1. The document provides an overview of the history and development of cardiac catheterization, from the first experiments on horses in 1844 to the techniques used today. 2. It describes the key principles and procedures for performing cardiac catheterization studies, including patient preparation, accessing venous routes, transducer setup, pressure measurements, and oxygen saturation assessments to detect shunts. 3. The document emphasizes the importance of collecting all hemodynamic data in a steady state and maintaining standards to ensure accurate measurements and interpretations.

1. MURTAZA KAMAL
MURTAZA.VMMC@GMAIL.COM
20/09/2018
PRINCIPLES AND
PRACTICES OF
CARDIAC
CATHETERISATION
1

2. OBJECTIVES…
 Overview of history and development
 How to perform a study tailored to answer
specific clinical question
 Gain better understanding of role of as a
diagnostic tool in specific situations
2

3. CLAUDE BERNARD
 1844: France
 1st RHC on horse
 Inserted glass tubes via
jugular vein and carotid
artery
 Measured temperature
in both ventricles
 Later measured
intracardiac pressures
too
3Nossaman BD et al. H/o RHC: 100 years of experimentation and methodology development. Cardiol Rev 2010;18:94-101.

4. WERNER FORSSMANN
 1929; Germany
 Self catheterization
using urethral catheter
 Used lt. anticubital
vein RV; (X-RAY)
 Against medical ethics
4
Meyer JA. W Forssmann and catheterisation of the heart, 1929.
Ann Thorac Surg 1990;49:497-9

5. FINALLY GOT RECOGNIZED…
5
The Nobel Foundation: 1956

6. INTRODUCTION
 Advent of non-invasive modalities (ECHO,
MRI): Cardiac catheterization reduced
 Gold standard: For assessment of cardiac
hemodynamics
 Resolves discrepancy b/w c/fs+ non-invasive
measurements
6

7. INTRODUCTION CONT…
 Through review of clinical history, physical
exam, ECG, CXR, ECHO, MRI(+/-) before
patient enters cath lab
 Why is study performed?
 If results are not going to alter course of
management: Best not to perform
 Have clear idea as what is the data one wishes
to seek
 Wild goose chase: More questions than
answers 7

8. CONDUCT OF CATHETERIZATION STUDY
 Adherence to standard protocols
 Due attention to pressure recordings and
saturation assessments
 Flexibility: Each case is different
8

9. PATIENT PREPARATION
 Parents informed of indication and risks of
procedure
 Retrospective and prospective data:
Serious adverse event: 1.1%
Mortality: 0.05%
Hoeper M et al. Complications of RHC procedures in patients with PH in experienced centers. J Am Coll Cardiol 2006;48: 2546-52
9

10. PATIENT PREPARATION CONT…
 MC complications:
Access site hematoma
Vagal reaction
Pneumothorax
Arrhythmias
 Quote individual/ departmental complications
10

11. PATIENT PREPARATION
 Rule out anemia, infections, thrombocytopenia
 Electrolyte/ metabolic disturbances
 Dehydration
 Digoxin toxicity
 Coagulopathy
Safe in patients with INR <3.5 undergoing
RHC via IJV or anti cubital veins
Ranu H et al. A retrospective review to evaluate the safety of RHC via IJV in assessment of PH.. Clin Cardiol 2010;33: 303-6
11

12. PROTOCOL
 Cath profile and PAC clearance before
admission (1 day prior)
 NBM: 4 hours before
 Caution: OVERZELOUS FASTING PROTOCOLS
MAY LEAD TO VOLUME DEPLETION: MAKING
CHALLENGING VENOUS ACCESS
 IVFs: 1/2DNS since NMB
 Blood in hand
 Injection Cefazolin 30mg/kg i/v 1 hr before
procedure 12

13. VENOUS ACCESS
 Route of access depends on:
 Operator experience
 Presence of cardiac devices and indwelling catheters
 Prior h/o venous cannulation and associated
complications
 FV access commonly used in children or if LHC
performed concurrently
 Small studies demonstrated feasibility and
safety of RHC+LHC via ACV+ radial artery
respectively
Yang CH, Guo GB, Yip HK. Bilateral cardiac catheterizations: the safety and feasibility of a superficial forearm venous and transradial arterial
approach. Int Heart J 2006;47:21–7.
Lo TS, Buch AN, Hall IR, et al. Percutaneous left and right heart catheterization in fully anticoagulated patients utilizing the radial artery and
forearm vein: a two-center experience. J Interv Cardiol 2006;19:258–63
Gilchrist IC, Kharabsheh S, Nickolaus MJ, et al. Radial approach to right heart catheterization: early experience with a promising technique.
13

14. VENOUS ACCESS CONT…
 USG guided vs landmark based:
Meta-analysis available
Clear benefit of USG for IJV cannulation
Higher success rate
Fewer complications
Faster access
Hind Daniel, Calvert Neill, McWilliams Richard, et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ
2003;327:361.
 Data very limited: USG for FV and SCV
cannulation
14

15. VENOUS ACCESS CONT…
 Balloon flotation catheters (Swan- Ganz) :
Balloon at distal end, facilitate passage through
RH
 Designed to be placed without fluoroscopy,
although screening helps (marked RH
dilatation/ severe TR)
15

16. VENOUS ACCESS CONT…
 Catheter inserted into RA and balloon inflated
 Catheter follows direction of blood flow towards
PAs
 Advancing further should allow performer to
obtain PCWP
 Important to avoid leaving balloon inflated for
longer than necessary : Risk of pulmonary
infarction/ rupture
16

17. CATHETERIZATION FROM FV
 Commonly performed using multipurpose end
hole catheter using direct fluoroscopy
 Requires greater manipulation than balloon
flotation catheters to navigate through RH:
Guide wire may be required to improve
steerability
 MP catheters can be used to
cross directly into LA in patients
with PFO for direct pressure
17

18. PROCEDURE
 Before starting: Confirm pressure transducers
are zeroed, leveled, appropriately calibrated
 Establishment of “zero” value: Concept of
making hydrostatic measurements with fluid
filled systems relative to a reference value,
usually atmospheric pressure (760mm Hg),
then examining change from that value
18

19. PROCEDURE
 Transducer should be placed at appropriate
level
 For every 1cm above/ below LA the catheter is
referenced, the pressure measurement is
underestimated/ overestimated by??
 0.74mmHg
19

20. 20

21. THE CONCEPT OF PHLEBOSTATIC AXIS
 Correct reference point
 Midpoint b/w anterior
and posterior surfaces
of chest at 4th ICS
 Essential that level of
stopcock of transducer
be at this level
 All transducers must
be at this level
21

22. PRINCIPALS TO BE ADHERED TO DURING CATH
STUDY
 Data to be obtained in a steady state
 Essential to maintain decorum in a quiet and
calm environment
 Appropriate sedation needed in case of agitated
child
 Watch for over sedation: Respiratory
depression, consequently changes in sats
22

23. PRINCIPALS TO BE ADHERED TO DURING CATH
STUDY
 Obtain entire data in………..??
 Withdrawal pressures and saturations better
than ingoing
 If sample can’t be obtained from a site due to
ventricular premature complex: Skip site until
rest of run completed
 Complete hemodynamic data must be obtained
before angiograms
 Obtain pressures and oxymetry samples as
close in time as possible
23

24. PRINCIPALS TO BE ADHERED TO DURING CATH
STUDY
 Repeated measurements : More accurate
 Record catheter course
 Sat syringes not to be overheparinized, sample
gets diluted; just quote inner lining of syringe
 Remove air bubbles: PO2 rises
24

25. PRINCIPALS TO BE ADHERED TO DURING CATH
STUDY
 Glass syringes: Gold standard
 Plastic syringes: Porous, fall in PO2
 Metabolism of WBCs: Tends to fall in PO2
 Measure sats <5 mins (if delay: Transfer in ice
<30 mins)
25

26. USE DEDICATED OXYMETRY MACHINE
 Should be in lab
 Measures directly o2 saturation using
spectrophotometry to correctly quantify oxy,
deoxy, carboxy and methHb and total Hb
 Do not use ABG machines: WHY???
 O2 saturation results derived from o2
dissociation curves, using PO2 values: Affected
by many factors ( Adult or fetal Hb, temp, ph,
CO2, 2,3-DPG levels)
26

27. THE ACTUAL MEASUREMENTS FOR SHUNTS
• Place catheter in PA (Swan Ganz) and pigtail in Ao
• Measure PA and Ao pressures
• Take o2 sat in PA+ Ao blood
• Enter LV by retrograde crossing of Ao valve
• Advance PA catheter to PCWP position
• Measure simultaneously LV-PCWP pressures
27

28. THE ACTUAL MEASUREMENTS FOR SHUNTS
CONT…
• Pull back from PCWP to PA
• Pull back from PA to RV for PS and record RV
pressure. Take RV sample for O2 sats
• Record simultaneous LV-RV pressure
• Pull back from RV to Rato screen for tricuspid
stenosis and record RA pressure. Take RA sample
• Take SVC+IVC samples for O2 saturations
• Pull back from LV to aorta for AS
28

29. NORMAL PRESSURE VALUES OF VARIOUS
HEART CHAMBERS
CHAMBER AVERAGE PRESSURE
RA 6/5/3
RV 25/4
PA 25/9/15
PCWP 9
LA 10/12/8
LV 130/8
Ao 130/70/85
29

30. DO MAKE A NOTE
 Mean RA pressure=RVEDP
 RVSP=Peak PA pressure
 PA diastolic pressure=Mean PCWP=Mean LA
pressure= LVEDP
 LVSP=Ao pressure
 Presence of gradients across these chambers
indicates obstruction to blood flow
30

31. RIGHT ATRIAL PRESSURES
 A: Atrial systole, just
after P wave
 C: RV contraction/ TV
closure
 V: Filling of RA against
closed TV valve
 X: Atrial relaxation
 Y: Opening of TV in
early diastole
31

32. RV PRESSURE
 A rapid upstroke
during isovolumetric
contraction
 A plateau during
systolic ejection
 A decline to near zero
during isovolumetric
relaxation
 A slow rise to the end
diastolic pressure
during diastolic filling
32

33. PA PRESSURE
 PA systolic pressure=
RVSP (<30mm Hg)
 Mean pressure< 20mm
Hg
 PA diastolic pressure
begins with dicrotic
notch caused by valve
closure, and the diastolic
pressure is typically no
more than 2-3 mm Hg
higher than the wedge
pressure
33

34. PCWP
 Is usually a good
reflection of LA and
LVEDP because of
absence of valves in
pulmonary circulation
 It has the characteristic
a and v wave
appearance of an atrial
tracing
34

35. SATURATIONS
Site Average Range
SVC 74% 67-83%
IVC 78% 65-87%
RA 75% 65-87%
RV 75% 67-84%
PA 75% 67-84%
LA 95% 92-98%
LV 95% 92-98%
FA 95% 92-98%
35

36. SATURATIONS
 Coronary sinus??
36

37. 37
SHUNT DETECTION & QUANTIFICATION

38. WHEN IS IT UTILISED?
 Discrepancy b/w physical and non-invasive
findings
 Time of device closure
 Assessment of shunt operability in patients
with severe PAH with borderline findings
38

39. SHUNT DETECTION
 Oximetric run used
 Past: Indicator dye (Indocyanine green) used
Detected very small lt rt shunt missed by
oxymetry
No longer used
 Presence of unexplained arterial desaturation
(FA SaO2<95%) or unexpectedly high O2
content in PA (SaO2>80%): Raises suspicion of
rt lt or a lt rt shunt respectively
 Follow this by a complete oximetry run 39

40. OXIMETRY RUN
 Full oximetry run
involves taking serial
samples at following
locations:
 Lt+ rt. PA
 MPA
 RVOT
 RV mid
 RV tricuspid valve or
apex
 RA low or near TV
 RA high
 SVC low (near RA
junction)
 SVC high (near
innominate vein junction)
 IVC high ( just at/ below
diaphragm)
 IVC low L4-5
 LV
 Ao (diatal to ductus
insertion)
40

41. DETECTION OF LEFT TO RIGHT SHUNT BY
OXIMETRY
41
Antman et al, AJC 80; Barrat et al, JLCM 57, Freed et al, BHJ 79

42. CAUSES OF STEP UP AT ATRIAL LEVEL??
ASD
PAPVC
VSD with TR
RSOV  RA
LV  RA shunt
Cor AV Fistula  RA
42

43. CAUSES OF STEP UP AT VENTRICULAR LEVEL??
VSD
RSOV  RV
Low ASD
Cor AV Fistula  RA
PDA with PR
AVSD
43

44. CAUSES OF STEP UP AT GREAT VESSEL LEVEL??
Patent Ductus Arteriosus
Aorto-pulmonary Window
Outlet VSD
Coronary origin from pulmonary artery
44

45. LIMITATIONS
 Steady state may not be present: Patient
agitation/ Arrhythmias
 Lacks sensitivity: Small shunts may be missed
 In conditions of high level of systemic blood
flow, mixed venous o2 sats tends to be higher
than normal and interchamber variablility would
be reduced equalization of arterial and venous
blood 45

46. UNDERSTANDING THE FICK’S PRINCIPAL
Total uptake/release of a substance by an
organ is the product of the bld flow to the organ
and the AV concentration difference of the
substance
46

47. PULMONARY BLOOD FLOW
 Lung as an organ and O2 as substance: Bld
flow to lung will be:
 Qp (L/min) =O2 consumption(VO2)/ AV O2
difference
=VO2/ PV O2 content-PA O2 content
47

48. PBF
If PV can’t be entered
See systemic arterial O2 content
≥95% <95
Use this value Determine if rt lt shunt
+nt –nt
Use 98% value Use observed systemic
arterial saturation value 48

49. SYSTEMIC BLOOD FLOW
 Using body as an organ and O2 as substance:
Bld flow to body will be:
 Qs= o2 consumption(VO2)/ SA02-MVO2
 In presence of shunt lesions, MVO2 is to be
measured in chamber immediately proximal to
shunt
49

50. CALCULATION OF QS IN PRESENCE OF LT->RT
SHUNT
50
Grossman & Baim’s, 8th edition (FLAMM’S FORMULA)

51. SHUNT QUANTIFICATION
 Absolute terms (L/min)=Qp-Qs
 Relative terms (ratio)=Qp/Qs
 Ratio advantageous as it takes out unreliable
variables like VO2
 Qp/Qs=(SAO2-MVO2)/ (PVO2-PAO2)
51

52. QP/QS
 1: No shunt
 <1: Rtlt shunt
 1-1.5: Small lt rt shunt (in absence of PAH;
would not need closure)
 1.5-2: Intermediate lt rt shunts (may be
closed if risk of closure low)
 >2: Large lt rt shunt (Needs closure)
52

53. CALCULATION OF BIDIRECTIONAL SHUNT
 Effective bld flow: Flow that would exist in
absence of any lt—>rt or rt lt shunt
 Qeff= O2 consumption/ (PVO2-MVO2)
 Lt rt: Qp-Qeff
 Rt lt: Qs-Qeff
53

54. SHUNT OPERABILITY
 Large shunts: High PAH due to increased flow
 Anatomic changes takes place in pul.
vasculature
 Reversible initially, later ir-reversible
 As PVRI increases> 6-8 Wood U: Poor
operative outcome
 In these cases: If PAH irreversible; Sx tends to
transform these from Eisenmenger’s syndrome
to one analogous to idiopathic PAH
54

55. SHUNT OPERABILITY CONT…
 Compared to idiopathic PAH; pts. with ES have
much better prognosis with 40% expected to
survive till 25 yoa
 Assessment of operability is not an “ all or
none” phenomenon
 Clinical and non invasive parameters too are
considered
55

56. CLINICAL & NON INVASIVE FINDINGS TO ASSESS
SHUNT OPERABILITY
56
Vijaylaxmi: Cardiac Catheterization From Pediatric to Geneatric: 1st edition

57. HEMODYNAMIC ASSESSMENT OF SHUNT
OPERABILITY
 Favorable outcomes:
Baseline Qp/Qs >1.5-2
PVRI <6Wood U
PVR:SVR <0.3 without vasoreactive test
Age <1 year (Most imp.)
57

58. TECHNIQUES TO ASSESS OPERABILITY
 Lung biopsy
 Exposure to vasodilator
 Temporary balloon occlusion of defect
58

59. 01. LUNG BIOPSY
 Gold standard
 Heath Edward classification Grade 4-6:
Irreversible
 Invasive
 Associated with morbidity
 Not available at all centers
 Some studies have questioned reliability
59

60. HEATH-EDWARDS CLASSIFICATION
60

61. 02. EXPOSURE TO VASODILATOR
 100% O2
 NO (+/- O2)
 Tolazoline
 Adenosine
 Epoprostenol
 Used to assess pulmonary reactivity in cath
labs
61

62. PROCEDURE
 Pt. adequately sedated
 Obtain baseline rt/lt heart studies (PVRI,SVRI,
Qp, Qs)
 100% o2 X 10 mins
 Repeat rt/lt heart studies (recalculate Qp, Qs,
PVRI, SVRI)
 If NO used: 20-80ppm by NO ventilator
62

63. TIPS FOR CALCULATION
 O2 consumption remains constant
 Post O2 inhalation: Dissolved O2 must be taken
into account in calculating O2 content
 Failure to take into consideration the dissolved
O2 may make an inoperable case appear
operable
 In pts with a positive response , there is a fall in
the diastolic and mean PA pressures without a
fall/rise in Ao pressure/ CO
63

64. PRESENCE OF ALL OF THESE INDICATES
FAVOURABLE OUTCOME FOLLOWING SURGERY
 Decrease of 20% in PVRI
 Decrease of 20% in PVR: SVR ratio
 Final PVRI <6Woods U/m2
 Final ratio of PVR: SVR <0.3
64

65. 03. TEMPORARY BALLOON OCCLUSION
 Occlusion abolishes lt rt shunt
 Operable pts: Drop in PA pressure
 Inoperable pts: No drop in PA pressure; actual
rise in PA pressure with/without a fall in Ao
pressure
 Best studied in PDAs and sometimes in ASDs
 Technically difficult in VSDs
65

66. PDA BALLOON OCCLUSION
 10 mins occlusion
 A 25% fall in PA pressures or 50% fall in ratio
b/w pulmonary and Ao diastolic pressures
 A fall in PA pressure with a > 20 mm Hg
systolic, diastolic and mean pressure difference
b/w PA and FA during balloon occlusion
66

67. ASD BALLOON OCCLUSION
 15 mins
 +ve response: Mean reduction in pulmonary
pressure of ≥25% after balloon occlusion
compared to basal levels, without a fall in
systemic pressure or an increase in VEDP
67

68. 68
MEASUREMENT OF CARDIAC OUTPUT

69. JUST A GLANCE AT THE FORMULAE
69Callan P, Clark AL. Heart 2016;102:1–11. doi:10.1136/heartjnl-2015-307786

70. CARDIAC OUTPUT
 Fick method
 Thermo dilution method
 Angiographic method
70

71. A. FICK METHOD OF CO ESTIMATION
 Gold standard
 Fick’s principal
 In the absence of shunts:
Qp=Qs=CO
 Also useful in patients with TR where
thermodilution method is unreliable
 2 main variables:
O2 consumption (VO2)
AVO2 71

72. 01. O2 CONSUMPTION (VO2)
 Earlier methods: Rarely used
 Douglas bag/ polarography method/ paramagnetic
method
 Cumbersome/ specialized equipments/ experienced
personnel
 Only means of getting accurate VO2
 Children: La Farge- Miettinen tables
72

73. LA FARGE- MIETTINEN TABLES: BOYS
73Vijaylaxmi: Cardiac Catheterization From Pediatric to Geneatric: 1st edition

74. LA FARGE- MIETTINEN TABLES: GIRLS
74Vijaylaxmi: Cardiac Catheterization From Pediatric to Geneatric: 1st edition

75. 02. AV O2 DIFFERENCE
 O2 content
= O2 bound to Hb+ Dissolved O2
= 1.36mlx Hbx saturation+ 0.003mlxPaO2
 In pts on RA: Content of dissolved O2 low:
Hence ignored (= 1.36x Hb(g/L)X 10X (AO2-
MVO2)
 If breathing with FiO2 >50%: Take dissolved O2
too (Imp when shunt operability in severe PAH
cases is assessed) 75

76. BEFORE STARTING THE CASE, DO HAVE THESE
HANDY
 Hb level
 Ht +Wt for BSA calculation
 HR, age, sex: For VO2
76

77. LIMITATIONS OF THE FICK PRINCIPAL
 Use of assumed VO2 value (Errors of 10-25%
can creep in)
 Inability to obtain steady state under certain
circumstances (samples to be obtained
simultaneously)
 Do not use this method in: Significant MR, AR
77

78. B. THERMODILUTION METHOD OF CO
ESTIMATION
 Values correlate well to Fick method
 Involves determining the extent and rate of
thermal changes in blood stream following
injection of fixed vol of cold NS
 Temperature time curve obtained: Area gives
CO
78

79. METHOD
 Distal tip of Swan Ganz catheter placed in PA,
proximal port in RA
 10 ml NS bolus injected rapidly in proximal port at
a constant rate
 Resultant change in temperature in liquid
measured by thermistor mounted at the distal end
of catheter
 Result displayed on computer
 Repeated 3 times
 3 recordings should be within 15-20% of each
other, otherwise repeat procedure 79

80. LIMITATIONS OF THERMODILUTION METHOD
 Do not use in:
Severe TR
Low CO states (overestimates CO)
Intracardiac shunts
Marked respiratory variation
Cardiac arrhythmias
80

81. C. ANGIOGRAPHIC METHOD OF CO ESTIMATION
 CO=SV X HR
 SV= EDV- ESV
 By tracing LV ED and ES images of a high
quality ventriculogram, EDV and ESV can be
calculated
 Inherent inaccuracies of calibrating
angiographic volumes: Rarely used clinically
 Only use: Calculation of stenotic valve areas in
pts with significant AR or MR
81

82. 82
MEASUREMENT OF RESISTANCE

83. RESISTANCE MEASUREMENT
 Ohm’s law??
 R=V/I
 Resistance= Δ Pressure/ Flow
 SVR= Mean Ao Pre – Mean RA pre/ Qs
Wood units(mm Hg/L/min)
X 80: dynes/sec/cm-5
 Normal SVR: 8-20 Wood U (700-1,66
dynes/sec/cm-5)
83

84. RESISTANCE MEASUREMENT CONT…
 PVR= Mean PA pre- Mean LA (or PCWP) pre/
Qp
 Normal PVR: 20-130dynes/sec/cm-5(.25-1.6W
U)
 PVRI
= Mean PA- Mean PCWP/ CI
= Mean PA- Mean PCWP/Qp/BSA
= (Mean PA- Mean PCWP/ Qp) x BSA
= PVR X BSA 84

85. RESISTANCE MEASUREMENT CONT…
85

86. 86
ANGIOGRAMS

87. ANGIOGRAMS
 Should be performed after all hemodynamic
and oximetry data have been obtained
 In pts with elevated LVEDP/ PCWP (>25
mmHg), avoid angiograms or perform only it
has been reduced to safe levels with NTG/ lasix
87

88. PRIOR TO PERFORMING ANGIOGRAMS, ALWAYS
DO:
 Confirm catheter type
 Ensure catheter is not entrapped and no air
bubble
 Perform a test injection to confirm that
catheter has not migrated
 Confirm contrast volume, flow rates and
injection pressures
88

89. COMMONLY USED RADIOLOGICAL VIEWS
89Vijaylaxmi: Cardiac Catheterization From Pediatric to Geneatric: 1st edition

90. 90
ERRORS AT VARIOUS LEVELS

91. 01. ERRORS IN PRESSURE RECORDING
 Errors at zero level, balancing, calibration of
transducers
 Clots or kinks in system
 Loose connections/ defective transducers
 Use of multi hole catheter for withdrawal
gradients
 Systolic pressure amplification in periphery
 Use of computer derived mean values in
patients with marked respiratory variation
91

92. 02. ERRORS IN SAMPLING
 Obtaining samples in different physiologic
states ( arrhythmias, acidosis,
hypoventilation)
 Partial wedging of catheter (PA)
 Non representative sampling (PVs)
92

93. 03. ERRORS IN OXIMETRY
 Diluted samples (saline/ heparin)
 Air bubble in syringe
 Delay in sample sending
 Using ABG samples to estimate O2 sats
 Using non standardized equipment
93

94. 04. ERRORS IN CALCULATION
 Assumed VO2
 Assumed PV saturation
 Failure to account for dissolved O2 during
O2 study
 Flows corrected for BSA by dividing instead
of multiplying
 Errors in identifying the mixing chamber
correctly and using O2 sats from wrong
chamber
94

95. 95
COMPLICATIONS

96. COMPLICATIONS
 Access site complications:
Access site hematomas
Pseudoaneurysms
AV fistulas
IJV access: Hemo/ pneumothorax
Acute/ chronic limb ischemia: Loss of
pulses secondary to thrombosis
Femoral vein thrombosis
96

97. COMPLICATIONS CONT…
 Arrtythmias: Ventricular/ Supraventricular-
Transient
 Embolism: Espec in rt lt shunts
Air/ blood clots
Lead to stroke/ MI/ pulmonary or peripheral
embolism
Appropriate anticoagulation and diligence
during flushing essential
Avoid entry into LV in pts with LV clot/ Ao
valve endocardotis
97

98. COMPLICATIONS CONT…
 Infections
 Bacterial endocarditis
 Cardiac perforation
 Tamponade
 Contrast reaction
 Precipitation of pulmonary edema
 Retained equipment
 ARF
 Rarely death
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99. SO, TAKE HOME MESSAGE IS…
Catheterization is
like a puzzle
Everything must
fit with
everything else
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