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Reviews in Cardiovascular Medicine Jan 2022Patients with chronic congestive heart failure belong to a population with reduced quality of life, poor functional class, and increased risk of mortality and morbidity.... (Review)
Review
Patients with chronic congestive heart failure belong to a population with reduced quality of life, poor functional class, and increased risk of mortality and morbidity. In these patients, assessment of invasive hemodynamics both serves therapeutic purposes and is useful for stratification roles. The right heart catheterization has become a cornerstone diagnostic tool for patients in refractory heart failure or cardiogenic shock, as well as for the assessment of candidacy for heart replacement therapies, and the management of patients following mechanical circulatory assist device implantation and heart transplantation.
Topics: Cardiac Catheterization; Heart Failure; Heart Transplantation; Hemodynamics; Humans; Quality of Life; Shock, Cardiogenic
PubMed: 35092204
DOI: 10.31083/j.rcm2301012 -
Rhode Island Medical Journal (2013) Sep 2021Pulmonary hypertension (PH) is a chronic disease of elevated pulmonary artery pressure that can result from pulmonary vascular diseases or complicate left heart and lung...
Pulmonary hypertension (PH) is a chronic disease of elevated pulmonary artery pressure that can result from pulmonary vascular diseases or complicate left heart and lung disease. Pulmonary arterial hypertension (PAH) is a rare pulmonary artery vasculopathy that leads to progressive right heart failure and death. Timely and accurate diagnosis of PH is paramount, given the increased morbidity and mortality, but can be challenging given the nonspecific nature of the presenting symptoms and the many potential causative or contributing conditions. The diagnosis of PH remains clinical and the initial workup uses history, physical exam, and echocardiography to evaluate likelihood of disease, followed by characterization of left heart and lung disease and the appropriate evaluation for chronic thromboembolic disease. A right heart catheterization is requisite for the diagnosis and thus early referral to a PH expert center is strongly recommended, particularly for patients with high-risk features and in high-risk populations.
Topics: Cardiac Catheterization; Echocardiography; Humans; Hypertension, Pulmonary; Lung; Lung Diseases
PubMed: 34437663
DOI: No ID Found -
Wiadomosci Lekarskie (Warsaw, Poland :... 2021Right heart catheterization is a unique tool not only in the diagnosis but also in the management of patients with a wide range of cardiovascular diseases. The technique... (Review)
Review
Right heart catheterization is a unique tool not only in the diagnosis but also in the management of patients with a wide range of cardiovascular diseases. The technique dates back to the 18th century, but the biggest advances were made in the 20th century. This review focuses on pulmonary hypertension for which right heart catheterization remains the diagnostic gold standard. Right heart catheterization-derived parameters help classify pulmonary hypertension into several subgroups, assess risk of adverse events or mortality and make therapeutic decisions. According to the European Society of Cardiology guidelines pulmonary hypertension (PH) is defined as an increase in mean pulmonary artery pressure (PAPm) > 25 mmHg, whereas a distinction between pre- and post-capillary PH is made based on levels of pulmonary artery wedge pressure (PAWP). Moreover, right atrial pressure (RAP), cardiac index (CI) and mixed venous oxygen saturation (SvO2) are the only parameters recommended to assess prognosis and only in patients with pulmonary arterial hypertension (PAH). Patients with RAP > 14 mmHg, CI < 2.0 l/min/m2 and SvO2 < 60% are at high (> 10%) risk of death within the next year. The purpose of this paper is to show that RHC-derived parameters can be used on a considerably larger scale than currently recommended. Several prognostic parameters, with specific thresholds have been identified for each subtype of pulmonary hypertension and can be helpful in everyday practice for treatment of PH.
Topics: Cardiac Catheterization; Humans; Hypertension, Pulmonary; Prognosis
PubMed: 33813466
DOI: No ID Found -
EuroIntervention : Journal of EuroPCR... Sep 2012The JenaValve is a next-generation TAVI device which consists of a well-proven porcine root valve mounted on a low-profile nitinol stent. Feeler guided positioning and...
The JenaValve is a next-generation TAVI device which consists of a well-proven porcine root valve mounted on a low-profile nitinol stent. Feeler guided positioning and clip fixation on the diseased leaflets allow for anatomically correct implantation of the device without rapid pacing. Safety and efficacy of transapical aortic valve implantation using the JenaValve were evaluated in a multicentre prospective study that showed good short and midterm results. The valve was CE-mark released in Europe in September 2011. A post-market registry ensures on-going and prospective data collection in "real-world" patients. The transfemoral JenaValve delivery system will be evaluated in a first-in-man study in the near future.
Topics: Aortic Valve Stenosis; Bioprosthesis; Cardiac Catheterization; Evidence-Based Medicine; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Patient Selection; Prosthesis Design; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 22995119
DOI: 10.4244/EIJV8SQA16 -
Methodist DeBakey Cardiovascular Journal 2021Pulmonary hypertension (PH) is a heterogenous disorder involving multiple pathophysiological processes that ultimately affect the vasculature within the lungs. Right... (Review)
Review
Pulmonary hypertension (PH) is a heterogenous disorder involving multiple pathophysiological processes that ultimately affect the vasculature within the lungs. Right heart catheterization (RHC) continues to be the benchmark for diagnosing PH. The use of provocation techniques during RHC can help sub-characterize the type of PH and thus assist in developing appropriate treatment strategies for the management of each PH subtype. This review examines proven and novel approaches for evaluating the pulmonary vasculature during RHC and aspires to provide an accurate, clinically relevant framework for using RHC to diagnose and manage PH. Further improvement in standardized protocols will help optimize the application of RHC in patients with PH.
Topics: Cardiac Catheterization; Humans; Hypertension, Pulmonary; Pulmonary Artery
PubMed: 34326928
DOI: 10.14797/AFUI4711 -
Journal of Cardiovascular Magnetic... Sep 2017Children with heart disease may require repeated X-Ray cardiac catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic...
BACKGROUND
Children with heart disease may require repeated X-Ray cardiac catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right heart catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety.
METHODS
We performed 50 CMR fluoroscopy guided comprehensive transfemoral right heart catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac catheterization. CMR guided catheterizations were assessed by completion (success/failure), procedure time, and safety events (catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected.
RESULTS
During a twenty-two month period (3/2015 - 12/2016), enrolled subjects had the following clinical indications: post-heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular heart disease 3%, and other 3%. Radiation-free CMR guided right heart catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left heart catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy heart catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested.
CONCLUSIONS
Comprehensive CMR fluoroscopy guided right heart catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left heart) cardiac catheterization and future CMR guided cardiac intervention.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02739087 registered February 17, 2016.
Topics: Adolescent; Age Factors; Cardiac Catheterization; Child; Feasibility Studies; Female; Heart Diseases; Hemodynamics; Humans; Magnetic Resonance Imaging, Interventional; Male; Predictive Value of Tests; Radiation Exposure; Time Factors
PubMed: 28874164
DOI: 10.1186/s12968-017-0374-2 -
Journal of Cardiovascular... Aug 2022Transseptal left atrial catheterization is routinely used for many common catheter-based interventions. Tools for transseptal catheterization have advanced over the... (Review)
Review
Transseptal left atrial catheterization is routinely used for many common catheter-based interventions. Tools for transseptal catheterization have advanced over the recent years. Such tools include imaging advances with intracardiac echocardiology as well as an array of needles, wires, and dilators to achieve transseptal access with greater ease and safety. This study will discuss the contemporary tools for transseptal catheterization and guidance for difficult cases.
Topics: Atrial Appendage; Cardiac Catheterization; Catheter Ablation; Heart Atria; Heart Septum; Humans; Punctures
PubMed: 35229417
DOI: 10.1111/jce.15428 -
Revue Medicale de Liege Mar 2019Pulmonary arterial hypertension (PAH) is a rare vascular lung disease with a complex etiopathogeny characterized by an increased pulmonary arterial pressure of 25 mmHg...
Pulmonary arterial hypertension (PAH) is a rare vascular lung disease with a complex etiopathogeny characterized by an increased pulmonary arterial pressure of 25 mmHg or above assessed by right heart catheterization. The diagnosis is difficult due to the atypical presentation with shortness of breath requiring a sequential approach bringing at the end the clinician to perform a right heart catheterization. Nowadays, several therapies have proven to be efficient for treating PAH. Recently, international recommendations have moved to an initial combination therapy reducing the overall morbi-mortality of the patients. Therefore, early therapy appears to be a priority in PAH underlying the need for increasing the global knowledge around PAH.
Topics: Cardiac Catheterization; Humans; Hypertension, Pulmonary
PubMed: 30897313
DOI: No ID Found -
The Journal of Invasive Cardiology May 2017With the advance of radial access and ulnar access there has been an increased interest in performing right heart catheterization (RHC) and right-heart based procedures... (Review)
Review
With the advance of radial access and ulnar access there has been an increased interest in performing right heart catheterization (RHC) and right-heart based procedures via antecubital venous access. Our purpose is to describe the venous anatomy of the upper extremities, technique, equipment, and cost for employing this approach. Reported also is the international experience based on publications assessing procedural success, complications, fluoroscopy time and radiation dose, access-site compression time, and time to ambulation. We conclude that antecubital-venous-access based RHC carries satisfactory success rates, requires a short learning curve, and is exceptionally safe even when performed with full anticoagulation. It is our hope that industry will provide us with even better tools to extend the practice of antecubital-venous-access based procedures and interventions.
Topics: Angiography; Cardiac Catheterization; Elbow; Female; Forearm; Humans; Male; Patient Safety; Radial Artery; Risk Assessment; Vascular Access Devices; Vascular Malformations; Veins
PubMed: 28441639
DOI: No ID Found -
Annals of the American Thoracic Society Jun 2022Hemodynamic assessments direct care among children with pulmonary hypertension, yet the use of cardiac catheterization is highly variable, which could impact patient...
Hemodynamic assessments direct care among children with pulmonary hypertension, yet the use of cardiac catheterization is highly variable, which could impact patient care and research. We analyzed hemodynamic findings from right heart catheterization (RHC) and left heart catheterization and acute vasodilator testing (AVT) and the safety of catheterization in children with World Symposium on Pulmonary Hypertension (WSPH) group 1 and 3 subtypes in a large multicenter North American cohort. Of 1,475 children enrolled in the Pediatric Pulmonary Hypertension Network Registry (2014-2020), there were 1,383 group 1 and 3 patients, of whom 671 (48.5%) underwent RHC at diagnosis and were included for analysis. Compared with those without diagnostic RHC, these children were older, less likely to be an infant or preterm, more often female, treated with targeted pulmonary hypertension medications at diagnosis, and had advanced World Health Organization functional class. Catheterization was performed without a difference in complication rates between WSPH groups. Pulmonary capillary wedge pressure was well correlated with left ventricular end-diastolic pressure and left atrial pressures. Results of AVT using three different methods were comparable; positive AVT results were observed in 8.0-11.8% of subjects, did not differ between WSPH groups 1 and 3, and were not associated with freedom from the composite endpoint of lung transplantation or death during follow-up. In a large pediatric pulmonary hypertension cohort, diagnostic RHC with or without left heart catheterization in WSPH group 1 and 3 patients was performed safely at experienced pediatric pulmonary hypertension centers. Hemodynamic differences were noted between group 1 and 3 subjects. Higher mean pulmonary arterial pressure and mean pulmonary arterial pressure/mean systemic arterial pressure ratio were associated with a higher risk of death/transplantation. Findings suggest overall safety and potential value of RHC as a standard diagnostic approach to guide pulmonary hypertension management in children.
Topics: Cardiac Catheterization; Child; Cohort Studies; Female; Hemodynamics; Humans; Hypertension, Pulmonary; Infant, Newborn; Pulmonary Wedge Pressure; Vasodilator Agents
PubMed: 35049414
DOI: 10.1513/AnnalsATS.202108-998OC