Cardiac Cath and Angiocardiography SPRING 2011

Catherization Studies and Procedures Adults Children

Basic Diagnostic Studies of the Vascular System for Adults

4 Cath of the LT side of the heart: ADULTS Catheter introduced into the radial, brachial or femoral artery to the ascending aorta Aortic root angio is performed to document competence of the aortic valve

5 Aorta Root Angiography Normal means backward flow of the contrast media into the LT ventricle during injection Atrial oximetry and blood pressure within aorta are measured Then advanced into the LT ventricle

6 LT Ventriculography Provides info on valvular competence Interventricular septal integrity Efficiency of the pumping action of LT ventricle Pressure measurements are made When systolic (LT ventricle) does not match systolic (aorta)- could mean aortic stenosis

7 Coronary Angiography Allows the extent of intracoronary stenosis to be evaluated

8 Coronary Angiography

9 Normal LT coronary Artery LT coronary artery

10 Cath of the RT side of the heart: ADULTS

11 Cath of the RT side of the heart: ADULTS Pressure measurements –Used to determine valvular heart disease –Congestive heart failure –Pulmonary hypertension –Cardiomyopathies

12 Exercise Hemodynamics For evaluation of valvular disease –When fatigue and dyspnea are present Simultaneous catherization is done and pressure measurements of RT & LT heart is taken –At rest –With exertion Catheter is placed in: –An artery (femoral or brachial) –Vein (femoral or basilic)

13 Basic Diagnostic Studies of the Vascular System for Children For evaluation of specific hemodynamic data –Selected aspects of cardiac function –Congenital heart defects Methods are different according to age and size of the heart

14 Advanced Diagnostic Studies of the Vascular System for Adults & Children Biopsy catheter with bioptome tip is inserted into jugular or femoral vein into RT ventricle Jaws are opened and many biopsies are taken

15 Bioptome Biopsies Used to monitor cardiac transplants for tissue rejection And to differentiate between various types of cardiomyopathies

16 Studies of the Conduction System for Adults & Children Mulipolar catheters are inserted in High RT atrium near sinus node Atrioventricular apex Coronary sinus

17 Studies of the Conduction System for Adults & Children Sometimes 3 introducer sheaths are placed in one vein –Femoral –Internal jugular vein –Subclavian vein Cathodes serve a dual function –Record electrical signals –Pace the heart

18 Interventional Procedures of the Vascular System: Adults Percutaneous Transluminal Coronary Angioplasty (PTCA) –Also known as balloon angioplasty –Employs balloon to dilate the coronary artery stenosis The placement of the catheter is placed much in the same way as standard coronary angiography

19 PTCA cont Special steerable PTCA guidewire is used. Guidewire is advanced to stenotic area through the balloon catheter Balloon is pushed through to the stenotic area Balloon is inflated and compresses fatty deposits

20 PTCA cont Followed by arteriography to make sure it blood is flowing This may be done repeated times to assure maximum dilatation Restenosis occurs in 30-50% of patients

21 PTCA

22 PTCA with Stent placement Similar to PTCA alone except a stent is placed Restenosis is lower for pt’s who do this rather than conventional angioplasty alone

23 PTCA with Stenting

24 PTCA with Stent Placement

25 Atherectomy Atherectomy devices remove the fatty deposit or thrombus material within artery Directional coronary atherectomy devices having a specialized cutting device to shave out the plaque There is a special nose cone that collect the free floating particles

26 Percutaneous transluminal coronary rotational atherectomy The tip is a football shape and is embedded with diamond particles Special torque guidewire between 160, ,000 rpm The plaque is pulverized into particles the size of RBC’s and removed by the reticuloendothial system

27 Interventional Procedures of the Vascular System: Children Balloon Septostomy to enlarge a patent foramen ovale or preexisting atrial septal defect This allows mixing of RT and LT blood –Resulting in improved arterial oxygenation Balloon is passed through atrial septal opening into the LT atrium, inflated with contrast and pulled back through the orifice –Causes septum to tear

28 Balloon Septostomy with Transeptal System Approach When there is not a preexisting hole in the atrial septum –Transeptal approach is used –Catheter with knife is employed into LT atrium blade is opened and pulled back through RT atrium –Then balloon septostomy may be performed to open the hole more

29 Interventional Procedures of the Conduction System: Adults & Children Antiarrhythmic devices –Pacemakers –Implantable cardioverter defibrillators

30 CXR with Pacemaker

31 Post Catheterization Care Firm pressure is applied to puncture site for minutes Wound sites are cleaned and dressed The patient will be observed in recovery for 4-8 hours The insertion site will be checked frequently for signs of bleeding. Medications and discharge instructions are given Lots of fluid should be taken in Vital signs should be monitored for 24 hours

Cardiac Catheterization Trends

33 Trends Vascular brachytherapy- technique where radiation is delivered to an area of a previously stented artery using endovascular techniques Drug eluting stents- drug coated stents used for treatment of CAD to reduce restenosis

34 MRI Is becoming more sophisticated and having greater detail and resolution Allows for is to be used more often for the cardiovascular system MRA is now able to assess anomalies in the coronary arteries –And identify calcifications in the coronary arteries and bypass grafts

35 Electron Beam CT Can detect heart disease at it earliest and most treatable stages –Measures the amount of coronary calcium, Electron Beam angiography is a simple and noninvasive technique that uses IV contrast media injection –Effective for visualization of great vessels, carotid arteries and peripheral vasculature