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Cardiac Catheterization (cardiac + catheterization)
Kinds of Cardiac Catheterization Terms modified by Cardiac Catheterization Selected AbstractsA Risk Adjusted Method for Comparing Adverse Outcomes among Practitioners in Pediatric and Congenital Cardiac CatheterizationCONGENITAL HEART DISEASE, Issue 4 2008Lisa Bergersen MD ABSTRACT Objective., We sought to develop a method to adjust for case mix diversity and allow comparison of adverse outcome rates among practitioners in pediatric and congenital cardiac catheterization. Patients and Methods., A single institutional database that captured demographic and procedural data was used to identify patient and procedural characteristics associated with adverse events (AE) and any high severity event classified as preventable or possibly preventable (P/PP). Diagnostic and procedural risk groups were created and indicators of hemodynamic vulnerability were defined. Expected event rates by the practitioners adjusting for case mix were calculated. Standardized adverse event ratios (SAER), defined as the observed rate divided by the expected rate for each practitioner were calculated with 95% confidence intervals. Results., The database included 1727 hemodynamic (30%) and interventional (70%) cases performed by seven practitioners in 18 months. During 147 cases, at least one P/PP AE occurred; among the seven practitioners observed, event rates ranged from 3.2 to 14.2%. In multivariable analysis, risk factors for all P/PP events included highest procedure risk group (odds ratio [OR] 2.1 for group 2, and 2.8 for group 3, relative to group 1, P = .001 and P < .001, respectively) and weight less than 4 kg (OR 2.8, P < .001). High severity P/PP events occurred in 67 cases with rates ranging from 2.0 to 6.6% by the practitioners. For these events, risk factors included: highest procedure risk group (OR 4.5 for group 2, and 4.9 for group 3, both P < .001) and an indicator of hemodynamic vulnerability (OR 1.8, P = .026). For the seven practitioners, the SAER ranged from 0.41 to 1.32 for any P/PP AE and from 0.69 to 1.44 for P/PP high severity events. In this cohort, we did not identify any statistically significant performance differences. Conclusion., Despite wide variations in case mix complexity in pediatric and congenital cardiac catheterization, this study demonstrates a method for risk adjustment which allows equitable comparisons among practitioners at a single institution. [source] Heart Failure and Cardiac CatheterizationCONGESTIVE HEART FAILURE, Issue 6 2009Editor, Hector O. Ventura MD No abstract is available for this article. [source] Discrepancy between Gradients Derived by Cardiac Catheterization and by Doppler Echocardiography in Aortic Stenosis: How Often Does Pressure Recovery Play a Role?ECHOCARDIOGRAPHY, Issue 9 2009Studies have shown very good correlation between Doppler-derived gradients and gradients obtained by cardiac catheterization (cath) in aortic stenosis (AS). However, the phenomenon of pressure recovery may lead to significant overestimation of aortic valve (AV) gradients by Doppler echocardiography (echo). We hypothesized that echo-derived gradients will be higher in mild,moderate AS because of pressure recovery. We studied 94 patients who had echo and cardiac caths in a span of 1 week. The mean age was 72 ± 13 years, 54% males, 79% had coronary artery disease, and the mean left ventricular ejection fraction was 45 ± 22%. The mean cardiac output and cardiac indices were 5.1 ± 1.4/2.7 ± 0.6 (l/mt), (l/m2), respectively. For those with mild AS, echo overestimated gradients in 9.5% of patients (4/42) by an average of 19 mmHg, thus misclassifying the degree of stenosis. In those with moderate AS, 14% (3/21) were misclassified as severe AS (gradient overestimation by an average of 13.6 mmHg). In those with severe AS, echo underestimated gradients in 13% (4/31) by an average of 22.7 mmHg. The aorta at the sinotubular junction was 2.8 cm in those patients with mild AS in whom gradients were overestimated by more than 20 mmHg compared to a sinotubular junction diameter of 3.12 cm in those with mild AS and no overestimation of gradients. The AV area/aortic root ratio was 0 .4 in those with mild AS and 0.2 in those with severe AS (P < 0.05). [source] Ulnar Artery as Access Site for Cardiac Catheterization: Anatomical ConsiderationsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2008DOBRIN VASSILEV M.D. Transradial approach to coronary angiography and angioplasty has been widely accepted in the last few years. As an alternative approach from the forearm, with some potential advantages, we decided to test the transulnar approach as a first-choice strategy. Methods and Results: Transulnar approach was tried in 131 patients. In 29 patients there was no palpable ulnar artery or Allen test was negative. From the remaining 92 patients we performed successful coronary angiography and angioplasties in 59 patients (64% success rate in those who had palpable artery). The most frequent reason for access site failure (54.5% of all failed procedures) was inability to introduce wire despite good arterial flow. We found that the ulnar artery was not the largest artery of the forearm (mean diameter 2.76 ± 0.08 mm compared with radial artery 3.11 ± 0.12 mm) and had relatively frequent anatomical anomalies,11.9%. There were no major local complications, with very few minor complications. Spasm frequency was 13.6%, which is higher than that reported for transradial studies. Conclusions: Transulnar artery approach is feasible for cardiac catheterization: however, it has higher access site failure rates in an unselected patient population. It could be used as an alternative option in selected patients, but operators must be prepared to overcome frequent anatomical anomalies and spasm. [source] Incidence and Treatment of Arterial Access Dissections Occurring during Cardiac CatheterizationJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2008AMIT PRASAD M.D. Background: Arterial access dissections may complicate cardiac catheterization and can often be treated percutaneously. The goal of this study was to examine the incidence, consequences, and the treatment of arterial access dissections at a tertiary referral hospital with an active training program. Methods: Patients experiencing arterial access dissection during coronary angiography or intervention at our institution between October 1, 2004, and January 31, 2007, were identified and their records were retrospectively reviewed. Results: Thirteen of the 3,062 consecutive patients (0.42%) had arterial access dissection during the study period. The location of the dissection was in the common femoral artery (CFA) (n = 6), the external iliac artery (EIA) (n = 6), or in an aortobifemoral graft (n = 1). Three of the six patients with CFA dissection were diagnosed during coronary angiography, and because of significant comorbidities were treated with self-expanding stents. After a mean follow-up of 7 months, they experienced no stent fracture or other complication. Six patients had EIA dissections. In one such patient, the dissection was not flow limiting and was treated conservatively. The remaining five patients underwent successful implantation of self-expanding stents, and during a mean follow-up of 9.6 months, no patient had any symptoms or events related to lower extremity ischemia. Finally, one patient had an aortobifemoral graft dissection. Due to the patient's critical condition, secondary to sepsis, his family elected to withdraw care, and he subsequently expired. Conclusions: Arterial access dissections occur infrequently during cardiac catheterization. Routine femoral artery angiography may help identify vascular access complications, often allowing simultaneous endovascular treatment, with excellent short-term outcomes. [source] Role of Manual Compression Time and Bed Rest Duration on the Occurrence of Femoral Bleeding Complications After Sheath Retrieval Following 4Fr Left-Sided Cardiac CatheterizationJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2001VÉRONIQUE THORÉ R.N. To shorten hospital stay or to allow ambulatory procedures, 4Fr catheters for left-sided cardiac catheterization can be used. These latter parameters may also be influenced by compression time and bed rest duration. The role of these parameters was assessed by prospectively including 130 consecutive patients who underwent 4Fr femoral diagnostic procedures. The patients were randomized into two groups: group 1 consisted of 70 patients undergoing 5-minute compression and group 2 consisted of 60 patients with 15-minute compression. In each group, a second randomization was applied to determine the bed rest duration (2,4 hours). More group 1 patients experienced immediate bleeding following manual compression than group 2 patients (12 [17%] vs 3 [5%], P < 0.03, respectively). Compared to group 2, a slight but nonsignificant increase in the total number of hematomas was observed in group 1 (31 vs 22%, NS). No difference existed in terms of local large hematomas at 24 hours (7% in each group) or in terms of benign 10 cm diffuse subcutaneous ecchymosis at 7-day follow-up (13 [19%] group 1 patients vs 8 [13%] group 2 patients, NS). However, persistence of diffuse subcutaneous ecchymosis at 7-day follow-up appeared to be related to the history of immediate bleeding following manual compression in both groups (group 1: 5/13 vs 7/57 patients [P < 0.04] and group 2: 3/8 vs 0/52 patients [P < 0.002]). In conclusion, 4Fr femoral left-sided cardiac catheterization is safe and could be performed as an ambulatory procedure. However, it requires 15-minute duration of manual compression associated with 2-hour bed rest to decrease local bleeding complications. (J Interven Cardiol 2001;14:7,10) [source] Clinical Implications of QRS Duration and QT Peak Prolongation in Patients with Suspected Coronary Disease Referred for Elective Cardiac CatheterizationANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2008M. Nadeem Attar M.D., M.R.C.P. Background: The electrocardiogram (ECG) remains a simple, universally available, and prognostically powerful investigation in heart failure, and acute coronary syndromes. We sought to assess the prognostic utility of clinical, angiographic, and simple ECG parameters in a large cohort of patients undergoing elective cardiac catheterization (CC) for known or suspected coronary artery disease. Methods: Consecutive consenting patients undergoing CC for coronary disease were enrolled at a single tertiary center. Patient data, drug therapy, catheter reports, and ECG recordings were prospectively recorded in a validated electronic archive. The primary outcome measure was death or nonfatal myocardial infarction (MI) over 1 year or until percutaneous or cardiac surgical intervention. Independent prognostic markers were identified using the Cox proportional hazard model. Results: A total of 682 individuals were recruited of whom 17(2.5%) died or suffered a nonfatal MI in 1 year. In multivariate analysis QRS duration (ms) (HR 1.03 95% CI 1.01,1.05, P = 0.003), extent of coronary disease (HR 2.01 95% CI 1.24,3.58, P = 0.006), and prolonged corrected QT peak interval in lead I (HR 1.02 95% CI 1.00,1.03, P = 0.044) were independently associated with death or nonfatal MI. Receiver-operator characteristic (ROC) analysis for the multivariate model against the primary end point yielded an area under the curve of 0.759 (95% CI 0.660,0.858), P < 0.001. Conclusions: QRS duration and QT peak are independently associated with increased risk of death or nonfatal MI in stable patients attending for coronary angiography. [source] Findings at Left Heart Cardiac Catheterization in NonagenariansCLINICAL CARDIOLOGY, Issue 11 2009Luis Afonso MD No abstract is available for this article. [source] Intraperitoneal Hematoma Manifest as Cullen's Sign after Femoral Cardiac CatheterizationCLINICAL CARDIOLOGY, Issue 7 2007Saurabh S. Dhawan M.D. No abstract is available for this article. [source] Successful Double Percutaneous Alcohol and Coil Embolization of Bilateral Coronary-to-Pulmonary Artery FistulasJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2000GIUSEPPE SANGIORGI M.D. We report the case of a 70-year-old man with recent myocardial infarction who was admitted for further evaluation of his effort angina. Cardiac catheterization and selective coronary angiography excluded significant coronary atherosclerotic disease of the coronary arteries. Double coronary-to-pulmonary artery fistulas, one originating from the proximal right, the other from the left anterior descending coronary arteries, and draining into the right and left branch of the pulmonary artery, respectively, were observed. A left-to-right shunt was visualized at angiography. The patient was successfully treated with percutaneous alcohol and coil embolization of both coronary artery fistulas with total resolution of clinical symptoms. At 6-month follow-up a coronary angiography confirmed complete disappearance of the fistulas. We conclude that a "coronary steal" phenomenon caused by the fistulas induced myocardial ischemia in this patient and that percutaneous transcatheter exclusion with chemical and mechanical devices is a safe. effective, and reasonable alternative to traditional cardiac surgery. [source] Perioperative management of long QT syndrome in a child with congenital heart diseaseACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2002S. N. Das During cardiac catheterization, a 2½-year-old boy developed sudden cardiac arrest. The presence of a long QT interval in the electrocardiogram (ECG) along with ventricular arrhythmia and syncope at that moment enabled us to diagnose long QT syndrome (LQTS). Immediate defibrillation and beta-blocker (metoprolol) therapy saved the life of the child. Cardiac catheterization was completed and the child was planned for Fontan operation. Beta-blocker coverage, prevention of sympathetic stimulation and avoidance of agents which prolong the QT interval made anesthesia uneventful. There were episodes of ventricular fibrillation (VF) in the postoperative period. The child was managed with electrical defibrillation, metoprolol and magnesium. [source] Resolution of protein-losing enteropathy after radiofrequency perforation and subsequent stent implantation for relief of complete occlusion of a redirected left superior vena cavaCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2006Rainer Schaeffler MD Abstract The application of radiofrequency (RF) technologies in the treatment of congenital heart defects has provided a safe and effective alternative to conventional therapies in the restoration of vascular patency for a variety of arterial and venous occlusions. This report concerns an 8-year old girl that developed protein-losing enteropathy and elevated central venous pressure after occlusion of a surgically redirected anomalous draining left superior vena cava (SVC). Cardiac catheterization revealed complete obstruction of the anastomosis of the SVC into the coronary sinus. Transcatheter recanalization by RF perforation and subsequent stent implantation led to the restoration of upper venous blood flow and the resolution of her symptoms. © 2006 Wiley-Liss, Inc. [source] Method for coronary angiography in morbidly obese patientsCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2005William G. Kussmaul III MD Abstract Cardiac catheterization in morbidly obese patients is difficult. In addition to problems regarding vascular access and radiographic penetration of the chest, the engineering parameters and physical limitations of the table and its supporting structures may limit these patients' ability to undergo clinically indicated coronary angiography. We describe a method for cardiac catheterization in which much of the obese patient's body weight is supported on a stretcher placed at right angles to the catheterization table, with only the thorax on the table under the image intensifier. Using this method, five consecutive successful diagnostic procedures and one coronary stent procedure have been performed without complication. Limitations of this procedure include inability to achieve the normal variety of angiographic views due to constraints on image intensifier rotation and skew. © 2005 Wiley-Liss, Inc. [source] Assessment of coronary morphology and flow in a patient with guillain-barré syndrome and st-segment elevationCLINICAL CARDIOLOGY, Issue 3 2001Nikolaos Dagres M.D. Abstract Patients with Guillain-Barré syndrome often have cardiac disturbances as a manifestation of autonomic dysfunction. Such abnormalities consist of arrhythmias and disturbances of heart rate and blood pressure. We report a case of a patient with Guillain-Barré syndrome who developed ST-segment elevation in the inferolateral leads, suggestive of an acute coronary syndrome. Cardiac catheterization revealed angiographically normal coronary arteries. Intracoronary ultrasound was also normal. Intracoronary Doppler flow measurements revealed an elevated baseline coronary flow velocity of up to 41 cm/s and decreased coronary flow reserve, particularly in the left circumflex artery. Myopericarditis as cause of the electrocardiographic changes could be ruled out by echocardiography and endomyocardial biopsy. We postulate that the intracoronary Doppler findings are caused by autonomic dysfunction with decrease of coronary resistance and redistribution of the transmural myocardial blood flow. [source] Early and Midterm Results of an Alternative Procedure to Homografts in Primary Repair of Truncus Arteriosus CommunisCONGENITAL HEART DISEASE, Issue 3 2010Pedro Curi-Curi MD ABSTRACT Background., Repair of truncus arteriosus communis (TAC) in the neonatal and early infant period has become a standard practice. We report our experience on primary repair of TAC with a bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early and midterm results. Methods., From January 2001 to December 2007, 15 patients with mean age 1.5 years (range 3 months to 8 years), underwent primary repair of simple TAC. Cases with cardiogenic shock, complex-associated cardiac lesions, or adverse anatomy of the truncal valve were excluded. The Collett and Edwards anatomical type classification of TAC was as follows: type I, 13 (87%); and type II, 2 (13%). Right ventricular outflow tract was reconstructed in all the cases with a bovine pericardial-valved woven Dacron conduit. Results., Overall mortality was 6.6% (1 death due to severe pulmonary hypertension). At a mean follow-up of 31 months (range 6,51), there were no deaths (5-year actuarial survival 93.4%). Out of the 14 midterm survivors, three developed stenosis of the pericardial-valved woven Dacron conduit, but only one underwent interventional procedure including percutaneous balloon dilation with stenting for associated left pulmonary artery hypoplasia. The rate of patients with no surgical or percutaneous reinterventions performed because of obstruction of the right ventricular outflow tract reconstruction in the midterm (5 years) was 86%. Conclusions., Truncus arteriosus communis repair with a bovine pericardial-valved woven Dacron conduit can be performed with a very low perioperative mortality and satisfactory midterm morbidity, favorably compared with that reported for the use of homografts. Interventional cardiac catheterization may delay the time of reoperation for inevitable conduit replacement due to stenosis. [source] Late Presenters with Dextro-transposition of Great Arteries and Intact Ventricular Septum: To Train or Not to Train the Left Ventricle for Arterial Switch Operation?CONGENITAL HEART DISEASE, Issue 6 2009Noor Mohamed Parker MBChB ABSTRACT Objective., We report our experience in managing late presenters (older than 4 weeks) with dextro-transposition of great arteries and intact ventricular septum (d-TGA/IVS) in an effort to achieve successful arterial switch operation (ASO) in a third world setting. Design., We retrospectively reviewed the charts of all late presenters with d-TGA/IVS. Patients were divided into two groups: left ventricular training (LVT) group and non-left ventricular training (non-LVT) group. LVT group underwent pulmonary artery banding and Blalock-Taussig Shunt prior to ASO. Results., Twenty-one late presenters were included in the study. In LVT group, 11 patients with median age of 6 months (range, 1,72 months) underwent LVT. Later, 8 patients with median age of 9.25 months (range, 1.33,84 months) underwent ASO. Prior to ASO, left ventricle (LV) collapse resolved in all and left ventricle to systemic pressure (LV/SP) ratio was 0.81 (range, 0.76,0.95) in 4 patients. Two patients who had LVT for ,14 days required postoperative extracorporeal membrane oxygenation (ECMO) support due to LV dysfunction. Seven patients survived to discharge. In non-LVT group, 10 patients with median age of 2.5 months (range, 1,98 months) underwent ASO. Five patients had LV collapse, and median LV/SP ratio was 0.67 (range, 0.56,1.19) in 5 patients. Seven patients needed ECMO support. Seven patients survived to discharge. Conclusion., Late presenters with d-TGA/IVS, who have LV collapse on echocardiography and/or a LV/SP ratio <0.67 on cardiac catheterization, should be subjected to LVT preferably for duration of longer than 14 days in order to avoid potential ECMO use. [source] A Risk Adjusted Method for Comparing Adverse Outcomes among Practitioners in Pediatric and Congenital Cardiac CatheterizationCONGENITAL HEART DISEASE, Issue 4 2008Lisa Bergersen MD ABSTRACT Objective., We sought to develop a method to adjust for case mix diversity and allow comparison of adverse outcome rates among practitioners in pediatric and congenital cardiac catheterization. Patients and Methods., A single institutional database that captured demographic and procedural data was used to identify patient and procedural characteristics associated with adverse events (AE) and any high severity event classified as preventable or possibly preventable (P/PP). Diagnostic and procedural risk groups were created and indicators of hemodynamic vulnerability were defined. Expected event rates by the practitioners adjusting for case mix were calculated. Standardized adverse event ratios (SAER), defined as the observed rate divided by the expected rate for each practitioner were calculated with 95% confidence intervals. Results., The database included 1727 hemodynamic (30%) and interventional (70%) cases performed by seven practitioners in 18 months. During 147 cases, at least one P/PP AE occurred; among the seven practitioners observed, event rates ranged from 3.2 to 14.2%. In multivariable analysis, risk factors for all P/PP events included highest procedure risk group (odds ratio [OR] 2.1 for group 2, and 2.8 for group 3, relative to group 1, P = .001 and P < .001, respectively) and weight less than 4 kg (OR 2.8, P < .001). High severity P/PP events occurred in 67 cases with rates ranging from 2.0 to 6.6% by the practitioners. For these events, risk factors included: highest procedure risk group (OR 4.5 for group 2, and 4.9 for group 3, both P < .001) and an indicator of hemodynamic vulnerability (OR 1.8, P = .026). For the seven practitioners, the SAER ranged from 0.41 to 1.32 for any P/PP AE and from 0.69 to 1.44 for P/PP high severity events. In this cohort, we did not identify any statistically significant performance differences. Conclusion., Despite wide variations in case mix complexity in pediatric and congenital cardiac catheterization, this study demonstrates a method for risk adjustment which allows equitable comparisons among practitioners at a single institution. [source] Elevated Serum Cardiac Markers Predict Coronary Artery Disease in Patients With a History of Heart Failure Who Present With Chest Pain: Insights From the i*trACS RegistryCONGESTIVE HEART FAILURE, Issue 3 2007Jonathan Glauser MD The significance of a history of heart failure (HF) in patients presenting with acute coronary syndromes and elevated cardiac markers is unclear. The authors performed an analysis of patients enrolled in the Internet Tracking Registry of Acute Coronary Syndromes (i*trACS). Cardiac marker measurement and cardiac catheterization were performed in 1174 patients. Of these, 116 (9.9%) had heart failure (HF). Coronary artery disease (CAD) was found in 61 (52.6%) patients in the HF group and 581 (54.9%) in the group without HF. In the non-HF cohort, positive markers occurred in 306 patients, in whom 217 (70.9%) had CAD at catheterization. In the HF subset, 24 patients had positive biomarkers and 15 (62.5%) had CAD. A history of HF did not lessen the likelihood of CAD as evidenced by angiography and does not diminish the utility of cardiac markers in diagnosing acute coronary syndromes. [source] The Utility of Heart Sounds and Systolic Intervals Across the Care ContinuumCONGESTIVE HEART FAILURE, Issue 2006W. Frank Peacock MD Acoustic cardiography is an exciting, new, easy-to-use, modernized technology that incorporates already proven techniques of phonocardiography. Application of acoustic cardiography to clinical practice can improve diagnosis and management of heart failure patients. Its clinical use should help address some of the need for robust, inexpensive, and widely accessible technology for proactive heart failure diagnosis and management. Acoustic cardiographically recorded measurements have been correlated with both cardiac catheterization and echocardiographically determined hemodynamic parameters. Heart sounds captured by acoustic cardiograms have proven to assist clinicians in assessing dyspneic patients in the emergency department by utilizing the strong specificity of an S3 for detecting acute decompensated heart failure. Acoustic cardiography offers a cost-efficient, easy-to-use method to optimize the devices used in cardiac resyncronization therapy. The rapidly and easily obtainable information gathered by acoustic cardiography should foster its more widespread use in diagnosis and treatment of heart failure, including cardiac resyncronization therapy device optimization. [source] The Utility of Heart Sounds and Systolic Intervals Across the Care ContinuumCONGESTIVE HEART FAILURE, Issue 2006W. Frank Peacock MD Acoustic cardiography is an exciting, new, easy-to-use, modernized technology that incorporates already proven techniques of phonocardiography. Application of acoustic cardiography to clinical practice can improve diagnosis and management of heart failure patients. Its clinical use should help address some of the need for robust, inexpensive, and widely accessible technology for proactive heart failure diagnosis and management. Acoustic cardiographically recorded measurements have been correlated with both cardiac catheterization and echocardiographically determined hemodynamic parameters. Heart sounds captured by acoustic cardiograms have proven to assist clinicians in assessing dyspneic patients in the emergency department by utilizing the strong specificity of an S3 for detecting acute decompensated heart failure. Acoustic cardiography offers a cost-efficient, easy-to-use method to optimize the devices used in cardiac resyncronization therapy. The rapidly and easily obtainable information gathered by acoustic cardiography should foster its more widespread use in diagnosis and treatment of heart failure, including cardiac resyncronization therapy device optimization. [source] Discrepancy between Gradients Derived by Cardiac Catheterization and by Doppler Echocardiography in Aortic Stenosis: How Often Does Pressure Recovery Play a Role?ECHOCARDIOGRAPHY, Issue 9 2009Studies have shown very good correlation between Doppler-derived gradients and gradients obtained by cardiac catheterization (cath) in aortic stenosis (AS). However, the phenomenon of pressure recovery may lead to significant overestimation of aortic valve (AV) gradients by Doppler echocardiography (echo). We hypothesized that echo-derived gradients will be higher in mild,moderate AS because of pressure recovery. We studied 94 patients who had echo and cardiac caths in a span of 1 week. The mean age was 72 ± 13 years, 54% males, 79% had coronary artery disease, and the mean left ventricular ejection fraction was 45 ± 22%. The mean cardiac output and cardiac indices were 5.1 ± 1.4/2.7 ± 0.6 (l/mt), (l/m2), respectively. For those with mild AS, echo overestimated gradients in 9.5% of patients (4/42) by an average of 19 mmHg, thus misclassifying the degree of stenosis. In those with moderate AS, 14% (3/21) were misclassified as severe AS (gradient overestimation by an average of 13.6 mmHg). In those with severe AS, echo underestimated gradients in 13% (4/31) by an average of 22.7 mmHg. The aorta at the sinotubular junction was 2.8 cm in those patients with mild AS in whom gradients were overestimated by more than 20 mmHg compared to a sinotubular junction diameter of 3.12 cm in those with mild AS and no overestimation of gradients. The AV area/aortic root ratio was 0 .4 in those with mild AS and 0.2 in those with severe AS (P < 0.05). [source] The Use of 3D Contrast-Enhanced CT Reconstructions to Project Images of Vascular Rings and Coarctation of the AortaECHOCARDIOGRAPHY, Issue 1 2009Thomas G. Di Sessa M.D. Background: Aortic arch and pulmonary artery anomalies make up a group of vascular structures that have complex three-dimensional (3D) shapes. Tortuosity as well as hypoplasia or atresia of segments of the aortic arch or pulmonary artery makes the conventional two-dimensional (2D) imaging difficult. Methods: Nine patients with native coarctation or recoarctation and 4 patients with a vascular ring had a CT scan as a part of their clinical evaluation. There were 7 males. The mean age was 11.7 years. (range 19 days to 29 years) The mean weight was 22.7 kg (range 3.3,139.0 kg). The dicom data from contrast CT scans were converted by the Amira software package into a 3D image. The areas of interest were selected. The images were then projected in 3D on a standard video monitor and could be rotated 360° in any dimension. Results: Adequate CT scans and 3D reconstructions were obtained in 12 of 13 patients. There were 85,1,044 slices obtained in the adequate studies. We could not reconstruct a 3D image from a patient's CT scan that had only 22 slices. The anatomy defined by 3D was compared to 2D CT imaging and confirmed by cardiac catheterization or direct visualization in the operating room in the 12 patients with adequate 3D reconstructions. In 5 of 12 patients, 3D reconstructions provided valuable spatial information not observed in the conventional 2D scans. Conclusion: We believe that 3D reconstruction of contrast-enhanced CT scans of these complex structures provides additional valuable information that is helpful in the decision-making process. [source] Validity of Revised Doppler Echocardiographic Algorithms and Composite Clinical and Angiographic Data in Diagnosis of Diastolic DysfunctionECHOCARDIOGRAPHY, Issue 10 2006Kofo O. Ogunyankin M.D. Background: Commonly used echocardiographic indices for grading diastolic function predicated on mitral inflow Doppler analysis have a poor diagnostic concordance and discriminatory value. Even when combined with other indices, significant overlap prevents a single group assignment for many subjects. We tested the relative validity of echocardiographic and clinical algorithms for grading diastolic function in patients undergoing cardiac catheterization. Method: Patients (n = 115), had echocardiograms immediately prior to measuring left ventricular (LV) diastolic (pre-A, mean, end-diastolic) pressures. Diastolic function was classified into the traditional four stages, and into three stages using a new classification that obviates the pseudonormal class. Summative clinical and angiographic data were used in a standardized fashion to classify each patient according to the probability for abnormal diastolic function. Measured LV diastolic pressure in each patient was compared with expected diastolic pressures based on the clinical and echocardiographic classifications. Result: The group means of the diastolic pressures were identical in patients stratified by four-stage or three-stage echocardiographic classifications, indicating that both classifications schemes are interchangeable. When severe diastolic dysfunction is diagnosed by the three-stage classification, 88% and 12%, respectively, were clinically classified as high and intermediate probability, and the mean LV pre-A pressures was >12 mmHg (P < 0.005). Conversely, the mean LV pre-A pressure in the clinical low probability or echocardiographic normal groups was <11 mmHg. Conclusion: Use of a standardized clinical algorithm to define the probability of diastolic function identifies patients with elevated LV filing pressure to the same extent as echocardiographic methods. [source] Analysis of Left Atrial Volume Change Rate for Evaluation of Left Ventricular Diastolic FunctionECHOCARDIOGRAPHY, Issue 7 2004F.E.S.C., Ming-Jui Hung M.D. An excellent correlation exists between the change in the left atrial (LA) angiographic area and posterior aortic wall motion. The aim of the study was to define the role of posterior aortic wall motion, indicating LA volume change, during the left ventricular (LV) phase for the assessment of LV diastolic function. A total of 155 patients underwent echocardiography after cardiac catheterization. Study patients were classified into four groups according to the ratio of early-to-late transmitral flow velocity (E/A ratio) and/or LV end-diastolic pressure (EDP): 42 patients with LVEDP < 15 mmHg and E/A ratio >1 (normal filling); 46 patients with E/A < 1 (impaired relaxation); 46 patients with LVEDP , 15 mmHg and E/A > 1 and <2 (pseudonormal filling); 21 patients with E/A > 2, E , 70 cm/s, and E-wave deceleration time ,160 ms (restrictive filling). The slopes of early and late (slopes E and A) diastolic motion of LA wall were derived from M-mode analysis, together with the LV isovolumic time constant Tau from cardiac catheterization. Values of slope E/A decreased in restrictive filling, pseudonormal filling, and impaired relaxation as compared with normal filling (0.41 ± 0.14, 0.69 ± 0.15, and 0.56 ± 0.23 vs 1.25 ± 0.26, P < 0.001, respectively) and correlated inversely with the isovolumic time constant Tau (r = 0.79, P < 0.001). In cases for which a value of slope E/A < 1 was obtained, indicating a relaxation abnormality, the M-mode derived pattern of LA wall motion identified the underlying abnormal LV diastolic function with a sensitivity of 98.3%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 95.2%. Analysis of the slope of LA wall motion, indicating LA volume change rate, during LV diastolic phase is useful in evaluating LV diastolic function. It provides a new noninvasive index that correlates well with invasive index of LV relaxation. [source] Asymptomatic Isolated Congenital Left Ventricular Muscular Diverticulum In An Adult: A Case ReportECHOCARDIOGRAPHY, Issue 2 2003Guoqian Huang M.D. Congenital ventricular diverticulum is a very rare malformation in adults. We describe a 21-year-old male with a congenital muscular left ventricular diverticulum in the inferior wall. The lesion was suspected on two-dimensional transthoracic echocardiography; transesophageal echocardiography allowed clear detection of the diverticulum as well of mild mitral valve prolapse. The diagnosis was confirmed by cardiac catheterization. There were no other thoracoabdominal or cardiac anomalies, the patient was asymptomatic, and surgery was not deemed necessary. (ECHOCARDIOGRAPHY, Volume 20, February 2003) [source] The Impact of Race on the Acute Management of Chest PainACADEMIC EMERGENCY MEDICINE, Issue 11 2003Arvind Venkat MD Abstract Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N= 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n= 400; 2) unstable angina/non,ST-elevation myocardial infarction (UA/NSTEMI), n= 1,153; and 3) nonacute coronary syndrome chest pain (non-ACS CP), n= 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non-ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non-ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non-ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation. [source] The Effect of Dementia on Outcomes and Process of Care for Medicare Beneficiaries Admitted with Acute Myocardial InfarctionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004Frank A. Sloan PhD Objectives: To determine differences in mortality after admission for acute myocardial infarction (AMI) and in use of noninvasive and invasive treatments for AMI between patients with and without dementia. Design: Retrospective chart review. Setting: Cooperative Cardiovascular Project. Patients: Medicare patients admitted for AMI (N=129,092) in 1994 and 1995. Measurements: Dementia noted on medical chart as history of dementia, Alzheimer's disease, chronic confusion, or senility. Outcome measures included mortality at 30 days and 1-year postadmission; use of aspirin, beta-blocker, angiotensin-converting enzyme (ACE) inhibitor, thrombolytic therapy, cardiac catheterization, coronary angioplasty, and cardiac bypass surgery compared by dementia status. Results: Dementia was associated with higher mortality at 30 days (relative risk (RR)=1.16, 95% confidence interval (CI)=1.09,1.22) and at 1-year postadmission (RR=1.18, 95% CI=1.13,1.23). There were few to no differences in the use of aspirin and beta-blockers between patients with and without a history of dementia. Patients with a history of dementia were less likely to receive ACE inhibitors during the stay (RR=0.89, 95% CI=0.86,0.93) or at discharge (RR=0.90, 95% CI=0.86,0.95), thrombolytic therapy (RR=0.82, 95% CI=0.74,0.90), catheterization (RR=0.51, 95% CI=0.47,0.55), coronary angioplasty (RR=0.58, 95% CI=0.51,0.66), and cardiac bypass surgery (RR=0.41, 95% CI=0.33,0.50) than patients without a history of dementia. Conclusion: The results imply that the presence of dementia had a major effect on mortality and care patterns for this condition. [source] Delayed Presentation of Injury to the Sinus of Valsalva with Aortic Regurgitation Resulting from Penetrating Cardiac WoundsJOURNAL OF CARDIAC SURGERY, Issue 3 2003Narutoshi Hibino M.D. An emergency operation was performed successfully to repair the penetrating cardiac injury of the right ventricular outflow tract without using cardiopulmonary bypass. Two years after the operation, he was complained of dyspnea and a continuous murmur was detected. Echocardiography and cardiac catheterization revealed aorto-right ventricular fistula in the sinus of valsalva with aortic regurgitation. In operation, the healed laceration of the right coronary cusp and the fistula between aorta and right ventricle were identified. The fistula was closed using a Dacron patch and the aortic valve was replaced with a mechanical valve. Long-term follow-up of penetrating thoracic injuries is important for detecting underlying intracardiac lesions. (J Card Surg 2003;18:236-239) [source] Incidence and Predictors of Sudden Cardiac Death in Patients with Diastolic Heart FailureJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2007M.H.S., SANA M. AL-KHATIB M.D. Introduction: Although it is known that patients with diastolic heart failure are at an increased risk of death, their mode of death has not been clearly defined. We conducted this study to examine the incidence and predictors of sudden cardiac death (SCD) in patients with isolated diastolic heart failure. Methods and Results: Using the Duke Databank for Cardiovascular Disease, we identified patients with a history of congestive heart failure (CHF) and an ejection fraction of greater than 50% who were enrolled in the database from 1995 through 2004. Mode of death was adjudicated by two independent reviewers. Of the 1,941 patients who met our inclusion criteria, 548 (28%) died (40 were SCD). Using a Cox proportional hazards model, five variables were found to be independently associated with a significant increase in the risk of SCD. These variables include diabetes mellitus (P < 0.01), the presence of mild mitral regurgitation (P < 0.01), severity of CHF (P < 0.01), the occurrence of a myocardial infarction within 3 days prior to the date of the index cardiac catheterization (P = 0.01), and severity of coronary artery disease (P = 0.02). Conclusions: SCD is not uncommon in patients with isolated diastolic heart failure. We identified some clinical variables that are associated with a significant increase in the risk of SCD and that may be used in the risk stratification of patients for SCD. Studies are needed to validate our findings. [source] Risk factors of Hong Kong Chinese patients with coronary heart diseaseJOURNAL OF CLINICAL NURSING, Issue 7 2007Sek Ying Chair RN Aims and objectives., The aims of the study were to describe the level of modifiable coronary risk factors and to explore the relationships among these risk factors in patients with coronary heart disease. Background., Appropriate patient education and therapies for coronary risk reduction will prevent recurrent cardiac events and progression of coronary heart disease. Therefore, having knowledge of the risk profile of these patients is essential so that appropriate contents and focus of patient educations can be developed. Methods., Coronary heart disease patients admitted for cardiac catheterization at the two studied hospitals in Hong Kong were recruited for this study. Demographic date and risk factors of blood pressure, smoking status, body mass index, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and exercise level were collected from subjects as well as from medical records for analysis. Results., The body mass index was significantly different among non-smoker, ex-smoker and smoker (p = 0·027). Non-smokers had the highest body mass index but smokers had the lowest body mass index among the three groups in this study. Physical inactivity, overweight and hypercholesterolaemia were the risk factors seen in about 50% of the studied subjects. Body mass index correlated positively with systolic blood pressure but negatively correlated with high-density lipoprotein cholesterol and hour of exercise. Conclusions., Heavier subjects had a higher systolic blood pressure but a lower level of high-density lipoprotein cholesterol. Heavier subjects also exercised less. The study results provided additional information on the database of the risk profile among Hong Kong cardiac patients. Relevance to clinical practice., Hypertension, obesity, physical inactivity, abnormal serum lipid levels and smoking are the modifiable risk factors for coronary heart diseases. As physical inactivity, overweight and hypercholesterolaemia were found in half of the studied subjects, the importance of risk factors control should be addressed to this group of patients. Nurses should be aware of their educator role to provide appropriate education to coronary heart disease patients with the focus on reducing and controlling of cardiac risk factors, which has been shown to be effective in reducing the progress of disease. [source] | ||||||||||||||||||||||||||||