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Cardiac Cath and Angiocardiography

Cardiac Cath and Angiocardiography. SPRING 2011. Catherization Studies and Procedures. Adults Children. Basic Diagnostic Studies of the Vascular System for Adults. Cath of the LT side of the heart: ADULTS.

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Cardiac Cath and Angiocardiography

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  1. Cardiac Cath and Angiocardiography SPRING 2011

  2. Catherization Studies and Procedures Adults Children

  3. Basic Diagnostic Studies of the Vascular System for Adults

  4. Cath of the LT side of the heart: ADULTS • Catheter introduced into the radial, brachial or femoral artery to the ascending aorta • Aortic root angio is performed to document competence of the aortic valve

  5. Aorta Root Angiography • Normal means backward flow of the contrast media into the LT ventricle during injection • Atrial oximetry and blood pressure within aorta are measured • Then advanced into the LT ventricle

  6. LT Ventriculography • Provides info on valvular competence • Interventricular septal integrity • Efficiency of the pumping action of LT ventricle • Pressure measurements are made • When systolic (LT ventricle) does not match systolic (aorta)- could mean aortic stenosis

  7. Coronary Angiography • Allows the extent of intracoronary stenosis to be evaluated

  8. Coronary Angiography

  9. Coronary Angiography LT coronary artery Normal LT coronary Artery

  10. Cath of the RT side of the heart: ADULTS

  11. Cath of the RT side of the heart: ADULTS • Pressure measurements • Used to determine valvular heart disease • Congestive heart failure • Pulmonary hypertension • Cardiomyopathies

  12. Exercise Hemodynamics • For evaluation of valvular disease • When fatigue and dyspnea are present • Simultaneous catherization is done and pressure measurements of RT & LT heart is taken • At rest • With exertion • Catheter is placed in: • An artery (femoral or brachial) • Vein (femoral or basilic)

  13. Basic Diagnostic Studies of the Vascular System for Children • For evaluation of specific hemodynamic data • Selected aspects of cardiac function • Congenital heart defects • Methods are different according to age and size of the heart

  14. Advanced Diagnostic Studies of the Vascular System for Adults & Children • Biopsy catheter with bioptome tip is inserted into jugular or femoral vein into RT ventricle • Jaws are opened and many biopsies are taken

  15. Bioptome Biopsies • Used to monitor cardiac transplants for tissue rejection • And to differentiate between various types of cardiomyopathies

  16. Studies of the Conduction System for Adults & Children • Mulipolar catheters are inserted in • High RT atrium near sinus node • Atrioventricular apex • Coronary sinus

  17. Studies of the Conduction System for Adults & Children • Sometimes 3 introducer sheaths are placed in one vein • Femoral • Internal jugular vein • Subclavian vein • Cathodes serve a dual function • Record electrical signals • Pace the heart

  18. Interventional Procedures of the Vascular System: Adults • Percutaneous Transluminal Coronary Angioplasty (PTCA) • Also known as balloon angioplasty • Employs balloon to dilate the coronary artery stenosis • The placement of the catheter is placed much in the same way as standard coronary angiography

  19. PTCA cont • Special steerable PTCA guidewire is used. • Guidewire is advanced to stenotic area through the balloon catheter • Balloon is pushed through to the stenotic area • Balloon is inflated and compresses fatty deposits

  20. PTCA cont • Followed by arteriography to make sure it blood is flowing • This may be done repeated times to assure maximum dilatation • Restenosis occurs in 30-50% of patients

  21. PTCA

  22. PTCA with Stent placement • Similar to PTCA alone except a stent is placed • Restenosis is lower for pt’s who do this rather than conventional angioplasty alone

  23. PTCA with Stenting

  24. PTCA with Stent Placement

  25. Atherectomy • Atherectomy devices remove the fatty deposit or thrombus material within artery • Directional coronary atherectomy devices having a specialized cutting device to shave out the plaque • There is a special nose cone that collect the free floating particles

  26. Percutaneous transluminal coronary rotational atherectomy • The tip is a football shape and is embedded with diamond particles • Special torque guidewire between 160,000- 200,000 rpm • The plaque is pulverized into particles the size of RBC’s and removed by the reticuloendothial system

  27. Interventional Procedures of the Vascular System: Children • Balloon Septostomy to enlarge a patent foramen ovale or preexisting atrial septal defect • This allows mixing of RT and LT blood • Resulting in improved arterial oxygenation • Balloon is passed through atrial septal opening into the LT atrium, inflated with contrast and pulled back through the orifice • Causes septum to tear

  28. Balloon Septostomy with Transeptal System Approach • When there is not a preexisting hole in the atrial septum • Transeptal approach is used • Catheter with knife is employed into LT atrium blade is opened and pulled back through RT atrium • Then balloon septostomy may be performed to open the hole more

  29. Interventional Procedures of the Conduction System: Adults & Children • Antiarrhythmic devices • Pacemakers • Implantable cardioverter defibrillators

  30. CXR with Pacemaker

  31. Post Catheterization Care • Firm pressure is applied to puncture site for 15-30 minutes • Wound sites are cleaned and dressed • The patient will be observed in recovery for 4-8 hours • The insertion site will be checked frequently for signs of bleeding. • Medications and discharge instructions are given • Lots of fluid should be taken in • Vital signs should be monitored for 24 hours

  32. Cardiac Catheterization Trends

  33. Trends • Vascular brachytherapy- technique where radiation is delivered to an area of a previously stented artery using endovascular techniques • Drug eluting stents- drug coated stents used for treatment of CAD to reduce restenosis

  34. MRI • Is becoming more sophisticated and having greater detail and resolution • Allows for is to be used more often for the cardiovascular system • MRA is now able to assess anomalies in the coronary arteries • And identify calcifications in the coronary arteries and bypass grafts

  35. Electron Beam CT • Can detect heart disease at it earliest and most treatable stages • Measures the amount of coronary calcium, • Electron Beam angiography is a simple and noninvasive technique that uses IV contrast media injection • Effective for visualization of great vessels, carotid arteries and peripheral vasculature

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