Jennifer; Rahman, Ehsanur; Weintraub, William S.; Doorey, Andrew J.

    2015-01-01

    Objectives To assess the impact of aggressive protocol to decrease door-to-balloon (DTB) time on the incidence of false-positive STEMI (FP-STEMI) and in-hospital mortality. Patients Consecutive patients with presumed STEMI with confirmed ST-segment elevation that underwent emergent catheterization. Methods In July 1, 2009 we instituted an aggressive protocol to further reduce DTB time. A quality improvement (QI) initiative was initiated in January 1, 2010 to maintain short DTB while improving outcomes. Outcomes were compared before and after aggressive DTB and similarly before and after the QI initiative. Outcomes were DTB time, the incidence of FP-STEMI and in-hospital mortality. A review of the emergency catheterization database over the last 10 years (January 2001-December 2010) was carried out for historical comparison. Results Between July 1, 2008 and December 1, 2012, 1031 consecutive patients with presumed STEMI were assessed. Of these 170 were considered FP-STEMI. The median DTB time decreased from 76 to 61 minutes with the aggressive DTB protocol (P=. 001), accompanied by an increase of FP-STEMI (7.7% vs. 16.5%, p=.02). While TP-STEMI in-hospital mortality witnessed non-significant reduction, this was associated with a significant increase of FP-STEMI in-hospital mortality. After the QI initiative, a shorter DTB time (59 minutes) was maintained while decreasing FP-STEMI in-hospital mortality. Conclusion Aggressive measures to reduce DTB time were associated with an increased incidence of FP-STEMI and FP-STEMI in-hospital mortality. Efforts to reduce DTB time should be monitored systematically to avoid unnecessary procedures that may delays other appropriate therapies in critically ill patients. PMID:26549506

  1. Optimal technique for deep breathing exercises after cardiac surgery.

    PubMed

    Westerdahl, E

    2015-06-01

    Cardiac surgery patients often develop a restrictive pulmonary impairment and gas exchange abnormalities in the early postoperative period. Chest physiotherapy is routinely prescribed in order to reduce or prevent these complications. Besides early mobilization, positioning and shoulder girdle exercises, various breathing exercises have been implemented as a major component of postoperative care. A variety of deep breathing maneuvres are recommended to the spontaneously breathing patient to reduce atelectasis and to improve lung function in the early postoperative period. Different breathing exercises are recommended in different parts of the world, and there is no consensus about the most effective breathing technique after cardiac surgery. Arbitrary instructions are given, and recommendations on performance and duration vary between hospitals. Deep breathing exercises are a major part of this therapy, but scientific evidence for the efficacy has been lacking until recently, and there is a lack of trials describing how postoperative breathing exercises actually should be performed. The purpose of this review is to provide a brief overview of postoperative breathing exercises for patients undergoing cardiac surgery via sternotomy, and to discuss and suggest an optimal technique for the performance of deep breathing exercises.

  2. Changes in Acute Coronary Syndrome Treatment and Prognosis After Implementation of the Infarction Code in a Hospital With a Cardiac Catheterization Unit.

    PubMed

    Cordero, Alberto; López-Palop, Ramón; Carrillo, Pilar; Frutos, Araceli; Miralles, Sandra; Gunturiz, Clara; García-Carrilero, María; Bertomeu-Martínez, Vicente

    2016-08-01

    Emergency care systems have been created to improve treatment and revascularization in myocardial infarction but they may also improve the management of all patients with acute coronary syndrome. A comparative study of all patients admitted with acute coronary syndrome before and after implementation of an infarction protocol. The study included 1210 patients. While the mean age was the same in both periods, the patient group admitted after implementation of the protocol had a lower prevalence of diabetes mellitus and hypertension but more active smokers and higher GRACE scores. The percentage of ST-segment elevation acute coronary syndrome (29.8%-39.5%) and coronary revascularizations (82.1%-90.1%) significantly increased among patients admitted with acute coronary syndrome, and primary angioplasty became routine (51.9%-94.9%); there was also a reduction in time to catheterization and an increase in early revascularization. The mean hospital stay was significantly shorter after implementation of the infarction protocol. In-hospital mortality was unchanged, except in high-risk patients (38.8%-22.4%). After discharge, no differences were observed between the 2 periods in cardiovascular mortality, all-cause mortality, reinfarction, or major cardiovascular complications. After implementation of the infarction protocol, the percentage of patients admitted with ST-segment elevation acute coronary syndrome and the mean GRACE score increased among patients admitted with acute coronary syndrome. Hospital stay was reduced, and primary angioplasty use increased. In-hospital mortality was reduced in high-risk patients, and prognosis after discharge was the same in both periods. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  3. Computed tomographic versus catheterization angiography in tetralogy of Fallot.

    PubMed

    Garg, Naveen; Walia, Rohit; Neyaz, Zafar; Kumar, Sunil

    2015-02-01

    To compare multidetector computed tomographic angiography with the gold standard cardiac catheterization and angiography in tetralogy of Fallot. In 40 consecutive patients over 5 years of age with tetralogy of Fallot, multidetector computed tomographic angiography and catheterization angiography studies were compared for intracardiac anatomy, pulmonary anatomy and indices, coronaries and collaterals. Safety parameters, relative advantages and limitations were also analyzed. All catheterization studies required hospitalization whereas all tomographic studies were performed as outpatient procedures. The need for sedation and amount of contrast used were significantly greater in catheterization than in tomographic studies. Complications noted during catheterization were access site complications in 4 patients, cyanotic spells in 2, transient complete heart block requiring temporary pacing in 2, and air embolism in one. No complication was observed during tomographic studies. All tomographic studies were adequate, but 2 catheterization studies were inadequate. Ventricular septal defects, aortic override, level of right ventricular outflow tract obstruction, and pulmonary artery anatomy were equally assessed by both imaging modalities. However, tomographic studies missed additional small muscular ventricular septal defects. There was a linear correlation between tomographic and catheterization studies for pulmonary annulus size, artery sizes, Z-score, and Nakata index. There was complete concordance with respect to side of aortic arch and detection of collaterals. Coronary anatomy was better delineated in tomographic studies. For preoperative evaluation of tetralogy of Fallot patients, multidetector computed tomographic angiography can be used as a reliable noninvasive alternative to cardiac catheterization angiography. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. Feature tracking cardiac magnetic resonance imaging: A review of a novel non-invasive cardiac imaging technique

    PubMed Central

    Rahman, Zia Ur; Sethi, Pooja; Murtaza, Ghulam; Virk, Hafeez Ul Hassan; Rai, Aitzaz; Mahmod, Masliza; Schoondyke, Jeffrey; Albalbissi, Kais

    2017-01-01

    Cardiovascular disease is a leading cause of morbidity and mortality globally. Early diagnostic markers are gaining popularity for better patient care disease outcomes. There is an increasing interest in noninvasive cardiac imaging biomarkers to diagnose subclinical cardiac disease. Feature tracking cardiac magnetic resonance imaging is a novel post-processing technique that is increasingly being employed to assess global and regional myocardial function. This technique has numerous applications in structural and functional diagnostics. It has been validated in multiple studies, although there is still a long way to go for it to become routine standard of care. PMID:28515849

  5. Comparative Study of Renal Protective Effects of Allopurinol and N-Acetyl-Cysteine on Contrast Induced Nephropathy in Patients Undergoing Cardiac Catheterization

    PubMed Central

    Bhawani, Goru; Kumari, Neera; Murthy, Kasturi SN; Lalwani, Vinod; Raju, CH Narasimha

    2014-01-01

    Objectives : To evaluate the difference in the renal protective effects of allopurinol and n-acetyl cysteine along with saline hydration in patients of contrast induced nephropathy (CIN) post cardiac interventions. Background: CIN remains a common complication of cardiac procedures. Radio contrast agents can cause a reduction in renal function that may be related to oxidative stress underlining various patho- physiologies. Conflicting evidence suggests that administration of allopurinol, a xanthine oxidase inhibitor can prevent CIN. Materials and Methods: This is a study of 500 patients undergoing angiography and coronary revascularisation in patients showing significant coronary block. The angiography positive patients (275) were prospectively randomised to different treatment protocol to study for their reno-protective effect. The patients received either of the three drugs saline hydration (SH, 1ml/kg/hr), n-acetylcysteine (SH+NAC, 600 mg bd) or Allopurinol (SH+ALLP, 300 mg/day) 12 hours before and after administration of radio contrast agent. Levels of serum creatinine and blood urea of the 275 patients recorded at 24 hour interval were noted post angioplasty over a course of 5 days in patients receiving either omnipaque (125) or visipaque (150) contrast media. All the 500 patients were also assessed for development of any kind of adverse drug effects/reactions with the two contrast media. Results: CIN occurred in 56 of 500 the patients (10.6%) who underwent angiography and 49 of 275 patients (17.8%) who underwent angioplasty. In the omnipaque group CIN occurred in 16/40, 8/40, nil/45 in patients receiving SH, NAC plus SH and SH plus ALLP respectively. In the visipaque group CIN occurred in 15/50, 10/50, nil/50 in the three treatments groups respectively. Allopurinol maintained a consistent fall in the serum creatinine & blood urea levels from the baseline values from the end of the 1st day (p < .01 & .001) in both the category. Visipaque proved to be better

  6. Comparative study of renal protective effects of allopurinol and N-acetyl-cysteine on contrast induced nephropathy in patients undergoing cardiac catheterization.

    PubMed

    Kumar, Ashutosh; Bhawani, Goru; Kumari, Neera; Murthy, Kasturi Sn; Lalwani, Vinod; Raju, Ch Narasimha

    2014-12-01

    Objectives : To evaluate the difference in the renal protective effects of allopurinol and n-acetyl cysteine along with saline hydration in patients of contrast induced nephropathy (CIN) post cardiac interventions. CIN remains a common complication of cardiac procedures. Radio contrast agents can cause a reduction in renal function that may be related to oxidative stress underlining various patho- physiologies. Conflicting evidence suggests that administration of allopurinol, a xanthine oxidase inhibitor can prevent CIN. This is a study of 500 patients undergoing angiography and coronary revascularisation in patients showing significant coronary block. The angiography positive patients (275) were prospectively randomised to different treatment protocol to study for their reno-protective effect. The patients received either of the three drugs saline hydration (SH, 1ml/kg/hr), n-acetylcysteine (SH+NAC, 600 mg bd) or Allopurinol (SH+ALLP, 300 mg/day) 12 hours before and after administration of radio contrast agent. Levels of serum creatinine and blood urea of the 275 patients recorded at 24 hour interval were noted post angioplasty over a course of 5 days in patients receiving either omnipaque (125) or visipaque (150) contrast media. All the 500 patients were also assessed for development of any kind of adverse drug effects/reactions with the two contrast media. CIN occurred in 56 of 500 the patients (10.6%) who underwent angiography and 49 of 275 patients (17.8%) who underwent angioplasty. In the omnipaque group CIN occurred in 16/40, 8/40, nil/45 in patients receiving SH, NAC plus SH and SH plus ALLP respectively. In the visipaque group CIN occurred in 15/50, 10/50, nil/50 in the three treatments groups respectively. Allopurinol maintained a consistent fall in the serum creatinine & blood urea levels from the baseline values from the end of the 1(st) day (p < .01 & .001) in both the category. Visipaque proved to be better dye than omnipaque with less adverse drug

  7. Current Trends in the Management of Difficult Urinary Catheterizations

    PubMed Central

    Willette, Paul A.; Coffield, Scott

    2012-01-01

    Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failed catheterization and concomitant complications increase. Repeated and unsuccessful attempts at urinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of follow-up evaluations. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient with acute urinary retention, including attending emergency physicians who often are the first physicians to encounter such patients. Best practice methods for blind catheter placement are summarized in this review. In addition, for progressive clinical practice, an algorithm for the management of difficult urinary catheterizations that incorporates technology enabling direct visualization of the urethra during catheter insertion is presented. This algorithm will aid healthcare personnel in decision making and has the potential to improve quality of care of patients. PMID:23359117

  8. An Extraperitoneal Technique for Murine Heterotopic Cardiac Transplantation.

    PubMed

    Nowocin, A K; Brown, K; Edwards, L A; Meader, L; Hill, J I; Wong, W

    2015-09-01

    The mouse heterotopic cardiac transplantation model has been used extensively by investigators in the field of organ transplantation to study the rejection process, test new antirejection treatments, tolerance induction protocols or to understand basic immunological principles. Due to its extensive use, any small refinement of the technique would have a major impact on replacement, reduction and refinement (commonly known as the 3Rs). Here, we describe a novel approach to refine this model. The donor aorta and pulmonary artery are anastomosed peripherally to the femoral artery and vein of the recipient, respectively. The technical success rate is comparable to the conventional abdominal site, but it avoids a laparotomy and handling of the bowels making it less invasive method. As a result, recipients recover faster and require less postoperative analgesia. It is a major refinement under one of the 3Rs and would represent an advance in animal welfare in scientific research. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  9. [Bases of central venous catheterization].

    PubMed

    Schmalz-Ott, Stéphane; Monti, Matteo; Vollenweider, Peter

    2008-10-29

    Central venous catheterization is a frequently performed procedure in internal medicine units. Residents in training frequently share the same questions, doubts and fears about this procedure : "Should I perform a subclavian catheterization in a patient with mild thrombopenia?"; "Which site has the lesser complication rate?"; "After how long does a catheter need to be replaced?". This mini-review of the current literature tries to answer this and other questions.

  10. Cardiac Limited Ultrasound Examination Techniques to Augment the Bedside Cardiac Physical Examination.

    PubMed

    Kimura, Bruce J; Shaw, David J; Amundson, Stan A; Phan, James N; Blanchard, Daniel G; DeMaria, Anthony N

    2015-09-01

    The current practice of physical diagnosis is dependent on physician skills and biases, inductive reasoning, and time efficiency. Although the clinical utility of echocardiography is well known, few data exist on how to integrate 2-dimensional screening "quick-look" ultrasound applications into a novel, modernized cardiac physical examination. We discuss the evidence basis behind ultrasound "signs" pertinent to the cardiovascular system and elemental in synthesis of bedside diagnoses and propose the application of a brief cardiac limited ultrasound examination based on these signs. An ultrasound-augmented cardiac physical examination can be taught in traditional medical education and has the potential to improve bedside diagnosis and patient care.

  11. The peripheral cannulation technique in minimally invasive congenital cardiac surgery.

    PubMed

    Vida, Vladimiro L; Tessari, Chiara; Putzu, Alessandro; Tiberio, Ivo; Guariento, Alvise; Gallo, Michele; Stellin, Giovanni

    2016-08-19

    Congenital minimally invasive cardiac surgery has gained wide acceptance thanks to its favorable outcomes. The introduction of peripheral cannulation for cardiopulmonary bypass further reduces surgical trauma by decreasing surgical access and allowing the spectrum of surgical access for the correction of simple congenital heart defects to be widened. Right internal jugular vein percutaneous cannulation, together with the direct surgical cannulation of femoral vessels, proves to be a safe and effective tool in patients with body weight above 15 kg.

  12. Myocardial blood flow: Roentgen videodensitometry techniques

    NASA Technical Reports Server (NTRS)

    Smith, H. C.; Robb, R. A.; Wood, E. H.

    1975-01-01

    The current status of roentgen videodensitometric techniques that provide an objective assessment of blood flow at selected sites within the coronary circulation were described. Roentgen videodensitometry employs conventional radiopaque indicators, radiological equipment and coronary angiographic techniques. Roentgen videodensitometry techniques developed in the laboratory during the past nine years, and for the past three years were applied to analysis of angiograms in the clinical cardiac catheterization laboratory.

  13. Myocardial blood flow: Roentgen videodensitometry techniques

    NASA Technical Reports Server (NTRS)

    Smith, H. C.; Robb, R. A.; Wood, E. H.

    1975-01-01

    The current status of roentgen videodensitometric techniques that provide an objective assessment of blood flow at selected sites within the coronary circulation were described. Roentgen videodensitometry employs conventional radiopaque indicators, radiological equipment and coronary angiographic techniques. Roentgen videodensitometry techniques developed in the laboratory during the past nine years, and for the past three years were applied to analysis of angiograms in the clinical cardiac catheterization laboratory.

  14. Evaluation of cardiac output by 5 arterial pulse contour techniques using trend interchangeability method

    PubMed Central

    Fischer, Marc-Olivier; Diouf, Momar; de Wilde, Robert B.P.; Dupont, Hervé; Hanouz, Jean-Luc; Lorne, Emmanuel

    2016-01-01

    Abstract Cardiac output measurement with pulse contour analysis is a continuous, mini-invasive, operator-independent, widely used, and cost-effective technique, which could be helpful to assess changes in cardiac output. The 4-quadrant plot and the polar plot have been described to compare the changes between 2 measurements performed under different conditions, and the direction of change by using different methods of measurements. However, the 4-quadrant plot and the polar plot present a number of limitations, with a risk of misinterpretation in routine clinical practice. We describe a new trend interchangeability method designed to objectively define the interchangeability of each change of a variable. Using the repeatability of the reference method, we classified each change as either uninterpretable or interpretable and then as either noninterchangeable, in the gray zone or interchangeable. An interchangeability rate can then be calculated by the number of interchangeable changes divided by the total number of interpretable changes. In this observational study, we used this objective method to assess cardiac output changes with 5 arterial pulse contour techniques (Wesseling's method, LiDCO, PiCCO, Hemac method, and Modelflow) in comparison with bolus thermodilution technique as reference method in 24 cardiac surgery patients. A total of 172 cardiac output variations were available from the 199 data points: 88 (51%) were uninterpretable, according to the first step of the method. The second step of the method, based on the 84 (49%) interpretable variations, showed that only 18 (21%) to 30 (36%) variations were interchangeable regardless of the technique used. None of pulse contour cardiac output technique could be interchangeable with bolus thermodilution to assess changes in cardiac output using the trend interchangeability method in cardiac surgery patients. Future studies may consider using this method to assess interchangeability of changes between different

  15. [Mechanical complication of central venous catheterization].

    PubMed

    Koja, Hiroki; Tokumine, Joho; Sugahara, Kazuhiro

    2007-01-01

    Central venous catheterization is a procedure with a high success rate. However, life-threatening complications are occasionally caused by mechanical injury during the catheterization process. Therefore, surgeons should have sufficient knowledge of the potential complications and the effective use of preventative measures when performing catheterization. We herein review and discuss the mechanical complications previously reported to have occurred in association with central venous catheterization. Comprehensive knowledge about various complication-inducing factors, the ability to make a quick and accurate diagnosis of such complications, and sufficient skill to prevent worsening of these complications can thus help patients from suffering lethal complications due to central venous catheterization.

  16. MR-Based Cardiac and Respiratory Motion-Compensation Techniques for PET-MR Imaging.

    PubMed

    Munoz, Camila; Kolbitsch, Christoph; Reader, Andrew J; Marsden, Paul; Schaeffter, Tobias; Prieto, Claudia

    2016-04-01

    Cardiac and respiratory motion cause image quality degradation in PET imaging, affecting diagnostic accuracy of the images. Whole-body simultaneous PET-MR scanners allow for using motion information estimated from MR images to correct PET data and produce motion-compensated PET images. This article reviews methods that have been proposed to estimate motion from MR images and different techniques to include this information in PET reconstruction, in order to overcome the problem of cardiac and respiratory motion in PET-MR imaging. MR-based motion correction techniques significantly increase lesion detectability and contrast, and also improve accuracy of uptake values in PET images.

  17. Current cardiac imaging techniques for detection of left ventricular mass

    PubMed Central

    2010-01-01

    Estimation of left ventricular (LV) mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE) is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test. PMID:20515461

  18. Gene therapy during cardiac surgery: role of surgical technique to minimize collateral organ gene expression

    PubMed Central

    Katz, Michael G.; Swain, JaBaris D.; Fargnoli, Anthony S.; Bridges, Charles R.

    2013-01-01

    Effective gene therapy for heart failure has not yet been achieved clinically. The aim of this study is to quantitatively assess the cardiac isolation efficiency of the molecular cardiac surgery with recirculating delivery (MCARD™) and to evaluate its efficacy as a means to limit collateral organ gene expression. 1014 genome copies (GC) of recombinant adeno-associated viral vector 6 encoding green fluorescent protein under control of the cytomegalovirus promoter was delivered to the nine arrested sheep hearts. Blood samples were assessed using real-time quantitative polymerase chain reaction (RT QPCR). Collateral organ gene expression was assessed at four-weeks using immunohistochemical staining. The blood vector GC concentration in the cardiac circuit during complete isolation trended from 9.59±0.73 to 9.05±0.65 (log GC/cm3), and no GC were detectable in the systemic circuit (P<0.001). The washing procedure performed prior to relinquishing the cardiac circuit decreased the systemic blood vector GC concentration >800-fold (P<0.001), consistent with >99% isolation efficiency. Conversely, incomplete isolation resulted in equalization of vector GC concentration in the circuits, leading to robust collateral organ gene expression. MCARD™ is an efficient, clinically translatable myocardial delivery platform for cardiac specific gene therapy. The cardiac surgical techniques utilized are critically important to limit collateral organ gene expression. PMID:20861057

  19. The development of a validated checklist for femoral venous catheterization: preliminary results.

    PubMed

    Riesenberg, Lee Ann; Berg, Katherine; Berg, Dale; Davis, Joshua; Schaeffer, Arielle; Justice, Ellen M; Tinkoff, Glen

    2014-01-01

    Femoral venous catheterization is a common, invasive procedure, which may lead to serious complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. The results of the first step of the validation of a femoral venous catheterization checklist are described. A comprehensive literature review of articles published on femoral venous catheterization did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 8 interdisciplinary, interinstitutional experts, was used to develop a femoral venous catheterization checklist. The internal consistency coefficient using Cronbach α was .99. Developing a 29-item checklist for teaching and assessing femoral venous catheterization is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

  20. Catheterization of the Hepatic Artery Via the Left Common Carotid Artery in Rats

    SciTech Connect

    Li Xiao; Wang Yixiang, J.; Zhou Xiangping Guan Yongsong; Tang Chengwei

    2006-12-15

    The commonly used approach for rat hepatic artery catheterization is via the gastroduodenal artery, which is ligated after the procedure. A new method of rat hepatic artery catheterization via the left common carotid artery (LCCA) is described. The LCCA is repaired after catheterization. The catheterization procedures included the following: (1) opening the rat's abdominal cavity and exposing the portion of abdominal aorta at the level of the celiac trunk; (2) separating and exposing the LCCA; inserting a microguidewire and microcatheter set into the LCCA via an incision; after placement into the descending aorta, the microguidewire and microcatheter are maneuvered into the hepatic artery under direct vision; (3) after transcatheter therapy, the catheter is withdrawn and the incision at the LCCA is repaired. This technique was employed on 60 male Sprague-Dawley rats with diethylnitrosamine-induced liver cancer, using a 3F microguidewire and microcatheter set. Selective hepatic artery catheterization was successfully performed in 57 rats. One rat died during the operation and five rats died within 7 days after the procedure. It is envisaged that as experience increases, the catheterization success rate will increase and the death rate will decrease. A new approach for selective hepatic artery catheterization via the LCCA in rats is introduced, which makes repeat catheterization of this artery possible and allows large embolization particles to be delivered by using a 3F catheter.

  1. Kalman filter techniques for accelerated Cartesian dynamic cardiac imaging.

    PubMed

    Feng, Xue; Salerno, Michael; Kramer, Christopher M; Meyer, Craig H

    2013-05-01

    In dynamic MRI, spatial and temporal parallel imaging can be exploited to reduce scan time. Real-time reconstruction enables immediate visualization during the scan. Commonly used view-sharing techniques suffer from limited temporal resolution, and many of the more advanced reconstruction methods are either retrospective, time-consuming, or both. A Kalman filter model capable of real-time reconstruction can be used to increase the spatial and temporal resolution in dynamic MRI reconstruction. The original study describing the use of the Kalman filter in dynamic MRI was limited to non-Cartesian trajectories because of a limitation intrinsic to the dynamic model used in that study. Here the limitation is overcome, and the model is applied to the more commonly used Cartesian trajectory with fast reconstruction. Furthermore, a combination of the Kalman filter model with Cartesian parallel imaging is presented to further increase the spatial and temporal resolution and signal-to-noise ratio. Simulations and experiments were conducted to demonstrate that the Kalman filter model can increase the temporal resolution of the image series compared with view-sharing techniques and decrease the spatial aliasing compared with TGRAPPA. The method requires relatively little computation, and thus is suitable for real-time reconstruction.

  2. Update: Cardiac Imaging (II). Transcatheter Aortic Valve Replacement: Advantages and Limitations of Different Cardiac Imaging Techniques.

    PubMed

    Podlesnikar, Tomaz; Delgado, Victoria

    2016-03-01

    Transcatheter aortic valve replacement is an established therapy for patients with symptomatic severe aortic stenosis and contraindications or high risk for surgery. Advances in prostheses and delivery system designs and continuous advances in multimodality imaging, particularly the 3-dimensional techniques, have led to improved outcomes with significant reductions in the incidence of frequent complications such as paravalvular aortic regurgitation. In addition, data on prosthesis durability are accumulating. Multimodality imaging plays a central role in the selection of patients who are candidates for transcatheter aortic valve replacement, procedure planning and guidance, and follow-up of prosthesis function. The strengths and limitations of each imaging technique for transcatheter aortic valve replacement will be discussed in this update article. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  3. Contemporary Mapping Techniques of Complex Cardiac Arrhythmias – Identifying and Modifying the Arrhythmogenic Substrate

    PubMed Central

    Koutalas, Emmanuel; Rolf, Sascha; Dinov, Borislav; Richter, Sergio; Arya, Arash; Bollmann, Andreas; Hindricks, Gerhard

    2015-01-01

    Cardiac electrophysiology has moved a long way forward during recent decades in the comprehension and treatment of complex cardiac arrhythmias. Contemporary electroanatomical mapping systems, along with state-of-the-art technology in the manufacture of electrophysiology catheters and cardiac imaging modalities, have significantly enriched our armamentarium, enabling the implementation of various mapping strategies and techniques in electrophysiology procedures. Beyond conventional mapping strategies, ablation of complex fractionated electrograms and rotor ablation in atrial fibrillation ablation procedures, the identification and modification of the underlying arrhythmogenic substrate has emerged as a strategy that leads to improved outcomes. Arrhythmogenic substrate modification also has a major role in ventricular tachycardia ablation procedures. Optimisation of contact between tissue and catheter and image integration are a further step forward to augment our precision and effectiveness. Hybridisation of existing technologies with a reasonable cost should be our goal over the next few years. PMID:26835095

  4. Evaluation of cardiac valvular disease with MR imaging: qualitative and quantitative techniques.

    PubMed

    Glockner, James F; Johnston, Donald L; McGee, Kiaran P

    2003-01-01

    Magnetic resonance (MR) imaging is almost never performed as the initial imaging test in cardiac valvular disease; that role is dominated by echocardiography. Nevertheless, MR imaging has much to offer in selected patients. Quantitative information regarding the severity of regurgitant or stenotic lesions can be obtained by using a combination of cine gradient-echo or steady-state free precession and cine phase-contrast sequences. In addition to providing measurements of peak velocity and flow, MR imaging is the standard of reference for evaluation of ventricular function, which can be a critical factor in determining when surgical intervention is indicated. Improvements in cardiac MR imaging technology have been particularly striking in the past few years, and these developments can easily be applied to the examination of cardiac valves. The authors briefly describe the pathophysiology of valvular disease, discuss standard MR techniques for qualitative and quantitative evaluation of valvular lesions, and illustrate these concepts with several case studies.

  5. Venous catheterization with ultrasound navigation

    NASA Astrophysics Data System (ADS)

    Kasatkin, A. A.; Urakov, A. L.; Nigmatullina, A. R.

    2015-11-01

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient's exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  6. Venous catheterization with ultrasound navigation

    SciTech Connect

    Kasatkin, A. A. Nigmatullina, A. R.; Urakov, A. L.

    2015-11-17

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient’s exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  7. Retrograde catheterization of the pulmonary veins following surgical correction of transposition of the great vessels.

    PubMed

    Carter, G A

    1976-01-01

    Prior to a Mustard repair for transposition of the great vessels, complete physiologic data of the pulmonary bed can be obtained by catheterization of the pulmonary artery with a "J" formed wire, and direct catheterization of the pulmonary veins via an atrial septal defect. Following "physiologic" repair ready access to the pulmonary veins is denied. Evaluation of the pulmonary venous pressure is of great importance, however, in differentiating pulmonary vascular disease from pulmonary hypertension secondary to patch obstruction of pulmonary venous return. This paper describes a technique of catheterization of the pulmonary veins following a Mustard repair for TGV.

  8. Mechanography: a non-invasive technique for the evaluation of cardiac function in children

    PubMed Central

    Spitaels, Silja; Fouron, Jean-Claude; Davignon, André

    1972-01-01

    Experience in the pediatric age group with mechanography, an indirect method of cardiovascular investigation, is described with emphasis on the recording technique and on the analysis of the tracings. A few examples are presented with comments on the morphological aspects and the time characteristics of the pulse curves, showing how much information about cardiac disease and especially myocardial function in children may be obtained. PMID:4640813

  9. Glucose-insulin-potassium techniques in cardiac surgery: historical overview and future perspectives.

    PubMed

    Van Wezel, Harry B

    2006-09-01

    Since the days of the first cardiac surgical operations in the previous century, myocardial preservation has been an essential component of the successful outcome of these procedures. Although many different techniques to achieve myocardial preservation and modulation have been described in the past 50 years, this review focuses on the use of glucose, insulin, and potassium (GIK) and its effect on ischemic and postischemic myocardium.

  10. Imaging Techniques in Percutaneous Cardiac Structural Interventions: Atrial Septal Defect Closure and Left Atrial Appendage Occlusion.

    PubMed

    Rodríguez Fernández, Antonio; Bethencourt González, Armando

    2016-08-01

    Because of advances in cardiac structural interventional procedures, imaging techniques are playing an increasingly important role. Imaging studies show sufficient anatomic detail of the heart structure to achieve an excellent outcome in interventional procedures. Up to 98% of atrial septal defects at the ostium secundum can be closed successfully with a percutaneous procedure. Candidates for this type of procedure can be identified through a systematic assessment of atrial septum anatomy, locating and measuring the size and shape of all defects, their rims, and the degree and direction of shunting. Three dimensional echocardiography has significantly improved anatomic assessments and the end result itself. In the future, when combined with other imaging techniques such as cardiac computed tomography and fluoroscopy, 3-dimensional echocardiography will be particularly useful for procedure guidance. Percutaneous closure of the left atrial appendage offers an alternative for treating patients with atrial fibrillation and contraindication for oral anticoagulants. In the future, the clinical focus may well turn to stroke prevention in selected patients. Percutaneous closure is effective and safe; device implantation is successful in 94% to 99% of procedures. However, the procedure requires an experienced cardiac structural interventional team. At present, 3-dimensional echocardiography is the most appropriate imaging technique to assess anatomy suitability, select device type and size, guide the procedure alongside fluoroscopy, and to follow-up the patient afterwards.

  11. Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside.

    PubMed

    Kimura, Bruce J

    2017-03-04

    The development of hand-carried, battery-powered ultrasound devices has created a new practice in ultrasound diagnostic imaging, called 'point-of-care' ultrasound (POCUS). Capitalising on device portability, POCUS is marked by brief and limited ultrasound imaging performed by the physician at the bedside to increase diagnostic accuracy and expediency. The natural evolution of POCUS techniques in general medicine, particularly with pocket-sized devices, may be in the development of a basic ultrasound examination similar to the use of the binaural stethoscope. This paper will specifically review how POCUS improves the limited sensitivity of the current practice of traditional cardiac physical examination by both cardiologists and non-cardiologists. Signs of left ventricular systolic dysfunction, left atrial enlargement, lung congestion and elevated central venous pressures are often missed by physical techniques but can be easily detected by POCUS and have prognostic and treatment implications. Creating a general set of repetitive imaging skills for these entities for application on all patients during routine examination will standardise and reduce heterogeneity in cardiac bedside ultrasound applications, simplify teaching curricula, enhance learning and recollection, and unify competency thresholds and practice. The addition of POCUS to standard physical examination techniques in cardiovascular medicine will result in an ultrasound-augmented cardiac physical examination that reaffirms the value of bedside diagnosis.

  12. Comparison of time to obtain intraosseous versus jugular venous catheterization on canine cadavers.

    PubMed

    Allukian, Alison R; Abelson, Amanda L; Babyak, Jonathan; Rozanski, Elizabeth A

    2017-09-01

    To compare the time required and the success rate of personnel with 4 different levels of experience to place a humeral intraosseous (IO) catheter versus a jugular venous catheter (IV) in cadaver dogs. Prospective study. Veterinary university teaching hospital. Canine cadavers from recently euthanized dogs were obtained from the cadaver donation program between May and December 2014. Catheter placers (CPs) with varying clinical experience, including a first year emergency and critical care resident, a senior emergency veterinary technician (VTS certified), a final year veterinary student, and an ACVECC diplomate, participated in the study. Each CP catheterized a total of 6 dogs so that there was a total of 6 IO and 6 IV catheters placed, by automatic rotary insertion device (with an EZ-IO gun) and vascular cut-down technique, respectively, for each CP. Time for IO catheterization and IV catheterization was recorded and compared. The success of IO catheterization and IV catheterization was verified by visualization of an injection of iodinated contrast material under fluoroscopy within the medullary cavity or vessel. Twenty-four canine cadavers. Outcomes were analyzed using the Wilcoxon rank-sum test and the Kruskal-Wallis one-way analysis of variance. The median time for all IO catheterization operators was faster at 55.4 seconds (range 15.0-153.0 s) compared to the median time for all IV catherization operators at 217.3 seconds (range 55.6-614 s). The success rate for IO and IV was equal at 87.5%. IO catheterization using an automatic rotary insertion device was performed more rapidly and successfully than jugular venous catheterization using a cut-down technique in canine cadaver. These findings suggest IO catheterization may be more efficient for gaining vascular access in the appropriate emergency clinical situations when preexisting IV access does not exist. © Veterinary Emergency and Critical Care Society 2017.

  13. [Suppurative thrombophlebitis central venous catheterization].

    PubMed

    Ramos Martínez, A; Sánchez Romero, I; Saura Lorente, P A; Parajón Díaz, A

    2008-06-01

    Suppurative thrombophlebitisis a very infrequent complication of the central venous catheterization. The majority of the cases are produced by species of staphylococci. A 22-year-old colombian-woman, student, without toxic habits was admitted because of temporary left astrocytoma (grade II). Nine days after implementing a catheter in the right subclavian vein she presented high fever (39.5 degrees C), shivers, progressive right side neck swelling and odinofagia. She had leukocytosis (26,300 cells/microl) and normal cerebrospinal fluid. After withdrawing the catheter, Staphylococcus aureus was isolated in the tip of the catheter and in four bottles of blood cultures. A neck CT demonstrated expansion and absence of contrast in the right internal jugular vein. The patient evolved satisfactorily with cloxacillin, gentamycin and low molecular weight heparin.

  14. Dynamic multiplanar real time ultrasound guided infraclavicular subclavian vein catheterization.

    PubMed

    Zhong, Xin; Hamill, Mark; Collier, Bryan; Bradburn, Eric; Ferrara, John

    2015-06-01

    Ultrasound guided vascular access has been well-characterized as a safe and effective technique for internal jugular and femoral vein catheterization. However, there is limited experience with the use of ultrasound to access the infraclavicular subclavian vein. Multiple ultrasound techniques do exist to identify the subclavian vein, but real time access is limited by vessel identification in a single planar view. To overcome this limitation, a novel technique of ultrasound guided infraclavicular subclavian vein catheterization using a real time multiplanar approach has been developed. The initial experience with this approach is described. A single surgeon used combined oblique, transverse, and longitudinal views along with Doppler color flow images to both define the infraclavicular anatomy and to obtain subclavian vein access in 42 adult patients (20 M/22 F and 22 L/20 R) with a mean body mass index of 29.2 (range = 18.9-55.4). Chest x-ray was obtained to confirm position and to rule out pneumothorax. Subclavian vein cannulation was achieved in 100 per cent of patients; subsequent catheterization was successful in 92.9 per cent. The number of attempts required for cannulation averaged 1.3 (range = 1-5), and decreased after a five patient learning curve. No patient developed a pneumothorax, hematoma, or cannula malposition. Ultrasound guided multiplanar infraclavicular subclavian vein access appears to be a safe and effective adjunct for central line placement.

  15. Massive hydrothorax following subclavian vein catheterization

    PubMed Central

    2010-01-01

    Since the introduction of central venous catheterization for monitoring of the venous pressure, fluid infusion and hyperalimentation, the literature has been full of serious life-threatening complications. Of these complications is the false positioning of the central venous catheter and subsequent development of pleural effusion. In this report we are describing a case of iatrogenic massive pleural effusion following subclavian vein catheterization necessitating intercostal tube drainage and mechanical ventilation. The case highlights the importance of ensuring adequate positioning of the catheter after insertion through aspiration of venous blood, immediate post insertion X-ray and the utilization of ultrasound guidance in cases with expected difficult catheterization. PMID:21073758

  16. Invasive hemodynamics of constrictive pericarditis, restrictive cardiomyopathy, and cardiac tamponade.

    PubMed

    Sorajja, Paul

    2011-05-01

    Cardiac catheterization historically has been the principal diagnostic modality for the evaluation of constrictive pericarditis, restrictive cardiomyopathy, and cardiac tamponade. In many instances, the hemodynamic consequences of these disorders can be accurately delineated with non-invasive methods. However, cardiac catheterization should be considered when there is a discrepancy between the clinical and non-invasive imaging data, and particularly may be required for the evaluation of patients with complex hemodynamic disorders. This report describes the methods and clinical utility of invasive hemodynamic catheterization for the evaluation of constriction, restriction, and cardiac tamponade.

  17. Algebraic reconstruction technique for parallel imaging reconstruction of undersampled radial data: application to cardiac cine.

    PubMed

    Li, Shu; Chan, Cheong; Stockmann, Jason P; Tagare, Hemant; Adluru, Ganesh; Tam, Leo K; Galiana, Gigi; Constable, R Todd; Kozerke, Sebastian; Peters, Dana C

    2015-04-01

    To investigate algebraic reconstruction technique (ART) for parallel imaging reconstruction of radial data, applied to accelerated cardiac cine. A graphics processing unit (GPU)-accelerated ART reconstruction was implemented and applied to simulations, point spread functions and in 12 subjects imaged with radial cardiac cine acquisitions. Cine images were reconstructed with radial ART at multiple undersampling levels (192 Nr × Np  = 96 to 16). Images were qualitatively and quantitatively analyzed for sharpness and artifacts, and compared to filtered back-projection, and conjugate gradient SENSE. Radial ART provided reduced artifacts and mainly preserved spatial resolution, for both simulations and in vivo data. Artifacts were qualitatively and quantitatively less with ART than filtered back-projection using 48, 32, and 24 Np , although filtered back-projection provided quantitatively sharper images at undersampling levels of 48-24 Np (all P < 0.05). Use of undersampled radial data for generating auto-calibrated coil-sensitivity profiles resulted in slightly reduced quality. ART was comparable to conjugate gradient SENSE. GPU-acceleration increased ART reconstruction speed 15-fold, with little impact on the images. GPU-accelerated ART is an alternative approach to image reconstruction for parallel radial MR imaging, providing reduced artifacts while mainly maintaining sharpness compared to filtered back-projection, as shown by its first application in cardiac studies. © 2014 Wiley Periodicals, Inc.

  18. Assessment of blind source separation techniques for video-based cardiac pulse extraction

    NASA Astrophysics Data System (ADS)

    Wedekind, Daniel; Trumpp, Alexander; Gaetjen, Frederik; Rasche, Stefan; Matschke, Klaus; Malberg, Hagen; Zaunseder, Sebastian

    2017-03-01

    Blind source separation (BSS) aims at separating useful signal content from distortions. In the contactless acquisition of vital signs by means of the camera-based photoplethysmogram (cbPPG), BSS has evolved the most widely used approach to extract the cardiac pulse. Despite its frequent application, there is no consensus about the optimal usage of BSS and its general benefit. This contribution investigates the performance of BSS to enhance the cardiac pulse from cbPPGs in dependency to varying input data characteristics. The BSS input conditions are controlled by an automated spatial preselection routine of regions of interest. Input data of different characteristics (wavelength, dominant frequency, and signal quality) from 18 postoperative cardiovascular patients are processed with standard BSS techniques, namely principal component analysis (PCA) and independent component analysis (ICA). The effect of BSS is assessed by the spectral signal-to-noise ratio (SNR) of the cardiac pulse. The preselection of cbPPGs, appears beneficial providing higher SNR compared to standard cbPPGs. Both, PCA and ICA yielded better outcomes by using monochrome inputs (green wavelength) instead of inputs of different wavelengths. PCA outperforms ICA for more homogeneous input signals. Moreover, for high input SNR, the application of ICA using standard contrast is likely to decrease the SNR.

  19. Algebraic Reconstruction Technique (ART) for parallel imaging reconstruction of undersampled radial data: Application to cardiac cine

    PubMed Central

    Li, Shu; Chan, Cheong; Stockmann, Jason P.; Tagare, Hemant; Adluru, Ganesh; Tam, Leo K.; Galiana, Gigi; Constable, R. Todd; Kozerke, Sebastian; Peters, Dana C.

    2014-01-01

    Purpose To investigate algebraic reconstruction technique (ART) for parallel imaging reconstruction of radial data, applied to accelerated cardiac cine. Methods A GPU-accelerated ART reconstruction was implemented and applied to simulations, point spread functions (PSF) and in twelve subjects imaged with radial cardiac cine acquisitions. Cine images were reconstructed with radial ART at multiple undersampling levels (192 Nr x Np = 96 to 16). Images were qualitatively and quantitatively analyzed for sharpness and artifacts, and compared to filtered back-projection (FBP), and conjugate gradient SENSE (CG SENSE). Results Radial ART provided reduced artifacts and mainly preserved spatial resolution, for both simulations and in vivo data. Artifacts were qualitatively and quantitatively less with ART than FBP using 48, 32, and 24 Np, although FBP provided quantitatively sharper images at undersampling levels of 48-24 Np (all p<0.05). Use of undersampled radial data for generating auto-calibrated coil-sensitivity profiles resulted in slightly reduced quality. ART was comparable to CG SENSE. GPU-acceleration increased ART reconstruction speed 15-fold, with little impact on the images. Conclusion GPU-accelerated ART is an alternative approach to image reconstruction for parallel radial MR imaging, providing reduced artifacts while mainly maintaining sharpness compared to FBP, as shown by its first application in cardiac studies. PMID:24753213

  20. Does posterior pericardial window technique prevent pericardial tamponade after cardiac surgery?

    PubMed

    Zhao, Jian; Cheng, Zhaoyun; Quan, Xiaoqiang; Zhao, Ziniu

    2014-04-01

    To investigate the efficacy of the intraoperative posterior pericardial window technique in preventing pericardial tamponade following open heart surgery. Adult patients undergoing coronary and/or valve surgery were randomly divided into a control (traditional) or a pericardial window (PW) technique group. Pre-, intra-, peri- and postoperative clinical data were collected prospectively, including incidence of pericardial tamponade, cardiac arrest, drainage volume, ventilation assistance time and moderate-to-large pericardial effusion. In total, 458 patients were included: 230 controls and 228 in the PW group. The incidence of pericardial tamponade in the PW group was significantly lower than in controls. Cardiac arrest occurred in one patient (0.4%) in the PW group and five (2.2%) controls; this difference was not statistically significant. Moderate-to-large pericardial effusion after drainage extubation and new-onset atrial fibrillation were significantly more common in controls than in the PW group. After stratification by age (≤ 70 versus > 70 years), there was no between-group difference in duration of endotracheal intubation, although in the PW group, after removal of the tracheal cannula, duration of noninvasive positive pressure ventilation was significantly longer in older patients. The pericardial window procedure did not increase the rate or severity of procedure-related complications. This simple technique significantly decreased the incidence of postoperative pericardial tamponade and new-onset atrial fibrillation.

  1. Safe and Simplified Salvage Technique for Exposed Implantable Cardiac Electronic Devices under Local Anesthesia

    PubMed Central

    Jung, Chang Young; Kim, Sung-Eun

    2017-01-01

    Background Skin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems, however, these may result in fatal complications. In this study, we present our experience with a simplified salvage technique for exposed implantable cardiac electronic devices (ICEDs) without removing the implanted device, in an attempt to reduce the risks and complication rates associated with this condition. Methods The records of 10 patients who experienced direct ICED exposure between January 2012 and December 2015 were retrospectively reviewed. The following surgical procedure was performed in all patients: removal of skin erosion and capsule, creation of a new pocket at least 1.0–1.5 cm inferior to its original position, migration of the ICED to the new pocket, and insertion of closed-suction drainage. Patients with gross local sepsis or septicemia were excluded from this study. Results Seven patients had cardiac pacemakers and the other 3 had implantable cardiac defibrillators. The time from primary ICED placement to exposure ranged from 0.3 to 151 months (mean, 29 months. Postoperative follow-up in this series ranged from 8 to 31 months (mean follow-up, 22 months). Among the 10 patients, none presented with any signs of overt infection or cutaneous lesions, except 1 patient with hematoma on postoperative day 5. The hematoma was successfully treated by surgical removal and repositioning of the closed-suction drainage. Conclusions Based on our experience, salvage of exposed ICEDs is possible without removing the device in selected patients. PMID:28194346

  2. To reduce catheter-related bloodstream infections: is the subclavian route better than the jugular route for central venous catheterization?

    PubMed

    Nagashima, Goro; Kikuchi, Toshiki; Tsuyuzaki, Hitomi; Kawano, Rumiko; Tanaka, Hiroyuki; Nemoto, Hiroshi; Taguchi, Kazumi; Ugajin, Kazuhisa

    2006-12-01

    The most important targets of hospital-acquired infection control are to reduce the incidence of surgical-site, catheter-related, and ventilator-associated infections. In this report, we address previously presented infection-control strategies for central venous (CV) line catheterization, using a CV catheter-related infection surveillance system. Data concerning CV catheter insertion were collected from all facilities in our 650-bed hospital, excluding the operating and hemodialysis wards. Collected data included the insertion method, purpose, length of catheter inserted, duration of catheterization, infection rate, and complication rate. Catheter-related infection was diagnosed based on bacteriological examinations from blood cultures. The total number of catheterizations was 806 a year, and average duration of catheterization was 9.8 days. The purpose of catheterization was nutritional support in 210 cases, hemodialysis in 96 cases, cardiac support in 174 cases, and other treatments in 260 cases. In 66 cases, the purpose of CV catheter was not specified. The rate of positive cultures was 7.1%, and complications other than infection occurred in 0.5%. The main causative organisms were methicillin-resistant Staphylococcus aureus (MRSA) in 38.6%, coagulase-negative Staphylococcus epidermidis (CNS) in 33.3%, and S. aureus in 12.3% of infections. Infection rates were 3.8 per 1000 catheter-days in subclavian, 6.1 in jugular, and 15.7 in femoral vein catheterization. In high-risk departments (intensive care unit [ICU] and emergency departments) the infection rate was 5.4 for subclavian and 10.2 for jugular catheterization, whereas it was 3.6 for subclavian and 4.6 for jugular catheterization in noncritical-care departments. Considering complications such as pneumothorax, CV catheterization of the jugular vein is recommended in certain situations.

  3. Frequency of radial artery anatomic variations in patients undergoing transradial heart catheterization.

    PubMed

    Ostojić, Zvonimir; Bulum, Joško; Ernst, Aleksander; Strozzi, Maja; Marić-Bešić, Kristina

    2015-03-01

    Over the last ten years, transradial cardiac catheterization has been increasingly applied, primarily because of its lower incidence of complications compared to the femoral approach. However, one of the greatest flaws of the transradial approach is a relatively high incidence of catheterization failure (1%-5%). Anatomic variations of radial artery are ranked second among the reasons for this. Previous studies have not provided unambiguous data on the frequency of these anomalies. It was therefore the aim of this study to determine the frequency of anatomic variations using routine angiographies of radial artery during left heart catheterization. This was a retrospective study involving examination of 602 images of routine angiographies of radial artery performed during cardiac catheterization. The frequency of anatomic variations of radial artery was 8.8%, exclusive of tortuosities with a frequency of 12.7%. The most frequent anatomic variation was the high origin of radial artery, found in 31 (5.1%) subjects. Radioulnar loops, being one of the potential contraindications for the procedure, were reported in 2% of cases. Regression analysis revealed that age (p < 0.001), female sex (p = 0.015) and high origin (p = 0.034) considerably contributed to the development of tortuosity. The results indicated the incidence of tortuosity to increase linearly with age. Although it is not a contraindication for continuing with the procedure, we recommend that elderly patients have angiography of radial artery performed at the beginning of the procedure due to the higher frequency of tortuosity.

  4. [Catheterization of the tubal ostium using hysteroscopy under laparoscopic guidance].

    PubMed

    Salazar López-Ortíz, C; Mondragón Alcocer, H L; Hernández Vivar, L; Castro López, J L; Sánchez Solís, V

    1999-02-01

    It is considered that one out of five couples present a transitory problem of infertility during their reproductive life and the most frequent cause is the tubarian pathology; from these, the proximal obstruction occupies between 25 and 30% of the cases. Unfortunatelly, the conventional method use to study tubarian patency such as histerosalpingography or the direct observation by laparoscopy and selective chromotubation, frequently do not allow to differentiate between an insufficient filling of the tubes, tubarian spasm or a true mechanical obstruction. There are certain selective tubarian cannulation techniques, for example, the catheterism with hysteroscopic guidance which is extremely usefull in the diagnosis of tubarian patency or in the confirmation of partial or total proximal tubal disease. The procedure permits to diagnosticate precisely the tubarian obstruction and also if it is due to the presence of a true pathology or simply functional, or secondary to a tubarian spasm; besides it also works as a therapeutic procedure since in the first case permits the lysis of laxe adherencies and the removal of the amorfus material that obstructs the tube and permits the catheterization. The present study determines the utility of catheterization of the tubarian ostium by hysteroscopy with laparoscopic control using the Novy (Cook, Ob/ Gyn) catheter in patients with infertility problems due to proximal obstruction of one or both of the fallopian tubes, to confirm or discard the presence of a pathological obstruction. The results are evaluated in terms of tubarian permeability and the pregnancy rate after the procedure.

  5. Right and left heart catheterization via an antecubital fossa vein and the radial artery--a prospective study.

    PubMed

    Williams, Paul D; Palmer, Sonny; Judkins, Chris; Gutman, Jack; Whitbourn, Rob; MacIsaac, Andrew; Xu, Bo; Burns, Andrew; Wilson, Andrew

    2014-12-01

    Right heart catheterization has been described via the arm but previous reports have been retrospective, performed for limited indications, and may not give an accurate assessment of the success rate or safety of this technique. We sought to prospectively examine the feasibility and safety of left and right heart catheterization entirely via the arm using the radial artery and an antecubital fossa vein for a broad range of indications. Fifty-eight consecutive procedures were included. Transradial arterial access was successful in 57 patients (98%), right heart catheterization via the antecubital fossa vein was successful in 54 patients (93%) and bilateral catheterization from the arm was achieved in 53 patients (91%). Standard diagnostic catheterization was the most frequent procedure (59%), although thermodilution (6.9%), percutaneous coronary intervention (33%), and coronary sinus sampling (16%) were also performed in selected cases. Compared to a historical cohort of patients undergoing right and left heart catheterization via femoral access, mean procedural time (38 vs 47 minutes; P=.03) and screening time (8.1 vs 11.2 minutes; P<.001) were significantly reduced. There was 1 venous forearm hematoma that was managed conservatively. Right and left heart catheterization can be performed routinely via the arm in a broad range of patients and is associated with reduced procedural and fluoroscopy time as compared to femoral access. This approach can be considered for all patients in whom right and left heart catheterization is planned.

  6. Permanent catheterization of the carotid artery induces kidney infection and inflammation in the rat.

    PubMed

    Fonseca, Uno N K; Nielsen, Sanne Gram; Hau, Jann; Hansen, Axel Kornerup

    2010-01-01

    Catheterization of the carotid artery and the jugular vein is one of the most commonly applied techniques used to gain intravascular access in pharmacology studies on rodents. We catheterized 10 rats by conventional clean techniques, 10 rats by aseptic techniques and 10 rats by conventional clean techniques using a heparin-coated catheter rather than an ordinary non-coated polyvinyl chloride catheter. In all groups, approximately 80% of the rats developed kidney infection and 10-30% of the rats were septicaemic. Clinical chemistry did not indicate severe kidney damage, but serum haptoglobin and body temperature rises indicated an inflammatory response in rats independent of the surgical method. Heparin coating did not seem to improve the usability of the catheter. It is concluded that this commonly used method for catheterization has an impact on animals that may very well render them unsuitable for the purpose, e.g. pharmacological research, and therefore an alternative method would be preferable.

  7. Cardiac MRI in restrictive cardiomyopathy.

    PubMed

    Gupta, A; Singh Gulati, G; Seth, S; Sharma, S

    2012-02-01

    Restrictive cardiomyopathy (RCM) is a specific group of heart muscle disorders characterized by inadequate ventricular relaxation during diastole. This leads to diastolic dysfunction with relative preservation of systolic function. Although short axis systolic function is usually preserved in RCM, the long axis systolic function may be severely impaired. Confirmation of diagnosis and information regarding aetiology, extent of myocardial damage, and response to treatment requires imaging. Importantly, differentiation from constrictive pericarditis (CCP) is needed, as only the latter is managed surgically. Echocardiography is the initial cardiac imaging technique but cannot reliably suggest a tissue diagnosis; although recent advances, especially tissue Doppler imaging and spectral tracking, have improved its ability to differentiate RCM from CCP. Cardiac catheterization is the reference standard, but is invasive, two-dimensional, and does not aid myocardial characterization. Cardiac magnetic resonance (CMR) is a versatile technique providing anatomical, morphological and functional information. In recent years, it has been shown to provide important information regarding disease mechanisms, and also been found useful to guide treatment, assess its outcome and predict patient prognosis. This review describes the CMR features of RCM, appearances in various diseases, its overall role in patient management, and how it compares with other imaging techniques.

  8. Internal jugular versus subclavian vein catheterization for central venous catheterization in orthotopic liver transplantation.

    PubMed

    Torgay, A; Pirat, A; Candan, S; Zeyneloglu, P; Arslan, G; Haberal, M

    2005-09-01

    The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein (IJV) versus the subclavian vein (SV) among 45 consecutive patients undergoing orthotopic liver transplantation (OLT) between January 2000 and June 2004. The subjects were divided into two groups according to the site of central venous catheterization (IJV or SV). We recorded each patient's physical characteristics, international normalized ratio (INR), partial thromboplastin time, platelet levels, number of puncture attempts, success/failure of central venous catheterization, duration of catheter placement, occurrence of catheter tip misplacement, arterial puncture, incidence of hematoma or pneumothorax, catheter-related infection, or bacterial colonization of the catheter. Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures. The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization. There were no significant differences between the groups with respect to success of central venous catheterization (100% for both), numbers of attempted punctures, duration of catheter placement, and incidence rates of mechanical and infectious complications. Both groups showed high frequencies of catheter tip misplacement, with right atrium as the site of misplacement in all cases. Two patients in the IJV group (8.7%) developed hematomas after accidental carotid artery puncture. The results suggest that, when performed by experienced anesthesiologists, central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT.

  9. A technique for respiratory motion correction in image guided cardiac catheterisation procedures

    NASA Astrophysics Data System (ADS)

    King, A. P.; Boubertakh, R.; Ng, K. L.; Ma, Y. L.; Chinchapatnam, P.; Gao, G.; Schaeffter, T.; Hawkes, D. J.; Razavi, R.; Rhode, K. S.

    2008-03-01

    This paper presents a technique for compensating for respiratory motion and deformation in an augmented reality system for cardiac catheterisation procedures. The technique uses a subject-specific affine model of cardiac motion which is quickly constructed from a pre-procedure magnetic resonance imaging (MRI) scan. Respiratory phase information is acquired during the procedure by tracking the motion of the diaphragm in real-time X-ray images. This information is used as input to the model which uses it to predict the position of structures of interest during respiration. 3-D validation is performed on 4 volunteers and 4 patients using a leave-one-out test on manually identified anatomical landmarks in the MRI scan, and 2-D validation is performed by using the model to predict the respiratory motion of structures of the heart which contain catheters that are visible in X-ray images. The technique is shown to reduce 3-D registration errors due to respiratory motion from up to 15mm down to less than 5mm, which is within clinical requirements for many procedures. 2-D validation showed that accuracy improved from 14mm to 2mm. In addition, we use the model to analyse the effects of different types of breathing on the motion and deformation of the heart, specifically increasing the breathing rate and depth of breathing. Our findings suggest that the accuracy of the model is reduced if the subject breathes in a different way during model construction and application. However, models formed during deep breathing may be accurate enough to be applied to other types of breathing.

  10. Cardiomegaly in a premature neonate after venous umbilical catheterization.

    PubMed

    Schlapbach, Luregn Jan; Pfammatter, Jean-Pierre; Nelle, Mathias; McDougall, Felicity Jane

    2009-01-01

    Umbilical venous catheters allow rapid central access in neonates, but may be associated with various complications. We present a case of a newborn with pericardial effusion following umbilical venous catheterization. An extremely low birth weight infant was intubated for respiratory distress syndrome and had umbilical venous and arterial lines in place. Massive cardiomegaly was noted on the subsequent chest X-ray. Echocardiography revealed a large pericardial effusion without signs of tamponade. After removing the catheter, the effusion gradually resolved. While pericardial effusion is a well-known complication of percutaneous long central lines, only a few case reports have documented sudden cardiovascular compromise associated with umbilical venous catheters. Pericardial effusion may be asymptomatic and should be suspected in infants with central catheters and progressive cardiomegaly. The prompt removal of catheters and, if signs of cardiac tamponade are present, emergency pericardiocentesis may prove to be life-saving.

  11. Comparison of Cardiac Rehabilitation Programs Combined with Relaxation and Meditation Techniques on Reduction of Depression and Anxiety of Cardiovascular Patients

    PubMed Central

    Delui, Mahdy Hassanzadeh; Yari, Maliheh; khouyinezhad, Gholamreza; Amini, Maral; Bayazi, Mohammad Hosein

    2013-01-01

    Cardiovascular disease (CVD) is a major cause of death in developed countries. Most cardiac rehabilitation programs include psychological interventions. The aim of this study was to determine the effectiveness of rehabilitation techniques in cardiac patients including psychological-physical interventions such as Meditation and Relaxation. We enrolled 45 patients with CVD and depression. The patients were allocated to 3 groups (Relaxation, Meditation and Control). There was a significant reduction on depression, systolic blood pressure and heart rate in the Meditation group compared with the control group. Our findings suggest that meditation techniques have better outcomes in cardiac patients for improving depression, reduction of systolic and diastolic blood pressure, and heart rate than relaxation techniques. PMID:24179555

  12. Coil Embolization Treatment in Pulmonary Artery Branch Rupture During Swan-Ganz Catheterization

    SciTech Connect

    Gottwalles, Yannick; Wunschel-Joseph, Marie-Eve; Hanssen, Michel

    2000-11-15

    Rupture of the pulmonary artery or one of its branches during Swan-Ganz catheterization is a complication that is rare but remains fatal in almost 50% of cases. The risk factors and mechanisms involved in the pathogenesis of this accident have been widely reported. Management is twofold: resuscitation procedures and specific medical or even surgical treatment. We report a case of pulmonary artery rupture occurring during Swan-Ganz catheterization that was treated by coil embolization. This technique, which is quick and simple to use, would appear to be very promising. This is the first case of successful emergency treatment of pulmonary artery rupture using an endovascular technique.

  13. [Current state of central venous catheterization in the operating theater in Japan].

    PubMed

    Morimoto, Yasuhiro; Yoshikawa, Chie

    2010-05-01

    Central venous catheterization is usually done in operating theater after general anesthesia. However, life-threatening complications can occasionally occur. Recently, application of ultrasound especially ultrasound-guided venipuncture has become popular for safe and reliable procedure. We investigated the current state of central venous catheterization by a questionnaire survey. 131 anesthesiologists answered the survey. The most common site for cathererization was internal jugular vein (85%). 97% of anesthesiologists use Seldinger's technique. Before internal jugular vein cathererization, 47% of anesthesiologists commonly and 19% of anethesiologists occasionally use ultrasound for checking the vein. Ultrasound-guided venipuncture was performed commonly by 19% and occasionally by 59% of anesthesiologists. The most common ultrasound device was iLook (37% of anesthesiologists, Japan Sherwood). The survey showed that 79% of anesthesiologists apply ultrasound for central venous catheterization in the operating theater. Establishing the standard technique and training methods will be the subsequent issue.

  14. Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation.

    PubMed

    Dewey, Marc; Zimmermann, Elke; Deissenrieder, Florian; Laule, Michael; Dübel, Hans-Peter; Schlattmann, Peter; Knebel, Fabian; Rutsch, Wolfgang; Hamm, Bernd

    2009-09-08

    Noninvasive coronary angiography with the use of multislice computed tomography (CT) scanners is feasible with high sensitivity and negative predictive value; however, the radiation exposure associated with this technique is rather high. We evaluated coronary angiography using whole-heart 320-row CT, which avoids exposure-intensive overscanning and overranging. A total of 30 consecutive patients with suspected coronary artery disease referred for clinically indicated conventional coronary angiography (CCA) were included in this prospective intention-to-diagnose study. CT was performed with the use of up to 320 simultaneous detector rows before same-day CCA, which, together with quantitative analysis, served as the reference standard. The per-patient sensitivity and specificity for CT compared with CCA were 100% (95% confidence interval [CI], 72 to 100) and 94% (95% CI, 73 to 100), respectively. Per-vessel versus per-segment sensitivity and specificity were 89% (95% CI, 62 to 98) and 96% (95% CI, 90 to 99) versus 78% (95% CI, 56 to 91) and 98% (95% CI, 96 to 99), respectively. Interobserver agreement between the 2 readers was significantly better for CCA (97% of 121 coronary arteries) than for CT (90%; P=0.04). Percent diameter stenosis determined with the use of CT showed good correlation with CCA (P<0.001, R=0.81) without significant underestimation or overestimation (-3.1+/-24.4%; P=0.08). Intraindividual comparison of CT with CCA revealed a significantly smaller effective radiation dose (median, 4.2 versus 8.5 mSv; P<0.05) and amount of contrast agent required (median, 80 versus 111 mL; P<0.001) for 320-row CT. The majority of patients (87%) indicated that they would prefer CT over CCA for future diagnostic imaging (P<0.001). CT with the use of emerging technology has the potential to significantly reduce the radiation dose and amount of contrast agent required compared with CCA while maintaining high diagnostic accuracy.

  15. Clean Intermittent Catheterization in the School Setting

    ERIC Educational Resources Information Center

    Katrancha, Elizabeth D.

    2008-01-01

    Spina bifida (SB) is a neural tube defect that causes many physical and mental disabilities. Bowel and bladder incontinence is the disability seen most often in these students that requires the school nurse's attention. Clean intermittent catheterization (CIC) provides the student with SB a vehicle to reach a satisfactory level of continence,…

  16. Clean Intermittent Catheterization in the School Setting

    ERIC Educational Resources Information Center

    Katrancha, Elizabeth D.

    2008-01-01

    Spina bifida (SB) is a neural tube defect that causes many physical and mental disabilities. Bowel and bladder incontinence is the disability seen most often in these students that requires the school nurse's attention. Clean intermittent catheterization (CIC) provides the student with SB a vehicle to reach a satisfactory level of continence,…

  17. Predictive Factors for Intermittent Self-catheterization in German and Brazilian Individuals With Spina Bifida and Neurogenic Bladder Dysfunction.

    PubMed

    Faleiros, Fabiana; Käppler, Christoph; Costa, Juliana Neves; Favoretto, Naira; Pontes, Fernando

    Our study aimed to identify predictive factors for the use of intermittent self-catheterization (ISC) in persons with spina bifida (SB) and neurogenic bladder. Cultural effects were evaluated by comparing ISC use in individuals from 2 countries, Germany and Brazil. Cross-sectional, descriptive study. The study included 71 Brazilian and 77 German individuals with SB (108 females and 92 males), aged between 6 and 55 years, who have used ISC for bladder management. Data were collected using printed (Brazil) and online (Germany) questionnaires, with 53 questions related to intermittent catheterization (IC) technique, the materials used in IC, difficulties with IC, and sociodemographic and health variables. Data were analyzed using analysis of variance and multivariate logistical regression. Self-catheterization and assisted catheterization were used for 92 and 56 patients, respectively. Intermittent self-catheterization was more common in German participants (79.2%), while most Brazilian participants used assisted catheterization (56.3%). The following variables influenced the choice of catheterization method, according to logistic regression: age, education level, presence of hydrocephalus, severity of SB, and nationality. The variables unrelated to ISC use included gender, difficulty obtaining ISC equipment or learning to perform ISC, and wheelchair dependency. The identification of predictive factors for ISC improved our understanding of ISC in SB patients and should aid in the development of more effective strategies to increase ISC use.

  18. The Techniques for Overcoming Depression Questionnaire: Mokken Scale Analysis, Reliability, and Concurrent Validity in Depressed Cardiac Patients.

    PubMed

    Freedland, Kenneth E; Lemos, Mariantonia; Doyle, Frank; Steinmeyer, Brian C; Csik, Iris; Carney, Robert M

    2017-02-01

    The Techniques for Overcoming Depression (TOD) questionnaire assesses the frequency with which patients being treated for depression use cognitive-behavioral techniques in daily life. This study examined its latent structure, reliability and concurrent validity in depressed cardiac patients. The TOD was administered at the initial and final treatment sessions in three trials of cognitive behavior therapy (CBT) (n = 260) for depression in cardiac patients. Mokken scaling was used to determine its dimensionality. The TOD is unidimensional in depressed cardiac patients, both at the initial evaluation (H = .46) and the end of treatment (H = .47). It is sensitive to change and the total score correlates with therapist ratings of the patient's socialization to CBT (r=.40, p<.05), homework adherence (r=0.36, p<0.05), and use of cognitive-behavioral techniques (r=.51, p<.01). TOD scores were associated with post-treatment depression scores in two of the trials (p<.01 in both analyses). The TOD is a unidimensional, reliable, valid, and clinically informative measure of self-reported use of cognitive-behavioral techniques for overcoming depression in cardiac patients. Studies of the TOD in other depressed patient populations are needed.

  19. A robust automated left ventricle region of interest localization technique using a cardiac cine MRI atlas

    NASA Astrophysics Data System (ADS)

    Ben-Zikri, Yehuda Kfir; Linte, Cristian A.

    2016-03-01

    Region of interest detection is a precursor to many medical image processing and analysis applications, including segmentation, registration and other image manipulation techniques. The optimal region of interest is often selected manually, based on empirical knowledge and features of the image dataset. However, if inconsistently identified, the selected region of interest may greatly affect the subsequent image analysis or interpretation steps, in turn leading to incomplete assessment during computer-aided diagnosis or incomplete visualization or identification of the surgical targets, if employed in the context of pre-procedural planning or image-guided interventions. Therefore, the need for robust, accurate and computationally efficient region of interest localization techniques is prevalent in many modern computer-assisted diagnosis and therapy applications. Here we propose a fully automated, robust, a priori learning-based approach that provides reliable estimates of the left and right ventricle features from cine cardiac MR images. The proposed approach leverages the temporal frame-to-frame motion extracted across a range of short axis left ventricle slice images with small training set generated from les than 10% of the population. This approach is based on histogram of oriented gradients features weighted by local intensities to first identify an initial region of interest depicting the left and right ventricles that exhibits the greatest extent of cardiac motion. This region is correlated with the homologous region that belongs to the training dataset that best matches the test image using feature vector correlation techniques. Lastly, the optimal left ventricle region of interest of the test image is identified based on the correlation of known ground truth segmentations associated with the training dataset deemed closest to the test image. The proposed approach was tested on a population of 100 patient datasets and was validated against the ground truth

  20. A simplified two-stitch sleeve technique for arterial anastomosis of cervical heterotopic cardiac transplantation in mice

    PubMed Central

    Fang, Jing; He, Long; Wang, Shi-Qiang; Ma, Ming-Jia; Liu, Hong-Yun; Zhu, Xue-Hai; Zhu, Ping; Wei, Xiang; Wang, Cong-Yi

    2013-01-01

    Although cervical cardiac transplantation is a well recognized useful model in diverse experimental settings, its widespread use, however, has been significantly hampered by the technical challenges relevant to small vessel anastomosis. We herein introduced a simplified two-stitch sleeve technique into arterial anastomosis during the course of cervical cardiac transplantation in mice. Cervical transplantation of allogenic and syngeneic cardiac grafts was conducted to assess the feasibility of this two-stitch sleeve technique in arterial anastomosis. Venous anastomosis was completed by the one-suture end-to-end microsuture technique, while arterial anastomosis was conducted by invaginating the recipient right common carotid artery into the graft left common carotid artery along with two guiding stitches. The two-stitch sleeve technique significantly simplified the procedures for arterial anastomosis as compared with that of the traditional microsuture technique (5.5 ± 1.8 min vs. 15.7 ± 3.0 min). However, the survival time for allografts (8.0 ± 0.2 day vs. 8.0 ± 0.4 day) and the long-term patency for syngeneic grafts (> 120 days) were the same as the grafts implanted by the traditional microsuture technique. This simplified sleeve technique is easy to learn, particularly for beginners without microsuture experience, and therefore, it has the great potential for widespread use in transplant immunology. PMID:23977411

  1. Equipment review: New techniques for cardiac output measurement – oesophageal Doppler, Fick principle using carbon dioxide, and pulse contour analysis

    PubMed Central

    Berton, Christine; Cholley, Bernard

    2002-01-01

    Measuring cardiac output is of paramount importance in the management of critically ill patients in the intensive care unit and of 'high risk' surgical patients in the operating room. Alternatives to thermodilution are now available and are gaining acceptance among practitioners who have been trained almost exclusively in the use of the pulmonary artery catheter. The present review focuses on the principles, advantages and limitations of oesophageal Doppler, Fick principle applied to carbon dioxide, and pulse contour analysis. No single method stands out or renders the others obsolete. By making cardiac output easily measurable, however, these techniques should all contribute to improvement in haemodynamic management. PMID:12133181

  2. Direct Measurement of Left Atrial Pressure during Routine Transradial Catheterization

    PubMed Central

    Fa'ak, Faisal; Younis, George

    2016-01-01

    Left atrial pressure indicates the left ventricular filling pressure in patients who have systolic or diastolic left ventricular dysfunction or valvular heart disease. The use of indirect surrogate methods to determine left atrial pressure has been essential in the modern evaluation and treatment of cardiovascular disease because of the difficulty and inherent risks associated with direct methods (typically the transseptal approach). One method that has been widely used to determine left atrial pressure indirectly is Swan-Ganz catheterization, in which a balloon-flotation technique is applied to measure pulmonary capillary wedge pressure; however, this approach has been associated with several limitations and potential risks. Measuring left ventricular end-diastolic pressure has also been widely used as a simple means to estimate filling pressures but remains a surrogate for the gold standard of directly measuring left atrial pressure. We describe a simple, low-risk method to directly measure left atrial pressure that involves the use of standard coronary catheterization techniques during a transradial procedure. PMID:28100968

  3. Radiation risk reduction in cardiac electrophysiology through use of a gridless imaging technique.

    PubMed

    Smith, Ian R; Stafford, Wayne J; Hayes, John R; Adsett, Michael C; Dauber, Kieran M; Rivers, John T

    2016-01-01

    It has been previously demonstrated that use of appropriate frame rates coupled with minimal use of high-dose digital acquisition can limit radiation risk to patients undergoing diagnostic and therapeutic electrophysiology (EP). Imaging without the anti-scatter grid has been proposed as a means of achieving further radiation reduction. We evaluate application of a gridless imaging technique to deliver further reductions in radiation risk to both patients and personnel. Radiation and clinical data for EP procedures performed for 16 months from March 2012 were monitored. The period was divided into three phases: Phase 1 (March 2012-June 2012) provided a performance baseline (radiation output modelling and procedural risk adjustment calibration), Phase 2 (July 2012-September 2012) confirmation of performance with the grid, and Phase 3 (September 2012-June 2013) gridless imaging period. Statistical process control (SPC) charts were used to monitor for changes in radiation use and clinical outcomes (procedural success). Imaging without the grid halved the levels of radiation delivered in undertaking EP procedures. Although there was a perceptible impact on image quality with the grid removed. Review of the SPC chart monitoring procedural outcomes did not identify any discernable adverse impact on success rates. Selected use of the gridless technique is recommended with re-introduction of the grid in larger patients or during aspects of the procedure where image quality is important (e.g. transeptal punctures). Use of a gridless imaging technique can contribute to a significant reduction in radiation risk to both patients and operators during cardiac EP procedures. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  4. Transient Cortical Blindness after Cardiac Catheterization with Iobitridol

    PubMed Central

    Yazici, Mehmet; Ozhan, Hakan; Kinay, Ozan; Kilicaslan, Baris; Karaca, Mustafa; Cece, Hasan; Biceroglu, Serdar; Ergene, Oktay

    2007-01-01

    The occurrence rate of transient cortical blindness after contrast media exposure has been reported to be as high as 1% to 4% after cerebral or vertebral angiography, but such blindness has been described in only a few cases of coronary angiography with modern, non-ionic, low-osmolality radio-contrast agents. In this study, we present a case of abrupt cortical blindness after exposure to contrast media during diagnostic coronary angiography; to our knowledge, this is the 1st report in the medical literature that describes transient cortical blindness after iobitridol use. PMID:17948092

  5. [Adverse events during diagnostic and therapeutic pediatric cardiac catheterization].

    PubMed

    Zepeda-Arámbula, Armando; Gutiérrez-Cobian, Lorenzo; Villatoro-Fernández, Jorge Luis; Pacheco-López, Sandra Livier; Tlacuilo-Parra, Alberto

    2016-01-01

    Introducción: el objetivo de este trabajo fue determinar la frecuencia de eventos adversos durante la realización de cateterismo cardíaco tanto diagnóstico, como terapéutico pediátrico. Métodos: se revisaron los expedientes de pacientes sometidos a cateterismo cardiaco durante el periodo del 1 de Mayo al 31 de Octubre de 2014, para determinar la frecuencia de eventos adversos presentados en las primeras 24 horas posteriores al procedimiento. Resultados: durante el periodo de seis meses se realizaron 143 procedimientos, de los cuales cumplieron criterios de inclusión 126, según el tipo de procedimiento se dividieron en: diagnósticos 68 (54%) y terapéuticos 58 (46%). Se presentó algún evento adverso en 16 pacientes (13% de los procedimientos), 11.7% durante cateterismo diagnóstico y 14% durante el procedimiento terapéutico. Se clasificaron como: serios 7 (5.5%), que ponen en peligro la vida 5 (3.9%) y como catastróficos 1 (0.79%). Los factores que se asociaron con el desarrollo de algún evento adverso fueron: edad menor de un año (OR = 5.45), ingreso a sala de hemodinamia no programado (OR = 1.2), y manejo con inotrópico (OR = 7). Conclusiones: el cateterismo cardiaco realizado en nuestra unidad es un procedimiento seguro, con un porcentaje de eventos adversos similar a lo reportado a nivel mundial. Es primordial efectuar una valoración adecuada e integral del paciente antes del ingreso a sala, considerando la estratificación según las categorías de riesgo, así como el estado de gravedad del niño.

  6. Patient Decision Control and the Use of Cardiac Catheterization.

    PubMed

    Mitchell, Suzanne E; Paasche-Orlow, Michael K; Orner, Michelle B; Stewart, Sabrina K; Kressin, Nancy R

    2015-07-01

    背景:共同作决策是以患者为中心 的护理的决定性因素。治疗决策过 程中缺少患者的参控,可能是心导 管插入术(CCATH)使用率持续存 在种族差异的原因。截至目前,可 证明参与共同决策的患者,是更可 能还是更不可能接受非紧急 CCATH 的现存证据仍很有限。目的:对患者在是否接受 CCATH 决策过程中的参与情况同 CCATH 使用率之间的关系进行评估。我 们也检验了患者对参控决策的喜 好或其实际参与决策的情况是否 会因患者的种族不同而有所不同。方法:我们对 826 名可适用 CCATH 且参加了心脏决策研究的 退伍军人管理局患者的数据进行 了分析。结果:刨除混杂因素的影响后, 与不参控决策的患者(医生自行 决策,不参考患者的意见)相 比,在决策过程中有任何程度参 控的患者更有可能接受 CCATH(39% 和 54%,P <0.0001)。不同种族的患者都同样喜欢参 控决策(P=0.53),且其对参控决 策的喜好与其对实际决策过程的 认识都同样存在不一致(P=0.59)。 因此,这些因素并不能解决 CCATH 使用率的种族差异。结论:共同决策是全人护理的必 要特征。既然决策参与并不能解 释 CCATH 使用率上的差异,我们 还需进一步努力确立一套策略来 提高患者参控意愿与实际参控程 度之间的一致性,以真正实现以 患者为中心的护理。.

  7. Therapeutic Cardiac Catheterizations for Children with Congenital Heart Disease

    MedlinePlus

    ... placing a special catheter connected to an electrical battery (pacemaker) may be required until the heart’s electrical ... of the valve is first taken and the size of the valve is measured carefully to select ...

  8. Therapeutic Cardiac Catheterizations for Children with Congenital Heart Disease

    MedlinePlus

    ... approved devices is included in the addendum. 2. Patent Foramen Ovale (PFO) This is a small, naturally ... no longer fills from the left ventricle. 5. Patent Ductus Arteriosus (PDA) This is a naturally occurring ...

  9. Finding the Gatekeeper to the Cardiac Catheterization Laboratory

    PubMed Central

    Marwick, Thomas H.; Cho, Iksung; Hartaigh, Bríain ó; Min, James K.

    2015-01-01

    Functional capacity is a robust predictor of clinical outcomes, and stress testing is used in current practice paradigms to guide referral to invasive coronary angiography. However, invasive coronary angiography is driven by ongoing symptoms, as well as risk of adverse outcomes. The limitations of current functional testing-based paradigms might be avoided by using coronary computed tomographic angiography (CCTA) for exclusion of obstructive coronary artery disease. The growth of CCTA has been supported by comparative prognostic evidence with CCTA and functional testing, as well as radiation dose reduction. Use of CCTA for physiological evaluation of coronary lesion-specific ischemia may facilitate evaluation of moderate stenoses, designation of the culprit lesion, and prediction of benefit from revascularization. The potential of CCTA to serve as an effective gatekeeper to invasive coronary angiography will depend, in part, on the adoption of these new developments, as well as definition of the benefit of detecting high-risk plaque for guiding the management of selected patients. PMID:26112200

  10. Vendor agreements offer cost savings for cardiac catheterization.

    PubMed

    Abramson, D

    1997-01-01

    Hospitals continue to search for ways to save money at the same time they provide their physicians and clinical staffs with the variety and quality of supplies needed to do their jobs. St. Joseph's Medical Center in Stockton, Calif. watched expenditures for its cath lab increase while its activity stabilized. They looked at their high-volume use of balloon catheters, says Gary Boyd, service director. At a cost of $600 to $700 apiece, it made sense to carefully manage their supply. Choosing a prime vendor was the first step in controlling inventory. Materials management, which had previously had a hands-off policy in the cath lab, took an active role in determining choices for this product. Through a lengthy selection process, medical center management and physicians reached a consensus for a single vendor. Having a prime vendor policy may increase the vendor's commitment to the hospital and provide added advantages. For St. Joseph's, selecting a prime vendor has better positioned the hospital to arrange for inventory to be stocked on consignment: the vendor owns the shelved supplies, which the hospital pays for only as they are used. However, some vendors may reduce their discounts when they enter into a consignment agreement. The best way is to get the maximum discount on the invoice price first, and then work with the vendor to manage inventories at the lowest level possible. Smaller facilities have less leverage and less flexibility, but they can often piggy-back onto large bargaining agreements by partnering with a larger institution.

  11. [Clinical estimation of the central vein catheterization in phthysiosurgical patients].

    PubMed

    Opanasenko, M S; Levanda, L I; Kononenko, V A; Klymenko, V I; Tereshkovych, O V; Kalenychenko, M I; Konik, B M; Obrems'ka, O K; Demus, R S; Kshanovs'kyĭ, O E

    2013-04-01

    The issue of actuality of the central veins catheterization application was studied in phthysiosurgical patients. The author's view, concerning indications and choosing of the central vein catheterization side, was presented. The data, concerning frequency of the certain veins catheterization, were adduced. General succeeding in performing central veins catheterization have had constituted 96%. While having complications rate of 11.8%, this included mechanical--8.2%, thrombotic--2.3%, infective--1.3%. There was substantiated one of the most optimal and secure procedure among central accesses--the internal jugular vein catheterization.

  12. Accidental carotid artery catheterization during attempted central venous catheter placement: a case report.

    PubMed

    Maietta, Pauline Marie

    2012-08-01

    More than 2.1 million central venous catheters are placed annually. While carotid artery cannulation is rare, its effects can be devastating. Anesthesia providers frequently work with central venous catheters in the perioperative setting. Therefore, it is imperative that they be able to identify and react appropriately to carotid artery injury both in preexisting central lines and those that they have placed. This case report details a case of accidental carotid artery catheterization during attempted right internal jugular vein catheterization and the steps taken to treat the patient following its recognition. A discussion of technique for central venous catheterization, indications for suspicion of arterial puncture, methods for confirming venous or arterial placement, appropriate methods for management of carotid artery cannulation, and the benefit of ultrasound in central venous cannulation follow. Through the appropriate use of equipment, early detection and management of carotid artery injury, and proper training, patient outcomes may be improved.

  13. Doppler-guided retrograde catheterization system

    NASA Astrophysics Data System (ADS)

    Frazin, Leon J.; Vonesh, Michael J.; Chandran, Krishnan B.; Khasho, Fouad; Lanza, George M.; Talano, James V.; McPherson, David D.

    1991-05-01

    The purpose of this study was to investigate a Doppler guided catheterization system as an adjunctive or alternative methodology to overcome the disadvantages of left heart catheterization and angiography. These disadvantages include the biological effects of radiation and the toxic and volume effects of iodine contrast. Doppler retrograde guidance uses a 20 MHz circular pulsed Doppler crystal incorporated into the tip of a triple lumen multipurpose catheter and is advanced retrogradely using the directional flow information provided by the Doppler waveform. The velocity detection limits are either 1 m/second or 4 m/second depending upon the instrumentation. In a physiologic flow model of the human aortic arch, multiple data points revealed a positive wave form when flow was traveling toward the catheter tip indicating proper alignment for retrograde advancement. There was a negative wave form when flow was traveling away from the catheter tip if the catheter was in a branch or bent upon itself indicating improper catheter tip position for retrograde advancement. In a series of six dogs, the catheter was able to be accurately advanced from the femoral artery to the left ventricular chamber under Doppler signal guidance without the use of x-ray. The potential applications of a Doppler guided retrograde catheterization system include decreasing time requirements and allowing safer catheter guidance in patients with atherosclerotic vascular disease and suspected aortic dissection. The Doppler system may allow left ventricular pressure monitoring in the intensive care unit without the need for x-ray and it may allow left sided contrast echocardiography. With pulse velocity detection limits of 4 m/second, this system may allow catheter direction and passage into the aortic root and left ventricle in patients with aortic stenosis. A modification of the Doppler catheter may include transponder technology which would allow precise catheter tip localization once the

  14. Accidental subclavian artery catheterization during attempted internal jugular central venous catheter placement: a case report.

    PubMed

    Paliwal, Bharat; Kamal, Manoj; Purohit, Anamika; Rana, Kirti; Chouhan, Dilip Singh

    2015-01-01

    Central venous catheter placement has been routinely employed for anesthetic and intensive care management. Despite proper technique used and expertise complications do occur; some of which are related to catheter misplacements. We report a case in which subclavian artery was accidently catheterized during attempted internal jugular venous cannulation.

  15. Pancreatic stone protein predicts postoperative infection in cardiac surgery patients irrespective of cardiopulmonary bypass or surgical technique.

    PubMed

    Klein, Holger J; Csordas, Adam; Falk, Volkmar; Slankamenac, Ksenija; Rudiger, Alain; Schönrath, Felix; Rodriguez Cetina Biefer, Hector; Starck, Christoph T; Graf, Rolf

    2015-01-01

    We investigated the role of pancreatic stone protein (PSP) in predicting the occurrence of infection in the postoperative course of cardiac surgery patients. Several biomarkers indicating the presence of inflammation and infection are available in the clinical routine; yet, their utility in the postoperative course of patients following cardiac surgery remains uncertain. Moreover, cardiopulmonary bypass, also referred to as "on-pump surgery", increases the susceptibility to an exaggerated inflammatory state. However, the impact of such extracorporeal circulation on circulating PSP levels remains poorly understood. In a prospective cohort of unselected patients undergoing cardiac surgery, we set out to elucidate the diagnostic accuracy of serum PSP levels as opposed to canonical biomarkers (CRP, WBC) of inflammation to discriminate between the presence of infection and surgical trauma,. In addition, we investigated whether the biomarkers were influenced by the surgical technique employed, i.e. on-pump vs. off-pump and minimally invasive surgery vs. sternotomy. Levels of circulating PSP and routine inflammatory biomarkers (CRP, WBC) were measured in samples taken from 120 patients at baseline as well as at postoperative day 1-3. Univariate analysis showed that among the biomarkers investigated, only PSP levels had discriminatory power to differentiate infection from surgical trauma in the postoperative course of the entire cohort of patients following cardiac surgery. With regard to cardiac surgical interventions, there was no significant association between the absence or presence of extracorporeal circulation and PSP levels. However, there was a significant difference in the slope of the rise of postoperative PSP between minimally invasive surgery as opposed to patients subjected to sternotomy. In an unselected population of cardiac surgery patients, post-operative serum PSP levels were significantly associated with the presence of infection in both the on-pump and

  16. The role of selective salpingography and tubal catheterization in the management of the infertile couple.

    PubMed

    Papaioannou, Spyros; Afnan, Masoud; Sharif, Khaldoun

    2004-08-01

    This review is intended to update the reader about recent developments in the field of selective salpingography and tubal catheterization, to offer an interpretation of the information presented and to suggest further research links. The measurement of tubal perfusion pressures at selective salpingography and tubal catheterization has offered a new dimension in the evaluation of the fallopian tube. A classification of infertile women based on tubal perfusion pressures is presented, and this is correlated with the possibility of spontaneous fertility, thus giving selective salpingography and tubal catheterization a prognostic profile in addition to diagnostic and therapeutic functions. Experience derived from the use of the technique in unselected infertile women (i.e. not with proximal tubal blockage) is presented. The use of selective tube catheterization for sterilization purposes joins the mainstream with the publication of the encouraging results of a multinational trial. The debate on the validity of the diagnosis of proximal tubal blockage is enriched by the suggestion that simply rotating the patient during hysterosalpingography will resolve most cases of the condition. The fertility gain by single-tube recanalization in women with unilateral proximal tubal blockage is given further support. The use of oil-based media for selective salpingography and tubal catheterization is discussed. A hypothesis on the pathophysiology of proximal tubal blockage is presented. The evidence clearly supports the use of selective salpingography and tubal catheterization for infertile women with proximal tubal blockage. The potential of the technique to play a wider role in the management of infertility is demonstrated by recent research. Copyright 2004 Lippincott Williams and Wilkins

  17. Automatic measure of the split in the second cardiac sound by using the wavelet transform technique.

    PubMed

    Debbal, S M; Bereksi-Reguig, F

    2007-03-01

    This paper is concerned with the identification and automatic measure of the split in the second heart sound (S2) of the phonocardiogram signal (PCGs) for normal or pathological case. The second heart sound S2 consists of two acoustic components A2 and P2, the former is due to the closure of the aortic valve and the latter is due to the closure of the pulmonary valve. The aortic valve usually closes before the pulmonary valve, introducing a time delay known as "split". A automatic technique based on the discrete wavelet transform (DWT) and the continuous wavelet transform (CWT) is developed in this paper to measure the split of the second cardiac sound (S2) for the normal and pathological cases of the PCG signals. To quantify the splitting, the two components in S2 (i.e. A2 and P2) are identified and, the delay between the two components can be estimated. It is shown that the wavelet transform can provide best information and features of the split of S2 and the major components (A2 and P2) and consequently aid in medical diagnosis.

  18. Assessment of cardiac function using myocardial perfusion imaging technique on SPECT with 99mTc sestamibi

    NASA Astrophysics Data System (ADS)

    Gani, M. R. A.; Nazir, F.; Pawiro, S. A.; Soejoko, D. S.

    2016-03-01

    Suspicion on coronary heart disease can be confirmed by observing the function of left ventricle cardiac muscle with Myocardial Perfusion Imaging techniques. The function perfusion itself is indicated by the uptake of radiopharmaceutical tracer. The 31 patients were studied undergoing the MPI examination on Gatot Soebroto Hospital using 99mTc-sestamibi radiopharmaceutical with stress and rest conditions. Stress was stimulated by physical exercise or pharmacological agent. After two hours, the patient did rest condition on the same day. The difference of uptake percentage between stress and rest conditions will be used to determine the malfunction of perfusion due to ischemic or infarct. Degradation of cardiac function was determined based on the image-based assessment of five segments of left ventricle cardiac. As a result, 8 (25.8%) patients had normal myocardial perfusion and 11 (35.5%) patients suspected for having partial ischemia. Total ischemia occurred to 8 (25.8%) patients with reversible and irreversible ischemia and the remaining 4 (12.9%) patients for partial infarct with characteristic the percentage of perfusion ≤50%. It is concluded that MPI technique of image-based assessment on uptake percentage difference between stress and rest conditions can be employed to predict abnormal perfusion as complementary information to diagnose the cardiac function.

  19. Ultrasound-guided central venous catheterization in prone position.

    PubMed

    Sofi, Khalid; Arab, Samer

    2010-01-01

    Central venous catheterization (CVC) is a commonly performed intraoperative procedure. Traditionally, CVC placement is performed blindly using anatomic landmarks as a guide to vessel position. Real-time ultrasound provides the operator the benefit of visualizing the target vein and the surrounding anatomic structures prior to and during the catheter insertion, thereby minimizing complications and increasing speed of placement. A 22-year-old male underwent open reduction and internal fixation of acetabulum fracture in prone position. Excessive continuous bleeding intraoperatively warranted placement of CVC in right internal jugular vein (IJV), which was not possible in prone position without the help of ultrasound. Best view of right IJV was obtained and CVC was placed using real-time ultrasound without complications. Ultrasound-guided CVC placement can be done in atypical patient positions where traditional anatomic landmark technique has no role. Use of ultrasound not only increases the speed of placement but also reduces complications known with the traditional blind technique.

  20. Quality of Life of Intermittent Urinary Catheterization Users and Their Caregivers: A Scoping Review.

    PubMed

    Fumincelli, Laís; Mazzo, Alessandra; Martins, José Carlos Amado; Henriques, Fernando Manuel Dias; Cardoso, Daniela; Rodrigues, Manuel Alves

    2017-08-01

    This study aimed to examine and map the scientific evidences regarding quality of life in neurogenic bladder patients and consequently their caregivers by means of a scoping review. This is a scoping review proposal of the Joanna Briggs Institute. It was conducted to examine and map the scientific evidences about quality of life (QoL) in neurogenic bladder patients and their caregivers, to identify the meanings attributed to QoL and its relation with intermittent urinary catheterization. The following guiding question was: "What scientific evidence has been produced on the QoL of neurogenic bladder patients using intermittent urinary catheterization and their caregivers?" A total of 2945 research studies were identified using The Cochrane Library, CINAHL, LILACS, Academic Search Premier (via EBSCO platform), PubMed, SCOPUS, the platforms Web of Science, the b-on and Gray Literature. The keywords established were patient, intermittent urinary catheterization, neurogenic urinary bladder, quality of life and caregiver. From 2,945 studies, 13 studies were selected. Most of the selected studies that analyzed variables related to the patients' QoL were regarding the urinary catheterization technique, assessment of urinary incontinence, individual perceptions of the procedure and experiences with urinary catheter in childhood and adult life. The meanings attributed to QoL, when compared to adult and child individuals with normal bladder functioning, presented lower QoL scores. Concerning caregivers, the QoL of caregivers of children using intermittent urinary catheterization demonstrated low scores. The QoL of patient's who use intermittent urinary catheterization can be determined by improvement of urinary symptoms and self-confidence. Research related to QoL of patients who use urinary catheter indicates the importance of adequate professional support and appropriate health public policies. © 2017 Sigma Theta Tau International.

  1. Automatic Cardiac Pacing Technique for Electrophysiologic Investigations: Measurement of Myocardial Excitability in the Dog during Exposure to +Gz

    DTIC Science & Technology

    1987-12-01

    computer-based instrument have been combined to provide a useful model in which cardiac threshold of excitability changes can be observed in response...demonstrated a system In which an animal with a chronic pacing catheter and a computer-based instrument have been combined to provide a useful model ...loading were measured by a technioue proven in previous studies (5)(7)(8). Invasive techniques were required so animal models rather than human

  2. Spectrally-Presaturated Modulation (SPM): An efficient fat suppression technique for STEAM-based cardiac imaging sequences.

    PubMed

    Fahmy, Ahmed S; Ibrahim, El-Sayed H; Osman, Nael F

    2017-04-01

    Stimulated-echo acquisition mode (STEAM) is a key pulse sequences in MRI in general, and in cardiac imaging in particular. Fat suppression is an important feature in cardiac imaging to improve visualization and eliminate off-resonance and chemical-shift artifacts. Nevertheless, fat suppression comes at the expense of reduced temporal resolution and signal-to-noise ratio (SNR). The purpose of this study is to develop an efficient fat suppression method (Spectrally-Presaturated Modulation) for STEAM-based sequences to enable imaging with high temporal-resolution, high SNR, and no increase in scan time. The developed method is based on saturating the fat magnetization prior to applying STEAM modulation; therefore, only the water-content of the tissues is modulated by the sequence, resulting in fat-suppressed images without the need to run the fat suppression module during image acquisition. The potential significance of the proposed method is presented in two STEAM-based cardiac MRI applications: complementary spatial-modulation of magnetization (CSPAMM), and black-blood cine imaging. Phantom and in vivo experiments are conducted to evaluate the developed technique and compare it to the commonly implemented chemical-shift selective (CHESS) and water-excitation using spectral-spatial selective pulses (SSSP) fat suppression techniques. The results from the phantom and in vivo experiments show superior performance of the proposed method compared to the CHESS and SSSP techniques in terms of temporal resolution and SNR. In conclusion, the developed fat suppression technique results in enhanced image quality of STEAM-based images, especially in cardiac applications, where high temporal-resolution is imperative for accurate measurement of functional parameters and improved performance of image analysis algorithms. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Comparison and reliability of two non-invasive acetylene uptake techniques for the measurement of cardiac output.

    PubMed

    Dibski, D W; Smith, D J; Jensen, R; Norris, S R; Ford, G T

    2005-08-01

    Comparison and reliability of two non-invasive acetylene uptake techniques for the measurement of cardiac output. Thirteen trained male cyclists performed CO2 rebreathing (CO2RB) at intensities from rest to 200 W, and open-circuit acetylene uptake (OpCirc) and single-breath acetylene uptake (SB) at intensities from rest to 300 W, with all procedures using 50 W increments. Oxygen consumption VO2 cardiac output Q and heart rate (HR), were measured at each stage, and the values for each variable were compared within each intensity to determine reliability of the measuring device. Both the OpCirc and SBs were shown to be reliable measures of cardiac output (r = 0.95 and 0.92, respectively) with decreasing coefficients of variation (CV) as intensity increased, and were similar to published data. The Q-VO2 relationship using the SB diverged from the regression line for OpCirc and CO2RB. Linear regression of the Q--VO2 relationship for CO2RB was y = 6.18 x VO2 + 2.59 for OpCirc was y = 6.12 x VO2 + 2.98 and for SB was y = 5.05 x VO2 + 3.76. The OpCirc and SBs were both shown to be reliable techniques for measuring cardiac output, comparable to previously reported cardiac output measurements, and suitable for use in exercise testing. However, the SB, requiring a constant, slow exhalation rate, made the procedure difficult to perform at higher exercise intensities.

  4. Noninvasive measurement of cardiac output during exercise by inert gas rebreathing technique.

    PubMed

    Cattadori, Gaia; Schmid, Jean-Paul; Agostoni, Piergiuseppe

    2009-04-01

    Reduced exercise tolerance and dyspnea during exercise are hallmarks of heart failure syndrome. Exercise capacity and various parameters of cardiopulmonary response to exercise are of important prognostic value. All the available parameters only indirectly reflect left ventricular dysfunction and hemodynamic adaptation to an increased demand. Noninvasive assessment of cardiac output, especially during an incremental exercise stress test, would allow the direct measure of cardiac reserve and may become the gold standard for prognostic evaluation in the future.

  5. Behaviour change techniques in home-based cardiac rehabilitation: a systematic review

    PubMed Central

    Heron, Neil; Kee, Frank; Donnelly, Michael; Cardwell, Christopher; Tully, Mark A; Cupples, Margaret E

    2016-01-01

    Background Cardiac rehabilitation (CR) programmes offering secondary prevention for cardiovascular disease (CVD) advise healthy lifestyle behaviours, with the behaviour change techniques (BCTs) of goals and planning, feedback and monitoring, and social support recommended. More information is needed about BCT use in home-based CR to support these programmes in practice. Aim To identify and describe the use of BCTs in home-based CR programmes. Design and setting Randomised controlled trials of home-based CR between 2005 and 2015 were identified by searching MEDLINE®, Embase, PsycINFO, Web of Science, and Cochrane Database. Method Reviewers independently screened titles and abstracts for eligibility. Relevant data, including BCTs, were extracted from included studies. A meta-analysis studied risk factor change in home-based and comparator programmes. Results From 2448 studies identified, 11 of good methodological quality (10 on post-myocardial infarction, one on heart failure, 1907 patients) were included. These reported the use of 20 different BCTs. Social support (unspecified) was used in all studies and goal setting (behaviour) in 10. Of the 11 studies, 10 reported effectiveness in reducing CVD risk factors, but one study showed no improvement compared to usual care. This study differed from effective programmes in that it didn’t include BCTs that had instructions on how to perform the behaviour and monitoring, or a credible source. Conclusion Social support and goal setting were frequently used BCTs in home-based CR programmes, with the BCTs related to monitoring, instruction on how to perform the behaviour, and credible source being included in effective programmes. Further robust trials are needed to determine the relative value of different BCTs within CR programmes. PMID:27481858

  6. Behaviour change techniques in home-based cardiac rehabilitation: a systematic review.

    PubMed

    Heron, Neil; Kee, Frank; Donnelly, Michael; Cardwell, Christopher; Tully, Mark A; Cupples, Margaret E

    2016-10-01

    Cardiac rehabilitation (CR) programmes offering secondary prevention for cardiovascular disease (CVD) advise healthy lifestyle behaviours, with the behaviour change techniques (BCTs) of goals and planning, feedback and monitoring, and social support recommended. More information is needed about BCT use in home-based CR to support these programmes in practice. To identify and describe the use of BCTs in home-based CR programmes. Randomised controlled trials of home-based CR between 2005 and 2015 were identified by searching MEDLINE(®), Embase, PsycINFO, Web of Science, and Cochrane Database. Reviewers independently screened titles and abstracts for eligibility. Relevant data, including BCTs, were extracted from included studies. A meta-analysis studied risk factor change in home-based and comparator programmes. From 2448 studies identified, 11 of good methodological quality (10 on post-myocardial infarction, one on heart failure, 1907 patients) were included. These reported the use of 20 different BCTs. Social support (unspecified) was used in all studies and goal setting (behaviour) in 10. Of the 11 studies, 10 reported effectiveness in reducing CVD risk factors, but one study showed no improvement compared to usual care. This study differed from effective programmes in that it didn't include BCTs that had instructions on how to perform the behaviour and monitoring, or a credible source. Social support and goal setting were frequently used BCTs in home-based CR programmes, with the BCTs related to monitoring, instruction on how to perform the behaviour, and credible source being included in effective programmes. Further robust trials are needed to determine the relative value of different BCTs within CR programmes. © British Journal of General Practice 2016.

  7. Redo sternotomy for cardiac reoperations using peripheral heparin-bonded cardiopulmonary bypass circuits without systemic heparinization: technique and results.

    PubMed

    Singh, Arun K; Stearns, Gary; Maslow, Andrew; Feng, William C; Schwartz, Carl

    2011-04-01

    Cardiac reoperations are challenging and time-consuming and incur a high incidence of perioperative complications because of injuries to cardiac structures, bleeding, and hemodynamic instability. Some centers are using extracorporeal circulation with heparinization at the time of resternotomy, but it leads to prolonged anticoagulation, platelet dysfunction, fibrinolysis, coagulopathy, and morbidity. The authors routinely perform resternotomy in complex surgery with the support of heparinless cardiopulmonary bypass with heparin-bonded circuits (HBCs). The authors describe their technique, indication, and results. The femoral artery or axillary artery and femoral veins are cannulated before sternotomy, and cardiopulmonary bypass is instituted using an HBC without systemic heparinization. Systemic heparin (200-300 U/kg) is administered when all structures are isolated before aortic cross-clamping (activated coagulation time >400 seconds). Between 1996 and 2008, 336 patients underwent redo sternotomy using the HBC for complex cardiac procedures, with 29 deaths (8.6% deaths within 30 days). Only 5 (1.5%) of 336 patients sustained injury to the right ventricle, aorta, bypass grafts, or ventricular fibrillation during re-entry without hemodynamic deterioration; and underwent uneventful repair and outcomes. There was no online HBC thrombosis. This study shows that HBC without systemic heparinization during resternotomy can be used safely in complex redo cardiac surgery. The heart is completely decompressed during the resternotomy, allowing easy dissection, less likely injury to vital structures, and less bleeding without compromising the hemodynamics. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Dual-Energy Computed Tomography Gemstone Spectral Imaging: A Novel Technique to Determine Human Cardiac Calculus Composition.

    PubMed

    Cheng, Ching-Li; Chang, Hsiao-Huang; Ko, Shih-Chi; Huang, Pei-Jung; Lin, Shan-Yang

    2016-01-01

    Understanding the chemical composition of any calculus in different human organs is essential for choosing the best treatment strategy for patients. The purpose of this study was to assess the capability of determining the chemical composition of a human cardiac calculus using gemstone spectral imaging (GSI) mode on a single-source dual-energy computed tomography (DECT) in vitro. The cardiac calculus was directly scanned on the Discovery CT750 HD FREEdom Edition using GSI mode, in vitro. A portable fiber-optic Raman spectroscopy was also applied to verify the quantitative accuracy of the DECT measurements. The results of spectral DECT measurements indicate that effective Z values in 3 designated positions located in this calculus were 15.02 to 15.47, which are close to values of 15.74 to 15.86, corresponding to the effective Z values of calcium apatite and hydroxyapatite. The Raman spectral data were also reflected by the predominant Raman peak at 960 cm for hydroxyapatite and the minor peak at 875 cm for calcium apatite. A potential single-source DECT with GSI mode was first used to examine the morphological characteristics and chemical compositions of a giant human cardiac calculus, in vitro. The CT results were consistent with the Raman spectral data, suggesting that spectral CT imaging techniques could be accurately used to diagnose and characterize the compositional materials in the cardiac calculus.

  9. Development and evaluation of a new fully automatic motion detection and correction technique in cardiac SPECT imaging.

    PubMed

    Bai, Chuanyong; Maddahi, Jamshid; Kindem, Joel; Conwell, Richard; Gurley, Michael; Old, Rex

    2009-01-01

    In cardiac SPECT perfusion imaging, motion correction of the data is critical to the minimization of motion introduced artifacts in the reconstructed images. Software-based (data-driven) motion correction techniques are the most convenient and economical approaches to fulfill this purpose. However, the accuracy is significantly affected by how the data complexities, such as activity overlap, non-uniform tissue attenuation, and noise are handled. We developed STASYS, a new, fully automatic technique, for motion detection and correction in cardiac SPECT. We evaluated the performance of STASYS by comparing its effectiveness of motion correcting patient studies with the current industry standard software (Cedars-Sinai MoCo) through blind readings by two readers independently. For 204 patient studies from multiple clinical sites, the first reader identified (1) 69 studies with medium to large axial motion, of which STASYS perfectly or significantly corrected 86.9% and MoCo 72.5%; and (2) 20 studies with medium to large lateral motion, of which STASYS perfectly or significantly corrected 80.0% and MoCo 60.0%. The second reader identified (1) 84 studies with medium to large axial motion, of which STASYS perfectly or significantly corrected 82.2% and MoCo 76.2%; and (2) 34 studies with medium to large lateral motion, of which STASYS perfectly or significantly corrected 58.9% and MoCo 50.0%. We developed a fully automatic software-based motion correction technique, STASYS, for cardiac SPECT. Clinical studies showed that STASYS was effective and corrected a larger percent of cardiac SPECT studies than the current industrial standard software.

  10. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey.

    PubMed

    Bongiorni, Maria Grazia; Proclemer, Alessandro; Dobreanu, Dan; Marinskis, Germanas; Pison, Laurent; Blomstrom-Lundqvist, Carina

    2013-11-01

    The aim of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in relation to the tools and techniques used for cardiac implantable electronic devices procedures in the European countries. Responses to the questionnaire were received from 62 members of the EHRA research network. The survey involved high-, medium-, and low-volume implanting centres, performing, respectively, more than 200, 100-199 and under 100 implants per year. The following topics were explored: the side approach for implantation, surgical techniques for pocket incision, first venous access for lead implantation, preference of lead fixation, preferred coil number for implantable cardioverter-defibrillator (ICD) leads, right ventricular pacing site, generator placement site, subcutaneous ICD implantation, specific tools and techniques for cardiac resynchronization therapy (CRT), lead implantation sequence in CRT, coronary sinus cannulation technique, target site for left ventricular lead placement, strategy in left ventricular lead implant failure, mean CRT implantation time, optimization of the atrioventricular (AV) and ventriculo-ventricular intervals, CRT implants in patients with permanent atrial fibrillation, AV node ablation in patients with permanent AF. This panoramic view allows us to find out the operator preferences regarding the techniques and tools for device implantation in Europe. The results showed different practices in all the fields we investigated, nevertheless the survey also outlines a good adherence to the common standards and recommendations.

  11. Role of Imaging Techniques for Diagnosis, Prognosis and Management of Heart Failure Patients: Cardiac Magnetic Resonance

    PubMed Central

    Gonzalez, Jorge A.; Kramer, Christopher M.

    2015-01-01

    Cardiac Magnetic Resonance (CMR) has evolved into a major tool for the diagnosis and assessment of prognosis of patients suffering from heart failure. Anatomical and structural imaging, functional assessment, T1 and T2 mapping tissue characterization and late gadolinium enhancement (LGE) have provided clinicians with tools to distinguish between non-ischemic and ischemic cardiomyopathies and to identify the etiology of non-ischemic cardiomyopathies. LGE is a useful tool to predict the likelihood of functional recovery after revascularization in patients with CAD and to guide the LV lead placement in those who qualify for cardiac resynchronization (CRT) therapy. In addition, the presence of LGE and its extent in myocardial tissue relates to overall cardiovascular outcomes. Emerging roles for cardiac imaging in Heart Failure with Preserved Ejection Fraction (HFpEF) are being studied and CMR continues to be among the most promising noninvasive imaging alternatives in the diagnosis of this disease. PMID:26041670

  12. Tricuspid regurgitation: noninvasive techniques for determining causes and severity.

    PubMed

    DePace, N L; Ross, J; Iskandrian, A S; Nestico, P F; Kotler, M N; Mintz, G S; Segal, B L; Hakki, A H; Morganroth, J

    1984-06-01

    Tricuspid regurgitation is often not apparent on physical examination and several methods are now available to aid in this difficult assessment. Cardiac catheterization using right ventriculography, previously considered the diagnostic standard, has several limitations. Currently available noninvasive tools such as M-mode and two-dimensional echocardiography (with or without contrast), Doppler techniques and even radionuclide cardiologic imaging have added significantly to the precise assessment of the presence and severity of tricuspid regurgitation. This review examines the comparative use and limitations of these various techniques.

  13. Comparison of the risk of vascular complications associated with femoral and radial access coronary catheterization procedures in obese versus nonobese patients.

    PubMed

    Cox, Nicholas; Resnic, Frederic S; Popma, Jeffrey J; Simon, Daniel I; Eisenhauer, Andrew C; Rogers, Campbell

    2004-11-01

    In this retrospective review of 5,234 cardiac catheterizations and percutaneous coronary interventions, the rate of vascular complications was highest in extremely thin and morbidly obese patients and lowest in moderately obese patients, consistent with the previously reported "obesity paradox." The use of transradial access and arterial access closure devices was associated with reduced vascular complications in the population of obese patients.

  14. Advanced computer techniques for inverse modeling of electric current in cardiac tissue

    SciTech Connect

    Hutchinson, S.A.; Romero, L.A.; Diegert, C.F.

    1996-08-01

    For many years, ECG`s and vector cardiograms have been the tools of choice for non-invasive diagnosis of cardiac conduction problems, such as found in reentrant tachycardia or Wolff-Parkinson-White (WPW) syndrome. Through skillful analysis of these skin-surface measurements of cardiac generated electric currents, a physician can deduce the general location of heart conduction irregularities. Using a combination of high-fidelity geometry modeling, advanced mathematical algorithms and massively parallel computing, Sandia`s approach would provide much more accurate information and thus allow the physician to pinpoint the source of an arrhythmia or abnormal conduction pathway.

  15. Subclavian artery- internal jugular vein fistula and heart failure: complication of internal jugular vein catheterization.

    PubMed

    Prakash, Jai; Takhellambam, Brojen; Ghosh, Biplab; Choudhury, Tauhidul Alam; Singh, Shivendra; Sharma, Om Prakash

    2013-02-01

    Hemodialysis in patients with end-stage renal disease (ESRD) requires vascular access which can be either temporary or permanent. However, these procedures are not without complications. Arterial puncture is the most common immediate complication and pseudoaneurysm formation is the most common late sequel of internal jugular venous catheterization (IJVC). However, arterio-venous fistula (AVF) formatiorn following IJVC is rare. We are reporting a case of AVF formation between subclavian artery (SCA) and internal jugular vein (IJV) following IJVC which later on leads to the development of cardiac failure.

  16. [Bleeding during central venous catheterization : Cannot intubate, cannot ventilate due to massive cervical hematoma].

    PubMed

    Engelen, C; Trebes, C; Czarnecki, S; Junger, A

    2016-03-01

    Central venous catheterization is an invasive procedure which can be associated with severe complications. These include in particular unsuccessful arterial puncture and vascular injuries, which in addition to loss of blood can lead to massive soft tissue swelling. A 63-year-old female patient developed massive cervical bleeding during ultrasound-guided internal jugular vein puncture and the rapidly enlarging hematoma led to compromisation of the airway. A cannot intubate, cannot ventilate situation developed and the subsequent hypoxia led to cardiac arrest that was only resolved after emergency surgical tracheotomy during cardiopulmonary resuscitation.

  17. Single therapeutic catheterization for treatment of late diagnosed native coarctation of aorta using a covered stent.

    PubMed

    Ural, Alper V; Caglar, Ilker Murat; Caglar, Fatma Nihan Turhan; Ciftci, Serkan; Karakaya, Osman

    2014-03-01

    Here in we are reporting a 35-year-old pregnant, hypertensive woman with a strict descending aorta coarctation. She had two missing pregnancies which were complicated with hypertension, but which were not diagnosed for any pathologies before. We diagnosed coarctation of aorta, but however postponed her treatment after delivery of baby, because hypertension was under control with medical treatment and she had no complication. She had an uneventful delivery. MRI angiography revealed coarctation of aorta and it was successfully treated by using an endovascular covered stent during a single cardiac catheterization. Endovascular covered stent implantation is an easy, safe and effective method for treating coarctation of aorta in adults.

  18. Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques.

    PubMed

    Raff, Gilbert L; Chinnaiyan, Kavitha M; Share, David A; Goraya, Tauqir Y; Kazerooni, Ella A; Moscucci, Mauro; Gentry, Ralph E; Abidov, Aiden

    2009-06-10

    Cardiac computed tomography angiography (CCTA) can accurately diagnose coronary artery disease, but radiation dose from this procedure is of concern. To determine whether a collaborative radiation dose-reduction program would be associated with reduced radiation dose in patients undergoing CCTA in a statewide registry over a 1-year period and to define its effect on image quality. A prospective, controlled, nonrandomized study conducted during a control period (July-August 2007), an intervention period (September 2007-April 2008), and a follow-up period (May-June 2008) at 15 hospital imaging centers participating in the Advanced Cardiovascular Imaging Consortium in Michigan, which included small community hospitals and large academic medical centers. A total of 4995 sequential patients undergoing CCTA for suspected coronary artery disease were enrolled; 4862 patients (97.3%) had complete radiation data for analysis. A best-practice CCTA scan model was used, which included minimized scan range, heart rate reduction, electrocardiographic-gated tube current modulation, and reduced tube voltage in suitable patients. Primary outcomes included dose-length product and effective radiation dose from all phases of the CCTA scan. Secondary outcomes were image quality assessed by a 4-point scale (1 indicated excellent; 2, good; 3, adequate; and 4, nondiagnostic) and frequency of diagnostic-quality scans. Compared with the control period, patients' estimated median radiation dose in the follow-up period was reduced by 53.3% (dose-length product decreased from 1493 mGy x cm [interquartile range {IQR}, 855-1823 mGy x cm] to 697 mGy x cm [IQR, 407-1163 mGy x cm]; P < .001) and effective dose from 21 mSv (IQR, 12-26 mSv) to 10 mSv (IQR, 6-16 mSv) (P < .001). The greatest reduction in dose occurred at low-volume sites. There were no significant changes in median image quality assessment during the control period compared with the follow-up period (median image quality of 2 [images

  19. Hysteroscopically guided transvaginal ultrasound tubal catheterization-a novel office procedure.

    PubMed

    Cohen, Shlomo B; Bouaziz, Jerome; Jakobson-Setton, Ariella; Goldenberg, Motti; Schiff, Eyal; Orvieto, Raoul; Shulman, Adrian

    2016-09-01

    Investigate a novel office hysteroscopic tubal catheterization therapeutic method for proximal tubal occlusion. Prospective cohort study in a tertiary referral center. We evaluated the procedure on a group of 27 patients that were referred to our unit for proximal tubal occlusion demonstrated by hysterosalpingography, 9 (33.3%) of them with primary infertility and 18 of them (66.6%) with secondary infertility. The intervention included the usage of the modified Novy cornual cannulation set which was inserted through a 5F working cannel during an office operative hysteroscopy, followed by fallopian tube irrigation with saline-air mixture under ultrasonographic imaging. Our series revealed no complication during or after the procedure; anesthesia was not required. One patient lost from follow-up. Of the remaining 26, 10 patients (38.4%) conceived either spontaneously or with treatment by clomiphene or gonadotropine associated with intrauterine insemination. The median time to conception was 5 months (range 4-17). We therefore concluded that office hysteroscopic tubal catheterization is a simple (without anesthesia required) option for the treatment of patients suffering from proximal tubal occlusion. Fertility outcomes in our series are comparable to other treatments options for tubal catheterization. Therefore, tubal catheterization should not delay the assisted reproducted techniques if indicated but we propose to include it in a global integrated approach. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Quality of documentation of urethral catheterization in a Nigerian teaching hospital.

    PubMed

    Tijani, K H; Lawal, A O; Ojewola, R W; Badmus, T A

    2010-01-01

    Urethral catheterization is a common minimally invasive procedure with well-known complications some of which may be severe. Quite often, a clinician is invited to manage the short and long-term complications of the procedure without adequate records of the procedure itself. This study aims to determine the quality of documentation of urethral catheterization in our health institution. This prospective study was carried out over a period of 1 month. The documentations in the medical notes and nursing records with respect to urethral catheterisation were assessed using 10 different parameters with the aid of a pro-forma. Statistical analysis was done with the Wilcoxon signed ranks test. A total of 89 patients were catheterised in the wards, the emergency departments and the theatre. All the catheterizations were performed by doctors. The overall quality of documentation of catheterisation was poor: It was significantly worse in the medical notes than the nursing records with 28% of all cases documented by the nurses not documented by the physicians. Documentation in the theatre and emergency were worse, while there was no documentation of aseptic technique in any patient. An 11% incidence of complications was noted. The quality of record keeping concerning urethral catheterization was inadequate. This is important not only for patients' care, but also for medico-legal purposes. We therefore recommend regular audit and introduction of protocols for proper documentation.

  1. Cardiovascular procedures/diagnostic techniques and therapeutic procedures

    SciTech Connect

    Tilkian, A.G.; Daily, E.K.

    1986-01-01

    This book covers the technical and therapeutic aspects of cardiovascular procedures in immense detail. There are large and appropriate diagrams and tables. The topics of the chapters are tools for catheterization, venous access, arterial access, hemodynamic monitoring, cardiac catheterization and coronary arteriography, ergonovine provocation testing for coronary artery spasm, pulmonary angiography, endomyocredial biopsy, electrophysiologic studies, pericardiocentesis and drainage, intraaortic balloon pumping, direct current cardioversion and defibrilaltion, pacemaker implantation of the automatic implantable cardioverter/defibrillator, coronary angioplasty, thrombolytic therapy, transluminal catheter extraction and resolution of intracardiac catheter knots, cardiopulmonary resuscitation, contrast media toxicity and allergic reactions, radiation hazards, and medicolegal concerns. An appendix and index follow these chapters. In general, each chapter covers historical aspects, indications, complications, techniques, and preoperative and postoperative care.

  2. Non-invasive cardiac imaging techniques and vascular tools for the assessment of cardiovascular disease in type 2 diabetes mellitus.

    PubMed

    Djaberi, R; Beishuizen, E D; Pereira, A M; Rabelink, T J; Smit, J W; Tamsma, J T; Huisman, M V; Jukema, J W

    2008-09-01

    Cardiovascular disease is the major cause of mortality in type 2 diabetes mellitus. The criteria for the selection of those asymptomatic patients with type 2 diabetes who should undergo cardiac screening and the therapeutic consequences of screening remain controversial. Non-invasive techniques as markers of atherosclerosis and myocardial ischaemia may aid risk stratification and the implementation of tailored therapy for the patient with type 2 diabetes. In the present article we review the literature on the implementation of non-invasive vascular tools and cardiac imaging techniques in this patient group. The value of these techniques as endpoints in clinical trials and as risk estimators in asymptomatic diabetic patients is discussed. Carotid intima-media thickness, arterial stiffness and flow-mediated dilation are abnormal long before the onset of type 2 diabetes. These vascular tools are therefore most likely to be useful for the identification of 'at risk' patients during the early stages of atherosclerotic disease. The additional value of these tools in risk stratification and tailored therapy in type 2 diabetes remains to be proven. Cardiac imaging techniques are more justified in individuals with a strong clinical suspicion of advanced coronary heart disease (CHD). Asymptomatic myocardial ischaemia can be detected by stress echocardiography and myocardial perfusion imaging. The more recently developed non-invasive multi-slice computed tomography angiography is recommended for exclusion of CHD, and can therefore be used to screen asymptomatic patients with type 2 diabetes, but has the associated disadvantages of high radiation exposure and costs. Therefore, we propose an algorithm for the screening of asymptomatic diabetic patients, the first step of which consists of coronary artery calcium score assessment and exercise ECG.

  3. Complications of internal jugular vein retrograde catheterization.

    PubMed

    Gemma, M; Beretta, L; De Vitis, A; Mattioli, C; Calvi, M R; Antonino, A; Rizzi, B; Crippa, L; D'Angelo, A

    1998-01-01

    We report on the incidence of complications of 172 internal jugular vein retrograde catheterizations (IJVRCs) performed on 126 patients. Standard cannulation and X-ray control of the catheter tip placement were performed. Difficulties encountered during the manouvre were registered. Patients with a jugular catheter in place for more than one day had neck echography on catheter removal and one week later. Carotid artery puncture occurred in 20 (12%) cases and lymphatic vessel puncture in one. In 13 (8%) cases IJVRC failed due to difficulties in advancing the guide. X-ray films documented catheter misplacement in 39 (23%) cases: loop into the internal jugular vein in 11 (6%); paravertebral venous plexus cannulated in one; other extracranial jugular afferent cannulated in 4 (2%); catheter tip into the jugular lumen in 10 (6%); catheter tip beyond the jugular bulb in 13 (8%). First neck echography documented: one perivascular hematoma (absent one week later); 3 (4%) jugular vein thrombosis (2 asymptomatic and absent one week later; one symptomatic and still evident one week later). Positive neck echography was not associated with difficulties, length of catheterization, diameter of the catheter. IJVRC is a simple and safe procedure with a low incidence of serious complications.

  4. Complex regional pain syndrome following transfemoral catheterization.

    PubMed

    Saad, Andre; Knolla, Raelene; Gupta, Kamal

    2011-11-01

    Complex regional pain syndrome (CRPS) (previously reflex sympathetic dystrophy) is a chronic pain condition usually resulting as a consequence of trauma or surgery. Though described occasionally after vascular surgery, it is distinctly rare after percutaneous cardiovascular procedures. We report a case of CRPS following trans- femoral catheterization-related groin pseudoaneurysm. To our knowledge, this is the first such report following transfemoral catheterization. A 36-year-old female underwent an electrophysiological study and AV node re-entry tachycardia ablation using the left femoral vein approach. One month later she presented complaining of numbness and tingling in her left foot with swelling and mild groin discomfort. A lower extremity duplex scan showed a left common femoral artery pseudoaneurysm that was partially thrombosed and subsequently resolved spontaneously. The patient had intractable symptoms of pain, temperature changes, color changes, and trophic changes of the left foot. Conventional angiography was done to rule out occlusive arterial disease but just showed very sluggish flow. Further evaluation with transcutaneous oxymetry and 3-phase bone scan was consistent with microvascular dysfunction and poor cutaneous blood flow suggestive of cold-type CRPS. In this case report, we also review the clinical features and the vascular changes associated with CRPS and discuss the pathophysiology of the syndrome from a cardiovascular specialist's perspective. Interventionalists should be aware that CRPS is a possible, albeit rare, condition that may follow many vascular procedures that they perform on a daily basis.

  5. Cardiac imaging: New technologies and clinical applications. Vol. 17, No. 1

    SciTech Connect

    Kotler, M.N.; Steiner, R.M.

    1986-01-01

    Imaging of the cardiovascular system has made much progress during the past several years. This book addresses the issues surrounding development and clinical utilization of techniques for diagnosis in valvular, coronary artery, and congenital heart disease. Included among the evaluation modalities are Doppler ultrasound, contrast 2-D echocardiography, thallium scintigraphy, nuclear magnetic resonance and emission tomography (CT, ECT, SPECT, PET). Advantages and disadvantages of these modes are discussed, and compared to each other and to older methods such as cardiac catheterization and angiography. Consideration is given to the use of the computer as an aid to the cardiologist.

  6. Percutaneous closure and "push-pull" technique to repair arterial lead and sheath placement complicating cardiac resynchronization therapy.

    PubMed

    Ullah, Waqas; Cooklin, Michael; Salter, Richard James; Sabharwal, Tarun; Rinaldi, Christopher Aldo

    2012-02-01

    We present a case of inadvertent subclavian arterial puncture and lead placement to the left ventricle in a patient undergoing cardiac resynchronization therapy. We describe the use of a "push-pull" technique within an arterial setting to allow removal of the lead, while maintaining access through the same puncture to allow an arterial-closure device to then seal the artery at this site. As a result of this percutaneous approach, the patient avoided the need for a vascular surgical procedure. ©2010, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  7. Introduction to cardiac imaging in infants and children: techniques, potential, and role in the imaging work-up of various cardiac malformations and other pediatric heart conditions.

    PubMed

    Bailliard, Frederique; Hughes, Marina L; Taylor, Andrew M

    2008-11-01

    The increasing prevalence of congenital heart disease (CHD) can be attributed to major improvements in diagnosis and treatment. Although echocardiography is the most commonly used imaging modality for diagnosis and follow-up of subjects with CHD, the evolution of cardiovascular magnetic resonance (MR) imaging and increasingly computed tomography (CT) does offer new ways to visualize the heart and the great vessels. The development of cardiovascular MR techniques allows for a comprehensive assessment of cardiac anatomy and function. This provides information about the long-term sequlae of the underlying complex anatomy, hemodynamic assessment of residual post-operative lesions and complications of surgery. As much of the functional data in CHD patients is usually acquired with invasive X-ray angiography, non-invasive alternatives such as cardiovascular MR (and CT) are desirable. This review evaluates the role of MR imaging in the management of subjects with CHD, particularly detailing recent developments in imaging techniques as they relate to the various CHD diagnoses we commonly encounter in our practice.

  8. Techniques for automated local activation time annotation and conduction velocity estimation in cardiac mapping

    PubMed Central

    Cantwell, C.D.; Roney, C.H.; Ng, F.S.; Siggers, J.H.; Sherwin, S.J.; Peters, N.S.

    2015-01-01

    Measurements of cardiac conduction velocity provide valuable functional and structural insight into the initiation and perpetuation of cardiac arrhythmias, in both a clinical and laboratory context. The interpretation of activation wavefronts and their propagation can identify mechanistic properties of a broad range of electrophysiological pathologies. However, the sparsity, distribution and uncertainty of recorded data make accurate conduction velocity calculation difficult. A wide range of mathematical approaches have been proposed for addressing this challenge, often targeted towards specific data modalities, species or recording environments. Many of these algorithms require identification of activation times from electrogram recordings which themselves may have complex morphology or low signal-to-noise ratio. This paper surveys algorithms designed for identifying local activation times and computing conduction direction and speed. Their suitability for use in different recording contexts and applications is assessed. PMID:25978869

  9. Techniques for automated local activation time annotation and conduction velocity estimation in cardiac mapping.

    PubMed

    Cantwell, C D; Roney, C H; Ng, F S; Siggers, J H; Sherwin, S J; Peters, N S

    2015-10-01

    Measurements of cardiac conduction velocity provide valuable functional and structural insight into the initiation and perpetuation of cardiac arrhythmias, in both a clinical and laboratory context. The interpretation of activation wavefronts and their propagation can identify mechanistic properties of a broad range of electrophysiological pathologies. However, the sparsity, distribution and uncertainty of recorded data make accurate conduction velocity calculation difficult. A wide range of mathematical approaches have been proposed for addressing this challenge, often targeted towards specific data modalities, species or recording environments. Many of these algorithms require identification of activation times from electrogram recordings which themselves may have complex morphology or low signal-to-noise ratio. This paper surveys algorithms designed for identifying local activation times and computing conduction direction and speed. Their suitability for use in different recording contexts and applications is assessed. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. Echocardiography of the normal camel (Camelus dromedaries) heart: technique and cardiac dimensions

    PubMed Central

    2012-01-01

    Background Echocardiography and intra-cardiac dimensions have not previously been reported in adult camels despite its potential application for medical purpose. The aim of this study was to describe the results of a prospective study, aiming to report normal cardiac appearance and normal chamber dimensions in adult camels (Camelus dromedarius). Results On the right side, when the probe was placed in the 5th or 4th intercostal space (ICS), the caudal long-axis four-chamber view of the ventricles, atria, and the interventricular septum was obtained. Placing the probe slightly more cranially in the 4th ICS, the caudal long-axis four-chamber view and the caudal long-axis view of the left ventricular outflow tract (LVOT) were imaged. In 7 camels, a hybrid view between a “four-chamber” and “LVOT view” was imaged from the same position. The short-axis view of the ventricles was obtained in the 4th ICS where the transducer was rotated between 0° and 25°. Placement of the transducer in the 3rd ICS allowed visualisation of the right ventricular outflow tract (RVOT). On the left side, when the probe was placed in the 5th or 4th ICS, a four-chamber view was obtained. The LVOT is imaged in the 4th ICS and the RVOT was seen from the 3rd ICS. Conclusions This study showed that it is possible to obtain good-quality echocardiograms in adult camels and provide normal cardiac dimensions. This study could be used as a reference for further studies concerning camels with cardiac diseases. PMID:22862855

  11. Echocardiography of the normal camel (Camelus dromedaries) heart: technique and cardiac dimensions.

    PubMed

    Tharwat, Mohamed; Al-Sobayil, Fahd; Ali, Ahmed; Buczinski, Sébastien

    2012-08-03

    Echocardiography and intra-cardiac dimensions have not previously been reported in adult camels despite its potential application for medical purpose. The aim of this study was to describe the results of a prospective study, aiming to report normal cardiac appearance and normal chamber dimensions in adult camels (Camelus dromedarius). On the right side, when the probe was placed in the 5th or 4th intercostal space (ICS), the caudal long-axis four-chamber view of the ventricles, atria, and the interventricular septum was obtained. Placing the probe slightly more cranially in the 4th ICS, the caudal long-axis four-chamber view and the caudal long-axis view of the left ventricular outflow tract (LVOT) were imaged. In 7 camels, a hybrid view between a "four-chamber" and "LVOT view" was imaged from the same position. The short-axis view of the ventricles was obtained in the 4th ICS where the transducer was rotated between 0° and 25°. Placement of the transducer in the 3rd ICS allowed visualisation of the right ventricular outflow tract (RVOT). On the left side, when the probe was placed in the 5th or 4th ICS, a four-chamber view was obtained. The LVOT is imaged in the 4th ICS and the RVOT was seen from the 3rd ICS. This study showed that it is possible to obtain good-quality echocardiograms in adult camels and provide normal cardiac dimensions. This study could be used as a reference for further studies concerning camels with cardiac diseases.

  12. New techniques for motion-artifact-free in vivo cardiac microscopy

    PubMed Central

    Vinegoni, Claudio; Lee, Sungon; Aguirre, Aaron D.; Weissleder, Ralph

    2015-01-01

    Intravital imaging microscopy (i.e., imaging in live animals at microscopic resolution) has become an indispensable tool for studying the cellular micro-dynamics in cancer, immunology and neurobiology. High spatial and temporal resolution, combined with large penetration depth and multi-reporter visualization capability make fluorescence intravital microscopy compelling for heart imaging. However, tissue motion caused by cardiac contraction and respiration critically limits its use. As a result, in vitro cell preparations or non-contracting explanted heart models are more commonly employed. Unfortunately, these approaches fall short of understanding the more complex host physiology that may be dynamic and occur over longer periods of time. In this review, we report on novel technologies, which have been recently developed by our group and others, aimed at overcoming motion-induced artifacts and capable of providing in vivo subcellular resolution imaging in the beating mouse heart. The methods are based on mechanical stabilization, image processing algorithms, gated/triggered acquisition schemes or a combination of both. We expect that in the immediate future all these methodologies will have considerable applications in expanding our understanding of the cardiac biology, elucidating cardiomyocyte function and interactions within the organism in vivo, and ultimately improving the treatment of cardiac diseases. PMID:26029116

  13. A potentially hazardous complication during central venous catheterization: lost guidewire retained in the patient.

    PubMed

    Song, Yohan; Messerlian, Aram K; Matevosian, Rima

    2012-05-01

    Guidewires are routinely used in the Seldinger technique during central venous catheter placement. A case in which a guidewire was unsuspectingly released and retained in a patient during the catheterization of the internal jugular vein is presented. Physicians from multiple services subsequently failed to detect the retained guidewire on several chest radiographs; however, the guidewire was incidentally discovered after a computed tomographic scan was obtained.

  14. Systemic effects of carbon dioxide insufflation technique for de-airing in left-sided cardiac surgery.

    PubMed

    Landenhed, Maya; Al-Rashidi, Faleh; Blomquist, Sten; Höglund, Peter; Pierre, Leif; Koul, Bansi

    2014-01-01

    Systemic effects of carbon dioxide (CO2) insufflation during left-sided cardiac surgery were evaluated in a prospective randomized study, with regard to acid-base status, gas exchange, cerebral hemodynamics, and red blood cell morphology. Twenty patients undergoing elective left-sided cardiac surgery were randomized to de-airing procedure either by CO2 insufflation technique (CO2 group, n = 10) or by Lund technique without CO2 insufflation (Lund group, n = 10). Groups underwent assessment of acid-base status by intermittent arterial blood gases and in-line blood gas monitoring. Capnography was used to determine volume of CO2 produced. Cerebral hemodynamics was measured by transcranial Doppler sonography and near-infrared spectroscopy. Red cell morphology from cardiotomy suction and vent tubing was studied by scanning electron microscopy. Patients in the CO2 group consequently developed significantly higher levels of hypercapnia with a concomitant increase in the volume of CO2 produced despite significantly higher oxygenator gas flows compared with the Lund group. Effects on cerebral hemodynamics were observed in the CO2 group with significantly higher blood flow velocities in the middle cerebral artery and higher regional cerebral saturation. Red blood cell damage was observed in the CO2 group by scanning electron microscopy (97% in CO2 group vs 18% in Lund group). Insufflation of CO2 into the cardiothoracic wound cavity during left-sided cardiac surgery can induce hypercapnic acidosis and increased cerebral blood flow and local blood cell damage. These systemic effects should be monitored by in-line capnography and acid-base measurements for early and effective correction by increase in gas flows to the oxygenator. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. Simultaneous ramp right heart catheterization and echocardiography in a ReliantHeart left ventricular assist device.

    PubMed

    Banerjee, Dipanjan; Dutt, Debleena; Duclos, Sebastien; Sallam, Karim; Wheeler, Matthew; Ha, Richard

    2017-01-26

    Many clinicians caring for patients with continuous flow left ventricular assist devices (CF-LVAD) use ramp right heart catheterization (RHC) studies to optimize pump speed and also to troubleshoot CF-LVAD malfunction. An investigational device, the ReliantHeart Heart Assist 5 (Houston, TX), provides the added benefit of an ultrasonic flow probe on the outflow graft that directly measures flow through the CF-LVAD. We performed a simultaneous ramp RHC and echocardiogram on a patient who received the above CF-LVAD to optimize pump parameters and investigate elevated flow through the CF-LVAD as measured by the flow probe. We found that the patient's hemodynamics were optimized at their baseline pump speed, and that the measured cardiac output via the Fick principle was lower than that measured by the flow probe. Right heart catheterization may be useful to investigate discrepancies between flow measured by a CF-LVAD and a patient's clinical presentation, particularly in investigational devices where little clinical experience exists. More data is needed to elucidate the correlation between the flow measured by an ultrasonic probe and cardiac output as measured by RHC.

  16. Simultaneous ramp right heart catheterization and echocardiography in a ReliantHeart left ventricular assist device

    PubMed Central

    Banerjee, Dipanjan; Dutt, Debleena; Duclos, Sebastien; Sallam, Karim; Wheeler, Matthew; Ha, Richard

    2017-01-01

    Many clinicians caring for patients with continuous flow left ventricular assist devices (CF-LVAD) use ramp right heart catheterization (RHC) studies to optimize pump speed and also to troubleshoot CF-LVAD malfunction. An investigational device, the ReliantHeart Heart Assist 5 (Houston, TX), provides the added benefit of an ultrasonic flow probe on the outflow graft that directly measures flow through the CF-LVAD. We performed a simultaneous ramp RHC and echocardiogram on a patient who received the above CF-LVAD to optimize pump parameters and investigate elevated flow through the CF-LVAD as measured by the flow probe. We found that the patient’s hemodynamics were optimized at their baseline pump speed, and that the measured cardiac output via the Fick principle was lower than that measured by the flow probe. Right heart catheterization may be useful to investigate discrepancies between flow measured by a CF-LVAD and a patient’s clinical presentation, particularly in investigational devices where little clinical experience exists. More data is needed to elucidate the correlation between the flow measured by an ultrasonic probe and cardiac output as measured by RHC. PMID:28163837

  17. Noninvasive external cardiac pacing for thallium-201 scintigraphy

    SciTech Connect

    Feldman, M.D.; Warren, S.E.; Gervino, E.V.; Aroesty, J.M.; Royal, H.D.; Parker, J.A.; Silverman, K.J.; Kolodny, G.M.; Zoll, P.M.; McKay, R.G.

    1988-01-01

    Improvements in noninvasive external cardiac pacing have led to a technique with reliable electrical capture and tolerable patient discomfort. To assess the use of this modality of pacing in combination with thallium scintigraphy as a noninvasive pacing stress test, we applied simultaneous noninvasive cardiac pacing, hemodynamic monitoring, and thallium-201 scintigraphy in 14 patients undergoing cardiac catheterization for chest pain syndromes. Two patients had normal coronary arteries, while the remaining 12 had significant coronary artery disease. Thallium scintigraphic responses to pacing were compared to routine exercise thallium stress testing in nine of these 14 patients. All patients were noninvasively paced to more than 85% of the age-predicted maximum heart rate. Twelve patients demonstrated reversible thallium defects, which corresponded in 11 cases to significant lesions seen on coronary angiography. Of nine patients who underwent both pacing and exercise thallium stress tests, comparable maximal rate-pressure products were achieved. Moreover, thallium imaging at peak pacing and during delayed views did not differ significantly from exercise thallium scintigraphy. A limiting factor associated with the technique was local patient discomfort, which occurred to some degree in all patients. We conclude that noninvasive external cardiac pacing together with thallium scintigraphy is capable of detecting significant coronary artery disease and may be comparable to routine exercise thallium stress testing. This new modality of stress testing could be useful in patients unable to undergo the exercise required for standard exercise tolerance testing, particularly if improvements in the technology can be found to reduce further the local discomfort.

  18. Pain during Female Urethral Catheterization: Intraurethral Lubricant Injection versus Catheter Tip Lubrication--A Prospective Randomized Trial.

    PubMed

    Stav, Kobi; Ohlgisser, Ronny; Siegel, Yoram I; Beberashvili, Ilia; Padoa, Anna; Zisman, Amnon

    2015-10-01

    Urethral lubrication during catheterization can be performed by instilling the gel directly in the urethra or by pouring the gel on the catheter tip. In this study we compared the pain level associated with each technique during female urethral catheterization in the setup of a multichannel urodynamic study. A total of 94 women with a mean ± SD age of 55 ± 14 years who were referred for a multichannel urodynamic study were prospectively randomized into 2 groups according to lubrication technique, including 1) instillation of 5 ml 2% lidocaine gel in the urethra 5 minutes before catheterization or 2) lubrication of the distal part of the catheter with 5 ml 2% lidocaine gel. A visual analog pain scale of 0 to 10 was completed at different time points, including prior to gel instillation (baseline), during gel instillation (group 1), during catheterization, and 5 and 30 minutes after the procedure ended. The study groups did not differ in demographic, clinical or urodynamic parameters. The mean visual analog scale score during catheterization was 2.3 ± 1.4 and 2.4 ± 1.6 in groups 1 and 2, respectively (p = 0.71). There was no difference in the reported visual analog scale score at the other checkpoints. The mean recorded visual analog scale score during instillation of the lubricant in the urethra in group 1 was 1.9 ± 0.9. The actual act of lubricant instillation in the urethra during catheterization in women causes additional and unnecessary pain. Therefore, it is not recommended. Other than that there is no difference in the urethral pain level between the 2 lubrication techniques. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  19. [A case report of aortic valvuloplasty by rasping technique for aortic stenosis with small annulus simultaneously performed with mitral valve replacement].

    PubMed

    Taniyasu, N; Kou, E; Hiramatsu, T; Yokoyama, S; Takenaka, A; Ikawa, O

    1997-02-01

    The patient was a 48-year-old woman with aortic stenosis and regurgitation and mitral stenosis. Preoperative cardiac catheterization revealed LV-Ao pressure gradient of 30 mmHg and regurgitation of Sellers III. The aortic annulus was measured less than 19 mm. As operative findings, the aortic annulus seemed to be too small to be replaced with 19 mm prosthetic valve. Aortic valvuloplasty (AVP) with rasping technique was performed for the aortic valve and valve replacement was carried out for the mitral valve. After aortic declamping and occurring her beat, the transesophageal echocardiographic evaluation for AVP was effective. Postoperative course was uneventful. Postoperative cardiac catheterization have shown decreased transvalvular pressure gradient up to 10 mmHg and aortic regurgitation of Sellers I.

  20. Radionecrosis induced by cardiac imaging procedures: a case study of a 66-year-old diabetic male with several comorbidities.

    PubMed

    Banaag, Liza De Olazo; Carter, Marissa J

    2008-08-01

    Radionecrosis is a rare sequitur of cardiac catheterization and imaging procedures. A 66-year-old diabetic male with several comorbidities developed a scapular burn immediately after the last of 3 cardiac catheterization and stenting procedures conducted over a 3-year period. The burn subsequently developed into a large eschar that required extensive debridement, a prolonged treatment of hyperbaric oxygen therapy, and plastic surgery to heal. Wound healing was compromised by the patient's diabetes and a potentially long course of steroids prescribed for other medical problems. Primary clinicians should be aware of suspicious-looking wounds that develop subsequent to cardiac catheterizations, especially in diabetic patients.

  1. Pencil and paper test: a new tool to predict the ability of neurological patients to practice clean intermittent self-catheterization.

    PubMed

    Amarenco, Gerard; Guinet, Amandine; Jousse, Marylene; Verollet, Delphine; Ismael, Samer Sheikh

    2011-02-01

    We created and validated the new pencil and paper test, which allows assessment of the ability of patients with a neurological disorder to practice clean intermittent self-catheterization. We developed a simple test including common gestures mimicking the usual maneuvers needed during clean intermittent self-catheterization, and involving the same cognitive and physical resources needed for this technique. We evaluated the test in 118 patients with a neurological condition. Instruments needed to perform the pencil and paper test are limited to a sheet of paper and a pencil. Each test item was quantified and graded with a total score of 15. A specific clean intermittent catheterization learning scale was used to classify the outcome of the ability to perform clean intermittent self-catheterization with a score range of 5--learning easy and self-catheterization complete to 0--learning impossible. Enrolled in the study were 118 patients with a neurological condition. There was strong correlation between the global pencil and paper test score, and the ability to perform clean intermittent self-catheterization, as evaluated by the learning scale (r = 0.82, p = 0.000091). At a test cutoff of 10 and a clean intermittent self-catheterization cutoff of 3, which was the limit needed to practice self-catheterization alone, the positive predictive value of the pencil and paper test was 85% and its negative predictive value was 94% (Cronbach's α = 0.88). The pencil and paper test is a valid way to predict the ability to practice clean intermittent self-catheterization in patients with a neurological disorder. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  2. Pluripotent stem cell derivation and differentiation toward cardiac muscle: novel techniques and advances in patent literature.

    PubMed

    Quattrocelli, Mattia; Thorrez, Lieven; Sampaolesi, Maurilio

    2013-04-01

    Pluripotent stem cells hold unprecedented potential for regenerative medicine, disease modeling and drug screening. Embryonic stem cells (ESCs), standard model for pluripotency studies, have been recently flanked by induced pluripotent stem cells (iPSCs). iPSCs are obtained from somatic cells via epigenetic and transcriptional reprogramming, overcoming ESC-related ethical issues and enabling the possibility of donor-matching pluripotent cell lines. Since the European Court of Justice banned patents involving embryo disaggregation to generate human ESCs, iPSCs can now fuel the willingness of European companies to invest in treatments based on stem cells. Moreover, iPSCs share many unique features of ESCs, such as unlimited self-renewal potential and broad differentiation capability, even though iPSCs seem more susceptible to genomic instability and display epigenetic biases as compared to ESCs. Both ESCs and iPSCs have been intensely investigated for cardiomyocyte production and cardiac muscle regeneration, both in human and animal models. In vitro and in vivo studies are continuously expanding and refining this field via genetic manipulation and cell conditioning, trying to achieve standard and reproducible products, eligible for clinical and biopharmaceutical scopes. This review focuses on the recently growing body of patents, concerning technical advances in production, expansion and cardiac differentiation of ESCs and iPSCs.

  3. New technique for single-staged repair of aortic coarctation and coexisting cardiac disorder.

    PubMed

    Korkmaz, Askin Ali; Guden, Mustafa; Onan, Burak; Tarakci, Sevim Indelen; Demir, Ali Soner; Sagbas, Ertan; Sarikaya, Tugay

    2011-01-01

    The management of adults with aortic coarctation and a coexisting cardiac disorder is still a surgical challenge. Single-staged procedures have lower postoperative morbidity and mortality rates than do 2-staged procedures. We present our experience with arch-to-descending aorta bypass grafting in combination with intracardiac or ascending aortic aneurysm repair.From October 2004 through April 2010, 5 patients (4 men, 1 woman; mean age, 45.8 ± 9.4 yr) underwent anatomic bypass grafting of the arch to the descending aorta through a median sternotomy and concomitant repair of an intracardiac disorder or an ascending aortic aneurysm. Operative indications included coarctation of the aorta in all cases, together with severe mitral insufficiency arising from damaged chordae tendineae in 2 patients, ascending aortic aneurysm with aortic regurgitation in 2 patients, and coronary artery disease in 1 patient. Data from early and midterm follow-up were reviewed.There was no early or late death. Follow-up was complete for all patients, and the mean follow-up period was 34.8 ± 18 months (range, 18 mo-5 yr). All grafts were patent. No late graft-related sequelae or reoperations were observed.For single-staged repair of aortic coarctation with a coexistent cardiac disorder, we propose arch-to-descending aorta bypass through a median sternotomy as an alternative for selected patients.

  4. Localization of pheochromocytoma by selective venous catheterization and assay of plasma catecholamines.

    PubMed Central

    Davies, R. A.; Patt, N. L.; Sole, M. J.

    1979-01-01

    The diagnosis of pheochromocytoma rests primarily on determination of the 24-hour urinary excretion of catecholamines and their metabolites. In most cases nephrotomography and selective arteriography or venography, or both, are sufficient to localize the tumour. Selective venous catheterization and the assay of plasma catecholamines should be considered for pheochromocytoma localization in: (a) patients in whom standard techniques fail to localize the tumour; (b) patients who exhibit idiosyncratic reactions to the angiographic contrast materials; (c) young patients or patients with familial pheochromocytoma, including those with multiple neurofibromatosis or multiple endocrine adenomatosis, type 2; (d) patients with recurrent, malignant, or suspected multicentric or extra-adrenal tumours; and (e) patients excreting only norepinephrine in the urine. The validity of the results is particularly dependent on the skill with which venous catheterization is carried out. PMID:436033

  5. [Determination of cardiac output by Doppler ultrasonics. Principle, techniques and limitations].

    PubMed

    Tribouilloy, C; Caze, F; Rey, J L; Marek, A; Quere, J P; Dufosse, H; Lesbre, J P

    1991-10-01

    The development of quantitative applications of Doppler ultrasound for the measurement of cardiac output was a lengthy and difficult process. These applications call for rigor of the part of the ultrasound cardiographer and a sufficiently echoic patient. Numerous studies have demonstrated the reliability of Doppler ultrasound in determining aortic flow. A high degree of consensus has emerged for measuring aortic areas and velocities at the ring. Doppler ultrasound quantification of the pulmonary flow has been validated in children. In adults, measurement of the pulmonary ring is often difficult and may lead to major errors in the estimation of the flow rates. The determination of mitral flow is also possible, either at the ring or at the tip of the mitral funnel. A few publications highlight the value of Doppler ultrasound in evaluation of tricuspid flow, however, these results require confirmation.

  6. Studies of Impedance in Cardiac Tissue Using Sucrose Gap and Computer Techniques

    PubMed Central

    McCann, Frances V.; Stibitz, George R.; Huguenin, Jan

    1973-01-01

    Impedances of cardiac cells of an insect were determined as a function of time to test the effects of sucrose and oil as insulating media in a gap arrangement. Impedance values are shown to increase markedly with time when sucrose is used as the insulating agent. Although impedance values are steady when oil is used, it is suggested that a layer of trapped electrolyte provides a shunt pathway and seriously impairs the validity of the measurements. A quick wash with sucrose followed by oil does not alleviate the situation but leaves a layer of sucrose trapped at the tissue-medium interface into which ions diffuse. The hypotheses (a) that the diffusion of intracellular K+ into the sucrose would result in an increase in tissue impedance and (b) that a layer of trapped electrolyte under the oil film provides a shunt pathway are examined by computer analyses of a simple model. ImagesFigure 1AFigure 1B PMID:4754198

  7. Automatic segmentation of the left ventricle in cardiac MRI using local binary fitting model and dynamic programming techniques.

    PubMed

    Hu, Huaifei; Gao, Zhiyong; Liu, Liman; Liu, Haihua; Gao, Junfeng; Xu, Shengzhou; Li, Wei; Huang, Lu

    2014-01-01

    Segmentation of the left ventricle is very important to quantitatively analyze global and regional cardiac function from magnetic resonance. The aim of this study is to develop a novel algorithm for segmenting left ventricle on short-axis cardiac magnetic resonance images (MRI) to improve the performance of computer-aided diagnosis (CAD) systems. In this research, an automatic segmentation method for left ventricle is proposed on the basis of local binary fitting (LBF) model and dynamic programming techniques. The validation experiments are performed on a pool of data sets of 45 cases. For both endo- and epi-cardial contours of our results, percentage of good contours is about 93.5%, the average perpendicular distance are about 2 mm. The overlapping dice metric is about 0.91. The regression and determination coefficient between the experts and our proposed method on the LV mass is 1.038 and 0.9033, respectively; they are 1.076 and 0.9386 for ejection fraction (EF). The proposed segmentation method shows the better performance and has great potential in improving the accuracy of computer-aided diagnosis systems in cardiovascular diseases.

  8. Carotid Catheterization and Automated Blood Sampling Induce Systemic IL-6 Secretion and Local Tissue Damage and Inflammation in the Heart, Kidneys, Liver and Salivary Glands in NMRI Mice

    PubMed Central

    Teilmann, Anne Charlotte; Rozell, Björn; Kalliokoski, Otto; Hau, Jann; Abelson, Klas S. P.

    2016-01-01

    Automated blood sampling through a vascular catheter is a frequently utilized technique in laboratory mice. The potential immunological and physiological implications associated with this technique have, however, not been investigated in detail. The present study compared plasma levels of the cytokines IL-1β, IL-2, IL-6, IL-10, IL-17A, GM-CSF, IFN-γ and TNF-α in male NMRI mice that had been subjected to carotid artery catheterization and subsequent automated blood sampling with age-matched control mice. Body weight and histopathological changes in the surgical area, including the salivary glands, the heart, brain, spleen, liver, kidneys and lungs were compared. Catheterized mice had higher levels of IL-6 than did control mice, but other cytokine levels did not differ between the groups. No significant difference in body weight was found. The histology revealed inflammatory and regenerative (healing) changes at surgical sites of all catheterized mice, with mild inflammatory changes extending into the salivary glands. Several catheterized mice had multifocal degenerative to necrotic changes with inflammation in the heart, kidneys and livers, suggesting that thrombi had detached from the catheter tip and embolized to distant sites. Thus, catheterization and subsequent automated blood sampling may have physiological impact. Possible confounding effects of visceral damage should be assessed and considered, when using catheterized mouse models. PMID:27832170

  9. Comparison of Urinary Tract Infection Rates Associated with Transurethral Catheterization, Suprapubic Tube and Clean Intermittent Catheterization in the Postoperative Setting: A Network Meta-Analysis.

    PubMed

    Han, Christopher S; Kim, Sinae; Radadia, Kushan D; Zhao, Philip T; Elsamra, Sammy E; Olweny, Ephrem O; Weiss, Robert E

    2017-07-20

    We performed a network meta-analysis of available randomized, controlled trials to elucidate the risks of urinary tract infection associated with transurethral catheterization, suprapubic tubes and intermittent catheterization in the postoperative setting. PubMed®, EMBASE® and Google Scholar™ searches were performed for eligible randomized, controlled trials from January 1980 to July 2015 that included patients who underwent transurethral catheterization, suprapubic tube placement or intermittent catheterization at the time of surgery and catheterization lasting up to postoperative day 30. The primary outcome of comparison was the urinary tract infection rate via a network meta-analysis with random effects model using the netmeta package in R 3.2 (www.r-project.org/). Included in analysis were 14 randomized, controlled trials in a total of 1,391 patients. Intermittent catheterization and suprapubic tubes showed no evidence of decreased urinary tract infection rates compared to transurethral catheterization. Suprapubic tubes and intermittent catheterization had comparable urinary tract infection rates (OR 0.903, 95% CI 0.479-2.555). On subgroup analysis of 10 randomized, controlled trials with available mean catheterization duration data in a total of 928 patients intermittent catheterization and suprapubic tube were associated with significantly decreased risk of urinary tract infection compared to transurethral catheterization when catheterization duration was greater than 5 days (OR 0.173, 95% CI 0.073-0.412 and OR 0.142, 95% CI 0.073-0.276, respectively). Transurethral catheterization is not associated with an increased urinary tract infection risk compared to suprapubic tubes and intermittent catheterization if catheterization duration is 5 days or less. However, a suprapubic tube or intermittent catheterization is associated with a lower rate of urinary tract infection if longer term catheterization is expected in the postoperative period. Copyright

  10. [Suprahepatic vein catheterization in 4 cases of severe septic shock].

    PubMed

    Inzunza, C; Cornu, M; Bruhn, A; Castillo, L; Bugedo, G; Acuña, D; Medeiros, S; Hernández, G

    2001-05-01

    Splanchnic hypoperfusion, with pathogenic implications for multiple organ failure, can occur during septic shock. We report four patients with septic shock in whom regional hepatosplenic splanchnic perfusion was monitored through suprahepatic vein catheterization and gastric tonometry. Suprahepatic lactate and oxygen saturation showed splanchnic hypoperfusion in all patients. These parameters improved only in the patient that survived. Gastric tonometry was more inconsistent. We conclude that suprahepatic vein catheterization could have a role in the management of septic shock.

  11. Nuclear cardiac

    SciTech Connect

    Slutsky, R.; Ashburn, W.L.

    1982-01-01

    The relationship between nuclear medicine and cardiology has continued to produce a surfeit of interesting, illuminating, and important reports involving the analysis of cardiac function, perfusion, and metabolism. To simplify the presentation, this review is broken down into three major subheadings: analysis of myocardial perfusion; imaging of the recent myocardial infarction; and the evaluation of myocardial function. There appears to be an increasingly important relationship between cardiology, particularly cardiac physiology, and nuclear imaging techniques. (KRM)

  12. [Central venous catheterization complication by a guide wire].

    PubMed

    Araki, Yoshiyuki; Fukuda, Isao; Hirano, Masato; Matsuoka, Nobuhiro; Kazama, Tomiei

    2009-03-01

    Central venous catheterization using the Seldinger technique is a well known and often used method. On the other hand, there are also well known complications by needle puncture or by indwelling catheter, there are few reports about a guide wire which got hung up around the tricuspid valve. We report a case in which a guide wire got hung up to the chordae tendineae of the tricuspid valve. To insert the AVA 3Xi (Edwards life science Co. Iervine) from the right internal jugular vein, we inserted a guide wire without ease. Resistance appeared when we tried to remove the wire for 20 cm from the inserted state. The X-ray and the transesophageal echocardiography, showed the guide wire in the right ventricle. As actions to be taken, we advanced the central vein catheter of the EXCV catheter kit (Nippon Sherwood Medical Industries Co., Ltd.) to the tip, and a the guide wire was easily removed. There are many reports of the complication by the central venepuncture, but there are few reports about the guide wire which was entrapped in the vicinity of a tricuspid valve. The tip of the guide wire in this case was bent excessively, but the cause of the damage did not become clear by investigation. When a guide wire became hard to withdraw, we should never withdraw a guide wire blindly, but should search a cause and we should use the material which was matched with the cause.

  13. Intermittent catheterization to obtain catheter-free bladder function in spinal cord injury.

    PubMed

    Sperling, K B

    1978-01-01

    The intermittent bladder catheterization technique has been proposed as an effective way of eliminating the need for an inlying. Foley catheter in patients with neurovesical dysfunction following spinal cord injury. In the study reported here, a group of 41 male patients with spinal cord injuries achieved a catheter-free state with this method. Of these 41 patients, 19 have been followed for 1 year. Data obtained from the 19 patients are presented here for comparison with data from other recent studies. In the present study, the patients' fluid intake was restricted to 2,000 cc daily. A detrusor reflex was triggered by lower abdominal percussion followed by a Credé maneuver. A 6-hour catheterization schedule was used unless autonomic dysreflexia required more frequent catheterizations. Ascorbic acid, methenamine mandelate and nitrofurantoin were routinely administered, and specific antibiotics were also given following trial off-catheter, depending on the results of urine cultures and sensitivity studies. All patients achieved a catheter-free state in an average time of 17.1 days; no late failures have occurred. Two patients developed vesicoureteral reflux, but no evidence of hydronephrosis was observed. At 1 year only 16% of the patients were found to have infected urine, as compared to 100% at initiation of the trial off-catheter.

  14. Validation of high-resolution echocardiography and magnetic resonance imaging vs. high-fidelity catheterization in experimental pulmonary hypertension.

    PubMed

    Urboniene, Dalia; Haber, Idith; Fang, Yong-Hu; Thenappan, Thenappan; Archer, Stephen L

    2010-09-01

    High-frequency echocardiography and high-field-strength magnetic resonance imaging (MRI) are new noninvasive methods for quantifying pulmonary arterial hypertension (PAH) and right ventricular (RV) hypertrophy (RVH). We compared these noninvasive methods of assessing the pulmonary circulation to the gold standard, cardiac catheterization (micromanometer-tipped catheters), in rats with monocrotaline-induced PAH and normal controls. Closed-chest, Sprague-Dawley rats were anesthetized with inhaled isoflurane (25 monocrotaline, 6 age-matched controls). Noninvasive studies used 37.5-MHz ultrasound (Vevo 770; VisualSonics) or a 9.4-T MRI (Bruker BioSpin). Catheterization used a 1.4-F micromanometer-tipped Millar catheter and a thermodilution catheter to measure cardiac output (CO). We compared noninvasive measures of pulmonary artery (PA) pressure (PAP) using PA acceleration time (PAAT) and CO, using the geometric PA flow method and RV free wall (RVFW) thickness/mass with cardiac catheterization and/or autopsy. Blinded operators performed comparisons using each method within 2 days of another. In a subset of rats with monocrotaline PAH, weekly echocardiograms, catheterization, and autopsy data assessed disease progression. Heart rate was similar during all studies (>323 beats/min). PAAT shortened, and the PA flow envelope displayed systolic "notching," reflective of downstream vascular remodeling/stiffening, within 3 wk of monocrotaline. MRI and echocardiography measures of PAAT were highly correlated (r(2) = 0.87) and were inversely proportional to invasive mean PAP (r(2) = 0.72). Mean PAP by echocardiography was estimated as 58.7 - (1.21 x PAAT). Invasive and noninvasive CO measurement correlated well (r(2) >or= 0.75). Noninvasive measures of RVFW thickness/mass correlated well with postmortem measurements. We conclude that high-resolution echocardiography and MRI accurately determine CO, PAP, and RV thickness/mass, offering similar results as high-fidelity right heart

  15. Safe genetic modification of cardiac stem cells using a site-specific integration technique.

    PubMed

    Lan, Feng; Liu, Junwei; Narsinh, Kazim H; Hu, Shijun; Han, Leng; Lee, Andrew S; Karow, Marisa; Nguyen, Patricia K; Nag, Divya; Calos, Michele P; Robbins, Robert C; Wu, Joseph C

    2012-09-11

    Human cardiac progenitor cells (hCPCs) are a promising cell source for regenerative repair after myocardial infarction. Exploitation of their full therapeutic potential may require stable genetic modification of the cells ex vivo. Safe genetic engineering of stem cells, using facile methods for site-specific integration of transgenes into known genomic contexts, would significantly enhance the overall safety and efficacy of cellular therapy in a variety of clinical contexts. We used the phiC31 site-specific recombinase to achieve targeted integration of a triple fusion reporter gene into a known chromosomal context in hCPCs and human endothelial cells. Stable expression of the reporter gene from its unique chromosomal integration site resulted in no discernible genomic instability or adverse changes in cell phenotype. Namely, phiC31-modified hCPCs were unchanged in their differentiation propensity, cellular proliferative rate, and global gene expression profile when compared with unaltered control hCPCs. Expression of the triple fusion reporter gene enabled multimodal assessment of cell fate in vitro and in vivo using fluorescence microscopy, bioluminescence imaging, and positron emission tomography. Intramyocardial transplantation of genetically modified hCPCs resulted in significant improvement in myocardial function 2 weeks after cell delivery, as assessed by echocardiography (P=0.002) and MRI (P=0.001). We also demonstrated the feasibility and therapeutic efficacy of genetically modifying differentiated human endothelial cells, which enhanced hind limb perfusion (P<0.05 at day 7 and 14 after transplantation) on laser Doppler imaging. The phiC31 integrase genomic modification system is a safe, efficient tool to enable site-specific integration of reporter transgenes in progenitor and differentiated cell types.

  16. Safe Genetic Modification of Cardiac Stem Cells Using a Site-Specific Integration Technique

    PubMed Central

    Lan, Feng; Liu, Junwei; Narsinh, Kazim H.; Hu, Shijun; Han, Leng; Lee, Andrew S.; Karow, Marisa; Nguyen, Patricia K.; Nag, Divya; Calos, Michele P.; Robbins, Robert C.; Wu, Joseph C.

    2012-01-01

    Background Human cardiac progenitor cells (hCPCs) are a promising cell source for regenerative repair after myocardial infarction. Exploitation of their full therapeutic potential may require stable genetic modification of the cells ex vivo. Safe genetic engineering of stem cells, using facile methods for site-specific integration of transgenes into known genomic contexts, would significantly enhance the overall safety and efficacy of cellular therapy in a variety of clinical contexts. Methods and Results We employed the phiC31 site-specific recombinase to achieve targeted integration of a triple fusion reporter gene into a known chromosomal context in hCPCs and human endothelial cells (hECs). Stable expression of the reporter gene from its unique chromosomal integration site resulted in no discernible genomic instability or adverse changes in cell phenotype. Namely, phiC31-modified hCPCs were unchanged in their differentiation propensity, cellular proliferative rate, and global gene expression profile when compared to unaltered control hCPCs. Expression of the triple fusion reporter gene enabled multimodal assessment of cell fate in vitro and in vivo using fluorescence microscopy, bioluminescence imaging (BLI), and positron emission tomography (PET). Intramyocardial transplantation of genetically modified hCPCs resulted in significant improvement in myocardial function two weeks after cell delivery, as assessed by echocardiography (P = 0.002) and magnetic resonance imaging (P = 0.001). We also demonstrated the feasibility and therapeutic efficacy of genetically modifying differentiated hECs, which enhanced hindlimb perfusion (P<0.05 at day 7 and 14 after transplantation) on laser Doppler imaging. Conclusions The phiC31 integrase genomic modification system is a safe, efficient tool to enable site-specific integration of reporter transgenes in progenitor and differentiated cell types. PMID:22965984

  17. Comparative evaluation of blood salvage techniques in patients undergoing cardiac surgery with cardiopulmonary bypass.

    PubMed

    Gunaydin, Serdar; Robertson, Craig; Budak, Ali Baran; Gourlay, Terence

    2017-08-01

    The primary objective of this study was to test and compare the efficacy of currently available intraoperative blood salvage systems via a demonstration of the level of increase in percentage concentration of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in the end product. In a prospective, randomized study, data of 80 patients undergoing elective cardiac surgery with cardiopulmonary bypass in a 6-month period was collected, of which the volume aspirated from the surgical field was processed by either the HemoSep Novel Collection Bag (Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad Homburg, Germany) (N=40) (Group 2). Hematocrit levels increased from 23.05%±2.7 to 43.02%±12 in Group 1 and from 24.5±2 up to 55.2±9 in Group 2 (p=0.013). The mean number of platelets rose to 225200±47000 from 116400 ±40000 in the HemoSep and decreased from 125200±25000 to 96500±30000 in the cell-saver group (p=0.00001). The leukocyte count was concentrated significantly better in Group 1 (from 10100±4300 to 18120±7000; p=0.001). IL-6 levels (pg/dL) decreased from 223±47 to 83±21 in Group 1 and from 219±40 to 200±40 in Group 2 (p=0.001). Fibrinogen was protected significantly better in the HemoSep group (from 185±35 to 455±45; p=0.004). Intraoperative blood salvage systems functioned properly and the resultant blood product was superior in terms of red blood cell species. The HemoSep group had significantly better platelet and leukocyte concentrations and fibrinogen content.

  18. [Multidetector computed tomography assessment of cardiac comorbidity in patients with chronic obstructive pulmonary disease].

    PubMed

    Bastarrika, G; Simón-Yarza, I; Viteri-Ramírez, G; Etxano, J; Slon, P J

    2013-01-01

    Cardiac comorbidity is one of the most important prognostic factors in lung disease, especially in chronic obstructive pulmonary disease (COPD). The imaging techniques available for the study of this systemic manifestation concomitant with COPD include heart catheterization, transthoracic echocardiography, and magnetic resonance imaging. Multidetector computed tomography (MDCT) represents a significant advance in this field because it enables the acquisition of simultaneous studies of the cardiopulmonary anatomy that go beyond anatomic and morphologic analysis to include a functional approach to this condition. In this article, we review the practical aspects necessary to evaluate cardiac comorbidity in patients with COPD, both from the point of view of pulmonary hypertension and of the analysis of ventricular dysfunction and coronary heart disease. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  19. Evaluation of the influence of pulmonary hypertension in ultra-fast-track anesthesia technique in adult patients undergoing cardiac surgery

    PubMed Central

    da Silva, Paulo Sérgio; Cartacho, Márcio Portugal Trindade; de Castro, Casimiro Cardoso; Salgado Filho, Marcello Fonseca; Brandão, Antônio Carlos Aguiar

    2015-01-01

    Objective To evaluate the influence of pulmonary hypertension in the ultra-fast-track anesthesia technique in adult cardiac surgery. Methods A retrospective study. They were included 40 patients divided into two groups: GI (without pulmonary hypertension) and GII (with pulmonary hypertension). Based on data obtained by transthoracic echocardiography. We considered as the absence of pulmonary hypertension: a pulmonary artery systolic pressure (sPAP) <36 mmHg, with tricuspid regurgitation velocity <2.8 m/s and no additional echocardiographic signs of PH, and PH as presence: a sPAP >40 mmHg associated with additional echocardiographic signs of PH. It was established as influence of pulmonary hypertension: the impossibility of extubation in the operating room, the increase in the time interval for extubation and reintubation the first 24 hours postoperatively. Univariate and multivariate analyzes were performed when necessary. Considered significant a P value <0.05. Results The GI was composed of 21 patients and GII for 19. All patients (100%) were extubated in the operating room in a medium time interval of 17.58±8.06 min with a median of 18 min in GII and 17 min in GI. PH did not increase the time interval for extubation (P=0.397). It required reintubation of 2 patients in GII (5% of the total), without statistically significant as compared to GI (P=0.488). Conclusion In this study, pulmonary hypertension did not influence on ultra-fast-track anesthesia in adult cardiac surgery. PMID:27163419

  20. A dosimetric study of cardiac dose sparing using the reverse semi-decubitus technique for left breast and internal mammary chain irradiation.

    PubMed

    Niglas, Mark; McCann, Claire; Keller, Brian M; Makhani, Nadiya; Presutti, Joseph; Vesprini, Danny; Rakovitch, Eileen; Elzibak, Alyaa; Mashouf, Shahram; Lee, Justin

    2016-01-01

    Breath-hold techniques can reduce cardiac dose in breast radiotherapy. The reverse semi-decubitus (RSD) technique is an alternative free-breathing method used at our centre. This study compares the dosimetry of free-breathing supine, RSD and moderate deep inspiration breath-hold (mDIBH) techniques. Twelve patients with left-sided breast cancer who were simulated using standard supine, RSD and mDIBH techniques were identified retrospectively. New plans using standard breast tangents and techniques for internal mammary chain (IMC) nodal coverage were assessed. Using standard tangents, mean heart dose, heart V25Gy and mean left anterior descending artery (LAD) dose were found to be significantly lower for RSD and mDIBH when compared to free-breathing supine (p ⩽ 0.03). Using wide-tangents, the maximum LAD point dose was also lower for RSD and mDIBH (p ⩽ 0.02). There were no statistically significant dosimetric differences found between the RSD and mDIBH simulation techniques for standard breast-tangent plans, though organ-at-risk doses were lower for mDIBH in wide-tangent plans. There was no improvement in cardiac dosimetry between RSD and free-breathing supine when using an electron field IMC plan. For patients unable to tolerate breath-hold, the RSD technique is an alternative approach that can reduce cardiac dose. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Anticoagulation monitoring during cardiac surgery: a review of current and emerging techniques.

    PubMed

    Despotis, G J; Gravlee, G; Filos, K; Levy, J

    1999-10-01

    The literature does not consistently support the importance of anticoagulation monitoring techniques during CPB. This is best reflected by studies that have evaluated the impact of the ACT method on blood loss and transfusion outcomes. Inconsistent findings from studies that evaluated the impact of ACT monitoring may be related to either suboptimal study design (i.e., retrospective, unblinded, nonrandomized) or possibly the diagnostic inprecision of the ACT method used in these studies. There are a small number of well-controlled studies, some of which suggest that bleeding and transfusion outcomes can be improved by refining heparin monitoring techniques, either by sustaining better anticoagulation during CPB or by optimizing protamine doses (i.e., when empiric protocols result in excessive protamine doses). More well-controlled studies are needed to better define the importance of anticoagulation management during CPB.

  2. Three-dimensional techniques and artificial intelligence in thallium-201 cardiac imaging

    SciTech Connect

    DePuey, E.G.; Garcia, E.V.; Ezquerra, N.F.

    1989-06-01

    Three-dimensional reconstruction techniques including bull's-eye polar-coordinate maps, surface rendering, and surface modeling have been developed that help interpreting physicians assimilate complex 3-D tomographic data. Comparison of patient data with normal files highlights myocardial perfusion abnormalities, thus facilitating their recognition. In addition, AI systems that use heuristically defined rules derived from an expert knowledge base assist inexperienced observers in drawing conclusions regarding scan abnormalities.24 references.

  3. Transseptal Leftventricular Endocardial Pacing is an Alternative Technique in Cardiac Resynchronization Therapy. One Year Experience in a High Volume Center.

    PubMed

    Neuhoff, I; Szilágyi, S; Molnár, L; Osztheimer, I; Zima, E; Dan, G A; Merkely, B; Gellér, L

    2016-01-01

    In patients receiving cardiac resynchronization therapy (CRT), failure rate to implant the left ventricular (LV) lead by the traditional trans-venous approach is 4-8%. Surgical epicardial implantation is considered as an alternative, but this technique is not without morbidity. Evidence from case documentation and from small trial batches demonstrated the viability of endocardial LV lead implantation where surgical epicardial lead placement is not applicable. Four patients were implanted with endocardial LV lead using the transseptal atrial approach after unsuccessful transvenous implantation. Implantation of an endocardial active fixation LV leads was successful in all patients with stable electrical parameters immediately after implantation and over the follow-up period. All patients received anticoagulation therapy in order to target the international normalized ratio of 2.5-3.5 and have not experienced any thromboembolic, hemorrhagic events, or infection. Follow-up echocardiography indicated significant improvement of LV systolic function (24 + 4.9 to 32 + 5.1 %, P = 0.023) with a notable improvement of the functional status. Endocardial left ventricular lead implantation can be a valuable and safe alternative technique to enable LV stimulation in high surgical risk patients where standard coronary sinus implant is unsuccessful.

  4. Treatment Techniques to Reduce Cardiac Irradiation for Breast Cancer Patients Treated with Breast-Conserving Surgery and Radiation Therapy: A Review

    PubMed Central

    Beck, Robert E.; Kim, Leonard; Yue, Ning J.; Haffty, Bruce G.; Khan, Atif J.; Goyal, Sharad

    2014-01-01

    Thousands of women diagnosed with breast cancer each year receive breast-conserving surgery followed by adjuvant radiation therapy. For women with left-sided breast cancer, there is risk of potential cardiotoxicity from the radiation therapy. As data have become available to quantify the risk of cardiotoxicity from radiation, strategies have also developed to reduce the dose of radiation to the heart without compromising radiation dose to the breast. Several broad categories of techniques to reduce cardiac radiation doses include breath hold techniques, prone positioning, intensity-modulated radiation therapy, and accelerated partial breast irradiation, as well as many small techniques to improve traditional three-dimensional conformal radiation therapy. This review summarizes the published scientific literature on the various techniques to decrease cardiac irradiation in women treated to the left breast for breast cancer after breast-conserving surgery. PMID:25452938

  5. Application of radionuclide ventriculography to cardiac screening

    SciTech Connect

    Lindsay, J. Jr.; Milner, M.R.; Chandeysson, P.L.; Rodman, D.J.; Okin, P.M.; Goldstein, S.A.

    1989-05-01

    Screening asymptomatic individuals for latent coronary disease often requires sequential testing because exercise electrocardiography typically produces more false positive than true positive results in a population with a low prevalence of coronary disease. Cardiac scintigraphy is a technique that may be employed as a confirmatory test in lieu of coronary arteriography to further evaluate the significance of a positive exercise electrocardiogram. Radionuclide ventriculography was employed in 98 asymptomatic individuals who were considered to be at moderate risk of heart disease after risk factor analysis and exercise electrocardiography. Seventeen (17%) patients had an abnormal study and underwent cardiac catheterization. Seven had coronary artery disease, two had cardiomyopathy, and eight were normal. Eighty-one (83%) patients had a normal study. Because the sensitivity of radionuclide ventriculography is 63-80%, it was postulated that 2 to 5 individuals with disease were missed. Thus, from a population with an 11-14% prevalence of disease, two subsets were identified. A large subset in which a prevalence of 2-6% could be estimated was separated from a much smaller one in which a prevalence of approximately 50% was demonstrated.

  6. [Cardiac tamponade after withdrawal of a peripheral access central catheter].

    PubMed

    García-Galiana, E; Sanchis-Gil, V; Martínez-Navarrete, M Á

    2015-03-01

    Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient's arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis.

  7. Techniques for efficient, real-time, 3D visualization of multi-modality cardiac data using consumer graphics hardware.

    PubMed

    Levin, David; Aladl, Usaf; Germano, Guido; Slomka, Piotr

    2005-09-01

    We exploit consumer graphics hardware to perform real-time processing and visualization of high-resolution, 4D cardiac data. We have implemented real-time, realistic volume rendering, interactive 4D motion segmentation of cardiac data, visualization of multi-modality cardiac data and 3D display of multiple series cardiac MRI. We show that an ATI Radeon 9700 Pro can render a 512x512x128 cardiac Computed Tomography (CT) study at 0.9 to 60 frames per second (fps) depending on rendering parameters and that 4D motion based segmentation can be performed in real-time. We conclude that real-time rendering and processing of cardiac data can be implemented on consumer graphics cards.

  8. Evaluation of the Transverse Oscillation Technique for Cardiac Phased Array Imaging: A Theoretical Study.

    PubMed

    Heyde, Brecht; Bottenus, Nick; D'hooge, Jan; Trahey, Gregg E

    2017-02-01

    The transverse oscillation (TO) technique can improve the estimation of tissue motion perpendicular to the ultrasound beam direction. TOs can be introduced using plane wave (PW) insonification and bilobed Gaussian apodization (BA) on receive (abbreviated as PWTO). Furthermore, the TO frequency of PWTO can be doubled after a heterodyning demodulation process is performed (abbreviated as PWTO*). This paper is concerned with identifying the limitations of the PWTO technique in the specific context of myocardial deformation imaging with phased arrays and investigating the conditions in which it remains advantageous over traditional focused (FOC) beamforming. For this purpose, several tissue phantoms were simulated using Field II, undergoing a wide range of displacement magnitudes and modes (lateral, axial, and rotational motions). The Cramer-Rao lower bound was used to optimize TO beamforming parameters and theoretically predict the fundamental tracking performance limits associated with the FOC, PWTO, and PWTO* beamforming scenarios. This framework was extended to also predict the performance for BA functions that are windowed by the physical aperture of the transducer, leading to higher lateral oscillations. It was found that windowed BA functions resulted in lower jitter errors compared with traditional BA functions. PWTO* outperformed FOC at all investigated signal-to-noise ratio (SNR) levels but only up to a certain displacement, with the advantage rapidly decreasing when the SNR increased. These results suggest that PWTO* improves lateral tracking performance, but only when interframe displacements remain relatively low. This paper concludes by translating these findings into a clinical environment by suggesting optimal scanner settings.

  9. Addressing Assumptions for the Use of Non-invasive Cardiac Output Measurement Techniques During Exercise in COPD.

    PubMed

    Perrault, Hélène; Richard, Ruddy; Kapchinsky, Sophia; Baril, Jacinthe; Bourbeau, Jean; Taivassalo, Tanja

    2016-01-01

    The multifactorial functional limitation of COPD increasingly demonstrates the need for an integrated circulatory assessment. In this study cardiac output (Qc) derived from non-inert (CO2-RB), inert (N2O-RB) gas rebreathing approaches and bioimpedance were compared to examine the limitations of currently available non-invasive techniques for exercise Qc determination in patients with chronic lung disease. Thirteen COPD patients (GOLD II-III) completed three constant cycling bouts at 20, 35, and 50% of peak work on two occasions to assess Qc with bioimpedance as well as using CO2-RB and N2O-RB for all exercise tests. Results showed significantly lower Qc using the N2O-RB or end-tidal CO2-derived Qc compared to the PaCO2-derived CO2-RB or the bioimpedance at rest and for all exercise intensities. End-tidal CO2-derived values are however not statistically different from those obtained using inert-gas rebreathing. This study show that in COPD patients, CO2-rebreathing Qc values obtained using PaCO2 contents which account for any gas exchange impairment or inadequate gas mixing are similar to those obtained using thoracic bioimpedance. Alternately, the lower values for N2O rebreathing derived Qc indicates the inability of this technique to account for gas exchange impairment in the computation of Qc. These findings indicate that the choice of a gas rebreathing technique to measure Qc in patients must be dictated by the ability to include in the derived computations a correction for either gas exchange inadequacies and/or a vascular shunt.

  10. Does robotic technology make minimally invasive cardiac surgery too expensive? A hospital cost analysis of robotic and conventional techniques.

    PubMed

    Morgan, Jeffrey A; Thornton, Barbara A; Peacock, Joy C; Hollingsworth, Karen W; Smith, Craig R; Oz, Mehmet C; Argenziano, Michael

    2005-01-01

    While potential benefits of robotic technology include decreased morbidity and improved recovery, some have suggested a prohibitively high cost. This study was undertaken to compare actual hospital costs of robotically assisted cardiac procedures with conventional techniques. We conducted a retrospective review of clinical and financial data of 20 patients who underwent atrial septal defect (ASD) closure and 20 patients who underwent mitral valve repair (MVr) using either robotic techniques or a conventional approach with a sternotomy. Total hospital cost (actual resource consumption) was subdivided into operative and postoperative costs. Robotic technology did not significantly increase total hospital cost for ASD closure or MVr (p = 0.518 and p = 0.539). However, when including the initial capital investment for the robot through amortization of institutional costs, total hospital cost was increased by $3,773 for robotic ASD closure and $3,444 for robotic MVr (p = 0.021 and p = 0.004). The major driver of cost for robotic cases (operating room time) decreased over time. Robotic technology did not significantly increase hospital cost. While the absolute cost for robotic surgery was higher than conventional techniques after taking into account the institutional cost of the robot, the major driver of cost for robotic procedures will likely continue to decrease, as the surgical team becomes increasingly familiar with robotic technology. Furthermore, other benefits, such as improvement in postoperative quality of life and more expeditious return to work may make a robotic approach cost-effective. Thus, it is possible that the benefits of robotic surgery may justify investment in this technology.

  11. Intermittent urethral catheterization-descriptive study at a Brazilian service.

    PubMed

    Mazzo, Alessandra; Souza-Junior, Valtuir D; Jorge, Beatriz M; Nassif, Aline; Biaziolo, Cintia F B; Cassini, Marcelo F; Santos, Raquel C R; Mendes, Isabel Amélia Costa

    2014-08-01

    The rehabilitation process of patients with neurogenic bladder involves psychosocial, cultural, political and economic human factors, representing a challenge for patients/caregivers as well as health professionals. This study was aimed at characterizing patients with neurogenic bladder who use intermittent urethral catheterization and were going through rehabilitation at a teaching hospital. This descriptive study was undertaken in the interior of São Paulo State-Brazil. All ethical guidelines were complied with. To collect the data, interviews were held during nursing consultations with patients more than 18years of age suffering from neurogenic bladder who used intermittent urethral catheterization. Most patients had spinal cord trauma, are single, male and gain a low income. They have been using catheterization for several years, at irregular frequencies, using polyethylene catheters. No standardization exists in the accomplishment of the practices used and strategies are needed to remodel the service. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Measurement of Mean Cardiac Dose for Various Breast Irradiation Techniques and Corresponding Risk of Major Cardiovascular Event

    PubMed Central

    Merino Lara, Tomas Rodrigo; Fleury, Emmanuelle; Mashouf, Shahram; Helou, Joelle; McCann, Claire; Ruschin, Mark; Kim, Anthony; Makhani, Nadiya; Ravi, Ananth; Pignol, Jean-Philippe

    2014-01-01

    After breast conserving surgery, early stage breast cancer patients are currently treated with a wide range of radiation techniques including whole breast irradiation (WBI), accelerated partial breast irradiation (APBI) using high-dose rate (HDR) brachytherapy, or 3D-conformal radiotherapy (3D-CRT). This study compares the mean heart’s doses for a left breast irradiated with different breast techniques. An anthropomorphic Rando phantom was modified with gelatin-based breast of different sizes and tumors located medially or laterally. The breasts were treated with WBI, 3D-CRT, or HDR APBI. The heart’s mean doses were measured with Gafchromic films and controlled with optically stimulated luminescent dosimeters. Following the model reported by Darby (1), major cardiac were estimated assuming a linear risk increase with the mean dose to the heart of 7.4% per gray. WBI lead to the highest mean heart dose (2.99 Gy) compared to 3D-CRT APBI (0.51 Gy), multicatheter (1.58 Gy), and balloon HDR (2.17 Gy) for a medially located tumor. This translated into long-term coronary event increases of 22, 3.8, 11.7, and 16% respectively. The sensitivity analysis showed that the tumor location had almost no effect on the mean heart dose for 3D-CRT APBI and a minimal impact for HDR APBI. In case of WBI large breast size and set-up errors lead to sharp increases of the mean heart dose. Its value reached 10.79 Gy for women with large breast and a set-up error of 1.5 cm. Such a high value could increase the risk of having long-term coronary events by 80%. Comparison among different irradiation techniques demonstrates that 3D-CRT APBI appears to be the safest one with less probability of having cardiovascular events in the future. A sensitivity analysis showed that WBI is the most challenging technique for patients with large breasts or when significant set-up errors are anticipated. In those cases, additional heart shielding techniques are required. PMID:25374841

  13. Comparison of Estimations Versus Measured Oxygen Consumption at Rest in Patients With Heart Failure and Reduced Ejection Fraction Who Underwent Right-Sided Heart Catheterization.

    PubMed

    Chase, Paul J; Davis, Paul G; Wideman, Laurie; Starnes, Joseph W; Schulz, Mark R; Bensimhon, Daniel R

    2015-12-01

    Cardiac output during right-sided heart catheterization is an important variable for patient selection of advanced therapies (cardiac transplantation and left ventricular assist device implantation). The Fick method to determine cardiac output is commonly used and typically uses estimated oxygen consumption (VO2) from 1 of 3 published empirical formulas. However, these estimation equations have not been validated in patients with heart failure and reduced ejection fraction (HFrEF). The objectives of the present study were to determine the accuracy of 3 equations for estimating VO2 compared with direct measurement of VO2 and determine the extent clinically significant error occurred in calculating cardiac output of patients with HFrEF. Breath-by-breath measurements of VO2 from 44 patients who underwent cardiac catheterization (66% men; age, 65 ± 11 years, left ventricular ejection fraction, 22 ± 6%) were compared with the derived estimations of LaFarge and Miettinen, Dehmer et al, and Bergstra et al. Single-sample t tests found only the mean difference between the estimation of LaFarge and Miettinen and the measured VO2 to be nonsignificant (-10.3 ml/min ± 6.2 SE, p = 0.053). Bland-Altman plots demonstrated unacceptably large limits of agreement for all equations. The rate of ≥25% error in the equations by LaFarge and Miettinen, Dehmer et al, and Bergstra et al occurred in 11%, 23%, and 45% of patients, respectively. Misclassification of cardiac index derived from each equation for 2 clinically important classifications: cardiogenic shock-21%, 23%, and 32% and hypoperfusion-16%, 16%, and 25%; respectively. In conclusion, these findings do not support the use of these empiric formulas to estimate the VO2 at rest in patients with HFrEF who underwent right-sided heart catheterization. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. A national clinical quality program for Veterans Affairs catheterization laboratories (from the Veterans Affairs clinical assessment, reporting, and tracking program).

    PubMed

    Maddox, Thomas M; Plomondon, Mary E; Petrich, Megan; Tsai, Thomas T; Gethoffer, Hans; Noonan, Gregory; Gillespie, Brian; Box, Tamara; Fihn, Stephen D; Jesse, Robert L; Rumsfeld, John S

    2014-12-01

    A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system.

  15. Fallopian tube catheterization in the treatment of proximal tubal obstruction: a systematic review and meta-analysis.

    PubMed

    De Silva, P M; Chu, J J; Gallos, I D; Vidyasagar, A T; Robinson, L; Coomarasamy, A

    2017-04-01

    studies scored satisfactorily on the Newcastle-Ottawa quality assessment scale. The pooled clinical pregnancy rate after tubal catheterization was found to be almost comparable to that after IVF. However, included studies were small, non-comparative series with significant clinical heterogeneity in population characteristics, follow-up and surgical equipment, technique and experience. These findings suggest fallopian tube catheterization as an alternative strategy to IVF in patients presenting with proximal tubal obstruction. Further research should focus on comparing different surgical techniques of fallopian tube catheterization with IVF and provide cumulative reproductive outcomes over long-term follow-up. No funding was required and the authors have no competing interests to declare. N/A.

  16. Pediatric patient radiation dosage during endomyocardial biopsies and right heart catheterization using a standard "ALARA" radiation reduction protocol in the modern fluoroscopic era.

    PubMed

    Sutton, Nicole J; Lamour, Jacqueline; Gellis, Laura A; Pass, Robert H

    2014-01-01

    Surveillance endomyocardial biopsy (EMB) with right heart catheterization (RHC) is the standard of care for the assessment of post cardiac transplantation rejection. This procedure has traditionally relied upon fluoroscopy, which exposes both patient and staff to the risks of ionizing radiation. These risks may be of particular concern in the transplant patient who must undergo many such procedures lifelong. We present data on a new "ALARA - As Low As Reasonably Achievable" protocol to reduce radiation exposure during the performance of RHC with EMB. All cardiac transplantation patients < 21 years of age who underwent RHC with EMB at The Children's Hospital at Montefiore from 6/11-12/11 were included. EMB was performed after all right heart pressures including wedge pressure and thermodilution cardiac output were measured. A novel ALARA protocol consisting of multiple features including ultra-low frame rates (2-3 fps), low fluoro dose/frame (10-18 nGy/frame), use of the "air-gap" technique for patients < 20 kg, and multiple other techniques aimed at minimizing use of fluoroscopy were employed in all cases. Demographics, procedural data and patient radiation exposure levels were collected and analyzed. 18 patients underwent 45 surveillance RHC with EMB in the study period and were the subject of this analysis. The mean age was 5.9 ± 6.1 years, weight was 20.4 kg ± 16.6 kg, and BSA was 0.75 ± 45 m(2) . PA fluoroscopy was used exclusively in 45/45. Vascular access was RFV (21/45; 47%), RIJV (17/45; 38%), LFV (4/45; 9%) and LIJV (3/45; 7%). The median number of EMB specimens obtained was 5 (range, 4-7). The median fluoroscopy time was 3.7 min (range, 1.2-9). The median air Kerma product (K) was 1.4 mGy (range, 0.4-14), and dose area product (DAP) was 15.8 uGym(2) (range, 3.5-144.5). The K and DAP are substantially lower than any prior published data for RHC/EMB in this patient group. There were no procedural complications. The use of a novel ALARA protocol for RHC

  17. Retrograde left ventricular catheterization in patients with an aortic valve prosthesis.

    PubMed

    Karsh, D L; Michaelson, S P; Langou, R A; Cohen, L S; Wolfson, S

    1978-05-01

    Twenty-seven consecutive patients with an aortic valve prosthesis were evaluated with retrograde left ventricular catheterization. The prosthesis was successfully crossed, permitting hemodynamic and angiographic evaluation of function of the prosthetic valve, left ventricle and mitral valve in all 27 cases. No complications were encountered. In patients with active endocarditis or recent embolization, the retrograde technique was avoided when possible, and attempts were made to utilize other techniques for study. However, three such patients were evaluated with the retrograde technique without complication. Examination of pressure tracings and cineangiographic films suggested only minor interference with valve poppet movement induced by the catheter transversing the valve. In three cases, hemodynamic data were recorded with the catheter crossing the prosthesis at one time and a paraprosthetic valve defect at another time. Identical gradients were recorded. This series documents the safety and efficacy of the retrograde approach, which is proposed as an alternative to the transseptal technique and left ventricular puncture.

  18. Microbial contamination of disinfectants used for intermittent self-catheterization.

    PubMed

    Hakuno, Harumasa; Yamamoto, Mitutaka; Oie, Shigeharu; Kamiya, Akira

    2010-07-01

    We investigated the microbial contamination of 0.02% benzalkonium chloride solution used in catheter kits for intermittent self-catheterization. Of 20 samples examined, 12 (60.0%) were contaminated with 8.8 x 10(2)-3.1 x 10(6) colony-forming units (cfu)/mL. The contaminants were Pseudomonas fluorescens, Burkholderia cepacia, and Aeromonas spp. These results showed that 0.02% benzalkonium chloride solution used for the lubrication/disinfection of catheters for self-catheterization is susceptible to contamination. Therefore, the lubricant/disinfectant for catheters for self-catheterization was changed from 0.02% benzalkonium chloride solution to 84-87% glycerin containing 0.02% benzalkonium chloride, and microbial contamination of the latter in catheter kits for self-catheterization was reinvestigated. Of 42 samples, 5 (11.9%) were contaminated with 20-2.0 x 10(4) cfu/mL. However, the rate of contamination of 84-87% glycerin containing 0.02% benzalkonium chloride was significantly lower than that of 0.02% benzalkonium chloride solution (P<0.0001). The contaminant of 84-87% glycerin containing 0.02% benzalkonium chloride was Bacillus spp. in all contaminated samples. In this survey, neither contaminants of 0.02% benzalkonium chloride solution nor the contaminant of 84-87% glycerin containing 0.02% benzalkonium chloride were the causative microbial species of urinary tract infection.

  19. Intermittent self-catheterization appliances for disabled patients.

    PubMed

    Robinson, John

    2006-12-01

    Occasionally, district nurses may be asked to teach a patient intermittent self-catheterization (ISC). However, if the patient has some form of physical disability that reduces their manual dexterity or limits their movement, should this stop the patient undertaking the procedure? This article outlines some of the appliances available to help disabled patients undertake ISC.

  20. Accidental catheterization of epidural venous plexus: tomographic analysis.

    PubMed

    Souza, Mariano Paiva; Magalhães, Edno; de Farias Cascudo, Elialba; Jogaib, Marco Antonio Dias; da Silva, Marcelo Carneiro

    2016-01-01

    Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  1. [Accidental catheterization of epidural venous plexus: tomographic analysis].

    PubMed

    Souza, Mariano Paiva; Magalhães, Edno; Cascudo, Elialba de Farias; Jogaib, Marco Antonio Dias; Silva, Marcelo Carneiro da

    2016-01-01

    Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  2. The learning curve of selective salpingography and tubal catheterization.

    PubMed

    Papaioannou, Spyros; Afnan, Masood; Girling, Alan J; Ola, Bolarinde; Hammadieh, Nehed; Coomarasamy, Aravinthan; Sharif, Kaldoun

    2002-05-01

    To determine the effect of increasing experience in fluoroscopically guided selective salpingography and tubal catheterization on radiation doses and screening times, thus establishing a learning curve for the procedure. Retrospective case note analysis. IVF center of an academic teaching hospital. Three hundred sixty-six patients with infertility seen over 3.5 years. Fluoroscopically guided selective salpingography and tubal catheterization. Reductions in radiation doses and screening times for different categories of selective salpingography and tubal catheterization, expressed as percentage reductions during the study period and reductions per 10 procedures. During the study period, The median dose of radiation decreased by 62.6%-71.9%, and the median screening time declined by 61.5%-78.5%. Reductions per 10 procedures were 2.5%-4.2% and 2.7%-5%, respectively. Significant reductions in radiation doses and screening times start early in a clinical team's practice of selective salpingography and tubal catheterization and continue even as trainees are added to the pool of operators.

  3. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  4. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  5. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  6. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  7. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  8. Pediatric cardiac emergencies.

    PubMed

    Lee, C; Mason, L J

    2001-06-01

    Successful management of pediatric cardiac emergencies requires an accurate diagnosis to institute an appropriate plan of therapy. The diagnosis, however, is not always straightforward, as evidenced by the nonspecific clinical picture that can be presented by congenital heart defects. Entertaining the possibility of a cardiac problem in neonates with pulmonary symptoms unresponsive to standard therapies is crucial for successful management of patients with congenital heart disease. In addition to ventilatory support, prostaglandin E1 infusions or emergency interventional cardiac catheterization is often a life-saving initial measure in patients with acutely decompensated congenital cardiac lesions that require a patent ductus arteriosus for survival. Pericardial tamponade is associated with various acquired and iatrogenic causes. Emergent pericardiocentesis is mandatory when cardiovascular compromise occurs. The goal of anesthetic management is to maintain cardiac output. With the increasing use of central venous catheters in neonatal ICUs and the high mortality rate for central venous catheter-related cardiac tamponade, the diagnosis must be considered in any patient with a central venous catheter in situ who acutely develops unexplained hypotension, bradycardia, and diminished pulses. Arrhythmias also can cause hemodynamic instability in infants and children. Supraventricular tachycardia is by far the most common emergently presenting arrhythmia in the pediatric population. Unstable patients require immediate intravenous adenosine or synchronized cardioversion. Complete heart block is rare, but it can lead to congestive heart failure and occasionally to cardiovascular collapse and sudden death. Emergency treatment of complete heart block includes pharmacologic support and temporary or permanent pacemaker placement as indicated. In infants, congestive heart failure usually is related to congenital heart disease, whereas in older children, it tends to be secondary

  9. [Percutaneous catheterization for extracorporeal membrane oxygenation: a retrospective case series].

    PubMed

    Li, X Y; He, H Y; Tang, X; Wang, R; Zhang, C Y; Wang, S Q; Sun, B; Tong, Z H

    2017-09-12

    Objective: To review the experience of percutaneous catheterization for extracorporeal membrane oxygenation (ECMO) by respiratory intensivists at a single institution. Methods: A retrospective review of 87 patients undergoing percutaneous catheterization for ECMO in Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital from November 2009 to January 2017. Subject demographics, type of support, cannulation configuration, types of cannulas, use of imaging modalities, and complications were recorded and summarized. Results: The 87 patients consisted of 61 males and 26 females. The average age was (47±16)years (range 15-82 years ). Fifty-six patients were given ECMO therapy because of acute respiratory distress syndrome(ARDS), and 16 were treated as a bridge for lung transplantation and 15 for other causes. Eighty-one cases were given VV-ECMO support, and 6 cases were given VA-ECMO support. The most commonly used cannulas were 15-17 F arterial cannulas and 21-23 F venous cannulas. Preinsertion ultrasound was performed in 62 patients (71%) . Bedside chest radiography was used to help adjust the position of the end of the cannula in 11 patients (13%). Percutaneous catheterization was successful in 85 cases (97%) , while it failed in 2 female patients due to thick subcutaneous fat layer, and open surgical approach was used. Percutaneous femoral artery collateral circulation was established by ourselves in 5 cases. One patient with femoral artery catheterization without collateral circulation had gangrene of limbs. The complications included 9 cases of catheter site hemorrhage, 4 catheter-related bloodstream infection and 1 pulmonary embolism during ECMO weaning. Conclusion: Percutaneous catheterization for ECMO can be performed with a high rate of success and a low rate of complications.

  10. Does Preprocedural Ultrasound Increase the First-Pass Success Rate of Epidural Catheterization Before Cesarean Delivery? A Randomized Controlled Trial.

    PubMed

    Tawfik, Mohamed Mohamed; Atallah, Magdy Mamdouh; Elkharboutly, Walaa Safaa; Allakkany, Nasser Sameh; Abdelkhalek, Mostafa

    2017-03-01

    Preprocedural ultrasound may improve the efficacy and safety of epidural catheterization, especially in difficult cases. Most studies of ultrasound-assisted epidural catheterization in the obstetric population are dated and nonblinded with inconsistent designs. This double-blind, randomized controlled study aimed to compare the ultrasound-assisted with the conventional palpation techniques for epidural catheterization in parturients undergoing cesarean delivery. We hypothesized that the use of preprocedural ultrasound would increase the success rate of epidural catheterization at the first needle pass. Eligible subjects were American Society of Anesthesiologists physical status II parturients with full-term singleton pregnancy undergoing elective cesarean delivery using double-interspace combined spinal-epidural anesthesia. Exclusion criteria were age <19 or >40 years, body mass index ≥35 kg/m, women presenting in labor or having any contraindication to neuraxial anesthesia, marked spinal deformity, previous spinal surgery, or impalpable anatomical landmarks. One hundred ten patients were randomly allocated into 2 equal groups (palpation and ultrasound groups). All procedures were performed by a single experienced anesthesiologist. Patients and investigators assessing the outcome data were blinded to group allocation. A systematic spinal ultrasound assessment and a sham procedure were performed in the ultrasound and palpation groups, respectively, before attempting epidural catheterization. The primary outcome was the rate of successful epidural catheterization at the first needle pass. Secondary outcomes were the rate of successful epidural catheterization at the first skin puncture, number of performed needle passes and skin punctures, duration of the epidural procedure, patient satisfaction from the procedure, and complications of the procedure (incidence of unintentional dural and vascular punctures, failed block, unilateral or patchy block, and backache

  11. Primary percutaneous coronary intervention in acute myocardial infarction: direct transportation to catheterization laboratory by emergency teams reduces door-to-balloon time.

    PubMed

    van de Loo, Andreas; Saurbier, Bernward; Kalbhenn, Johannes; Koberne, Frank; Zehender, Manfred

    2006-03-01

    Primary percutaneous coronary intervention (PCI) is the recommended revascularization strategy for patients presenting with acute ST-elevation myocardial infarction (STEMI). In most hospitals, transfer of patients with STEMI is organized from the emergency site via emergency room (medical and cardiologic evaluation) and then to the catheterization laboratory. In this prospective study, we sought to evaluate the effect of a logistic modification in this treatment process. Local emergency ambulance teams were instructed to identify and evaluate patients with STEMI eligible for direct PCI and to transport them directly to the cardiac catheterization laboratory for immediate percutaneous coronary intervention ("ER bypass"). This study prospectively included 74 consecutive patients with acute coronary syndromes (STEMI) and compared them with a matched historic control group ("ER evaluation"). Primary endpoint was the reduction in door-to-balloon time; secondary endpoint was quality of preclinical emergency diagnosis. Median door-to-balloon time was reduced by 27 min. Primary interventional success was achieved in 92% of patients. Preclinical emergency diagnoses were correct in 95% of patients. The preclinical emergency diagnosis of STEMI was reliable. Direct transport of patients with STEMI to the cardiac catheterization laboratory and early preclinical alert by the interventional PCI team significantly reduces door-to-balloon-times compared with established standard processes-of-care for patients considered for primary PCI.

  12. Fiberoptic ear densitometer for measurement of cardiac output.

    PubMed

    Sekelj, P; Retfalvi, S; Lavoie, A

    1978-02-01

    This study presents theory, operation, and evaluation of a new earpiece method for measurement of cardiac output using the multichannel fiberoptic system recently described. The system includes an earpiece of simple design and small size suitable for applications in all subjects regardless of their age or size. The method requires no withdrawal and analysis of blood samples for calibration. Compared with earlier techniques the present method, based on measurements in three distinct absorption bands in the infrared, provides an increase in accuracy of the estimations. This accuracy was tested in children undergoing routine cardiac catheterization. Comparisons were made in 39 instances (25 subjects) between simultaneously carried out determinations by the earpiece and cuvette densitometer methods. The agreement was good (r = 0.97, p less than 0.001), with a standard deviation of the differences of 0.479 litre/min, or 10.2% of the mean values derived from the cuvette curves. The regression equation describing the values derived from ear curves in terms of values from the cuvette curves differed only slightly from unity (Y = 0.167 + 0.985X). The usefulness of the fiberoptic earpiece technique both in clinical investigations and cardiovascular diagnosis was demonstrated.

  13. Complications of central venous catheterization in critically ill children.

    PubMed

    Karapinar, Bulent; Cura, Alphan

    2007-10-01

    Placement of central venous catheter is essential in the management of critically ill children. The purpose of the present paper was to evaluate the success rate, mechanical and thrombotic complications and risk factors associated with these complications from different central venous access sites in critically ill children. A prospective study was undertaken from February 2000 to March 2005 of 369 central venous catheterizations in children in a pediatric intensive care unit. The veins most frequently used were femoral vein (45%), subclavian vein (32.2%), and internal jugular vein (22.8%). Mean +/- SD duration of catheterization was 9.5 +/- 6.5 days. The procedure was performed under emergency conditions in 18% of patients with an overall success rate of 92.4%. The success rate was significantly lower in younger patients with subclavian catheterization. Insertion-related complications were noted, including 33 arterial punctures (8.9%), 27 cases of malposition (7.3%), 19 hematomas (5.2%), 12 cases of minor bleeding (3.3%), and three cases of pneumothorax (0.8%), and they were more common in the subclavian vein than in the internal jugular and femoral vein. Multiple attempts and failed attempts significantly correlated with higher incidence of complications. Maintenance-related complications included obstruction (n = 26; 7%), accidental removal (n = 14; 3.8%), central venous thrombosis (n = 8; 2.2%), subcutaneous extravasation (n = 14; 3.8%), dislodgment (n = 1; 0.25%), and extravascular infusion (n = 1; 0.25%). The frequency of catheter maintenance-related complications was significantly higher in femoral catheterizations and increased significantly with an increase in the duration of catheterization. A total of five serious complications were seen (pneumothorax in three, dislodgment in one and extravascular infusion in one) in the present series. Central venous catheterization in critically ill children is a relatively safe procedure, with a 1.3% rate of serious

  14. Pulmonary artery pseudoaneurysm after Swan-Ganz catheterization: a case presentation and review of literature.

    PubMed

    Nellaiyappan, Madhan; Omar, Hesham R; Justiz, Rafael; Sprenker, Collin; Camporesi, Enrico M; Mangar, Devanand

    2014-09-01

    The Swan-Ganz catheter for pulmonary artery (PA) cannulation was introduced in 1970 and has been utilized in the management of critically ill and cardiac patients. Although the routine use of this catheter has not been associated with better patient outcomes in prospective randomized trials, their ability to provide crucial hemodynamic measurements and the ease of bedside insertion makes them valuable in certain complex clinical scenarios. However, Swan-Ganz catheter insertion is not without complications. PA injury is the most serious complication suspected by the occurrence of hemoptysis after the procedure. We present a case of PA injury with pseudoaneurysm formation after Swan-Ganz catheterization along with a comprehensive review of literature. We reviewed all PubMed/Medline indexed articles published between 1993-2013, reporting the development of PA pseudoaneurysm after Swan-Ganz catheter use. Cases were analyzed with specific reference to patient demographics, indication for Swan-Ganz insertion, initial presenting symptom, duration between insertion and first evidence of PA injury, inciting event, site of pseudoaneurysm, treatment and outcome. Forty-one patients were identified from 27 papers. In the reviewed population, 87.8% were older than 60 years of age and 82.9% were females. Fifty-one percent of the patients had an episode of hemoptysis on the day of Swan-Ganz catheter insertion. Ninety-seven percent of the patients had PA pseudoaneurysm in the right pulmonary circulation. The admission-to-discharge mortality rate in the reviewed cohort was 15%. Cause of death in 22% of the cases was hemoptysis, while non-catheter related complications were responsible for the remaining deaths. PA injury is a feared complication after Swan-Ganz catheterization and can be fatal. In patients who develop massive or recurrent hemoptysis after Swan-Ganz catheter use, PA injury must be considered and airway protection should be employed along with appropriate catheter

  15. Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State.

    PubMed

    Hannan, Edward L; Samadashvili, Zaza; Cozzens, Kimberly; Walford, Gary; Holmes, David R; Jacobs, Alice K; Stamato, Nicholas J; Venditti, Ferdinand J; Sharma, Samin; King, Spencer B

    2014-02-01

    Appropriate use criteria for diagnostic catheterization (DC) were recently published. These criteria are yet to be examined for a large population of patients undergoing DC. New York State's Cardiac Diagnostic Catheterization Database was used to identify patients undergoing DC for coronary artery disease between 2010 and 2011 for suspected coronary artery disease. Patients were rated by the appropriate use criteria as appropriate, uncertain, and inappropriate for DC. The relationships between various patient characteristics and the appropriateness ratings were examined, along with the relationships between hospital-level inappropriateness, for DC and 2 other hospital-level variables (hospital DC volume and percutaneous coronary intervention inappropriateness). Of the 8986 patients who could be rated for appropriateness, 35.3% were rated as appropriate, 39.8% as uncertain, and 24.9% as inappropriate. Of the 2240 patients rated as inappropriate, 56.7% were asymptomatic/had no previous stress test/had low or intermediate global coronary artery disease risk, 36.0% had a previous stress test with low-risk findings and no symptoms, and 7.3% were symptomatic/had no previous stress test/had low pretest probability. The median hospital-level inappropriateness rate was 28.5%, with a maximum of 48.8% and a minimum of 8.6%. Hospital-level inappropriateness was not related to hospital volume or inappropriateness for percutaneous coronary intervention. One quarter of patients undergoing DC for suspected coronary artery disease were rated as inappropriate for the procedure, approximately two thirds of these inappropriate patients had no previous stress test, and ≈90% of inappropriate patients with no previous stress test were asymptomatic with low or intermediate global risk scores.

  16. Atlanto-occipital catheterization of young rats for long-term drug delivery into the lumbar subarachnoid space combined with in vivo testing and electrophysiology in situ.

    PubMed

    Kopach, Olga; Krotov, Volodymyr; Voitenko, Nana

    2017-10-01

    Catheterization has been widely used in neuroscience and pain research for local drug delivery. Though different modifications were developed, the use of young animals for spinal catheterization remains limited because of a little success rate. A reliable technique is needed to catheterize young animals aimed for in vivo testing combined with spinal cord electrophysiology, often limited by animal age, to facilitate pain research. We describe intrathecal catheterization of young rats (3-week-old) through atlanto-occipical approach for long-lasting drug delivery into the lumbar subarachnoid space. The technique represents a surgical approach of minimized invasiveness that requires PE-10 catheter and few equipment of standard laboratory use. Behavioral assessments revealed that spinal catheterization does not change peripheral sensitivity of different modalities (thermal and mechanical) and gives no rise to locomotive deficit or anxiety-like behavior in young rats. The long-term administration of genetic material (oligodeoxynucleotides given up to 4days), examined both in vivo and in situ, produced no adverse effects on basal peripheral sensitivity, but changed the AMPA receptor-mediated currents in sensory interneurons of the spinal cord. Dissimilar to already described methods, the method is designed for the use of young rats for behavioral testing in vivo and/or spinal cord electrophysiology in situ. A practical method for spinal catheterization of young animals designed for studies in vivo and in situ is proposed. The method is rapid and effective and should facilitate investigation of therapeutic effects on both systemic and subcellular levels, as an advantage over the existing methods. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. SU-E-T-622: Planning Technique for Passively-Scattered Involved-Node Proton Therapy of Mediastinal Lymphoma with Consideration of Cardiac Motion

    SciTech Connect

    Flampouri, S; Li, Z; Hoppe, B

    2015-06-15

    Purpose: To develop a treatment planning method for passively-scattered involved-node proton therapy of mediastinal lymphoma robust to breathing and cardiac motions. Methods: Beam-specific planning treatment volumes (bsPTV) are calculated for each proton field to incorporate pertinent uncertainties. Geometric margins are added laterally to each beam while margins for range uncertainty due to setup errors, breathing, and calibration curve uncertainties are added along each beam. The calculation of breathing motion and deformation effects on proton range includes all 4DCT phases. The anisotropic water equivalent margins are translated to distances on average 4DCT. Treatment plans are designed so each beam adequately covers the corresponding bsPTV. For targets close to the heart, cardiac motion effects on dosemaps are estimated by using a library of anonymous ECG-gated cardiac CTs (cCT). The cCT, originally contrast-enhanced, are partially overridden to allow meaningful proton dose calculations. Targets similar to the treatment targets are drawn on one or more cCT sets matching the anatomy of the patient. Plans based on the average cCT are calculated on individual phases, then deformed to the average and accumulated. When clinically significant dose discrepancies occur between planned and accumulated doses, the patient plan is modified to reduce the cardiac motion effects. Results: We found that bsPTVs as planning targets create dose distributions similar to the conventional proton planning distributions, while they are a valuable tool for visualization of the uncertainties. For large targets with variability in motion and depth, integral dose was reduced because of the anisotropic margins. In most cases, heart motion has a clinically insignificant effect on target coverage. Conclusion: A treatment planning method was developed and used for proton therapy of mediastinal lymphoma. The technique incorporates bsPTVs compensating for all common sources of uncertainties

  18. Simultaneous Characterization of Sympathetic and Cardiac Arms of the Baroreflex through Sequence Techniques during Incremental Head-Up Tilt

    PubMed Central

    Marchi, Andrea; Bari, Vlasta; De Maria, Beatrice; Esler, Murray; Lambert, Elisabeth; Baumert, Mathias; Porta, Alberto

    2016-01-01

    We propose a sympathetic baroreflex (sBR) sequence method for characterizing sBR from spontaneous beat-to-beat fluctuations of muscle sympathetic nerve activity (MSNA) and diastolic arterial pressure (DAP). The method exploits a previously defined MSNA variability quantifying the fluctuations of MSNA burst rate. The method is based on the detection of MSNA and DAP sequences characterized by the contemporaneous DAP increase and MSNA decrease or vice versa. The percentage of sBR sequences (SEQ%sBR) was taken as an indication of the degree of sBR solicitation and the average slope of the regression lines in the (DAP, MSNA) plane was taken as sBR sensitivity (sBRSSEQ) and expressed in bursts.s−1.mmHg−1. sBRSSEQ was compared to a more traditional estimate based on the baroreflex threshold analysis (sBRSBTA). An incremental head-up tilt protocol, carried out in 12 young healthy subjects (age: 20–36 yr, median = 22.5 yr, 9 females) sequentially tilted at 0, 20, 30, 40, 60° table inclinations, was utilized to set the sBR sequence method parameters. Traditional sequence analysis was exploited to estimate cardiac baroreflex (cBR) sensitivity (cBRSSEQ) and percentage of cBR sequences (SEQ%cBR). The head-up tilt induced the progressive increase of SEQ%sBR and SEQ%cBR and gradual decrease of both sBRSSEQ and cBRSSEQ, thus suggesting the gradual rise of the sBR and cBR solicitations and the progressive reduction of their effectiveness with the stimulus. sBRSSEQ was significantly associated with sBRSBTA. sBRSSEQ and cBRSSEQ were significantly correlated as well as SEQ%sBR and SEQ%cBR, even though the correlation was not strong, thus suggesting a certain degree of independence between the baroreflex arms. The proposed sBR sequence approach provides a dynamical characterization of the sBR alternative to more traditional static pharmacological and nonpharmacological methods and fully homogenous with the cBR sequence technique. PMID:27746741

  19. Simultaneous Characterization of Sympathetic and Cardiac Arms of the Baroreflex through Sequence Techniques during Incremental Head-Up Tilt.

    PubMed

    Marchi, Andrea; Bari, Vlasta; De Maria, Beatrice; Esler, Murray; Lambert, Elisabeth; Baumert, Mathias; Porta, Alberto

    2016-01-01

    We propose a sympathetic baroreflex (sBR) sequence method for characterizing sBR from spontaneous beat-to-beat fluctuations of muscle sympathetic nerve activity (MSNA) and diastolic arterial pressure (DAP). The method exploits a previously defined MSNA variability quantifying the fluctuations of MSNA burst rate. The method is based on the detection of MSNA and DAP sequences characterized by the contemporaneous DAP increase and MSNA decrease or vice versa. The percentage of sBR sequences (SEQ%sBR) was taken as an indication of the degree of sBR solicitation and the average slope of the regression lines in the (DAP, MSNA) plane was taken as sBR sensitivity (sBRSSEQ) and expressed in bursts(.)s(-1.)mmHg(-1). sBRSSEQ was compared to a more traditional estimate based on the baroreflex threshold analysis (sBRSBTA). An incremental head-up tilt protocol, carried out in 12 young healthy subjects (age: 20-36 yr, median = 22.5 yr, 9 females) sequentially tilted at 0, 20, 30, 40, 60° table inclinations, was utilized to set the sBR sequence method parameters. Traditional sequence analysis was exploited to estimate cardiac baroreflex (cBR) sensitivity (cBRSSEQ) and percentage of cBR sequences (SEQ%cBR). The head-up tilt induced the progressive increase of SEQ%sBR and SEQ%cBR and gradual decrease of both sBRSSEQ and cBRSSEQ, thus suggesting the gradual rise of the sBR and cBR solicitations and the progressive reduction of their effectiveness with the stimulus. sBRSSEQ was significantly associated with sBRSBTA. sBRSSEQ and cBRSSEQ were significantly correlated as well as SEQ%sBR and SEQ%cBR, even though the correlation was not strong, thus suggesting a certain degree of independence between the baroreflex arms. The proposed sBR sequence approach provides a dynamical characterization of the sBR alternative to more traditional static pharmacological and nonpharmacological methods and fully homogenous with the cBR sequence technique.

  20. Infective endocarditis at the tricuspid valve following central venous catheterization.

    PubMed

    Yamashita, Shu-ichi; Noma, Kenji; Kuwata, Go; Miyoshi, Kahori; Honaga, Kaoru

    2005-01-01

    We report a case of infective endocarditis at the tricuspid valve attributed to central venous catheterization. The patient was a 35-year-old woman who had multiple septic emboli in her lung due to tricuspid valve endocarditis after successful treatment of bronchiolitis obliterans organizing pneumonia. She also had right ileosacral arthritis. The case was closely related to catheter-associated Staphylococcus aureus bacteremia. She was treated with intravenous administration of vancomycin and surgical removal of vegetation and tricuspid valvuloplasty. Since infective endocarditis can be a complication of central venous catheterization with high morbidity and mortality, maximal precautions to minimize the risk, early detection, and appropriate treatment of these complications are mandatory to improve patients' outcome.

  1. Noninvasive aortic bloodflow by Pulsed Doppler Echocardiography (PDE) compared to cardiac output by the direct Fick procedure

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Left ventricular stroke volume was estimated from the systolic velocity integral in the ascending aorta by pulsed Doppler Echocardiography (PDE) and the cross sectional area of the aorta estimated by M mode echocardiography on 15 patients with coronary disease undergoing right catheterization for diagnostic purposes. Cardiac output was calculated from stroke volume and heart volume using the PDE method as well as the Fick procedure for comparison. The mean value for the cardiac output via the PDE method (4.42 L/min) was only 6% lower than for the cardiac output obtained from the Fick procedure (4.69 L/min) and the correlation between the two methods was excellent (r=0.967, p less than .01). The good agreement between the two methods demonstrates that the PDE technique offers a reliable noninvasive alternative for estimating cardiac output, requiring no active cooperation by the subject. It was concluded that the Doppler method is superior to the Fick method in that it provides beat by beat information on cardiac performance.

  2. [The central vein catheterization. 2. Procedure, step by step].

    PubMed

    Schmalz-Ott, Stéphane; Monti, Matteo; Vollenweider, Peter

    2008-10-29

    Several approaches exist for central vein catheterization. Mastery of the various steps of this procedure and understanding of the basics of asepsis are critical to prevent any complication. They also built the basis for an exhaustive communication with the patient, to obtain an informed consent. This article can in addition be used to develop a checklist in order to (self-)assess competence in procedural skills.

  3. Quality of life of patients using intermittent urinary catheterization 1

    PubMed Central

    Fumincelli, Laís; Mazzo, Alessandra; Martins, José Carlos Amado; Henriques, Fernando Manuel Dias; Orlandin, Leonardo

    2017-01-01

    ABSTRACT Objectives: measure and compare the quality of life of neurogenic bladder patients using intermittent urinary catheterization who were going through rehabilitation in Brazil and Portugal. Method: multicenter, quantitative, cross-sectional, observational-analytic and correlational study executed in Brazil and Portugal. Two data collection tools were used, being one questionnaire with sociodemographic and clinical data and the World Health Organization Quality of Life-bref. Patients were included who were over 18 years of age, suffering from neurogenic urinary bladder and using intermittent urinary catheterization. Results: in the sample of Brazilian (n = 170) and Portuguese (n = 52) patients, respectively, most patients were single (87-51.2%; 25-48.1%), had finished primary education (47-45.3%; 31-59.6%) and were retired (70-41.2%; 21-40.4%). Spinal cord injury was the main cause of using the urinary catheter in both countries. The Brazilian patients presented higher mean quality of life scores in the psychological domain (68.9) and lower scores in the physical domain (58.9). The Portuguese patients presented higher scores in the psychological domain (68.4) and lower scores in the environment domain (59.4). The execution of intermittent urinary self-catheterization was significant for both countries. Conclusions: in the two countries, these patients’ quality of life can be determined by the improvement in the urinary symptoms, independence, self-confidence, social relationships and access to work activities. PMID:28699993

  4. Superselective intracerebral catheterization for administration of oncolytic virotherapy in a case of diffuse intrinsic pontine glioma.

    PubMed

    Carceller, Fernando; Aleu, Aitziber; Casasco, Alfredo; Guimaraens, Leopoldo; López-Pino, Migel A; Madero, Luís; Ramírez, Manuel

    2014-10-01

    New therapies are needed to improve current results in diffuse intrinsic pontine glioma. We present here the initial experience of administering Celyvir, autologous mesenchymal stem cells infected with ICOVIR-5, an oncolytic adenovirus that selectively replicates in cancer cells, by means of superselective intra-arterial delivery, in a patient diagnosed of diffuse intrinsic pontine glioma. Feasibility, safety, and morbidity rates of the superselective catheterization technique are comparable with those of diagnostic angiography. The intra-arterial approach warrants a greater contact of the mesenchymal stem cells with the tumor mass, and minimizes hemorrhages or vascular disruption. The tolerance to the 2 administrations was excellent, with no acute or delayed adverse effect, underscoring the feasibility of this technique for the delivery of virotherapies and/or cellular therapies in this location.

  5. Clinical effect of peripherally inserted central catheters based on modified seldinger technique under guidance of vascular ultrasound

    PubMed Central

    Wang, Qingguo; Wang, Ni; Sun, Yuzhen

    2016-01-01

    Objective: To observe and analyze the application effect of ultrasound-guided modified Seldinger technique (MST) in Peripherally Inserted Central Catheter (PICC) catheterization. Methods: Two hundred patients treated with PICC catheterization from January 2013 to December 2015 were selected and randomly divided into two groups, namely, observation group and control group. The observation group adopted ultrasound-guided MST for catheterization while the control group applied traditional puncture technique for catheterization. Then efficacy of catheterization, success rate of catheterization and incidence rates of complications were compared between two groups. Results: Various indicators of catheterization effects of the observation group were better than those of the control group, and the differences were statistically significant (P<0.05); one-time success rate of puncture and catheterization of the observation group was both higher than the control group (P<0.05);. Moreover, the incidence of puncture points bleeding, phlebitis and thrombus were all lower than those of the control group (P<0.05). Conclusion: Implementing PICC catheterization based on ultrasound-guided modified Seldinger puncture technique can increase success rate of puncture, improve the effect of catheterization, lower incidence rate of adverse effects of catheterization and improve satisfaction and comfort level of patients. PMID:27882017

  6. Pediatric cardiac surgery with echocardiographic diagnosis alone.

    PubMed Central

    Sohn, Sejung; Kim, Hae Soon; Han, Jae Jin

    2002-01-01

    The diagnostic accuracy of echocardiography alone and the safety of cardiac surgery using this diagnostic approach were retrospectively assessed in 111 children operated for congenital heart defects (CHD) during a 3.5-yr period ending in October 2001. Preoperative diagnosis was compared with the intraoperative findings obtained by surgical inspection. Perioperative death was defined as death within 30 days postoperatively. Of the patients, 70% were operated on in infancy. Seventy-six percent (84 of 111) underwent surgery after echocardiographic diagnosis alone. A high percentage of patients with patent ductus arteriosus (100%), partial atrioventricular canal (100%), coarctation of the aorta (89%), ventricular septal defect (86%), atrial septal defect (85%), and total anomalous pulmonary venous connection (75%) was operated without prior catheterization. Diagnostic errors occurred in 2.4% (2 of 84) of patients with echocardiography only and in 7.4% of patients with catheterization. No error in either group was related to surgical morbidity or mortality. There were five (6.0%) perioperative deaths in the echocardiography group and two (7.4%) in the catheterization group, with no difference in the mortality between the groups. In conclusion, many patients with CHD can be accurately diagnosed by echocardiography alone, and can safely undergo surgery without catheterization, not increasing the overall risk. PMID:12172039

  7. Thallium cardiac stressing by esophageal pacing

    SciTech Connect

    Allen, M.L.; Vacek, J.L.; Preston, D.F.; Robinson, R.G.; Feldkamp, M.J. )

    1989-09-01

    Forty-three patients were examined with the transesophageal pacing method of cardiac stressing and thallium imaging. Transesophageal cardiac pacing, using a pill electrode or a permanent pacemaker lead, is a safe alternative for patients who are physically unable to exercise. Prior studies suggest that transvenous right atrial pacing with thallium injection is equivalent to physical exercise thallium studies in the detection of coronary artery disease. The esophageal pacing bipolar electrode similarly increases heart rate without the necessity of transvenous pacing or fluoroscopy and without the adverse side effects often seen when using pharmacologic stressing agents (i.e., dipyridamole). The results compare well with cardiac catheterization, echocardiographic, and electrocardiographic results. Cardiac paced stress testing requires no sedation, is performed on an out-patient basis, and causes little if any discomfort for the patient.

  8. Acute thigh compartment syndrome post femoral vein catheterization: a case report.

    PubMed

    Asplund, Mark W

    2008-08-01

    This case report presents a previously unreported etiology of acute thigh compartment syndrome following ipsilateral femoral vein catheterization, including clinical results and a brief review of the literature.

  9. A systematic review: effectiveness of pediatric peripheral intravenous catheterization strategies.

    PubMed

    Parker, Shannon I A; Benzies, Karen M; Hayden, K Alix

    2017-07-01

    The aim of this study was to identify interventions associated with peripheral intravenous catheterization first attempt success in pediatric inpatients and emergency department patients who require vascular access for therapeutic interventions. Unsuccessful peripheral intravenous catheterization puts children at risk for increased pain and treatment delays. Effective interventions to increase peripheral intravenous catheterization first attempt success are unclear. Systematic review of randomized controlled trials according to the Cochrane Handbook for the Systematic Review of Interventions. Through November and December 2014, we searched 10 databases including MEDLINE (OVID), EMBASE (OVID) and CINAHL (EBSCO) without date limits. The references of articles were also reviewed. We included full text reports of randomized controlled trials testing intervention first attempt success rates vs. standard of care. According to inclusion and exclusion criteria set a priori, data were extracted using a standardized tool. We assessed for risk of bias with the Cochrane Collaboration Risk of Bias Tool. Due to unclear reporting narrative synthesis was used to report results. Four cluster randomized control trials and ten randomized control trials involving 4539 participants ranging from 15·6 days to 16 years of age met our inclusion criteria. We excluded the four cluster trials from meta-analysis due to unclear reporting. Interventions did not increase first attempt success rate compared with standard of care. There was insufficient evidence to support the use of ultrasound, infrared light or transillumination. Interventions to reduce children's pain did not decrease first attempt success. Research examining between-clinician proficiency and persistence differences is absent. © 2016 John Wiley & Sons Ltd.

  10. An integrated platform for image-guided cardiac resynchronization therapy.

    PubMed

    Ma, Ying Liang; Shetty, Anoop K; Duckett, Simon; Etyngier, Patrick; Gijsbers, Geert; Bullens, Roland; Schaeffter, Tobias; Razavi, Reza; Rinaldi, Christopher A; Rhode, Kawal S

    2012-05-21

    Cardiac resynchronization therapy (CRT) is an effective procedure for patients with heart failure but 30% of patients do not respond. This may be due to sub-optimal placement of the left ventricular (LV) lead. It is hypothesized that the use of cardiac anatomy, myocardial scar distribution and dyssynchrony information, derived from cardiac magnetic resonance imaging (MRI), may improve outcome by guiding the physician for optimal LV lead positioning. Whole heart MR data can be processed to yield detailed anatomical models including the coronary veins. Cine MR data can be used to measure the motion of the LV to determine which regions are late-activating. Finally, delayed Gadolinium enhancement imaging can be used to detect regions of scarring. This paper presents a complete platform for the guidance of CRT using pre-procedural MR data combined with live x-ray fluoroscopy. The platform was used for 21 patients undergoing CRT in a standard catheterization laboratory. The patients underwent cardiac MRI prior to their procedure. For each patient, a MRI-derived cardiac model, showing the LV lead targets, was registered to x-ray fluoroscopy using multiple views of a catheter looped in the right atrium. Registration was maintained throughout the procedure by a combination of C-arm/x-ray table tracking and respiratory motion compensation. Validation of the registration between the three-dimensional (3D) roadmap and the 2D x-ray images was performed using balloon occlusion coronary venograms. A 2D registration error of 1.2 ± 0.7 mm was achieved. In addition, a novel navigation technique was developed, called Cardiac Unfold, where an entire cardiac chamber is unfolded from 3D to 2D along with all relevant anatomical and functional information and coupled to real-time device detection. This allowed more intuitive navigation as the entire 3D scene was displayed simultaneously on a 2D plot. The accuracy of the unfold navigation was assessed off-line using 13 patient data sets

  11. An integrated platform for image-guided cardiac resynchronization therapy

    NASA Astrophysics Data System (ADS)

    Ma, Ying Liang; Shetty, Anoop K.; Duckett, Simon; Etyngier, Patrick; Gijsbers, Geert; Bullens, Roland; Schaeffter, Tobias; Razavi, Reza; Rinaldi, Christopher A.; Rhode, Kawal S.

    2012-05-01

    Cardiac resynchronization therapy (CRT) is an effective procedure for patients with heart failure but 30% of patients do not respond. This may be due to sub-optimal placement of the left ventricular (LV) lead. It is hypothesized that the use of cardiac anatomy, myocardial scar distribution and dyssynchrony information, derived from cardiac magnetic resonance imaging (MRI), may improve outcome by guiding the physician for optimal LV lead positioning. Whole heart MR data can be processed to yield detailed anatomical models including the coronary veins. Cine MR data can be used to measure the motion of the LV to determine which regions are late-activating. Finally, delayed Gadolinium enhancement imaging can be used to detect regions of scarring. This paper presents a complete platform for the guidance of CRT using pre-procedural MR data combined with live x-ray fluoroscopy. The platform was used for 21 patients undergoing CRT in a standard catheterization laboratory. The patients underwent cardiac MRI prior to their procedure. For each patient, a MRI-derived cardiac model, showing the LV lead targets, was registered to x-ray fluoroscopy using multiple views of a catheter looped in the right atrium. Registration was maintained throughout the procedure by a combination of C-arm/x-ray table tracking and respiratory motion compensation. Validation of the registration between the three-dimensional (3D) roadmap and the 2D x-ray images was performed using balloon occlusion coronary venograms. A 2D registration error of 1.2 ± 0.7 mm was achieved. In addition, a novel navigation technique was developed, called Cardiac Unfold, where an entire cardiac chamber is unfolded from 3D to 2D along with all relevant anatomical and functional information and coupled to real-time device detection. This allowed more intuitive navigation as the entire 3D scene was displayed simultaneously on a 2D plot. The accuracy of the unfold navigation was assessed off-line using 13 patient data sets

  12. Effect of khat on uteroplacental blood flow in awake, chronically catheterized, late-pregnant guinea pigs.

    PubMed

    Jansson, T; Kristiansson, B; Qirbi, A

    1988-01-01

    In order to investigate effects of khat chewing on uteroplacental blood flow, eight awake, chronically catheterized guinea pigs were fed 2.2 g khat leaves/kg in late pregnancy and regional blood flows were measured with the microsphere technique. Seven animals fed with aspen leaves in the same amounts served as controls. The mean concentration of (+)-norpseudoephedrine in urine 3 h after the end of the feeding was 4.6 micrograms/ml in the khat-fed group with no detectable amounts in the controls. Placental blood flow was reduced by 10% 75 min and by 24% 180 min after khat feeding. Since the khat dose used gave urinary concentrations of (+)-norpseudoephedrine of the same magnitude as those reported in khat chewing women, khat chewing in pregnancy may reduce placental blood flow and impair fetal growth.

  13. Tomographic ultrasound imaging of the fetal heart: a new technique for identifying normal and abnormal cardiac anatomy.

    PubMed

    Devore, Greggory R; Polanko, Bardo

    2005-12-01

    In 2003 and 2004, the American College of Radiology, the American Institute of Ultrasound in Medicine, and the American College of Obstetricians and Gynecologists published guidelines for the standard ultrasound examination of the fetus. Each group recommended that the outflow tracts of the fetal heart be examined if technically feasible. One method to accomplish this task is to perform a free-hand sweep of the transducer beam directed in a transverse plane from the 4-chamber view to the fetal neck. One problem with this approach is that the examiner may not direct the beam transversely and, therefore, may not accurately identify the outflow tract anatomy. A new technology, tomographic ultrasound imaging (TUI), allows the examiner to obtain a volume data set that simultaneously displays multiple images at specific distances from the 4-chamber view. This study examined TUI technology for identifying normal and abnormal fetal cardiac anatomy with the use of either static or spatiotemporal image correlation volume data sets. The 4 views used in the screening examination of the outflow tracts of the fetal heart (4-chamber, 5-chamber, 3-vessel, and tracheal views) could be identified with the use of TUI technology in fetuses between 13 and 40 weeks' gestation. Examples of fetuses with abnormal cardiac anatomy of the outflow tracts (tetralogy of Fallot, transposition of the great vessels, and pulmonary stenosis) all showed abnormal anatomy on TUI. Tomographic ultrasound imaging technology enables the fetal examiner to evaluate the 4-chamber view and the outflow tracts in a systematic manner to identify normal and abnormal cardiac anatomy.

  14. A bulbar artery pseudoaneurysm following traumatic urethral catheterization

    PubMed Central

    Bettez, Mathieu; Aubé, Melanie; Sherbiny, Mohamed El; Cabrera, Tatiana; Jednak, Roman

    2017-01-01

    Traumatic urethral catheterization may result in a number of serious complications. A rare occurrence is the development of a urethral pseudoaneurysm. We report the case of a 13-year-old male who required placement of a Foley catheter for an orthopedic surgical procedure. The Foley was misplaced in the bulbourethra, resulting in the development of a bulbar artery pseudoaneurysm. Profuse bleeding via the urethra was noted after removal of the catheter, and the patient experienced severe intermittent hematuria during the postoperative period. Cystoscopy revealed a pulsatile mass within the bulbourethra. Angiography confirmed a bulbar artery pseudoaneurysm, which was successfully embolized with resolution of bleeding. PMID:28163815

  15. Reduction in operator radiation exposure during transradial catheterization and intervention using a simple lead drape.

    PubMed

    Iqtidar, Ali F; Jeon, Cathy; Rothman, Richard; Snead, Randall; Pyne, Christopher T

    2013-03-01

    Transradial access for cardiac catheterization and intervention is a recognized method for reducing complications and improving patient comfort. However, there are concerns over possible increased operator radiation exposure. We tested the hypothesis that a simple lead drape would reduce operator exposure in transradial procedures. Patients undergoing either diagnostic or interventional procedures using transradial access were assigned in an alternating manner to the use of a 0.5-mm lead apron across the patient's abdomen in addition to standard operator protection. Patients were divided into 4 groups: (left enhanced shielding vs left standard shielding; right enhanced shielding vs right standard shielding). Dosimeters were taped to the primary and secondary operators' left wrist and outside the thyroid guard. The operator exposure was measured for each site on every case in centigray. In standard shielded patients, there was no increase in operator exposure between the left and right approach patients at any measurement site. Measured exposure was reduced with enhanced shielding at all dosimeter sites except the secondary operator's collar (both left and right) and the primary operator's collar from the right. There was no significant difference in fluoroscopy, air kerma, or dose area product between standard and enhanced shielded patients. The use of a lead drape reduces the rate of operator radiation exposure at multiple measurement sites. Use of the left radial approach was not associated with an increase in operator exposure compared with the right radial approach. Copyright © 2013 Mosby, Inc. All rights reserved.

  16. Cardiac involvement in a female carrier of Duchenne muscular dystrophy.

    PubMed

    Walcher, Thomas; Kunze, Markus; Steinbach, Peter; Sperfeld, Anne-Dorte; Burgstahler, Christof; Hombach, Vinzenz; Torzewski, Jan

    2010-02-04

    A 42 year-old female carrier of Duchenne muscular dystrophy (DMD) was referred with suspected subacute myocarditis and non-sustained ventricular tachycardia. Echochardiography and cardiac catheterization revealed severely reduced left ventricular function (LVF). Coronary artery disease was excluded. Cardiac magnetic resonance imaging showed transmural, intramural and subepicardial late gadolinium enhancement. Myocardial biopsy excluded viral infection and showed severe myopathic changes with abnormal expression of dystrophin and utrophin. Moleculargenetic analysis of the DMD gene revealed frameshift duplication of exon 2. The patient received conventional heart failure therapy, implantable cardioverter/defibrillator-implantation and prednisolone to attenuate cardiac degradation. 6 months later she had improved clinically though LVF was still severely reduced.

  17. Whole-heart cine MRI in a single breath-hold--a compressed sensing accelerated 3D acquisition technique for assessment of cardiac function.

    PubMed

    Wech, T; Pickl, W; Tran-Gia, J; Ritter, C; Beer, M; Hahn, D; Köstler, H

    2014-01-01

    The aim of this study was to perform functional MR imaging of the whole heart in a single breath-hold using an undersampled 3 D trajectory for data acquisition in combination with compressed sensing for image reconstruction. Measurements were performed using an SSFP sequence on a 3 T whole-body system equipped with a 32-channel body array coil. A 3 D radial stack-of-stars sampling scheme was utilized enabling efficient undersampling of the k-space and thereby accelerating data acquisition. Compressed sensing was applied for the reconstruction of the missing data. A validation study was performed based on a fully sampled dataset acquired by standard Cartesian cine imaging of 2 D slices on a healthy volunteer. The results were investigated with regard to systematic errors and resolution losses possibly introduced by the developed reconstruction. Subsequently, the proposed technique was applied for in-vivo functional cardiac imaging of the whole heart in a single breath-hold of 27  s. The developed technique was tested on three healthy volunteers to examine its reproducibility. By means of the results of the simulation (temporal resolution: 47  ms, spatial resolution: 1.4 × 1.4 × 8  mm, 3 D image matrix: 208 × 208 × 10), an overall acceleration factor of 10 has been found where the compressed sensing reconstructed image series shows only very low systematic errors and a slight in-plane resolution loss of 15 %. The results of the in-vivo study (temporal resolution: 40.5  ms, spatial resolution: 2.1 × 2.1 × 8  mm, 3 D image matrix: 224 × 224 × 12) performed with an acceleration factor of 10.7 confirm the overall good image quality of the presented technique for undersampled acquisitions. The combination of 3 D radial data acquisition and model-based compressed sensing reconstruction allows high acceleration factors enabling cardiac functional imaging of the whole heart within only one breath-hold. The

  18. Establishing a cardiac imaging rotation in radiology residency.

    PubMed

    Zaheer, Atif; Raptopoulos, Vassilios

    2006-07-01

    The advent of new technologies for cardiac imaging such as magnetic resonance imaging (MRI) and cardiac computed tomography (CT) have added new tools in the armamentarium of noninvasive methods for predicting cardiac disease. However, training in cardiac anatomy and physiology is critical if radiology is to meet the demands of this service. We designed a core rotation in cardiac imaging at the Beth Israel Deaconess Medical Center, Harvard Medical School, to train residents in noninvasive cardiac imaging methods, such as cardiac echocardiography, nuclear cardiac imaging, cardiac MRI, and with special emphasis on cardiac CT. This 1-month block includes cardiac imaging conferences and a lecture series, hands-on training in the use of imaging software, introduction to cardiac catheterization, and clinical cardiology. Residents are provided with a set of research and review articles along with textbooks on coronary imaging to serve as references for this rotation. We believe that this educational exercise will establish a core of young, knowledgeable, and capable physicians who will be able to meet the clinical demand for noninvasive cardiac imaging and maintain a major role in this emerging specialty.

  19. Norfloxacin-releasing urethral catheter for long-term catheterization.

    PubMed

    Park, Jae Hyung; Cho, Yong Woo; Cho, Yong-Hyun; Choi, Joong Myung; Shin, Hee Jong; Bae, You Han; Chung, Hesson; Jeong, Seo Young; Kwon, Ick Chan

    2003-01-01

    Norfloxacin-releasing urethral catheters were prepared for the purpose of preventing urinary tract infections during long-term catheterization. The outer and inner surfaces of the catheters were coated with poly(ethylene-co-vinyl acetate) (EVA) and an amphiphilic multiblock co-polymer (PEO2kPDMS), composed of poly(ethylene oxide) and poly(dimethyl siloxane). Norfloxacin, a fluoroquinolone synthetic antibiotic, was impregnated into a coating layer. The in vitro drug release behavior was monitored for 30 days, the surface topography was investigated using scanning electron microscopy (SEM) and the antibacterial activity against different bacteria implicated in urinary tract infection was evaluated by the in vitro inhibition zone test. All the coated catheters showed continuous delivery of norfloxacin for up to 30 days owing to hydrophobic natures of norfloxacin and EVA. PEO2kPDMS incorporated in a coating layer produced a smooth and uniform surface. The coated catheters created considerable inhibition zones for 10 days against Escherichia coli. Klebsiella pneumoniae and Proteus vulgaris, indicating the continuous release of norfloxacin. Overall, it was evident that the catheters coated with EVA/PEO2kPDMS blends containing norfloxacin have a promising potential for the clinical use in patients undergoing long-term catheterization.

  20. Continuous cardiac output monitoring via arterial pressure waveform analysis following severe hemorrhagic shock in dogs.

    PubMed

    Cooper, Edward S; Muir, William W

    2007-07-01

    To determine agreement and correlation between cardiac output determined by arterial pressure waveform analysis (PulseCO) and the lithium dilution indicator technique (LiDCO) during severe hemorrhagic shock and after fluid resuscitation in dogs. Prospective experimental study. University research laboratory. Twelve adult mongrel dogs. Dogs were anesthetized, and selected arteries and veins were catheterized. Baseline cardiac output was determined by LiDCO and used to calibrate the PulseCO. Hemorrhagic shock was induced by withdrawing blood to achieve and maintain a mean arterial pressure of 30-40 mm Hg for 60 mins, and cardiac output was measured again using both methods. All dogs were resuscitated by administering lactated Ringer's solution intravenously to achieve and maintain a mean arterial pressure between 60 and 70 mm Hg. PulseCO and LiDCO values were measured at 10 and 120 mins after resuscitation. Mean baseline cardiac output was 2.93 +/- 0.45 L/min. PulseCO values overestimated cardiac output compared with LiDCO during hemorrhagic shock (2.25 vs. 0.78 L/min). There were no differences in cardiac output determined by PulseCO and LiDCO at 10 and 120 mins after fluid resuscitation. Bland-Altman analysis suggested that PulseCO values were inaccurate after hemorrhage, producing significant bias with wide limits of agreement and percentage error (1.47 +/- 1.46 L/min; 97%). Bias was small but the limits of agreement and percentage error were large for cardiac output at 10 and 120 mins after resuscitation (-0.1 +/- 1.88 [98%] and -0.17 +/- 1.32 [71%] L/min, respectively). There appeared to be a negative but not significant correlation after hemorrhage (r = -.45; p = .15). PulseCO determination of cardiac output does not accurately predict rapid decreases in cardiac output or the effects of fluid resuscitation in dogs. Recalibration of PulseCO may be necessary after any apparent or suspected decrease in cardiac preload, afterload, or contractility.

  1. Cardiac optogenetics.

    PubMed

    Entcheva, Emilia

    2013-05-01

    Optogenetics is an emerging technology for optical interrogation and control of biological function with high specificity and high spatiotemporal resolution. Mammalian cells and tissues can be sensitized to respond to light by a relatively simple and well-tolerated genetic modification using microbial opsins (light-gated ion channels and pumps). These can achieve fast and specific excitatory or inhibitory response, offering distinct advantages over traditional pharmacological or electrical means of perturbation. Since the first demonstrations of utility in mammalian cells (neurons) in 2005, optogenetics has spurred immense research activity and has inspired numerous applications for dissection of neural circuitry and understanding of brain function in health and disease, applications ranging from in vitro to work in behaving animals. Only recently (since 2010), the field has extended to cardiac applications with less than a dozen publications to date. In consideration of the early phase of work on cardiac optogenetics and the impact of the technique in understanding another excitable tissue, the brain, this review is largely a perspective of possibilities in the heart. It covers the basic principles of operation of light-sensitive ion channels and pumps, the available tools and ongoing efforts in optimizing them, overview of neuroscience use, as well as cardiac-specific questions of implementation and ideas for best use of this emerging technology in the heart.

  2. Cardiac optogenetics

    PubMed Central

    2013-01-01

    Optogenetics is an emerging technology for optical interrogation and control of biological function with high specificity and high spatiotemporal resolution. Mammalian cells and tissues can be sensitized to respond to light by a relatively simple and well-tolerated genetic modification using microbial opsins (light-gated ion channels and pumps). These can achieve fast and specific excitatory or inhibitory response, offering distinct advantages over traditional pharmacological or electrical means of perturbation. Since the first demonstrations of utility in mammalian cells (neurons) in 2005, optogenetics has spurred immense research activity and has inspired numerous applications for dissection of neural circuitry and understanding of brain function in health and disease, applications ranging from in vitro to work in behaving animals. Only recently (since 2010), the field has extended to cardiac applications with less than a dozen publications to date. In consideration of the early phase of work on cardiac optogenetics and the impact of the technique in understanding another excitable tissue, the brain, this review is largely a perspective of possibilities in the heart. It covers the basic principles of operation of light-sensitive ion channels and pumps, the available tools and ongoing efforts in optimizing them, overview of neuroscience use, as well as cardiac-specific questions of implementation and ideas for best use of this emerging technology in the heart. PMID:23457014

  3. Image quality and radiation dose of dual-source CT cardiac angiography using prospective ECG-triggering technique in pediatric patients with congenital heart disease.

    PubMed

    Liu, Ying; Li, Jian; Zhao, Hongliang; Jia, Yan; Ren, Jing; Xu, Jian; Hao, Yuewen; Zheng, Minwen

    2016-04-09

    All studies involving use of ionizing radiation should be performed in accordance with the ALARA (As Low As Reasonably Achievable) principle, especially in children. In this study, the prospective ECG triggering technique with low voltage was used in dual-source computed tomography (DSCT) angiography to investigate if image quality with low radiation dose could be satisfactory in pediatric patients with congenital heart disease. Sixty pediatric patients with suspected congenital cardiovascular anomalies were enrolled prospectively in the study. They were randomly assigned to two groups for DSCT angiography. Group A were scanned by prospective ECG-triggering computed tomography angiography (CTA) with 80 kV tube voltage, while group B by used non-ECG-gated CTA with the same tube voltage. The anomaly accuracy was evaluated based on the surgical and/or conventional cardiac angiography findings. The overall image quality was assessed on a five-point scale. And the diagnostic accuracy and radiation dose was evaluated in both groups. There were 127 cardiovascular anomalies in Group A and 108 in Group B. The mean subjective image quality and diagnostic accuracy between these two groups were significantly different (P = 0.007 and 0.011, respectively). The mean effective dose in Group A and Group B was 0.38 ± 0.13 mSv and 0.35 ± 0.17 mSv, respectively. But there was no significant difference between two groups (P = 0.197). The prospective ECG triggering technique in DSCT scan can offer better image quality and diagnostic accuracy with low radiation exposure in pediatric patients with congenital heart diseases. This technique has potential to become a new clinical routine in pediatric cardiac computed tomography (CT) imaging.

  4. Adequate performance of cardiopulmonary resuscitation techniques during simulated cardiac arrest over and under protective equipment in football.

    PubMed

    Waninger, Kevin N; Goodbred, Andrew; Vanic, Keith; Hauth, John; Onia, Joshua; Stoltzfus, Jill; Melanson, Scott

    2014-07-01

    To investigate (1) cardiopulmonary resuscitation (CPR) adequacy during simulated cardiac arrest of equipped football players and (2) whether protective football equipment impedes CPR performance measures. Exploratory crossover study performed on Laerdal SimMan 3 G interactive manikin simulator. Temple University/St Luke's University Health Network Regional Medical School Simulation Laboratory. Thirty BCLS-certified ATCs and 6 ACLS-certified emergency department technicians. Subjects were given standardized rescuer scenarios to perform three 2-minute sequences of compression-only CPR. Baseline CPR sequences were captured on each subject. Experimental conditions included 2-minute sequences of CPR either over protective football shoulder pads or under unlaced pads. Subjects were instructed to adhere to 2010 American Heart Association guidelines (initiation of compressions alone at 100/min to 51 mm). Dependent variables included average compression depth, average compression rate, percentage of time chest wall recoiled, and percentage of hands-on contact during compressions. Differences between subject groups were not found to be statistically significant, so groups were combined (n = 36) for analysis of CPR compression adequacy. Compression depth was deeper under shoulder pads than over (P = 0.02), with mean depths of 36.50 and 31.50 mm, respectively. No significant difference was found with compression rate or chest wall recoil. Chest compression depth is significantly decreased when performed over shoulder pads, while there is no apparent effect on rate or chest wall recoil. Although the clinical outcomes from our observed 15% difference in compression depth are uncertain, chest compression under the pads significantly increases the depth of compressions and more closely approaches American Heart Association guidelines for chest compression depth in cardiac arrest.

  5. MR imaging of cardiac masses.

    PubMed

    Syed, Imran S; Feng, Dali; Harris, Scott R; Martinez, Matthew W; Misselt, Andrew J; Breen, Jerome F; Miller, Dylan V; Araoz, Philip A

    2008-05-01

    Cardiac MR imaging is the preferred method for assessment of cardiac masses. A comprehensive cardiac MR imaging examination for a cardiac mass consists of static morphologic images using fast spin-echo sequences, including single-shot techniques, with T1 and T2 weighting and fat suppression pulses as well as dynamic imaging with cine steady-state free precession techniques. Further tissue characterization is provided with perfusion and delayed enhancement imaging. Specific cardiac tumoral characterization is possible in many cases. When specific tumor characterization is not possible, MR imaging often can demonstrate aggressive versus nonaggressive features that help in differentiating malignant from benign tumors.

  6. Subclavian artery to internal jugular vein fistula following percutaneous internal jugular vein catheterization.

    PubMed

    Merino-Angulo, J; Cortazar, J L; Saez-Garmendia, F; Montejo, M

    1984-01-01

    The percutaneous internal jugular vein approach is now a commonly performed procedure for central venous catheterization. Iatrogenic arteriovenous fistulae are a very infrequent complication. We report an asymptomatic subclavian artery to internal jugular vein fistula following two percutaneous internal jugular vein catheterization attempts.

  7. Urinary catheterization may not adversely impact quality of life in multiple sclerosis patients.

    PubMed

    James, Rebecca; Frasure, Heidi E; Mahajan, Sangeeta T

    2014-01-01

    Background. Multiple sclerosis (MS) healthcare providers (HCP) have undergone considerable educational efforts regarding the importance of evaluating and treating pelvic floor disorders, specifically, urinary dysfunction. However, limited data are available to determine the impact of catheterization on patient quality of life (QoL). Objectives. To describe the use of urinary catheterization among MS patients and determine the differences between those who report positive versus negative impact of this treatment on QoL. Methods. Patients were queried as part of the 2010 North American Research Committee On Multiple Sclerosis survey; topics included 1) urinary/bladder, bowel, or sexual problems; 2) current urine leakage; 3) current catheter use; 4) catheterizing and QoL. Results. Respondents with current urine leakage were 5143 (54.7%), of which 1201 reported current catheter use (12.8%). The types of catheters (intermittent self-catheterization and Foley catheter (indwelling and suprapubic)) did not differ significantly. Of the current catheter users, 304 (25.35%) respondents reported catheterization negatively impacting QoL, 629 (52.4%) reported a positive impact on QoL, and 223 (18.6%) reported neutral QoL. Conclusions. A large proportion of catheterized MS patients report negative or positive changes in QoL associated with urinary catheterization. Urinary catheterization does not appear to have a universally negative impact on patient QoL.

  8. Right Heart Catheterization via Dialysis Arteriovenous Shunts in End-Stage Renal Disease Patients.

    PubMed

    Hsieh, Mu-Yang; Chen, Tsung-Yan; Lin, Lin; Liao, Min-Tsun; Wang, Ren-Huei; Kuo, Ruei-Cheng; Lai, Chao-Lun; Wu, Chih-Cheng

    2016-12-01

    Right heart catheterization is an important diagnostic tool but carries risks of adverse events. Little is known about the feasibility and safety of using dialysis arteriovenous (AV) shunts. We aim to evaluate the feasibility and safety of using dialysis AV shunts for access in right heart catheterization. Hemodialysis patients who required right heart catheterization were prospectively enrolled. A 7 Fr sheath was inserted and a balloon-tipped pulmonary artery catheter was advanced for right heart catheterization. Patients were followed for 1 month, and technical success, procedure details, and complications were recorded. Thirteen patients received right heart catheterization via AV shunts. Three patients were evaluated for heart failure, and 10 were examined for pulmonary hypertension. Median patient age was 69 years (interquartile range [IQR], 58-77 years), and median shunt age was 50 months (IQR, 32-75 months). Five shunts were located in the upper arm, 2 were in the right arm, and 5 were native fistulas. All AV shunt punctures were successful on the first attempt. All right heart catheterizations were completed via AV shunts, and the technical success rate was 100%. Median fluoroscopy time was 6.9 minutes. No venous access complications or right heart catheterization-related complications occurred immediately after the procedure or during the 1-month follow-up period. AV dialysis shunts can be used for venous access for right heart catheterization with acceptable feasibility and patient tolerability. Further randomized studies are needed to confirm the benefits of this approach compared with other approaches.

  9. Brachial plexus compression due to subclavian artery pseudoaneurysm from internal jugular vein catheterization

    PubMed Central

    Mol, T. N.; Gupta, A.; Narain, U.

    2017-01-01

    Internal jugular vein (IJV) catheterization has become the preferred approach for temporary vascular access for hemodialysis. However, complications such as internal carotid artery puncture, vessel erosion, thrombosis, and infection may occur. We report a case of brachial plexus palsy due to compression by right subclavian artery pseudoaneurysm as a result of IJV catheterization in a patient who was under maintenance hemodialysis. PMID:28356671

  10. Dynamic Control of Cardiac Alternans

    NASA Astrophysics Data System (ADS)

    Hall, Kevin; Christini, David J.; Tremblay, Maurice; Collins, James J.; Glass, Leon; Billette, Jacques

    1997-06-01

    A dynamic control technique was used to suppress a cardiac arrhythmia called an alternans rhythm in a piece of dissected rabbit heart. Our control algorithm adapted to drifting system parameters, making it well suited for the control of physiological rhythms. Control of cardiac alternans rhythms may have important clinical implications since they often precede serious cardiac arrhythmias and are a harbinger of sudden cardiac death.

  11. Controlling urinary tract infections associated with intermittent bladder catheterization in geriatric hospitals.

    PubMed

    Girard, R; Gaujard, S; Pergay, V; Pornon, P; Martin Gaujard, G; Vieux, C; Bourguignon, L

    2015-07-01

    Controlling urinary tract infections (UTIs) associated with intermittent catheterization in geriatric patients. After a local epidemiological study identified high rates of UTI, a multi-disciplinary working group implemented and evaluated corrective measures. In 2009, a one-month prospective study measured the incidence of UTI, controlled for risk factors and exposure, in six geriatric hospitals. In 2010, a self-administered questionnaire on practices was administered to physicians and nurses working in these geriatric units. In 2011, the working group developed a multi-modal programme to: improve understanding of micturition, measurement of bladder volume and indications for catheter drainage; limit available medical devices; and improve prescription and traceability procedures. Detailed training was provided to all personnel on all sites. The epidemiological study was repeated in 2012 to assess the impact of the programme. Over 1500 patients were included in the 2009 study. The incidence of acquired infection was 4.8%. The infection rate was higher in patients with intermittent catheters than in patients with indwelling catheters (29.7 vs 9.9 UTI per 100 patients, P = 0.1013) which contradicts the literature. In 2010, the 269 responses to the questionnaire showed that staff did not consider catheterization to place patients at risk of infection, staff had poor knowledge of the recommended indications and techniques, and the equipment varied widely between units. Following implementation of the programme, the study was repeated in 2012 with over 1500 patients. The frequency of UTI in patients with intermittent catheters fell to rates in the published literature. Multi-modal programmes are an effective means to control UTI. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  12. A Coaxial Dual-element Focused Ultrasound Probe for Guidance of Epidural Catheterization: An Experimental Study.

    PubMed

    Dong, Guo-Chung; Chiu, Li-Chen; Ting, Chien-Kun; Hsu, Jia-Ruei; Huang, Chih-Chung; Chang, Yin; Chen, Gin-Shin

    2017-09-01

    Ultrasound guidance for epidural block has improved clinical blind-trial problems but the design of present ultrasonic probes poses operating difficulty of ultrasound-guided catheterization, increasing the failure rate. The purpose of this study was to develop a novel ultrasonic probe to avoid needle contact with vertebral bone during epidural catheterization. The probe has a central circular passage for needle insertion. Two focused annular transducers are deployed around the passage for on-axis guidance. A 17-gauge insulated Tuohy needle containing the self-developed fiber-optic-modified stylet was inserted into the back of the anesthetized pig, in the lumbar region under the guidance of our ultrasonic probe. The inner transducer of the probe detected the shallow echo signals of the peak-peak amplitude of 2.8 V over L3 at the depth of 2.4 cm, and the amplitude was decreased to 0.8 V directly over the L3 to L4 interspace. The outer transducer could detect the echoes from the deeper bone at the depth of 4.5 cm, which did not appear for the inner transducer. The operator tilted the probe slightly in left-right and cranial-caudal directions until the echoes at the depth of 4.5 cm disappeared, and the epidural needle was inserted through the central passage of the probe. The needle was advanced and stopped when the epidural space was identified by optical technique. The needle passed without bone contact. Designs of the hollow probe for needle pass and dual transducers with different focal lengths for detection of shallow and deep vertebrae may benefit operation, bone/nonbone identification, and cost.

  13. Cardiac imaging in adults

    SciTech Connect

    Jaffe, C.C.

    1987-01-01

    This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority.

  14. The effect of anesthetization and urinary bladder catheterization on renal function of rainbow trout

    USGS Publications Warehouse

    Hunn, J.B.; Willford, W.A.

    1970-01-01

    1. Rainbow trout were anesthetized with MS-222 (Sandoz) or methylpentynol and catheterized. Urine was collected at selected intervals up to 48 hr. 2. Effects of MS-222 anesthesia on urine flow and composition were isolated from the stress of catheterization by re-anesthetizing the fish 18 to 20 hr post catheterization. 3. Urine output patterns were similar following MS-222 or methylpentynol anesthesia and catheterization. Highest urine flows were measured 4 to 8 hr post treatment. The highest urine output after re-anesthetization with MS-222 was observed 2 to 4 hr post-anesthesia. 4. Highest concentrations of Na2+, K+, Ca2+, Cl- and inorganic PO4 in the urine were measured in the first 2 hr after anesthesia and catheterization. 5. Flow rates and chemical composition of urine indicate that "normal" renal function is re-established 12 to 24 hr post-treatment.

  15. Long-Term Catheterization of the Intestinal Lymph Trunk and Collection of Lymph in Neonatal Pigs.

    PubMed

    Uwiera, Richard R; Mangat, Rabban; Kelly, Sandra; Uwiera, Trina C; Proctor, Spencer D

    2016-03-05

    Catheterization of the intestinal lymph trunk in neonatal pigs is a technique allowing for the long-term collection of large quantities of intestinal (central) efferent lymph. Importantly, the collection of central lymph from the intestine enables researchers to study both the mechanisms and lipid constitutes associated with lipid metabolism, intestinal inflammation and cancer metastasis, as well as cells involved in immune function and immunosurveillance. A ventral mid-line surgical approach permits excellent surgical exposure to the cranial abdomen and relatively easy access to the intestinal lymph trunk vessel that lies near the pancreas and the right ventral segment of the portal vein underneath the visceral aspect of the right liver lobe. The vessel is meticulously dissected and released from the surrounding fascia and then dilated with sutures allowing for insertion and subsequent securing of the catheter into the vessel. The catheter is exteriorized and approximately 1 L/24 hr of lymph is collected over a 7 day period. While this technique enables the collection of large quantities of central lymph over an extended period of time, the success depends on careful surgical dissection, tissue handling and close attention to proper surgical technique. This is particularly important with surgeries in young animals as the lymph vessels can easily tear, potentially leading to surgical and experimental failure. The video demonstrates an excellent surgical technique for the collection of intestinal lymph.

  16. Effect of the stop-flow technique on cardiac retention of c-kit positive human cardiac stem cells after intracoronary infusion in a porcine model of chronic ischemic cardiomyopathy.

    PubMed

    Keith, Matthew C L; Tokita, Yukichi; Tang, Xian-Liang; Ghafghazi, Shahab; Moore, Joseph B; Hong, Kyung U; Elmore, Julius B; Amraotkar, Alok R; Guo, Haixun; Ganzel, Brian L; Grubb, Kendra J; Flaherty, Michael P; Vajravelu, Bathri N; Wysoczynski, Marcin; Bolli, Roberto

    2015-09-01

    It is commonly thought that the optimal method for intracoronary administration of cells is to stop coronary flow during cell infusion, in order to prolong cell/vascular wall contact, enhance adhesion, and promote extravasation of cells into the interstitial space. However, occlusion of a coronary artery with a balloon involves serious risks of vascular damage and/or dissection, particularly in non-stented segments such as those commonly found in patients with heart failure. It remains unknown whether the use of the stop-flow technique results in improved donor cell retention. Acute myocardial infarction was produced in 14 pigs. One to two months later, pigs received 10 million indium-111 oxyquinoline (oxine)-labeled c-kit(pos) human cardiac stem cells (hCSCs) via intracoronary infusion with (n = 7) or without (n = 7) balloon inflation. Pigs received cyclosporine to prevent acute graft rejection. Animals were euthanized 24 h later and hearts harvested for radioactivity measurements. With the stop-flow technique, the retention of hCSCs at 24 h was 5.41 ± 0.80 % of the injected dose (n = 7), compared with 4.87 ± 0.62 % without coronary occlusion (n = 7), (P = 0.60). When cells are delivered intracoronarily in a clinically relevant porcine model of chronic ischemic cardiomyopathy, the use of the stop-flow technique does not result in greater myocardial cell retention at 24 h compared with non-occlusive infusion. These results have practical implications for the design of cell therapy trials. Our observations suggest that the increased risk of complications secondary to coronary manipulation and occlusion is not warranted.

  17. A non-invasive cardiac output measurement as an alternative to the test bolus technique during CT angiography.

    PubMed

    Nijhof, W H; Hilbink, M; Jager, G J; Slump, C H; Rutten, M J C M

    2016-09-01

    To investigate the association between a non-invasive cardiac output (CO) measurement and the scan delay, as derived from a test bolus injection protocol. The secondary objective was to determine which factors affect the relationship between the CO and scan delay. Fifty-five patients referred for a contrast-enhanced (thorax-)abdomen CT examination were included in this feasibility study. A test bolus examination was performed prior to the abdominal CT. During the test bolus injection, the CO of the patient was measured using a non-invasive finger-cuff measurement. Associations were analysed using linear regression analyses. Age, gender, height, weight, and blood pressure were included as potential confounders. Linear regression analysis showed a negative and significant association between CO and delay. The regression formula was as follows: scan delay (seconds) = 26.8-1.6 CO (l/min), with a 95% CI between -2.3 and -1.0 (p<0.001). Weight appeared to be a confounder in this relation, and gender and blood pressure were effect modifiers. There was no interaction between scan delay and age, height and weight. There is a negative and significant association between the non-invasive CO measurement and the CT scan delay; however, to validate these findings a larger cohort study is needed to investigate whether the non-invasively determined scan delay is as accurate as the use of a test bolus. Copyright © 2016. Published by Elsevier Ltd.

  18. Evaluation of two coated catheters in intermittent self-catheterization.

    PubMed

    Pascoe, G; Clovis, S

    Intermittent self-catheterization (ISC) has addressed the problems of mechanical or functional urological voiding since the 1970s. Patient quality of life is enhanced by the increased independence and security offered by ISC (Lapides et al, 1972). A randomized, comparative crossover study was undertaken in two centres to evaluate the performance of SpeediCath (Coloplast) and Lofric (Astra Tech) catheters. A total of 27 subjects were recruited, all of whom had been performing ISC more than twice a day for longer than 3 months with a coated catheter. Each catheter was used for 1 week to assess catheter performance and acceptability. There were no significant differences recorded for the performance of each catheter. However, SpeediCath demonstrated favourable statistical significance in relation to ease of use, speed of use, and the concept of water as an integral part of the packaging of the catheter.

  19. Update on voiding dysfunction managed with suprapubic catheterization.

    PubMed

    English, Sharon F

    2017-07-01

    As the population ages the prevalence of long-term urinary catheters, especially in the elderly, is going to increase. Urinary catheters are usually placed to manage urinary retention or incontinence that cannot be managed any other way. There is significant morbidity associated with an indwelling catheter. The commonest problems are catheter blockages, infection and bladder stones. These will occur with a similar incidence with either a suprapubic or a urethral catheter. Urethral complications such as strictures, scrotal infection and erosion are less common with suprapubic catheterization (SPC). However the benefit of having a SPC needs to be balanced against the risks involved in inserting the catheter suprapubically. Patient reported symptoms show that a SPC is more comfortable and better tolerated than a urethral catheter. However there needs to be more research into developing better catheters that reduce the frequency of urinary infections and blockages and hence catheter morbidity.

  20. Vestibular system paresis due to emergency endovascular catheterization

    PubMed Central

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-01-01

    Summary Objective: The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case: Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation. Conclusion: Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations. PMID:25991947

  1. Compartment Syndrome of the Hand: A Rare Sequela of Transradial Cardiac Catheterization

    PubMed Central

    Jue, Jennifer; Karam, Joseph A.; Mejia, Alfonso

    2017-01-01

    A 64-year-old man who underwent percutaneous coronary intervention via right radial artery access reported right-hand pain and swelling 2 hours after the procedure. He had developed compartment syndrome of the hand, specifically with muscular compromise of the thenar compartment but with no involvement of the forearm. He underwent emergency right-hand compartment release and carpal tunnel release, followed by an uneventful postoperative course. In addition to our patient's case, we discuss compartment syndrome of the hand and related issues. PMID:28265219

  2. Evaluation of depression and anxiety in parents of children undergoing cardiac catheterization.

    PubMed

    Üzger, Ahmet; Başpınar, Osman; Bülbül, Feridun; Yavuz, Sibel; Kılınç, Metin

    2015-09-01

    This study aimed to determine pre-procedure depression and anxiety levels among a group of parents whose children had congenital heart disease and were undergoing angiography. The study comprised parents of 73 congenital heart disease patients undergoing angiography. The Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) were used to evaluate the depression and anxiety scores. Sixty-one patients (83.6%) had acyanotic congenital heart disease, and 25 patients (34.2%) were undergoing diagnostic angiography. BDI scores among the mothers determined that 8 (11%) had mild, 14 (19.2%) moderate, and 10 (13.7%) severe depression. Their BAI scores showed that 16 (21.9%) had mild, 8 (11%) moderate, and 13 (17.8%) severe anxiety. BDI scores for the fathers showed that 12 (16.4%) had mild, 10 (13.7%) moderate, and 8 (11%) severe depression. Their BAI scores showed that 12 (16.4%) had mild, 10 (13.7%) moderate, and 8 (11%) severe anxiety. A comparison of mothers of cyanotic patients and those of acyanotic patients in terms of depression and anxiety levels revealed a statistically significant difference (p=0.050 and 0.043, respectively). Angiography was associated with increased levels of depression and anxiety in parents of children with congenital heart diseases. In comparison to parents of patients with acyanotic congenital heart disease, mothers of patients with cyanotic congenital heart disease had significantly higher levels of depression and anxiety.

  3. Optimization of dose and image quality of paediatric cardiac catheterization procedure.

    PubMed

    Lubis, Lukmanda Evan; Bayuadi, Ika; Pawiro, Supriyanto Ardjo; Ng, Kwan-Hoong; Bosmans, Hilde; Soejoko, Djarwani Soeharso

    2015-11-01

    The purpose of this study is to quantify the quality of the available imaging modes for various iodine-based contrast agent concentration in paediatric cardiology. The figure of merit (FOM) was defined as the squared signal to noise ratio divided by a patient dose related parameter. An in house constructed phantom simulated a series of vessel segments with iodine concentrations from 10% or 30 mg/cc to 16% or 48 mg/cc of iodine in a blood plasma solution, all within the dimensional constraints of a paediatric patient. The phantom also used test inserts of tin (Sn). Measurements of Entrance Surface Air Kerma (ESAK) and exit dose rate were performed along with calculations of the signal-to-noise ratio (SNR) of all the objects. A first result showed that it was favourable to employ low dose fluoroscopy mode and lower frame rate modes in cine acquisition if dynamic information is not critical. Normal fluoroscopy dose mode provided a considerably higher dose level (in comparison to low dose mode) with only a slight improvement in SNR. Higher frame rate cine modes should be used however when the clinical situation dictates so. This work also found that tin should not be intended as iodine replacement material for research purposes due to the mismatching SNR, particularly on small vessel sizes. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  4. Stored-fluorography mode reduces radiation dose during cardiac catheterization measured with OSLD dosimeter

    NASA Astrophysics Data System (ADS)

    Ting, Chien-Yi; Chen, Zhih-Cherng; Tang, Kuo-Ting; Liu, Wei-Chung; Lin, Chun-Chih; Wang, Hsin-Ell

    2015-12-01

    Coronary angiogram is an imperative tool for diagnosis of coronary artery diseases, in which cine-angiography is a commonly used method. Although the angiography proceeds under radiation, the potential risk of radiation exposure for both the patients and the operators was seldom noticed. In this study, the absorbed radiation dose in stored-fluorography mode was compared with that in cine-angiography mode by using optically simulated luminescent dosimeters to realize their effects on radiation dose. Patients received coronary angiogram via radial artery approach were randomized into the stored-fluorography group (N=30) or the cine-angiography group (N=30). The excluded criteria were: 1. women at pregnancy or on breast feeding, 2. chronic kidney diseases with glomerular filtration rate less than 60 mL/min. During the coronary angiogram, absorbed dose of the patients and the operator radiation exposure was measured with optically simulated luminescent dosimeter (OSLD). The absorbed dose of the patients in the stored-fluorography group (3.13±0.25 mGy) was apparently lower than that in the cine-angiography group (65.57±5.37 mGy; P<0.001). For the operator, a statistical difference (P<0.001) was also found between the stored-fluorography group (0.09163 μGy) and the cine-angiography (0.6519μGy). Compared with traditional cine-angiography mode, the stored-fluorography mode can apparently reduce radiation exposure of the patients and the operator in coronary angiogram.

  5. Cardiac catheterization: What causes a pseudoaneurysm? Should a pseudoaneurysm always be treated?

    MedlinePlus

    Pseudoaneurysm: What causes it? What causes a pseudoaneurysm? Should a pseudoaneurysm always be treated? Answers from Rekha Mankad, M.D. A pseudoaneurysm, sometimes called a false aneurysm, occurs when ...

  6. Ultrasound calibration using intensity-based image registration: for application in cardiac catheterization procedures

    NASA Astrophysics Data System (ADS)

    Ma, Y. L.; Rhode, K. S.; Gao, G.; King, A. P.; Chinchapatnam, P.; Schaeffter, T.; Hawkes, D. J.; Razavi, R.; Penney, G. P.

    2008-03-01

    We present a novel method to calibrate a 3D ultrasound probe which has a 2D transducer array. By optically tracking a calibrated 3D probe we are able to produce extended field of view 3D ultrasound images. Tracking also enables us to register our ultrasound images to other tracked and calibrated surgical instruments or to other tracked and calibrated imaging devices. Our method applies rigid intensity-based image registration to three or more ultrasound images. These images can either be of a simple phantom, or could potentially be images of the patient. In this latter case we would have an automated calibration system which required no phantom, no image segmentation and was optimized to the patient's ultrasound characteristics i.e. speed of sound. We have carried out experiments using a simple calibration phantom and with ultrasound images of a volunteer's liver. Results are compared to an independent gold-standard. These showed our method to be accurate to 1.43mm using the phantom images and 1.56mm using the liver data, which is slightly better than the traditional point-based calibration method (1.7mm in our experiments).

  7. Simulation in cardiac catheterization laboratory: Need of the hour to improve the clinical skills

    PubMed Central

    Aggarwal, Shivani; Choudhury, Erin; Ladha, Suruchi; Kapoor, Poonam Malhotra; Kiran, Usha

    2016-01-01

    Simulation is an effective teaching tool to decrease the learning curve for novices without compromising patient safety. Simulation helps interventionalist in mentally translating a two dimentional, black and white image into a usable three dimentional model. It also bridges the gap in training diverse team members on new procedures and products. All simulators have collision detection, i.e., virtual contact forces generated from collision which updates haptic output with new calculations. PMID:27397459

  8. [Determination of right ventricular ejection fraction by thermodilution catheter technique during exercise: a comparison with radionuclide ventriculography].

    PubMed

    Perings, S M; Perings, C; Kelm, M; Strauer, B E

    2001-01-01

    Since the development of a Swan-Ganz Thermodilution Ejection Fraction Catheter, several studies have been published which compare this technique for obtaining right ventricular ejection fraction (RVEFTD) with alternative methods. However, the reliability of RVEFTD measurements under exercise conditions remains undetermined. Therefore, the aim of the present study was to evaluate RVEFTD with the Gated Blood Pool method (RVEFGBP) under exercise conditions. Twenty patients with different cardiac diseases (coronary artery disease, valvular incompetence, cardiomyopathy) underwent right heart catheterization, including RVEFTD and simultaneous RVEFGBP determination at rest and during supine bicycle exercise. Cardiac index at rest-/exercise was 2.9 +/- 0.8/5.7 +/- 2.2 l/min/m2, mean pulmonary artery pressure was 15 +/- 5/25 +/- 8 mmHg, RVEFTD was 38 +/- 6/41 +/- 11% and RVEFRNV was 39 +/- 6/43 +/- 8%. Linear regression analysis showed a significant correlation between RVEFTD and RVEFGBP at rest (r = 0.72, p < or = 0.0005) and during exercise (r = 0.72, p < or = 0.0005). It is concluded that the Thermodilution Ejection Fraction Catheter is a useful device for reliable, repetitive and safe RVEF measurements, not only at rest but also under exercise conditions. This is clinically important, because RVEF, as a sensitive parameter of primary or secondary right ventricular dysfunction, can be determined in the course of standard right heart catheterization.

  9. Intracoronary administration of cardiac stem cells in mice: a new, improved technique for cell therapy in murine models.

    PubMed

    Li, Qianhong; Guo, Yiru; Ou, Qinghui; Chen, Ning; Wu, Wen-Jian; Yuan, Fangping; O'Brien, Erin; Wang, Tao; Luo, Li; Hunt, Gregory N; Zhu, Xiaoping; Bolli, Roberto

    2011-09-01

    A model of intracoronary stem cell delivery that enables transgenesis/gene targeting would be a powerful tool but is still lacking. To address this gap, we compared intracoronary and intramyocardial delivery of lin(-)/c-kit(+)/GFP(+) cardiac stem cells (CSCs) in a murine model of reperfused myocardial infarction (MI). Lin(-)/c-kit(+)/GFP(+) CSCs were successfully expanded from GFP transgenic hearts and cultured with no detectable phenotypic change for up to ten passages. Intracoronary delivery of CSCs 2 days post-MI resulted in significant alleviation of adverse LV remodeling and dysfunction, which was at least equivalent, if not superior, to that achieved with intramyocardial delivery. Compared with intramyocardial injection, intracoronary infusion was associated with a more homogeneous distribution of CSCs in the infarcted region and a greater increase in viable tissue in this region, suggesting greater formation of new cardiomyocytes. Intracoronary CSC delivery resulted in improved function in the infarcted region, as well as in improved global LV systolic and diastolic function, and in decreased LV dilation and LV expansion index; the magnitude of these effects was similar to that observed after intramyocardial injection. We conclude that, in the murine model of reperfused MI, intracoronary CSC infusion is at least as effective as intramyocardial injection in limiting LV remodeling and improving both regional and global LV function. The intracoronary route appears to be superior in terms of uniformity of cell distribution, myocyte regeneration, and amount of viable tissue in the risk region. To our knowledge, this is the first study to report that intracoronary infusion of stem cells in mice is feasible and effective.

  10. Intracoronary administration of cardiac stem cells in mice: a new, improved technique for cell therapy in murine models

    PubMed Central

    Li, Qianhong; Guo, Yiru; Ou, Qinghui; Chen, Ning; Wu, Wen-Jian; Yuan, Fangping; O’Brien, Erin; Wang, Tao; Luo, Li; Hunt, Gregory N.; Zhu, Xiaoping

    2013-01-01

    A model of intracoronary stem cell delivery that enables transgenesis/gene targeting would be a powerful tool but is still lacking. To address this gap, we compared intracoronary and intramyocardial delivery of lin−/c-kit+/GFP+ cardiac stem cells (CSCs) in a murine model of reperfused myocardial infarction (MI). Lin−/c-kit+/GFP+ CSCs were successfully expanded from GFP transgenic hearts and cultured with no detectable phenotypic change for up to ten passages. Intracoronary delivery of CSCs 2 days post-MI resulted in significant alleviation of adverse LV remodeling and dysfunction, which was at least equivalent, if not superior, to that achieved with intramyocardial delivery. Compared with intramyocardial injection, intracoronary infusion was associated with a more homogeneous distribution of CSCs in the infarcted region and a greater increase in viable tissue in this region, suggesting greater formation of new cardiomyocytes. Intracoronary CSC delivery resulted in improved function in the infarcted region, as well as in improved global LV systolic and diastolic function, and in decreased LV dilation and LV expansion index; the magnitude of these effects was similar to that observed after intramyocardial injection. We conclude that, in the murine model of reperfused MI, intracoronary CSC infusion is at least as effective as intramyocardial injection in limiting LV remodeling and improving both regional and global LV function. The intracoronary route appears to be superior in terms of uniformity of cell distribution, myocyte regeneration, and amount of viable tissue in the risk region. To our knowledge, this is the first study to report that intracoronary infusion of stem cells in mice is feasible and effective. PMID:21516491

  11. [Teaching practices of thoracic epidural catheterizations in different grade of anesthesia residents].

    PubMed

    Alagoz, Ali; Sazak, Hilal; Tunc, Mehtap; Ulus, Fatma; Kokulu, Serdar; Pehlivanoglu, Polat; Sahin, Saziye

    2016-01-01

    In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients. After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second-third year (Group I) and fourth year (Group II) according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization. Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups (p>0.05). Change of needle insertion level was statistically higher in Group II (p=0.008), whereas paresthesia was significantly higher in Group I (p=0.007). Dural puncture and postdural puncture headache rates were higher in Group I. Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents' experience (p<0.001, 0.005). Body mass index and level of insertion site were significant on thoracic epidural catheterization failure and postoperative complication rate. We think that residents' grade is not a significant factor in terms overall success rate of thoracic epidural catheterization, but it is important for outcome of these procedures. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  12. A new method to catheterize a femoral artery in mice using a nylon suture as a 'guide wire'.

    PubMed

    Fukui, S; Nawshiro, H; Wada, K; Shima, K; Hallenbeck, J M

    2001-09-01

    Mice are commonly used in laboratory experiments. Their femoral arteries are so tiny that catheterization is quite difficult. We describe a new method to catheterize the femoral artery in mice. The key feature of this new method is the use of a nylon suture as a 'guide wire'. The full catheterization system consists of two sizes of polyethylene tubes (PE-10, PE-50) and a 4-0 nylon suture. We have been able to repeatedly catheterize mouse femoral arteries (n = 57) successfully and easily with this new system. We believe that this new method can facilitate vascular catheterization in small animals such as mice.

  13. Procedural outcomes of fluoroless catheter ablation outside the traditional catheterization lab.

    PubMed

    Bigelow, Amee M; Smith, Philip C; Timberlake, Dylan T; McNinch, Neil L; Smith, Grace L; Lane, John R; Clark, John M

    2017-08-01

    Non-fluoroscopic catheter ablation is becoming routine. In experienced centres, fluoroscopy is rarely required. The use of a traditional catheterization lab (cath lab) may no longer be necessary. We began performing catheter ablations at a paediatric centre outside the traditional cardiac cath lab in 2013. The purpose of this study was to compare procedural features of paediatric catheter ablation performed outside the cath lab to those performed within a cath lab. We prospectively looked at patients presenting to the paediatric centre with supraventricular tachycardia (SVT) undergoing catheter ablation outside the cath lab in a standard operating room (OR group). We compared retrospectively to a control group matched for age, type, and location of arrhythmia who had ablations in a traditional cath lab (CL group). Catheter visualization was exclusively by electro-anatomic mapping. Fifty-nine patients with SVT underwent catheter ablation in the OR from October 2013 to December 2015. Thirty-three patients had accessory pathways, 29 were manifest, and 13 of those were left sided. Twenty-six had atrioventricular nodal re-entrant tachycardia. Transseptal puncture with transoesophageal echocardiography guidance was used for 10 left-sided pathways, whereas the other 3 had patent foramen ovales. Procedure time did not differ significantly between groups (OR group mean 131 min, range 57-408; CL group mean 152 min, range 68-376; P = 0.12). Acute success was similar in both groups [OR group: 58/59 (98.3%) and CL group: 57/59 (96.6%)]. There were no major complications in either group. There was no fluoroscopy used in either group. Although performing paediatric catheter ablations outside the traditional cath lab is early in our experience, we produced similar outcomes and results without encountering procedural difficulties of performing ablations in a non-conventional setting. Larger multi-centred trials will be essential to determine the feasibility of this practice.

  14. Comparison of catheterization laboratory initiated abciximab and eptifibatide during percutaneous coronary intervention in acute coronary syndromes (an ACUITY substudy).

    PubMed

    Kirtane, Ajay J; Parise, Helen; Mehran, Roxana; Moses, Jeffrey W; Fahy, Martin; Bertrand, Michel E; Ohman, E Magnus; White, Harvey D; Feit, Frederick; Colombo, Antonio; McLaurin, Brent T; Cox, David A; Ware, James H; Pocock, Stuart J; Lansky, Alexandra J; Stone, Gregg W

    2010-07-15

    Abciximab and eptifibatide have been shown to reduce ischemic complications compared with heparin alone in patients with acute coronary syndromes who undergo percutaneous coronary intervention. Whether 1 agent is safer and/or more effective has not been prospectively examined. The aim of this study was to assess the outcomes related to downstream glycoprotein IIb/IIIa inhibitor treatment selection during percutaneous coronary intervention in 2,211 patients with moderate and high-risk acute coronary syndromes in the prospective multicenter Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. The protocol permitted operator selection of abciximab (n = 835) or eptifibatide (n = 1,376) for routine use in the trial. Multivariate and propensity-based adjustments were used to assess the independent association of glycoprotein IIb/IIIa inhibitor treatment selection with prespecified study end points. Compared to patients receiving eptifibatide, those administered abciximab were older, more likely to be enrolled outside of North America, more frequently had biomarker elevations and ST-segment deviation, but had fewer baseline cardiac risk factors and previous revascularization procedures. After multivariate propensity-based adjustment, abciximab was independently associated with significantly fewer net clinical adverse events (odds ratio 0.61, 95% confidence interval 0.42 to 0.90, p = 0.01), mediated by composite ischemia (odds ratio 0.61, 95% confidence interval 0.38 to 0.98, p = 0.04) and major bleeding (odds ratio 0.58, 95% confidence interval 0.34 to 1.00, p = 0.051). In conclusion, in this prespecified but nonrandomized comparison in patients with acute coronary syndromes who underwent percutaneous coronary intervention with catheterization laboratory initiation of glycoprotein IIb/IIIa inhibitors, the use of abciximab rather than eptifibatide was associated with improved clinical outcomes at 30 days. These findings should be viewed as

  15. Isovolumic pressure-to-early rapid filling decay rate relation: model-based derivation and validation via simultaneous catheterization echocardiography.

    PubMed

    Chung, Charles S; Ajo, David M; Kovács, Sándor J

    2006-02-01

    Transmitral Doppler echocardiography is the preferred method of noninvasive diastolic function assessment. Correlations between catheterization-based measures of isovolumic relaxation (IVR) and transmitral, early rapid filling (Doppler E-wave)-derived parameters have been observed, but no model-based, causal explanation has been offered. IVR has also been characterized in terms of its duration as IVR time (IVRT) and by tau, the time-constant of IVR, by approximating the terminal left ventricular IVR pressure contour as Pt= Pinfinity + P(o)e(-t/tau), where Pt is the continuity of pressure, Pinfinity and Po are constants, t is time, and tau is the time constant of IVR. To characterize the relation between IVR and early rapid filling more fully, simultaneous (micromanometric) left ventricular pressure and transmitral Doppler E-wave data from 25 subjects undergoing elective cardiac catheterization and having normal physiology were analyzed. The time constant tau was determined from the dP/dt vs. P (phase) plane and, simultaneous Doppler E-waves provided global indexes of chamber viscosity/relaxation (c), chamber stiffness (k), and load (xo). We hypothesize that temporal continuity of pressure decay at mitral valve opening and physiological constraints permit the algebraic derivation of linear relations relating 1/tau to both peak atrioventricular pressure gradient (kxo) and E-wave-derived viscosity/relaxation (c) but does not support a similar, causal (linear) relation between deceleration time and tau or IVRT. Both predicted linear relations were observed: kxo to 1/tau (r = 0.71) and viscosity/relaxation to 1/tau (r = 0.71). Similarly, as anticipated, only a weak linear correlation between deceleration time and IVRT or tau was observed (r = 0.41). The observed in vivo relationship provides insight into the isovolumic mechanism of relaxation and the changing-volume mechanism of early rapid filling via a link of the respective relaxation properties.

  16. Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization.

    PubMed Central

    Brismar, B; Hårdstedt, C; Jacobson, S

    1981-01-01

    Sixty central venous catheterizations in 53 patients were prospectively studied with respect to phlebographic findings after prolonged parenteral nutrition. Phlebography was performed by a special technique on completion of the intravenous therapy. Under fluoroscopic control, the central venous catheter was slowly removed, while simultaneously contrast medium was continuously injected through it. Two types of thrombosis were demonstrated--sleeve thrombosis, on 25 occasions (42%), and mural veno-occlusive thrombosis, on five occasions (8%). On removal of the catheter the sleeve thrombosis peeled off the catheter and in several cases it was noticed that parts of the sleeve thrombus or the entire sleeve became detached and were carried away with the blood flow. Although the sleeve thrombus seldom gave rise to any symptoms, this type of thrombosis is of great importance in view of the risk of pulmonary embolism, especially in connection with removal of the catheter. With use of the described phlebographic technique thrombi of this type can be visualized. Images Fig. 1A. Fig. 1B. Fig. 2. Fig. 3. Fig. 4. PMID:7305496

  17. Stabilization of Coronary Stents Using the Floating-Wire Technique.

    PubMed

    Li, Yue; Xue, Jingyi; Li, Shuang; Sheng, Li; Sun, Danghui; Li, Weimin; Gong, Yongtai

    2015-11-01

    Excessive movement of coronary stents within the artery can make accurate stent placement difficult. This study assessed the use of the floating-wire technique to reduce stent motion to improve placement accuracy. During percutaneous coronary intervention, if excessive stent movement prevented accurate stent placement, the floating-wire technique was performed to reduce stent motion within the coronary artery during both stent positioning and deployment. Postprocedural angiograms were analyzed by two independent operators to measure the motion length of the stent delivery system relative to the coronary artery before and after using the floating-wire technique. The floating-wire technique was considered necessary in 19 patients. No procedural complications occurred. The extent of motion was markedly reduced by using the floating-wire technique (4.04 ± 1.25 mm to 1.11 ± 0.81 mm; P<.001). The floating-wire technique is an effective and safe method to reduce stent movement and facilitate accurate stent deployment. This simple technique can be easily applied in any interventional cardiac catheterization laboratory without the need for additional training or equipment.

  18. Relation of Coronary Flow Reserve to Other Findings on Positron Emission Tomography Myocardial Perfusion Imaging and Left Heart Catheterization in Patients With End-stage Renal Disease Being Evaluated for Kidney Transplant.

    PubMed

    Paz, Yehuda; Morgenstern, Rachelle; Weinberg, Richard; Chiles, Mariana; Bhatti, Navdeep; Ali, Ziad; Mohan, Sumit; Bokhari, Sabahat

    2017-08-30

    Cardiovascular disease is the leading cause of death in patients with end-stage renal disease (ESRD) and often goes undetected. Abnormal coronary flow reserve (CFR), which predicts increased risk of cardiac death, may be present in patients with ESRD without other evidence of coronary artery disease (CAD). We prospectively studied 131 patients who had rest and dipyridamole pharmacologic stress N(13)-ammonia positron emission tomography myocardial perfusion imaging (PET MPI) for kidney transplant evaluation. Thirty-four patients also had left heart catheterization. Abnormal PET MPI was defined as qualitative ischemia or infarct, stress electrocardiogram ischemia, or transient ischemic dilation. CFR was calculated as the ratio of stress to rest coronary blood flow. Global CFR < 2 was defined as abnormal. Of 131 patients who had PET MPI (66% male, 55.6 ± 12.1 years), 30% (39 of 131) had abnormal PET MPI and 59% (77 of 131) had abnormal CFR. In a subset of 34 patients who had left heart catheterization (66% male, 61.0 ± 12.1 years), 68% (23 of 34) had abnormal CFR on PET MPI, and 68% (23 of 34) had ≥70% obstruction on left heart catheterization. Abnormal CFR was not significantly associated with abnormal PET MPI (p = 0.13) or obstructive CAD on left heart catheterization (p = 0.26). In conclusion, in the first prospective study of PET MPI in patients with ESRD, abnormal CFR is highly prevalent and is independent of abnormal findings on PET MPI or obstructive CAD on left heart catheterization. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Data analysis in cardiac arrhythmias.

    PubMed

    Rodrigo, Miguel; Pedrón-Torecilla, Jorge; Hernández, Ismael; Liberos, Alejandro; Climent, Andreu M; Guillem, María S

    2015-01-01

    Cardiac arrhythmias are an increasingly present in developed countries and represent a major health and economic burden. The occurrence of cardiac arrhythmias is closely linked to the electrical function of the heart. Consequently, the analysis of the electrical signal generated by the heart tissue, either recorded invasively or noninvasively, provides valuable information for the study of cardiac arrhythmias. In this chapter, novel cardiac signal analysis techniques that allow the study and diagnosis of cardiac arrhythmias are described, with emphasis on cardiac mapping which allows for spatiotemporal analysis of cardiac signals.Cardiac mapping can serve as a diagnostic tool by recording cardiac signals either in close contact to the heart tissue or noninvasively from the body surface, and allows the identification of cardiac sites responsible of the development or maintenance of arrhythmias. Cardiac mapping can also be used for research in cardiac arrhythmias in order to understand their mechanisms. For this purpose, both synthetic signals generated by computer simulations and animal experimental models allow for more controlled physiological conditions and complete access to the organ.

  20. Cardiac tamponade caused by central venous catheter in two newborns.

    PubMed

    Monteiro, Andrey José; Canale, Leonardo Secchin; Barbosa, Rodrigo; Méier, Milton

    2008-01-01

    Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.

  1. Options for independent bladder management in patients with spinal cord injury and hand function prohibiting intermittent catheterization.

    PubMed

    Sorokin, Igor; De, Elise

    2015-02-01

    Choosing the appropriate bladder management strategy for the spinal cord injury patient with neurogenic bladder and hand function prohibitive of self catheterization (urethral or stomal) catheterization is complex and based on limited literature. We have catalogued the available data in this review. A literature review was conducted on external sphincterotomy, suprapubic tube, ileal conduit, and ileovesicostomy between 1994 and 2012. Articles on neurogenic bladder focused primarily on spinal cord injury were included. Important aspects of each technique, patient selection, urologic events, and quality of life are described. The available literature consists primarily of level 3 data. Patient reported outcomes were rarely measured. External sphincterotomy is a good option for males who are candidates for an external catheter and who wish to avoid a complicated reconstruction-most will need re-operations for failure. Suprapubic tube is an option in both genders. Complaints usually involve urine leakage and urinary tract infection, which typically resolve with conservative measures. There is some evidence to support patient satisfaction. Ileal conduit is an option for all patients with quadriplegia, offering continuous drainage and absence of foreign material. Many providers and patients will choose more conservative options first. The ileovesicostomy is best applied to small bladders with severe overactivity. The "reversibility" of this procedure makes it attractive to those not interested in an ileal conduit and who have had complications from prolonged suprapubic tube placement. The authors conclude with recommendations for future research, most importantly more standard reporting of objective data. © 2013 Wiley Periodicals, Inc.

  2. Puncture point-traction method: A novel method applied for right internal jugular vein catheterization

    PubMed Central

    WU, TIANLIANG; ZANG, HONGCHENG

    2016-01-01

    The ultrasound probe and advancement of the needle during real-time ultrasound-assisted guidance of catheterization of the right internal jugular vein (RIJV) tend to collapse the vein, which reduces the success rate of the procedure. We have developed a novel puncture point-traction method (PPTM) to facilitate RIJV cannulation. The present study examined whether this method facilitated the performance of RIJV catheterization in anesthetized patients. In this study, 120 patients were randomly assigned to a group in which PPTM was performed (PPTM group, n=60) or a group in which it was not performed (non-PPTM group, n=60). One patient was excluded because of internal carotid artery puncture and 119 patients remained for analysis. The cross-sectional area (CSA), anteroposterior diameter (AD) and transverse diameter (TD) of the RIJV at the cricoid cartilage level following the induction of anesthesia and during catheterization were measured, and the number with obvious loss of resistance (NOLR), the number with easy aspiration of blood into syringe (NEABS) during advancement of the needle, and the number of first-pass punctures (NFPP) during catheterization were determined. In the non-PPTM group, the CSA was smaller during catheterization compared with that following the induction of anesthesia (P<0.01). In the PPTM group compared with the non-PPTM group during catheterization, the CSA was larger (P<0.01) and the AD (P<0.01) and TD (P<0.05) were wider; NOLR (P<0.01), NEABS (P<0.01) and NFPP (P<0.01) increased significantly. The findings from this study confirmed that the PPTM facilitated catheterization of the RIJV and improved the success rate of RIJV catheterization in anesthetized patients in the supine position. PMID:27347054

  3. Development of Needle Insertion Manipulator for Central Venous Catheterization

    NASA Astrophysics Data System (ADS)

    Kobayashi, Yo; Hong, Jaesung; Hamano, Ryutaro; Hashizume, Makoto; Okada, Kaoru; Fujie, Masakatsu G.

    Central venous catheterization is a procedure, which a doctor insert a catheter into the patient’s vein for transfusion. Since there are risks of bleeding from arterial puncture or pneumothorax from pleural puncture. Physicians are strictly required to make needle reach up into the vein and to stop the needle in the middle of vein. We proposed a robot system for assisting the venous puncture, which can relieve the difficulties in conventional procedure, and the risks of complication. This paper reports the design structuring and experimental results of needle insertion manipulator. First, we investigated the relationship between insertion force and angle into the vein. The results indicated that the judgment of perforation using the reaction force is possible in case where the needling angle is from 10 to 20 degree. The experiment to evaluate accuracy of the robot also revealed that it has beyond 0.5 mm accuracy. We also evaluated the positioning accuracy in the ultrasound images. The results displays that the accuracy is beyond 1.0 mm and it has enough for venous puncture. We also carried out the venous puncture experiment to the phantom and confirm our manipulator realized to make needle reach up into the vein.

  4. Central venous catheterization--an anatomical review of a clinical skill. Part 2. Internal jugular vein via the supraclavicular approach.

    PubMed

    Boon, J M; van Schoor, A N; Abrahams, P H; Meiring, J H; Welch, T

    2008-01-01

    The safe and successful performance of a central venous catheterization (CVC) requires a specific knowledge of anatomy in addition to a working knowledge. Misunderstanding the anatomy may result in failure or complications. This review aims to aid understanding of the anatomical framework, pitfalls, and complications of CVC of the internal jugular veins. CVC is common practice amongst surgeons, anesthesiologists, and emergency room physicians during the preparations for major surgical procedures such as open-heart surgery, as well as for intensive care monitoring and rapid restoration of blood volume. Associated with this technique are certain anatomical pitfalls and complications that can be successfully avoided if one possesses a thorough knowledge of the contraindications, regional anatomy, and rationale of the technique.

  5. Central venous catheterization -- an anatomical review of a clinical skill -- Part 1: subclavian vein via the infraclavicular approach.

    PubMed

    Boon, J M; van Schoor, A N; Abrahams, P H; Meiring, J H; Welch, T; Shanahan, D

    2007-08-01

    The safe and successful performance of a central venous catheterization (CVC) requires a specific knowledge of anatomy in addition to a working knowledge. Misunderstanding the anatomy may result in failure or complications. This review aims to aid understanding of the anatomical framework, pitfalls, and complications of CVC of the subclavian (SCV). CVC is common practice amongst surgeons, anesthesiologists, and emergency room physicians during the preparations for major surgical procedures such as open-heart surgery, as well as, for intensive care monitoring and rapid restoration of blood volume. Associated with this technique are certain anatomical pitfalls and complications that can be successfully avoided if one possesses a thorough knowledge of the contraindications, regional anatomy, and rationale of the technique.

  6. Bladder catheterization increases susceptibility to infection that can be prevented by prophylactic antibiotic treatment

    PubMed Central

    Rousseau, Matthieu; Goh, H.M. Sharon; Holec, Sarah; Albert, Matthew L.; Williams, Rohan B.H.; Ingersoll, Molly A.; Kline, Kimberly A.

    2016-01-01

    Catheter-associated urinary tract infections (CAUTI) are the most common hospital-associated infections. Here, we report that bladder catheterization initiated a persistent sterile inflammatory reaction within minutes of catheter implantation. Catheterization resulted in increased expression of genes associated with defense responses and cellular migration, with ensuing rapid and sustained innate immune cell infiltration into the bladder. Catheterization also resulted in hypersensitivity to Enterococcus faecalis and uropathogenic Escherichia coli (UPEC) infection, in which colonization was achieved using an inoculum 100-fold lower than the ID90 for infection of an undamaged urothelium with the same uropathogens. As the time of catheterization increased, however, colonization by the Gram-positive uropathogen E. faecalis was reduced, whereas catheterization created a sustained window of vulnerability to infection for Gram-negative UPEC over time. As CAUTI contributes to poorer patient outcomes and increased health care expenditures, we tested whether a single prophylactic antibiotic treatment, concurrent with catheterization, would prevent infection. We observed that antibiotic treatment protected against UPEC and E. faecalis bladder and catheter colonization as late as 6 hours after implantation. Thus, our study has revealed a simple, safe, and immediately employable intervention, with the potential to decrease one of the most costly hospital-incurred infections, thereby improving patient and health care economic outcome. PMID:27699248

  7. Catheterization of Intestinal Loops in Ruminants Does Not Adversely Affect Loop Function

    PubMed Central

    Inglis, G Douglas; Kastelic, John P; Uwiera, Richard R E

    2010-01-01

    Catheterized intestinal loops may be a valuable model to elucidate key components of the host response to various treatments within the small intestine of ruminants. We examined whether catheterizing ileal loops in sheep affected the overall health of animals and intestinal function, whether a bacterial treatment could be introduced into the loops through the catheters, and whether broad-spectrum antibiotics could sterilize the loops. Escherichia coli cells transformed to express the GFP gene were introduced readily into the loops through the catheters, and GFP E. coli cells were localized within the injected loops. Catheterized loops, interspaces, and intact ileum exhibited no abnormalities in tissue appearance or electrical resistance. Expression of the IFNγ, IL1α, IL4, IL6, IL12p40, IL18, TGFβ1, and TNFα cytokine genes did not differ significantly among the intact ileum, catheterized loops, and interspaces, nor did the expression of the gene for inducible nitric oxide synthase. Broad-spectrum antibiotics administered during surgery did not sterilize the loops or interspaces and did not substantively change the composition of the microbiota. However, antibiotics reduced the overall number of bacterial cells within the loop and the relative abundance of community constituents. We concluded that catheterization of intestinal loops did not adversely affect health or loop function in sheep. Furthermore, allowing animals to recover fully from surgery and to clear pharmaceuticals will remove any confounding effects due to these factors, making catheterized intestinal loops a feasible model for studying host responses in ruminants. PMID:21262134

  8. Diagnostic and therapeutic value of selective salpingography and tubal catheterization in an unselected infertile population.

    PubMed

    Papaioannou, Spyros; Afnan, Masood; Girling, Alan J; Ola, Bolarinde; Olufowobi, Olufemi; Coomarasamy, Aravinthan; Sharif, Kaldoun

    2003-03-01

    To present diagnostic findings and fertility outcome after selective salpingography and tubal catheterization in an unselected infertile population. Cohort study. Tertiary reproductive medicine unit. One hundred ten consecutive infertile women. No exclusion criteria were applied. Follow-up