Pulmonary Artery Catheterization Blogs This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Fontan Fenestration: To do or not to do?
Leaving a fenestration in the interatrial septum during a Fontan repair is useful in relieving the central venous congestion when pulmonary blood flow is driven by venous pressure in Fontan repair. Data from a multicenter Pediatric Heart Network has been published in JACC: Advances [1]. Subjects were between 2-6 years at Fontan surgery done between 2010 and 2020 with cardiac catheterization done within 1 year prior to the surgery. Fenestration was done in 465 of the 702 patients. Interestingly placement of fenestration was associated with center and Fontan type – whether it was lateral tunnel or extra cardiac. Shorte...
Source: Cardiophile MD - February 24, 2024 Category: Cardiology Authors: Johnson Francis Tags: Cardiac Surgery General Cardiology Source Type: blogs

Right Heart Catheterization in Tetralogy of Fallot
With the availability of high resolution echocardiographic images and Doppler echocardiography, role of cardiac catheterization has come down in tetralogy of Fallot and other congenital heart diseases in general. Important risks for cardiac catheterization in a deeply cyanotic infant are the chance of precipitation of a cyanotic spell and thrombotic strokes due to hemoconcentration. Chance of precipitating a cyanotic spell are more when pulmonary angiography is attempted through the already narrow right ventricular outflow tract. Hemocontration is due to the diuresis following contrast angiography, which can be prevented ...
Source: Cardiophile MD - January 15, 2024 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Source Type: blogs

Pulmonary angiography
Pulmonary angiography can be done by introducing a guidewire initially followed by a modified pigtail catheter like Grollman catheter, under fluoroscopic guidance. Grollman catheter has a gentle rightward curve and an additional right angled leftward curve proximal to the side holes. The tip of the Grollman catheter has a pigtail shape. Schematic diagram of modified pigtail Grollman catheter Non-ionic contrast can be injected into the right and left pulmonary arteries to get corresponding angiograms. The guidewire and catheter are introduced through the femoral vein and directed to the pulmonary artery through the inferio...
Source: Cardiophile MD - November 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is arterial switch operation for TGA? Cardiology Basics
Arterial switch operation is the ideal corrective surgery for transposition of great arteries (TGA). It was described by Jatene and colleagues in 1976. Normally aorta originates from the left ventricle and pulmonary artery originates from the right ventricle. This is reversed in TGA, so that pulmonary artery arises from the left ventricle and aorta originates from the right ventricle. Arterial switch operation normalizes this relationship, by moving the aorta and pulmonary artery back to their expected positions. When the blood vessels are switched, the coronary arteries are also repositioned to arise from the new aorta w...
Source: Cardiophile MD - October 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What are atrial switch operations? Cardiology Basics
Atrial switch operations were the initial operations developed for the treatment of transposition of great arteries. In transposition of great arteries, the aorta arises from the right ventricle and pulmonary artery from the left ventricle. Normally aorta originates from the left ventricle and pulmonary artery arises from the right ventricle. Schematic diagram of transposition of great arteries In transposition of great arteries, systemic venous return is pumped back into the body without being sent to the lungs for oxygenation. Blood returning from the lungs is pumped back into the lungs. So, survival is impossible unles...
Source: Cardiophile MD - October 27, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

What is TAPVC? Cardiology Basics
TAPVC stands for total anomalous pulmonary venous connection. It is also known as TAPVD or total anomalous pulmonary venous drainage. Normally, pulmonary veins join the left atrium. When it drains to the right atrium through one of the blood vessels leading to the right atrium, it is known as TAPVC. If only some of the four pulmonary veins join the right side of the heart, then it is called PAPVC or partial anomalous pulmonary venous connection. When all the pulmonary veins join the right side of the heart instead of the left side, an atrial septal defect (ASD) is needed to maintain life. Otherwise body will not get any o...
Source: Cardiophile MD - October 19, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Pulmonary stenosis – Cardiology Basics
Pulmonary stenosis – Cardiology Basics Pulmonary stenosis is most often congenital, though occasionally it can occur in carcinoid syndrome and related disorders. Dysplastic pulmonary valve occurs in Noonan’s syndrome. Pulmonary stenosis increases the workload of the right ventricle, which gets hypertrophied in an attempt to overcome the obstruction. Hypertrophied right ventricle becomes less compliant, increasing its filling pressure. Decrease in right ventricular compliance increases right atrial pressure. This will be more when the right ventricle fails ultimately. Forceful right atrial contraction produces a...
Source: Cardiophile MD - October 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

A 40-something without past history presents with wide complex tachycardia and crushing chest pain
See Ken Grauer ' s important and detailed ECG analysis at the bottom.CaseA 40-something with no PMH presented with palpitations, tachycardia, and crushing chest pain.This was the prehospital ECG.Sustained wide complex tachycardia. Is it VT or SVT with Aberrancy?Also: there is no concordant ST segments or clearly excessively discordant ST segments, so superimposed Occlusion MI (OMI) is unlikely.There is a regular wide complex tachycardia, without P-waves, and anLBBB configuration andinferior axis. [LBBB "configuration" is different from LBBB: it means that there is a predominant S-wave in V1 and V2 and...
Source: Dr. Smith's ECG Blog - February 14, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

Basics of hemodynamic evaluation – 3
Basics of hemodynamic evaluation – 3 While evaluating intracardiac shunt lesions by cardiac catheterization, an easy way is to look at the step up or step down in the oxygen saturation between two chambers. For example, in case of left to right shunts, step up is noted between superior vena cava (SVC) and right atrium in case of atrial septal defect (ASD). Among the atrial septal defects, step up is noted in high right atrium for sinus venosus ASD, mid right atrium for secundum ASD and low right atrium for primum ASD. Step up from right atrium to right ventricle is noted in ventricular septal defect. In case of paten...
Source: Cardiophile MD - December 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Basics of hemodynamic evaluation – 2
Basics of hemodynamic evaluation – 2 Click here to see Part 1 This is the article in the series on basics of hemodynamic evaluation. As mentioned earlier, pressure measurement in each chamber is an important aspect of hemodynamic evaluation. Two types of catheter based pressure measurements are possible. One is using a catheter tipped manometer, which is more ideal, but expensive. Second, more commonly used method is using fluid filled systems with an external transducer. While using fluid filled systems, care has to be taken to avoid air bubbles in the connecting tubings to avoid damping of pressure wave transmissio...
Source: Cardiophile MD - December 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Basics of hemodynamic evaluation
Though invasive hemodynamic evaluation was pushed to the backstage with the development of Doppler echocardiography, it is again coming to centre stage with newer therapeutic options being available in pulmonary hypertension and heart failure. A basic knowledge of the principles of hemodynamic evaluation is essential to understand cardiac physiology. Hemodynamic evaluation usually includes both right and left heart catheterization, though in some cases only one may be done. While writing a report of hemodynamic evaluation, it is customary to note the catheter course as it gives valuable complementary information. Catheter...
Source: Cardiophile MD - December 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Toothache, incidental Wide Complex Tachycardia
Discussion by our ElectrophysiologistSmith: “I thought that the wide complex tachy (WCT) could be AVRT or VT” EP: " Antidromic AVRT morphology would essentially be the same as “VT” originating from ventricular the insertion site of the accessory pathway. Therefore, traditional criteria for SVT with aberrancy do not apply to antidromic AVRT (except, that negative concordance can never be AVRT!) " Smith: “But then when the patient converted and had PVCs of exactly the same morphology as the WCT, that it must be VT and not AVRT ” EP: " In cases of intermittent pre-excitation, you cou...
Source: Dr. Smith's ECG Blog - November 17, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs

Mural endocarditis
Vegetations in infective endocarditis are usually situated on the valves. If they are located on the walls of the cardiac chambers, it is known as mural endocarditis [1]. When mural endocarditis occurs without any cardiac structural abnormalities like ventricular septal defects, it is called primary mural endocarditis [2]. Primary mural endocarditis is extremely rare. Left atrial mural endocarditis usually occurs due to the jet lesion of mitral regurgitation [1,3]. Left atrial mural endocarditis is usually picked up by trans esophageal echocardiography. Vegetations are mostly located just distal to the mitral orifice betw...
Source: Cardiophile MD - October 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs

Right Heart Catheters
Right heart catheterization was the initial type of cardiac catheterization introduced by Werner Forssmann in 1929, who did self-catheterization [1]. But later, with development of coronary interventions, it became less commonly done. Now there is a renewed interest as it is useful in the evaluation of pulmonary hypertension [2] and heart failure as well as in congenital heart diseases. Though the catheter used by Forssmann was a ureteral catheter, dedicated right heart catheters came into use later. Cournand catheter is a right heart diagnostic catheter named after the Nobel laureate André Cournand, who shared the Nob...
Source: Cardiophile MD - September 16, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Percutaneous pulmonary valve implantation
Percutaneous pulmonary valve implantation has the elite distinction that it was first percutaneous intervention for a regurgitant lesion in humans [1]. Bonhoeffer P et al described the development of a system for percutaneous stent implantation combined with valve replacement for right ventricle to pulmonary artery prosthetic conduit with valve dysfunction [2]. They used it in a 12 year old boy with stenosis and regurgitation of a prosthetic conduit from right ventricle to pulmonary artery. Percutaneous implantation of bovine jugular valve in the conduit was achieved successfully in 2000. Echo, angio and hemodynamic asses...
Source: Cardiophile MD - June 28, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Structural Heart Disease Interventions Source Type: blogs