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Catheterization Laboratory (catheterization + laboratory)
Kinds of Catheterization Laboratory Selected AbstractsFeasibility and applicability of computer-assisted myocardial blush quantification after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2010Joost D.E. Haeck MD Abstract Objectives: The aim of the study was to evaluate whether the "Quantitative Blush Evaluator" (QuBE) score is associated with measures of myocardial reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated in two hospitals with 24/7 coronary intervention facilities. Background: QuBE is an open source computer program to quantify myocardial perfusion. Although QuBE has shown to be practical and feasible in the patients enrolled in the Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS), QuBE has not yet been verified on reperfusion outcomes of primary percutaneous coronary intervention (PCI) patients treated in other catheterization laboratories. Methods: Core lab adjudicated angiographic outcomes and QuBE values were assessed on angiograms of patients who were enrolled in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation (PREPARE) trial. ST-segment resolution immediately after PCI measured by continuous ST Holter monitoring was calculated by a blinded core lab. Results: The QuBE score could be assessed on 229 of the 284 angiograms (81%) and was significantly associated with visually assessed myocardial blush grade (P < 0.0001). Patients with improved postprocedural Thrombolysis in Myocardial Infarction-graded flow, myocardial blush grade, ST-segment resolution immediately after PCI, or a small infarct size measured by peak CK-MB had a significant better QuBE score. Conclusions: QuBE is feasible and applicable at angiograms of patients with STEMI recorded at other catheterization laboratories and is associated with measures of myocardial reperfusion. © 2010 Wiley-Liss, Inc. [source] Coronary Artery Fistulas: A Review of the Literature and Presentation of Two Cases of Coronary Fistulas with Drainage into the Left AtriumCONGENITAL HEART DISEASE, Issue 3 2007Scott Ceresnak MD Abstract We report 2 cases of infants presenting with a murmur shortly after birth and diagnosed with coronary artery fistulas with drainage into the left atrium. The first infant had a fistulous communication between the left main coronary artery and the left atrial appendage and presented with signs and symptoms of heart failure. The infant was repaired surgically in the first week of life. The second infant was asymptomatic and had a fistulous communication between the right coronary artery and the left atrium. The infant will have the fistula closed in the cardiac catheterization laboratory when the child is older. The literature on coronary artery fistulas is reviewed, and the diagnosis and management of coronary artery fistulas is discussed. [source] New Technology and Methodologies for Intraoperative, Perioperative, and Intraprocedural Monitoring of Surgical and Catheter Interventions for Congenital Heart DiseaseECHOCARDIOGRAPHY, Issue 8 2002Mary J. Rice M.D. We review the new technology and methods available for support of intraoperative and intraprocedural imaging in the catheterization laboratory for surgical and interventional catheterization procedures in the treatment of congenital heart disease. The methods reviewed include miniaturized probes and new ways of using them perioperatively for cardiac imaging from transesophageal, substernal, and intracardiac imaging locations. The smaller and more versatile the probes, the better adapted they will be in providing methods to improve the outcomes in babies born with serious forms of congenital heart disease. [source] Selection of glycoprotein IIb/IIIa inhibitors for upstream use in patients with diabetes experiencing unstable angina or non-ST segment elevation myocardial infarction.JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2004What have we learned in the last 10 years? Summary Coronary disease accounts for the majority of deaths among patients with diabetes and the thrombotic milieu accelerated by diabetes results in unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI) or ST-segment elevation myocardial infarction (STEMI) or death. Upstream use of a glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitor with percutaneous coronary intervention (PCI) as part of an early invasive approach is preferred. However substantial numbers of patients present to rural or non-teaching hospitals without immediate access to a catheterization laboratory. Enhanced GP IIb/IIIa receptor mobilization, TXA2 production and platelet activation together present an extensive thrombotic challenge that may not be overcome with current doses of GP IIb/IIIa inhibitors when used without PCI. Heterogeneity of platelet aggregometric analysis may have identified GP IIb/IIIa doses used in clinical trials that may not fully overcome the thrombotic challenge in patients with diabetes. GUSTO-IV ACS failed to demonstrate a difference in mortality when used without PCI. The PURSUIT trial provided evidence that eptifibatide decreases death or non-fatal myocardial infarction (MI) in the main group and in the diabetic subgroup. Reductions in this primary endpoint were driven by the reduction in non-fatal MI. The PRISM and PRISM-PLUS trials demonstrated a reduction in death, MI or refractory ischaemia at 48 h or 7 days in the main cohort but not specifically in patients with diabetes. Data supporting use of GP IIb/IIIa inhibitors are inconsistent, raising the question of whether these agents should be used at all without PCI. Variability in experimental methodology of platelet aggregometry and selection of anticoagulant used during dose finding studies may have generated doses that are insufficient to overcome the thrombotic burden. A new marker of active inflammation, sCD40L is found to be upregulated at subtherapeutic doses of GP IIb/IIIa inhibitors, suggesting that rebound inflammatory processes may partially account for absence of clear evidence of benefit with some GP IIb/IIIa inhibitors in patients with diabetes experiencing UA/NSTEMI. [source] The Intracoronary Electrocardiogram in Percutaneous Coronary InterventionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2009ANDY SC YONG M.B.B.S. The technique of obtaining an epicardial electrocardiogram trace by connecting the guidewire during coronary angioplasty to an electrocardiogram lead has been used since 1985. The intracoronary electrocardiogram appears to be more sensitive than the surface electrocardiogram in detecting transient ischemia, particularly in the territory of the left anterior descending and left circumflex coronary arteries. Importantly, recent studies have shown the intracoronary electrocardiogram to be particularly useful in demonstrating pre- and postconditioning during interventional procedures, predicting periprocedural myocardial damage, and in the determination of regional viability in the catheterization laboratory. Barriers to the use of the intracoronary electrocardiogram in the clinical setting include the lack of standardized methods for acquiring and analyzing the intracoronary electrocardiogram, and the lack of commercially available continuous intracoronary monitoring systems to permit analysis while performing coronary interventions. Facilitating these relatively simple technical developments may permit optimal integration of the intracoronary electrocardiogram into the catheterization laboratory. [source] Shortening of Median Door-to-Balloon Time in Primary Percutaneous Coronary Intervention in Singapore by Simple and Inexpensive Operational Measures: Clinical Practice Improvement ProgramJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2008CHI-HANG LEE M.B.B.S., F.A.C.C. Background: Primary percutaneous coronary intervention is the standard reperfusion strategy for ST-segment elevation myocardial infarction in our center. We aimed to shorten the median door-to-balloon time from over 100 minutes to 90 minutes or less. Methods: We have been using three strategies since March 2007 to shorten the door-to-balloon time: (1) the intervention team is now activated by emergency department physicians (where previously it had been activated by coronary care unit); (2) all members of the intervention team have converted from using pagers to using cell phones; and (3) as soon as the intervention team is activated, patients are transferred immediately to the cardiac catheterization laboratory (where previously they had waited in the emergency department for the intervention team to arrive). An in-house physician and a nurse would stay with the patients before arrival of the intervention team. Results: During 12 months, 285 nontransfer patients (analyzed, n = 270) underwent primary PCI. The shortest monthly median door-to-balloon time was 59 minutes; the longest monthly median door-to-balloon time was 111 minutes. The overall median door-to-balloon time for the entire 12 months was 72 minutes. On a per-month basis, the median door-to-balloon time was 90 minutes or less in 10 of 12 months. On a per-patient basis, the median door-to-balloon time was 90 minutes or less in 182 patients (67.4%). There was 1 case (0.4%) of inappropriate activation by the emergency department. While waiting for the intervention team to convene, 1 patient (0.4%) deteriorated and had to be resuscitated in the cardiac catheterization laboratory. Conclusions: Improved health care delivery can be achieved by changing simple and inexpensive operational processes. [source] Occlusion of an Aberrant Artery to a Pulmonary Sequestration Using a Duct OccluderJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2002D.C.H., ELLEN CRUSHELL M.D., M.R.C.P.I. This report describes a female infant with a rare chromosome defect, del. 12 (q22-24.1), who has severe pulmonary valve stenosis, an atrial septal defect, and a small muscular ventricular septal defect. At 4 months of age a balloon pulmonary valvuloplasty was performed in the cardiac catheterization laboratory. During the procedure, a large aberrant artery from the aorta to a sequestration of the right lower lobe of lung was found. The flow-off from the sequestration was into a dilated left atrium. The single artery supplying the sequestration was successfully occluded using an Amplatzer Duct Occluder device. There were no complications and the infant remains well at 1-yearfollow-up. [source] Noninvasive Study of Ventricular Preexcitation Using Multichannel MagnetocardiographyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1p2 2003RICCARDO FENICI FENICI, R., et al.: Noninvasive Study of Ventricular Preexcitation Using Multichannel Magnetocardiography. In clinical practice, noninvasive classification of ventricular preexcitation (VPX) is usually done with ECG algorithms, which provide only a qualitative localization of accessory pathways. Since 1984, single or multichannel magnetocardiograpy (MMCG) has been used for three-dimensional localization of VPX sites, but a systematic study comparing the results of ECG and MMCG methods was lacking. This study evaluated the reliability of MMCG in an unshielded electrophysiological catheterization laboratory, and compared VPX classification as achieved with the five most recent ECG algorithms with that obtained by MMCG mapping and imaging techniques. A nine-channel direct current superconducting quantum interference device (DC-SQUID) MMCG system (sensitivity is 20 fT/Hz0.5) was used for sequential MMCG from 36 points on the anterior chest wall, within an area20 × 20 cm. Twenty-eight patients with Wolff-Parkinson-White syndrome were examined at least twice, on the same day or after several months to test the reproducibility of the measurements. In eight patients, the reproducibility of MMCG was also evaluated using different MCG instrumentation during maximal VPX and/or atrioventricular reentrant tachycardia induced by transesophageal atrial pacing via a nonmagnetic catheter. The results of VPX localization with ECG algorithms and MMCG were compared. Equivalent current dipole, effective magnetic dipole, and distributed currents imaging models were used for the inverse solution. MMCG classification of VPX was found to be more accurate than ECG methods, and also provided additional information for the identification of paraseptal pathways. Furthermore, in patients with complex activation patterns during the delta wave, distributed currents imaging revealed two different activation patterns, suggesting the existence of multiple accessory pathways. (PACE 2003; 26[Pt. II]:431,435) [source] Comparison of different near-infrared spectroscopic cerebral oxygenation indices with central venous and jugular venous oxygenation saturation in childrenPEDIATRIC ANESTHESIA, Issue 2 2008NICOLE NAGDYMAN Summary Background:, We compared two different near-infrared spectrophotometers: cerebral tissue oxygenation index (TOI) measured by NIRO 200 and regional cerebral oxygenation index (rSO2) measured by INVOS 5100 with venous oxygen saturation in the jugular bulb (SjO2) and central SvO2 from the superior caval vein (SVC) during elective cardiac catheterization in children. Methods:, A prospective observational clinical study in 31 children with congenital heart defects in a catheterization laboratory was undertaken. TOI was compared with SjO2 in the left jugular bulb and with SvO2. rSO2 was compared with SjO2 from the right jugular bulb and SvO2. Linear regression analysis and Pearson's correlation coefficient were calculated and Bland,Altman analyses were performed. Results:, Cerebral TOI and SjO2 were significantly correlated (r = 0.56, P < 0.0001), as well as TOI and SvO2 with r = 0.74 (P < 0.0001). Bland,Altman plots showed a mean bias of ,4.3% with limits of agreement of 15.7% and ,24.3% for TOI and SjO2 and a mean bias of ,4.9% with limits of agreement of 10.3% and ,20.1% for TOI and SvO2. Cerebral rSO2 and SjO2 showed a significant correlation (r = 0.83, P < 0.0001) and rSO2 and SvO2 showed excellent correlation with r = 0.93 (P < 0.0001). Bland,Altman plots showed a mean bias of ,5.2% with limits of agreement of between 8.4% and ,18.8% for rSO2 and SjO2 and a mean bias of 5.6% with limits of agreement of 13.4% and ,2.2% for rSO2 and SvO2. Conclusions:, Both near-infrared spectroscopy devices demonstrate a significant correlation with SjO2 and SvO2 values; nevertheless both devices demonstrate a substantial bias of the measurements to both SjO2 and SvO2. [source] A Comparison of Door-to-balloon Times and False-positive Activations between Emergency Department and Out-of-hospital Activation of the Coronary Catheterization TeamACADEMIC EMERGENCY MEDICINE, Issue 8 2008Scott T. Youngquist MD Abstract Objectives:, The objectives were to compare the proportion of false-positive activations and intervention times between emergency department (ED) and field-based activation of the coronary catheterization laboratory (cath) team for emergency medical services (EMS) patients identified by out-of-hospital (OOH) 12-lead electrocardiogram (ECG) with ST-segment elevation myocardial infarction (STEMI). Methods:, This was a retrospective review of prospectively collected continuous quality improvement data at a single, urban, academic medical center. By protocol, weekday activation of the cath team occurred based on OOH notification of a computer-interpreted OOH ECG indicating potential STEMI. Night and weekend activation occurred at the discretion of the attending emergency physician (EP) after advanced ED notification and after patient arrival and assessment. Basic demographic information and cardiac risk factors were recorded, as well as door-to-balloon (DTB) and ultimate diagnosis. Results:, From May 2007 through March 2008, there were 23 field activations and 33 ED activations. There was no difference in demographic or clinical characteristics between the two groups. In the field activation group, 9/23 (39%) were false-positives, while 3/33 (9%) were false-positives in the ED activation group (30% higher absolute difference in the field activation group, 95% confidence interval [CI] = 8% to 52%, p = 0.02). OOH times and time spent in the ED were similar between the two groups. DTB times were 77 minutes for field activation and 68 minutes for ED activation, respectively (difference 9 minutes, 95% CI = ,9 to 27). Conclusions:, Emergency physician activation of the cath team results in a lower proportion of false-positive activations without clearly sacrificing DTB time when compared to field activation based solely on the results of the OOH ECG. [source] Catheter closure of atrial septal defects with deficient inferior vena cava rim under transesophageal echo guidance,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2009K.S. Remadevi MD Abstract Objectives: To describe the case selection, imaging considerations, technique, and results of catheter closure of atrial septal defects (ASD) with deficient inferior vena cava (IVC) rim. Background: Transcatheter closure with Amplatzer septal occluder (ASO) has become standard treatment for most secundum ASDs. Defects with deficient IVC rim continue to be challenging to image and close in the catheterization laboratory. Methods: Records of 12 patients with deficient IVC rim (<5 mm), who underwent catheter closure (April 2007 to June 2008) were reviewed. General anesthesia and transesophageal echo (TEE) guidance was used in all. The IVC rim was imaged at 70°,90° with retroflexion of the TEE probe, in addition to the conventional views. Devices 1,4 mm > maximal ASD size were selected. Deployment was accomplished either from the left atrium, left upper or from the right pulmonary veins. Results: The median age was 5.5 (2.5,27) years and median weight was 19.5 (9-65) kg. The defects measured 16,32 mm and 18,36 mm septal occluders were used. The median fluoroscopic time was 13.1 (4.2,32.7) min. Initial device selection was revised in four patients. Two patients had residual flows at IVC margin. The device embolized to right ventricular outflow tract in one patient. This was retrieved, and a larger device was deployed. No other complications were observed immediately or on follow-up (median 6; range 1,14 months). Conclusions: Transcatheter closure of ASDs with deficient IVC rim is feasible under TEE guidance. The modified retroflexed view allows adequate imaging of IVC rim through TEE. © 2008 Wiley-Liss, Inc. [source] Coronary no-reflow phenomenon: From the experimental laboratory to the cardiac catheterization laboratory,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2008Shereif H. Rezkalla MD Abstract Coronary no-reflow occurs commonly during acute percutaneous coronary intervention, particularly in patients with acute myocardial infarction and those with degenerated vein grafts. It is associated with a guarded prognosis, and thus needs to be recognized and treated promptly. The pathophysiology originates during the ischemic phase and is characterized by localized and diffuse capillary swelling and arteriolar endothelial dysfunction. In addition, leukocytes become activated and are attracted to the lumen of the capillaries, exhibit diapedesis and may contribute to cellular and intracellular edema and clogging of vessels. At the moment of perfusion, the sudden rush of leukocytes and distal atheroemboli further contributes to impaired tissue perfusion. Shortening the door-to-balloon time, use of glycoprotein IIb/IIIa platelet receptor inhibitors and distal protection devices are predicted to limit the development of no-reflow during percutaneous interventions. Distal intracoronary injection of verapamil, nicardipine, adenosine, and nitroprusside may improve coronary flow in the majority of patients. Hemodynamic support of the patient may be needed in some cases until coronary flow improves. © 2008 Wiley-Liss, Inc. [source] Reproducible microvascular dysfunction with dobutamine infusion in Takotsubo cardiomyopathy presenting with ST segment elevationCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2006Stacy D. Brewington MD Abstract Takotsubo (ampulla) cardiomyopathy, or broken heart syndrome, is an underrecognized cardiac illness that usually presents as an acute coronary syndrome in postmenopausal females. The disorder is frequently associated with episodes of mental or physical stress, implicating an abnormal cardiac response to increased catecholamines. Although death has been reported during the index event, the long-term prognosis is good with full recovery of left ventricular function. We present a case of Takotsubo cardiomyopathy mimicking anterior ST segment elevation myocardial infarction precipitated by dobutamine stress testing. Reinfusion of dobutamine in the catheterization laboratory reproduced symptoms with angiography and intravascular ultrasound supporting the theory of abnormal microvascular circulation as the etiology of Takotsubo cardiomyopathy. Acute and delayed magnetic resonance imaging demonstrated no infarction with complete recovery of ventricular function. © 2005 Wiley-Liss, Inc. [source] Reproducibility and variability of activated clotting time measurements in the cardiac catheterization laboratoryCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2005Terence M. Doherty Abstract The objective of this study was to characterize the reproducibility and variability in the measurement to the activated clotting time (ACT) when performed on two different types of instruments, the HemoTec ACT (Medtronic) and the Hemochron 801 (International Technidyne). The ACT has evolved into the most common point-of-care test used in the cardiac catheterization lab to manage patient heparinization. Since the test has not been standardized, different systems frequently produce different results under the same clinical conditions. Duplicate paired ACT tests (n = 885) from 359 patients were performed on both instruments. Prothrombin times (PT) and activated partial thromboplastin times (aPTT) were also determined on subsets of these same samples (PT = 533; aPTT = 487). The performance and relationships between the two tests were determined using a variety of statistical analytical techniques. The average difference between the ACT devices was only 8 sec, yet more than 60% of the measurements varied by more than 10%. Over one-fourth of measurements varied by more than 20%. The reproducibility to the HemoTec instrument was superior to the Hemochron instrument across the entire range of ACTs measured (mean coefficient of variation 2.4% 54± 3.1% vs. 7.2% 54± 6.1% for HemoTec and Hemochron, respectively; P < 0.00001; range = 65,555 sec). The relationship between the two ACTs was nonlinear. In therapeutic ranges used for interventional procedures (200,350 sec), HemoTec and Hemochron ACTs are not comparable to one another. Statistical comparative analysis indicated that the HemoTec ACT has better overall performance. © 2005 Wiley-Liss, Inc. [source] | ||||||||||