- Introduction of Cardiac Catheterization - Type of Cardiac Catheters and its Uses

1. - VIKRAM SINGH RAJAWAT
- MSC(M), MSC(N), MBA
- JNU HOSPITAL
Cardiac Catheters

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 In 1929 Werner Forssmann
demonstrated that a simple
Rubber catheter could be passed to
the pulmonary artery through the
antecubital Vein and
An angiographic film could be
obtained using radiographic
contrast.

3.  Introduction :-
 An invasive diagnostic procedure in which
one or more catheters are introduced into
heart and selected blood vessels to measure
pressure and to determine oxygen saturation
in the various heart chambers. The procedure
is carried out in the cardiac catheterization
lab.
CARDIAC CATHETERS
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Idealcharacteristicsof catheters
 BetterTorque Control
 Strength
 Radio-opacity
 Flexible
 AtraumaticTip
 Low Surface frictional resistance for good trackability
over guide wire.

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PARTSOF A CATHETER
 HUB
 BODY
TIP
HUB
BODY
TIP

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FRENCHCATHETERSCALE:
The French catheter scale is commonly used to measure the outer
diameter of cylindrical medical instruments including catheters,
needles etc.
D(mm) = Fr/3 or Fr = D(mm)*3
MEASUREMENT:
 Most commonly in adult DiagnosticCatheters of 5 – 7 Fr is used.

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8.  Thick walled- Accentuates pressure
waveform-systolic overshoot & diastolic dips.
 Thin walled _ Improves monitoring, blood
sampling & flushing abilities, decrease
thrombogenicity.
 Disadvantage – less torque control, not
suitable high pressure injection.
SIZE – wall thickness
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Whatis a Catheter made up of ?
Materials:
A range of polymers are used for the construction of
catheters, including silicone rubber latex and
thermoplastic elastomers.
Silicone is one of the most common choices because it is
inert and unreactive to body fluids and a range of medical
fluids with which it might come into contact.
Materials:
CATHETER:
Polyvinylchloride (PVC)
Polyethylene (PE)
Fluoropolymers (PTFE) (TEFLON)
Polyurethane (PUR)
Silicone (SI)

10.  Very maneuverable & flexible.
 Covered by polyurethane coating – reduce
vascular trauma.
 Nylon core-increase bursting pressure
 Nylon – great mechanical & physical
strength, reduced friction coefficient.
 Eg- USCI Cournand, birds eye, eppendorf &
sones.
DACRON
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11.  Stiffness inbetween polyurethane &Teflon.
 Selective injection.
 More thrombogenic than PVC, polyurethane,
silicone catheters.
 Stainless steel mesh braid improves
rotational control & increase bursting
pressure.
 Eg – pigtail angiographic catheters (cook),
judkins catheters, NIH & cournand.
POLYETHYLENE
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12.  Excellent memory – Superselective injection.
 Softer than polyethylene orTeflon.
 Increased thrombogenicity
 Reshaped if immersed in boling water.
 Eg – pigtail angiographic (cordis) catheters &
original judkins catheters.
POLYURETHANE
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13.  Stiffest.
 Low friction coefficient.
 Eg – Brockenbrough catheters, transducer-tip
catheters & introducer sheaths.
TEFLON
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14.  Softest & flexible.
 High friction coefficient- venous spasm.
 Increased thrombogenicity.
 Very poor tensile strength ( memory)
 Cant be reformed.
 Most hydrophilic.
 Drugs absorbed- NTG, insulin,
diazepam,thiopentone.
 Eg- Balloon-tip flow directed catheters.
POLYVINYL CHLORIDE
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15. CHARACTERISTIC TEFLON POLYETHYLENE POLYURETHANE PVC
FRICTION
COEFFICIENT
0.04 0.21 1.35 2.0
STIFFNESS +4 +3 +2 +1
MEMORY Good Excellent Excellent Fair
MOISTURE
ABSORPTION (%
24 HRS)
0 0.015 0.9 0.75
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16.  TIP: Neither blunt nor too sharp, soft &
flexible.
 Bullet nose tip- least trauma,Though too
taper increased tip penetration.
 HUB: Metal or plastic, larger than catheter,
tapered hubs – easier insertion of guidewire.
TIP & HUB
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17.  Rt heart catheters- 100 to 125cm.
 Lt heart catheters- 100 to 110cm.
 125cm for very tall person.
LENGTH
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18.  Cournand
 Lehman
 Goodale–lubin
 Balloon floatation catheters
General purpose – RIGHT heart
catheters
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19.  Gensini
 NIH
 Eppendorf
 Lehman ventriculography
 Pigtail angiographic catheter
 Flow directed angiographic catheter
ANGIOGRAPHIC CATHETERS
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20.  Judkins
 Amplatz
 Schoonmaker multipurpose catheter
 Coronary bypass catheter
 Sones
 Castillo
PREFORMED CORONARY CATHETERS
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21.  Shirey transvascular catheter
 Brockenbrough transeptal catheter
 Double lumen catheter
 Multilumen catheter
 Fogarty catheter
 Transducer-tip catheter
 Angioscopic catheter
 Pacing catheter.
SPECIALISED CATHETERS
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22. COURNAND catheter
 Designer: Andre Cournand,1939.
End hole radio-opaque woven Dacron
catheter with an outer coating of
polyurethane.
 Construction: very gradual distal curve
Tapered tip.
 Use : All purpose right heart catheter.
 Size : 5 to 8Fr.length – 100 & 125cm.
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23. SCHOOMAKER MULTIPURPOSE CATHETER
 Designer : Dr.FredW Schoomaker.
 Construction: polyurethane with an inner wire braid
.
A-1 MP:A bend –hockey stick with straight tip 1-one end hole
only
A-2 MP:2side holes ,1end hole
B-1 MP :B bend gradual 90 degree curve,1 end hole only
B -2 MP: 2 sideholes and an end hole
Use- CAG & LV,for crossing different lesions
PDA and MAPCAcoiling.
 Size : 7 & 8 Fr. length –100cm.
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24. NIH catheter

Construction: USCI version- woven dacron with a nylon
core.Injection at high flow rates
6 sideholes
COOK – polyethylene with a stainless steel braid, 4 to 6
sideholes.
Hole : No end hole , only sidehole catheter with a gentle
curve.[excellent mixing of contrast ]
 Use : visualizing RV.LV,arterial,pulmonary vasculature &
great veins.
 Size :USCI 5 to 8Fr.length –50, 80,100 cms
125cm.
 COOK:6.5,7.3 & 8.2Fr, all 100cm.
 Disadvantage : perforation
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25. PIGTAIL CATHETER
 Designed : Judkins.
 Construction: woven dacron coated with
polyurethane or polyethylene.
 Hole : 4-12 non-laterally opposed sidehole in the
terminal 5cm.Terminal 5cm coiled back.
 Use : most commonly used LV, aortography &
pulmonary angiography.
 Size : 6.5,7,3 & 8.2Fr.length – 65,80,100 &
110cm.side holes-4,6,8 or 12.
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26.  Advantage : least traumatic, less
incidence of arrythmia,catheter recoil,
intramyocardial injection & cardiac
perforation.
 Disadvantage :Thrombogenicity, & not
for prolonged haemodynamic monitoring.
Pigtail catheter
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27.  Construction: polyurethane with stainless
steel braid.
 Hole : 8 nonlaterally opposed sidehole near
the endhole.
 Use. most commonly used LV, aortography &
pulmonary angiography
 Size : 7 & 8Fr. length – 110cm.
Positrol II pigtail catheter
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28.  Construction: polyurethane over a thin nylon
core.
 Hole : 8 nonlaterally opposed sidehole near
the endhole.
 Use: LV, aortography.
 Size : 7 & 8Fr. length – 65,80 & 110cm.
 Advantage : flow rate equal to one Fr > than
designated.
Nycore high-flow pigtail
catheter
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29.  Construction: polyurethane with a stainless
steel braid except in tip.
 Hole : 12 nonlaterally opposed sidehole near
the endhole.
 Use: LV, aortography.
 Size : 5,7 & 8Fr. length – 65,90 & 110cm.
 Advantage : can withstand upto 1000psi.
Ducor high-flow femoral-
ventricular Pigtail catheter
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30. PIG TAIL ANGIOGRAPHIC
 12 Side holes
evenly disperses contrast in LV
QUANTICOR [Cardiomarker pig tail]
Radiopaque markers set 2 cm apart
Used for quantitative angiography
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32. Grollman pigtail catheter
 Construction: polyethylene with for spiraled
side ports near tip.
 Hole : 12 nonlaterally opposed sidehole near
the endhole. 60 degree bend.
 Use: RV & selective PA angiography.
 Size : 5,7 & 8Fr. length – 65,90 & 110cm.
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33. VANTASSELANGLED PIGTAIL
Construction: polyurethane over a thin
nylon core.
 Hole : 8 nonlaterally opposed sidehole near
the endhole 145˚or 155˚ angle 7cm from the
tip.Use: LV, aortography.
 Size : 7 & 8Fr. length – 110cm.
 Advantage : can cross stenotic aortic valve
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34. GOODALE-LUBIN CATHETER
 Birdseye catheter.
 Construction: woven dacron coated with
polyurethane.
 Hole :Two laterally opposed sidehole near the
endhole.
 Use : right heart pressure, including wedge &
blood sampling.
 Size : 4 to 8Fr.length – 80,100 & 125cm.
 Variation :Standard wall –Cournand
 Thin wall- Lehman
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35. LEHMAN CATHETER;
 Thin wall variation of cournand.
 Shorter distal curve, increased inner
diameter & decreased stiffness.
 size-4 to 9Fr.length-50,80,100 &125cm.
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36. GENSINI catheter
 Construction: woven dacron coated with
polyurethane.
 Hole :Three laterally opposed oval sidehole
within 1.5cm of its open tip.
 Use : right or left heart, pulmonary & vena
cava angiographic studies.
 Size : 5 to 8Fr.length – 80,100 & 125cm.
 Disadvantage: More arrythmogenic
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37. EPPENDORF catheter

Construction: woven dacron coated with polyurethane area
20cm proximal to hub is reinforced with nylon
 Hole : closed-end, six laterally opposed sidehole catheter
with a gentle curve.
 Use : visualizing RV.LV,arterial,pulmonary vasculature &
great veins.
 Size : 7 to 8Fr.length –100 & 125cm.
 Feature: less stiff, & more torque control.
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38. GUIDEWIRES
 Three components
Central core that tapers distally.
 Flexible tip
 Lubricious coating.
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39. Fixed & movable core GW
 1.spring coils
 2.inner safety
wire
 3.mandrel core
 4.flexible tip
 5.proximal end
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40. Guidewire
 First available standard guidewire -0.018’
contains 2 to 3cm,safety wire in the tip
 Safetywire is replaced by a ribbon
 steerability,trackability,torquability,kink
resistence, frictional resistance.
 Standard length- 175 to 190cm- usually 20cm
longer than the catheter.
 For exchange wire-300cm.
 Thickness – 0.035 inch (0.9mm).
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41. CORE
 single or multiple segment.
 Provides tensile strength, torque strength,
torque transmission & blood compatibility.
 Commonly composed of stainless steel.
 Nitinol – increased tractability.
 Disadvantage- tends to store rather
than transmit torque- wireWINDING UP.
 Commonly used “workhorse wire” have
moderate flexibility & support.
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42. Distal tip
 Platinum or tungsten alloy.
 Radiopacity ,flexibilty & blood compatibility.
 Radiopacity -2 to 3cm. Rarely 11 to 40cm.
 High radiopacity is a feature of more
aggressive wire,
 Tip load- Amount of force required to deflect
the tip into a predetermined configuration.
Exp-gms of force.
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43. Coating
 - silicone, teflon, polytetrafluoroethylene,
hydrophilic polymer.
 Hydrophilic wire- crosses severe stenosis &
total occlusion,
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44. J-curve guidewire
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46. Spring tip wire & Plastic
wire
 Spring wire:A) stainless steel tip
 B) Nitinol tip jointed to stainless steel shaft
 Steerability helps
 Plastic wire: Little resistence, torquability
lost , useful for severe stenosis with heavy
calcification.
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48. Thanks
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