TY  - CHAP
M1  - Book, Section
TI  - Cardiac Catheterization and Interventions
A1  - Dorfman, Todd A.
A1  - Resar, Jon R.
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - The  most  common  complications  of  cardiac  catheterization  include  groin  complications  (0.43  percent)  such  as  hematomas,  retroperitoneal  bleeding,  pseudoaneurysm,  and  arteriovenous  fistulas.  Other  complications  include  contrast  reactions,  renal  failure,  perforation,  dissection,  hypotension,  and  bradycardia.When  performing  coronary  angiography,  at  least  two  orthogonal  views  are  needed  for  each  vessel  to  assess  the  severity  of  eccentric  lesions,  and  at  least  five  views  are  recommended  to  adequately  evaluate  the  left  coronary  system.By  coronary  angiography,  a  lesion  is  considered  to  be  severe  if  there  is  a  greater  than  70  percent  narrowing  of  the  luminal  diameter.For  intermediate  lesions  of  uncertain  significance  on  coronary  angiography,  intravascular  ultrasound  (IVUS)  and  fractional  flow  reserve  (FFR)  can  be  useful.  IVUS  delineates  and  quantifies  the  atherosclerotic  burden  and  consistently  demonstrates  that  lesions  are  underestimated  using  angiography  alone.  FFR  is  probably  the  best  test  to  determine  both  physiologic  ischemia  (i.e.,  disease  severity)  and  the  need  for  revascularization.Balloon  angioplasty  alone  is  associated  with  a  5  percent  risk  of  abrupt  closure  and  a  50  percent  risk  of  angiographic  restenosis  within  6  months.  Bare  metal  intracoronary  stents  decrease  restenosis  by  nearly  50  percent  compared  to  balloon  angioplasty  with  a  20  to  30  percent  risk  of  in-stent  angiographic  restenosis  after  6  months.Drug-eluting  intracoronary  stents  are  associated  with  lower  in-stent  restenosis  rates  as  low  as  5  percent  at  12  months,  but  also  carry  a  higher  risk  of  late  and  very  late  stent  thrombosis.  Patients  receiving  drug-eluting  stents  (DESs)  must  take  aspirin  for  life  and  clopidogrel  for  at  least  12  months  after  implantation  to  mitigate  the  risk  of  stent  thrombosis.Cardiac  output  measurements  can  be  obtained  during  right-heart  catheterization  by  the  Fick  and/or  thermodilution  method.  The  thermodilution  method  is  more  accurate  at  high-output  states,  whereas  the  Fick  method  is  more  accurate  with  low-output  conditions  and  atrial  fibrillation.Aortic  valve  gradients  can  be  estimated  by  several  methods:  (1)  Peak-to-peak  gradient,  (2)  “pull-back”  method,  and  (3)  simultaneous  pressure  measurements  in  the  left  ventricle  (LV)  and  aorta  using  a  double-lumen  catheter  (most  accurate).  The  modified  Hakki  equation  can  be  used  to  measure  the  aortic  valve  area:  aortic  valve  area  =  cardiac  output/square  root  of  the  peak-to-peak  pressure  gradient.Balloon  aortic  valvuloplasty  (BAV)  rarely  increases  aortic  valve  area  greater  than  1.0  cm2  and,  although  it  improves  symptoms,  clinical  deterioration  frequently  occurs  within  6  to  12  months.Percutaneous  patent  foramen  ovale  (PFO)  closure  devices  are  associated  with  high  procedural  success  and  low  complication  rates.  Complication  rates  are  around  5  percent  and  include  device  migration,  pericardial  tamponade,  and  arrhythmias.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/24
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104594178
ER  -