Complete atrioventricular block induced during left heart catheterization

Complete atrioventricular block (CAVB) during cardiac catheterization is a rare complication. We describe a patient with preexisting complete right bundle branch block who developed CAVB during left-sided cardiac catheterization. CAVB was induced when a left-sided catheter was passed through the aortic valve. We speculate that the patient's His bundle was injured by mechanical compression. Physicians should always pay attention to the possibility of the development of CAVB during cardiac catheterization, particularly in patients with preexisting heart block.     

Complex right subclavian artery dissection during diagnostic cardiac catheterization

Vascular complications are important and unfortunate sequelae of cardiac catheterization. We report a case of complex right subclavian artery dissection following attempted diagnostic cardiac catheterization of a right internal mammary artery (RIMA) coronary bypass graft. Subsequent dissection of the right subclavian artery involved the origin of the right vertebral and internal mammary arteries, as well as producing critical right upper limb ischemia. The anatomy dictated that therapy consist of conservative management of the proximal dissection involving the vertebral artery and the RIMA graft origins, with endovascular stent deployment at the distal site of the vessel occlusion. This example reinforces the need for prompt diagnosis and management of vascular complications, and emphasizes the need for available, appropriate skills relevant to the peripheral vascular interventions.     

Antegrade left heart catheterization

Retrograde arterial catheterization has been the standard approach to hemodynamic and angiographic evaluation of the left ventricle and systemic arterial system. An alternative approach—antegrade left heart catheterization—is reported that circumvents arterial puncture. During cardiac catheterization from the femoral vein in 18 children with normally related great arteries who had interatrial communications, a balloon-tipped catheter was looped in a ?clockwise”? fashion through the left atrium and left ventricle and into the ascending aorta. In 17 children the maneuver was rapidly accomplished without complications; it proved possible to perform in an infant with a hypoplastic left ventricular cavity, and was employed to perform a renal arteriogram. The major advantage of antegrade left heart catheterization is avoidance of complications related to arterial puncture. The antegrade approach also avoids right arm cut-down in children with coarctation of the aorta.     

Measurement of cardiac output without right heart catheterization: reliability, advantages, and limitations of a left-sided indicator dilution technique

This study was done to determine the accuracy and reliability of cardiac output measurements by the injection of indocyanine green into the left ventricle, with simultaneous sampling from a systemic artery. In 40 patients (18 men, 22 women, aged 34 to 74 years), cardiac output was measured in close temporal proximity by (a) standard indicator dilution (right atrium-to-pulmonary artery thermodilution in 11, pulmonary artery-to-systemic artery indocyanine green in 29) and (b) left ventricle-to-systemic artery indocyanine green. There was excellent agreement between the two techniques (r = 0.98, SEE = 0.12 liters/minute). In 28 of the patients, cardiac output also was measured by ascending aorta-to-systemic artery indocyanine green. In these individuals, this technique yielded results that were disparate from those obtained by standard indicator dilution (difference between standard indicator dilution and left ventricle-to-systemic artery indocyanine green = 0.18 +/- 0.13 [mean +/- SD] liters/minute; difference between standard indicator dilution and ascending aorta-to-systemic artery indocyanine green = 0.72 +/- 0.55 liters/minute; p less than 0.001), and in 22 of the 28, the ascending aorta-to-systemic artery indocyanine green cardiac outputs were greater than those obtained by standard indicator dilution. Thus, cardiac output can be measured accurately by injecting indocyanine green into the left ventricle, with simultaneous sampling from a systemic artery, but it cannot be quantified reliably by introducing indicator into the ascending aorta. The left ventricle-to-systemic artery indocyanine green technique can be used in patients undergoing only left heart catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intracardiac amputation of a plastic catheter during left heart catheterization

A case of accidental intracardiac amputation of a plastic catheter during left heart catheterization is reported. Operation as well as mitral commissurotomy with removal of the catheter was followed by uneventful recovery of the patient.

The case is reported as a reminder of the possibility of its occurrence and the serious consequences. With proper smoothing of the heel of the bevel of the needle tip such a mishap should be preventable.     

肺动脉高压患者经左前臂行标准右心导管检查科学性的探讨

目的:探讨经左前臂行右心导管检查的科学性。方法:本研究对所有在我科就诊的疑诊肺血管病患者行右心导管检查,首选经肘前静脉穿刺,穿刺失败改为颈内静脉。需要围手术期监测肺动脉压者直接行右侧颈内静脉穿刺。结果:110例患者经肘前静脉穿刺,穿刺置入鞘管成功者为106例(96.4%),置入鞘管成功后完成右心导管检查者为104例(94.5%);6例患者经颈内静脉穿刺,均成功置入鞘管,顺利完成右心导管检查。结论:右心导管检查操作简便,安全性高,尤其经左侧肘前静脉进行右心导管检查操作简便,并发症发生率低,术后患者痛苦小,可以作为右心导管的检查路径。