Cardiac Cath and Angiocardiography

SPRING 2011

Catherization Studies and Procedures

•Adults

•Children

Basic Diagnostic Studies of the Vascular System for Adults

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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

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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

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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

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Coronary Angiography

• Allows the extent of intracoronary stenosis to be evaluated

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Coronary Angiography

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Coronary Angiography

Normal LT coronary Artery

LT coronary artery

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Cath of the RT side of the heart:

ADULTS

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Cath of the RT side of the heart: ADULTS

• Pressure measurements– Used to determine valvular heart disease– Congestive heart failure– Pulmonary hypertension– Cardiomyopathies

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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)

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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

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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

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Bioptome Biopsies

• Used to monitor cardiac transplants for tissue rejection

• And to differentiate between various types of cardiomyopathies

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Studies of the Conduction System for Adults & Children

Mulipolar catheters are inserted in •High RT atrium near sinus node•Atrioventricular apex•Coronary sinus

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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

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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

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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

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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

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PTCA

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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

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PTCA with Stenting

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PTCA with Stent Placement

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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

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Percutaneous transluminal coronary rotational atherectomy

• The tip is a football shape and is embedded with diamond particles

• Special torque guidewire between 160,000- 200,000 rpm

• The plaque is pulverized into particles the size of RBC’s and removed by the reticuloendothial system

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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

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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

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Interventional Procedures of the Conduction System: Adults &

Children

• Antiarrhythmic devices– Pacemakers– Implantable

cardioverter defibrillators

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CXR with Pacemaker

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Post Catheterization Care

• Firm pressure is applied to puncture site for 15-30 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

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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

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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

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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