history, indications, contraindications, swan-gauge catheter, catheter, pulmonary artery catheterization, shunt calculation, equipment,equipments

2. Right Heart Catheterization
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI,
FAPSC, FAPSIC, FAHA, FCCP, FRCPG
Associate Professor of Cardiology
National Institute of Cardiovascular Diseases(NICVD),
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova, Malibagh branch
Honorary Consultant, Apollo Hospitals, Dhaka and
STS Life Care Centre, Dhanmondi
drtoufiq19711@yahoo.com
CRT 2014
Washington
DC, USA

4. History
• First Cardiac catheterization –
▫ According to Andre Cournand, it was first performed by Claude
Bernard in 1844, in a horse, both rt and lt ventrilces were
entered by retrograde approach from the jugular vein and
carotid artery
▫ Werner Forssmann is credited with performing the
first cardiac catheterization of a living person
himself, at the age of 25 yrs
• Forssmann for his contribution and foresight shared
the Nobel Prize in Medicine with Andre Cournand and
Dickinson Richards in 1956

5. History
• 1929- Dr. Warner
Forssman proven that
right heart catheterization
is possible in humans
• 1964- Dr. Bradley
introduced small
diagnostic catheter
• 1970- Balloon Flotation
Catheter by Doctor H.J.C
Swan and William Ganz

7. Technique for vascular access:
 The true “Seldinger™ technique” is not used
for percutaneous puncture into vessels.

8. Vascular Sheath
 Percutaneous introduction and then the use of an
indwelling vascular sheath in vessels is the standard
technique for catheterization of pediatric and congenital
heart patients.
 Ideal sheath should have:
1. Dilator 
1. long, fine and smoothly tapered tip.
2. inner lumen of the dilator tip should tightly fit over the guide wire
3. tip of the dilator should have a smooth, fine transitional taper onto
the surface of the wire.
2. female Lure™ lock connecting hub at the proximal end
3. back-bleed valve
4. Lateral tube / flush port

9. Vascular Sheath
When introduced from the inguinal area, the sheath should be long enough to
extend into the common iliac vein.
In small infants a sheath into the femoral vein should extend proximal to the
formation of the inferior vena cava.

10. Vascular Sheath
 Ideal short sheath (7.5 cm long) for venous site –
 5 Fr for an infant or child (<15– 20 Kg) and
 7 Fr for a larger child or adult
 Extra long sheaths (45 to 90 cm ) are used to –
1. guide catheters directly and repeatedly to an area
within the heart itself (biopsies, blade catheters),
2. for trans septal procedures,
3. to deliver special devices within the heart or great
vessels (stents, occlusion devices), and
4. for the withdrawal of foreign bodies from the vascular
system.

11. Swan-Ganz Catheter(Pulmonary
Artery Catheterization)
• Swan-Ganz Catheter-
Balloon flotation
Pulmonary Artery catheter
• Use for monitoring
critically ill patients
(mostly in the ICU)
• Catheterization only
possible on the right side
of the heart
• Catheter is hooked up to a
Cardiac Output computer

13. Thank Youdrtoufiq19711@yahoo.com
Asia Pacific Congress of
Hypertension, 2014, February
Cebu city, Phillipines
Seminar on Management
of Hypertension,
Gulshan, Dhaka