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Sheath Size (sheath + size)
Selected AbstractsNoncatheter-Based Delivery of a Single-Chamber Lumenless Pacing Lead in Small ChildrenPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2007DAMIEN KENNY M.B.Ch.B., M.R.C.P.C.H. Objectives:The model 3830 lead (SelectSecureÔ Medtronic, Minneapolis, MN, USA) is a bipolar, fixed-screw, 4.1-F pacing lead designed for site-selective pacing. Implantation is usually performed using an 8-F deflectable catheter system. This catheter is not ideal for smaller children because of both the sheath size and the relatively large deflected curves. We describe a simpler noncatheter-based delivery system in seven children. Methods:A 4.1-F SelectSecure lead was introduced via a 5-F SafeSheath (Thomas Medical, Malvern, PA, USA) placed in the left subclavian vein. The SelectSecure lead was passed into the inferior vena cava (IVC) and a loop created, which was then withdrawn into the right atrium. Once in position, the lead was screwed into the myocardium, the SafeSheath was peeled off, and the lead connected to the generator. Results:From March 2005 until September 2006, five right atrial leads and two right ventricular leads were implanted in seven patients (six female) with a median weight of 15 kg (8.1,19.4). All leads were successfully placed with excellent pacing thresholds. The median screening time was 7.1 minutes (4.8,11.4) with a median radiation dose of 83 cGy cm2. There were no procedural complications and no lead displacements seen on a median follow-up of 10 months. Conclusions:Delivery of the 4.1-F SelectSecure pacing lead to the right heart is possible using a noncatheter-based delivery system. This is effective and safe and does not require the use of a larger delivery system. This allows these thin isodiametric pacing leads to be used advantageously in small children. [source] Risk of local adverse events by gender following cardiac catheterization,,§PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 2 2007Dale R. Tavris MD Abstract Purpose To assess the reason for the relative high risk of local complications for women following cardiac catheterization by evaluating the associations between gender, sheath size, and local adverse outcomes following cardiac catheterization. Methods The data used in this study were obtained from a portion of the American College of Cardiology-National Cardiovascular Data RegistryÔ (ACC-NCDRÔ), which included 13,878 patients who underwent cardiac catheterization at one of 59 participating cardiac catheterization institutions throughout the United States during late 2003. Rates of serious local vascular adverse events were calculated by gender following cardiac catheterization, by type of vascular hemostasis used, stratified by arterial sheath size. Results Serious local vascular events were reported in 3.54% of patients, most commonly hematoma (2.00%). The relative risk for women of any vascular complication was 1.40 [95%CI,=,1.17, 1.67, p,=,0.0002]. A statistically significant relative risk for woman was evident when collagen plug devices or manual compression alone were used as the first method for hemostasis. The rate of vascular complications increased progressively with increasing sheath size, more so in women than in men. Conclusions High relative risk for women of local vascular complications following cardiac catheterization was demonstrated with use of manual compression, as well as with collagen plug devices to control femoral artery bleeding. Large sheath size is associated with both a relatively high absolute risk and a high relative risk for women. Knowledge of this information should be considered by interventional cardiologists in making decisions on how to achieve hemostasis following cardiac catheterization. Copyright © 2006 John Wiley & Sons, Ltd. [source] Experience with the Cardiva Boomerang CatalystÔ system in pediatric cardiac catheterization,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2009Sharon Seltzer MD Abstract Objectives: We studied the safety and efficacy of the Cardiva Boomerang CatalystÔ vascular closure system in pediatric patients after cardiac catheterization with access in femoral and internal jugular vessels. Background: Recurrent catheterization and advances in pediatric interventions increase the need for easy hemostasis without a residual foreign body that may prevent re-accessing the vessel. The Boomerang can be deployed in sheaths as small as 4Fr without residual foreign body, with minimal orientation needed, and few complications reported. Methods: In a two-month period, all patients between 18 months and 21 years old catheterized with 4,8Fr sheaths less than 15 cm long were eligible for Boomerang placement. These were compared retrospectively with control patients with manual hemostasis. Anthropomorphic measurements, procedure type, activated clotting time, and sheath size as well as total times of cases, intubation, hemostasis, and extubation were compared between the two groups. Results: Forty-six Boomerangs were deployed in 31 patients and compared with 40 patients with manual hemostasis. Boomerangs were deployed in femoral vessels and the internal jugular vein. Device success with hemostasis was achieved in 39 patients (85%). There were no significant differences in time to hemostasis or extubation between the two groups. No major complications or operator error occurred, including hematoma, transfusion, retroperitoneal bleed, infection, vessel occlusion, or need for surgery. Conclusions: The Boomerang is a safe and easy means of achieving hemostasis in the pediatric population, in femoral vessels as well as internal jugular veins. Its times to hemostasis and extubation were not significantly different from manual hold. © 2009 Wiley-Liss, Inc. [source] Percutaneous transthoracic ventricular puncture for diagnostic and interventional catheterizationCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2008D. Scott Lim MD Abstract Objective: To describe our experience in a case series of patients requiring percutaneous direct ventricular puncture and sheath placement for diagnosis or intervention. Background: Access to the right or left ventricle for percutaneous interventions is limited in patients with mechanical prostheses in either the tricuspid, or mitral and aortic positions. Methods: After coronary angiography, direct ventricular puncture under ultrasound and fluoroscopic guidance was performed. At end of case, protamine was given to reverse the heparin, and sheaths were pulled with purse-string suture closure of the skin entrance. Results: For right ventricular access, 8- to 9-F sheaths were placed from subxiphoid approach in 2 patients to allow conduit and pulmonary artery interventions. For left ventricular access in patients with mitral and aortic prostheses, 4- to 8-F sheaths were placed from apical approach to allow diagnostic evaluation in 1 and interventions in 5 to occlude perivalvular mitral leaks and postoperative ventricular septal defect. Complication in one consisted of intercostal vein injury resulting in hemothorax requiring chest tube drainage. Conclusion: In this small cases series, direct ventricular puncture allowed the intervention to proceed with up to 9-F sheath size. Attention to puncture site relative to intercostal vascular anatomy is warranted. © 2008 Wiley-Liss, Inc. [source] | ||||||||||