Editorial Comment

IVC Occlusion Catheter:Works Well But Will It BeWidely Applied?

Neil WilsonYorkhill Hospital, NHS Trust, Glasgow, Scotland

The preceding article clearly demonstrates the me-chanical effectiveness of a balloon catheter to occlude theinferior vena cava in the context of measuring ventricularpressure volume curves across the spectrum of congeni-tal heart disease, the majority of which have normalventricular morphology. There is a range of catheters, thelargest of which is deployed through a short 7 Fr venoussheath, which compares favorably with competitors. Thepreceding article also demonstrates superiority of thiscatheter over the standard Berman catheter. Assessingthe efficacy of this catheter, the ventricular functionmeasurements in a series of 92 patients constitute a lotof hard work and this is applauded. The catheterappears easy to use with inflation, deflation, and re-moval. The balloon constitution of Latex means onewould have to be very careful in patients with potentialhypersensitivity.

Pressure area curves are undoubtedly helpful in theassessment of ventricular function and load-independentmeasurements may be potentially very useful in the as-sessment of complex congenital heart disease when ven-tricular morphology and topology are abnormal. Thisfunction assessment an important part for example in theevaluation of suitability for cavopulmonary connectionvariations of the Fontan circulations where hitherto as-sessments of ventricular function are very subjective. Isuspect, however, the proposed IVC and balloon occlu-sion catheter is not going to be the answer to our prob-lems because of the difficulties in achieving volumemeasurements of the ventricle echocardiographically.The preceding study has only 10 patients of single-ventricle-type anatomy, the area most needed of objec-tive investigation. Assessment of ventricular function inless complex disease such as ventricular septal defect,atrial septal defect, and patent ductus arteriosus is usuallynot an issue as the volume loading in these situations isassociated with normal or supranormal function. I doubtvery much, however, if reliable error-free automatic edgerecognition on an echocardiogram of an abnormalmorphology ventricle in a supine patient on the cathetertable is easily obtained. This potential problem is notaddressed in the discussion and my fear is that comparativestudies with other operators may well unearth this flaw.

Catheterization and Cardiovascular Interventions 53:397 (2001)

© 2001 Wiley-Liss, Inc.