This document discusses pressure changes that can occur during coronary angiography, specifically damping and ventricularization. Damping is defined as a significant decrease in pressure at the coronary ostium when the catheter is placed, accompanied by the disappearance of pressure waveforms, suggesting no antegrade flow. Ventricularization occurs when blood circulates within a coronary artery like a closed system, deforming the aortic pressure waveform. The document emphasizes the importance of the operator recognizing abnormal pressure changes to avoid complications, and provides solutions like catheter replacement or intracoronary nitroglycerin to address issues.
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Foreign body removal during cardiac catheterizationRamachandra Barik
The removal of foreign bodies from the heart and vasculature has shifted from the domain of the radiologist and even the thoracic or vascular surgeon to the terventional cardiologist and, in turn, from the radiographic suite or operating room to the cardiac catheterization Laboratory.
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
Foreign body removal during cardiac catheterizationRamachandra Barik
The removal of foreign bodies from the heart and vasculature has shifted from the domain of the radiologist and even the thoracic or vascular surgeon to the terventional cardiologist and, in turn, from the radiographic suite or operating room to the cardiac catheterization Laboratory.
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
EFFECT OF NEGATIVE ANGLE CANNULATION DURING CARDIOPULMONARY BYPASS – A COMPUT...ijbesjournal
Creation of emboli in the aortic root and changes in flow distribution between supra-aortic arteries and descending aorta can lead to stroke and perfusion related tissue damage during cardiopulmonary bypass. A thorough understanding of how the angle of cannulation affects the overall success of cardiopulmonary bypass during cannulation of the ascending aorta is needed. Previous simulation research has observed the effect of outflow cannula position by changing the location of the cannulation site to the subclavian artery and other vessels, as well as positions for innovative cannula designs. The purpose of this study is to evaluate the success of the procedure while using a straight cannula, modulating the angle of cannulation below horizontal in the frontal plane. A simplified geometry of the aorta was used. The success of the procedure was quantified by observing wall shear stress, normal stress, intra-fluid shear stress, and flow distribution. A numerical study was performed to solve the Reynolds Averaged Naiver Stokes governing equations, which were used in conjunction with a constant density fluid to simulate blood, and a realizable two-layer k-ε turbulence model
The passage of the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA) was meant to be the dawn of a new day in healthcare to help rectify these disparities. For graduate medical education trainees transitioning from practicing in sheltered residency and fellowship environments into independent practice, understanding these new healthcare delivery models will be vital to providing high-quality care to patients.
Primary mitral valve regurgitation is the second most frequent valve disease in the Western world. Definite treatment is surgical with few controlled studies to rely on. In general mild and mild/moderate regurgitation is well tolerated for years, but severe regurgitation often necessitates valve surgery. It is equally important to rule out severe mitral valve regurgitation, since unnecessary surgery can be avoided, but also rule in severe regurgitation because surgery too late often may be associated with an unfavourable outcome due to poor left ventricular function going unnoticed as a result of the mitral valve regurgitation related low impedance to left ventricular output.
a clinical syndrome that results from inadequate tissue perfusion.
Hypovolemic shock - Blood or fluid loss, both leading to a decreased circulating blood volume, diastolic filling pressure, and volume.
Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes
Extra-cardiac/obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload
Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation leading to a decrease in preload, with decreased, normal, or elevated cardiac output, depending on the presence of myocardial depression.
Aorta in takayasu's arteritis is as brittle as glassRamachandra Barik
Balloon angioplasty of a critically or completely occluded segment of the aorta in Takayasu’s arteritis is challenging because of extensive panarteritis and diffuse fibrosis. In contrast to atheromatous disease, the aorta is left with very little elastic tissue, leading to higher incidence of dissection during intervention. Neither the profile of the angioplasty balloon (compliant vs non-compliant, length, diameter) nor the stent type (covered vs self-expanding) have been defined in performing angioplasty in this situation. We report the case of a 38-year-old female with aortoarteritis. The diseased aorta had diffuse narrowing in its thoracoabdominal part with critical stenosis at the level of the 11th thoracic vertebra. The stenotic segment suffered full-length dissection after balloon dilatation. A self-expanding stent was deployed to contain the dissection. At 12-month follow-up exam, the dissection was healed, without significant lumen loss.
Coronary cameral fistula is a sizeable communication between a coronary artery, bypassing the myocardial capillary bed and entering a chamber of heart. It constitutes 0.2%-0.4% of congenital cardiac anomaly.Sixty percent of these fistula arise from the right coronary artery and terminate mostly (90%) in the right side of the heart..
Similar to Pressure, Damping and Ventricularization_Crimson Publishers (20)
Coarctation of aorta is characterized by narrowing of the aortic lumen. Complex lesion are complicated by associated cardiac anomalies and picked in infancy while simple coarctations are not diagnosed until adulthood when it manifests as secondary hypertension or its complications. We are reporting a case of severe coarctation of aorta which presented as ST elevation on anterior chest leads with severe sudden onset left sided neck pain mimicking anterior wall myocardial infarction and patient was thrombolysed due to dynamic ECG changes and new onset severe left sided neck pain.
The autonomic nervous system (ANS) controls all body functions. Dysregulation of this system may be responsible of bradycardia. The main objective of our study is to describe the autonomic profile of patients with bradycardia and to determine, through testing cardiovascular autonomic reflexes its involvement in the pathogenesis of idiopathic symptomatic bradycardia.
The study objective was to evaluate the cardioprotective activity of Biofield Energized test item (DMEM) in rat cardiomyocytes (H9c2) cells. The test item (DMEM medium) was divided into three parts, first part received one-time Consciousness Energy Healing Treatment by a renowned Biofield Energy Healer, Dahryn Trivedi and was labeled as the one-time Biofield Energy Treated (BT-I) DMEM, while second part received the two-times Biofield Energy Treatment and is denoted as BT-II DMEM.
Essential hypertension, the most common type, is an important cause of morbidity and mortality in the elderly, a rapidly growing section of the population. It is a sad reality that until the 1950s treating benign hypertension was not thought to be necessary. The tragic death of Franklin Delano Roosevelt on April 12, 1945 at the age of 63 years, with a blood pressure of 350/195mmHg, and without treatment shocked the healthcare community.
Beats classification is an essential step in the ECG signal analysis for cardiac arrhythmias detection. There are multiple alternatives to solve this problem, but these are considerably reduced when re-al-time restrictions are added to the analysis. The goal of this work is to expose an optimal solution based mainly on the use of voltage values of the signal in the time domain and compare it with other based on Daubechies’ Wavelets analysis. Several measures are used in both feature spaces to determine the similarity of every beat to a patient’s specific patterns and, after that, a method similar to clustering’s algorithms is used to assign a class to each.
Coronary artery diseases (CAD) known as atherosclerotic heart disease, atherosclerotic cardiovascular disease, coronary heart disease (CHD), or ischemic heart disease (IHD). CAD is the largest contributor of cardiovascular diseases (CVDs) and mortality rate is due in prevalence to atherosclerosis, a chronic inflammatory condition of the arterial wall. Unfortunately, myocardial infarction (MI) is still a first common manifestation of CHD and, in about 50% of patients; angina pectoris is the first symptom of the pathology.
“In past centuries physicians in some cardiologic PATHOLOGY were used to prescribe to the patient a long rest in order to recuperate health status. (There weren’t available highly efficient drugs strategies and so a long rest without physical and-or psychological high stress contributes to this process). In example in oriental medicine we can see body balances strategies, and in some psychologic techniques we can see that time is relevant to reequilibrate some conditions (acute stress).
Intraoperative aortic dissection during cardiac surgery is infrequent, complicating surgical intervention in 0.04 - 1% of cases. Dissections can occur anywhere, most often as a result of direct mechanical damage at the location of the side clamp, site of cannulation of the aorta, or at the site of proximal anastomosis and may manifest as hematoma, bleeding at the cannulation site or bleeding from the proximal anastomoses or aortic suture lines. Delayed diagnosis and treatment can lead to extremely (23-41%) high mortality rate.
Hemorheological indexes, living habits, medical history and genetics factor are primary risk factors in Coronary Heart Disease (CHD). In the present study the relation of all factors to the severity of CHD was examined. The data of 282 patients (mean age: 60±9 years) diagnosed with CHD and 229 healthy controls (mean age: 59±7 years) from Wenzhou Medical University were analyzed.
In 2001, a mathematical model for determining the surface area of the left ventricle (LV) and another one for its volume (VLV) was presented. Both were based on the consideration that the geometry of a normal LV is similar to the one of a Truncated Prolate Spheroid (TPS).
Transcatheter Aortic Valve Replacement (TAVR) had become a novel and secure procedure to treat aortic stenosis that had become more accepted over the years; the approach and different types of device improve the life expectancy, diminish the complications and costs in public health. Along with the improvement in technology the minimalist approach had gain popularity to ameliorate the overall patient health.
Despite the advances in diagnostic methods and techniques for surgical treatment in the last two decades, aortic diseases remain a major cause of mortality and cardiovascular morbidity, challenging physicians and molecular biologists. It is believed that about 600 million years ago, during the Cambrian period, variant forms of life appeared, among them were the oxygen-producing cyano bacteria.
The central venous access is one of the most common procedures in interventional nephrology [1-3]. One of the known complications of this procedure is the right branch lesion of the His bundle that leads to temporary or permanent blockage.
Infective endocarditis is a life-threatening disease caused by bacterial infection of the endothelium and cardiac valves, either native or prosthetic. In the present work the role of the new microbiological techniques (techniques of detection and amplification of the subunit 16 ribosomal sRNA by means of the chain reaction of the polymerase in blood or tissue, fluorescent in situ hybridization, and matrix-assisted laser is reviewed desorption/ ionization time-of-flight mass spectrometry (MALDI-TOF MS) in the diagnosis of infective endocarditis.
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Coronary angioplasty has revolutionized the management of coronary artery disease. It has not ceased to develop to become the reference method of myocardial revascularization. The aim of our study is to evaluate the ultrasound parameters of left ventricular function after coronary angioplasty. This is a prospective analytical study including patients with stable coronary artery disease with a known coronary artery anatomy programmed for coronary angioplasty. Transthoracic echocardiography was performed four hours before and seven days after myocardial revascularization.
Cardiomyopathies are heart muscle diseases originated from a series of aggressions, such as genetic defects, cardiac myocyte injury or infiltration of myocardial tissue. Dilated cardiomyopathy (DCM) is characterized by an impairment of the left ventricular or biventricular contraction, caused by familial, genetic, viral, autoimmune, alcoholic, toxic, or of unknown cause.
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
![Nuray Kahraman Ay*
Department of Cardiology, Bezmialem Vakif University, Turkey
*Corresponding author: Nuray Kahraman Ay, Department of Cardiology, Bezmialem Vakif University, Adnan Menderes Boulevard (Vatan Street )
34093 Fatih/ Istanbul, Turkey; Tel: +90.5359864489; Fax: +90.212 6217580; Email:
Submission: February 16, 2018; Published: March 21, 2018
Pressure, Damping and Ventricularization
Introduction
Pressure
Although the risks of coronary angiography have declined
over the years by increased clinical experience and advanced
technologies, it still requires attention, knowledge and experience
due to being an interventional diagnostic method. A safe coronary
angiography begins with the selection of the appropriate catheter
for the anatomical structure of the patient and the evaluation of
the pressure when the catheter is placed in the coronary ostium.
Coronary pressure waves are complementary requirements of
angiography. The recognition, evaluation and precautions to be
taken for abnormal pressure waves directly affect the mortality of
the patient.
One of the first clues to the presence of stenosis in the left main
coronary artery (LMCA) is abnormal changes in pressure when
the catheter is seated in the ostial LMCA. This often occurs as a
“ventricularization” or “damping”. For decades, ventricularization
was mostly experienced as a stenosis by invasive cardiologists [1].
Recognition of abnormal changes in pressure and precautions to be
taken prevent catastrophic outcomes in patients.
Damping
Damping can be defined as a significant decrease in the aortic
pressure of the aortic root occurring when the catheter is placed
in the coronary ostium accompanied with the disappearance of
systolic and diastolic waveforms (Figure 1). At that moment, there
is no pressure which means that there is no antegrade flow into the
artery and that the area fed by the relevant artery cannot get blood.
This suggests that either the size of the catheter used may be the
same with the ostium of the vessel, or a catheter-related spasm has
developed. The coronary ostium may have narrowed due to a lesion
or the patient’s artery may be anatomically thin. It is also possible
that the catheter has occluded the vessel, blocking the blood flow.
Arrhythmia, chest pain, and ischemia may occur if the catheter
is not withdrawn quickly. It is very important for the operator to
check the pressure as soon as possible after placing the catheter in
the coronary ostium. Sometimes, the catheter is not properly placed
in the ostium and leans on the vessel wall, which may potentially
cause a decrease in the pressure. However, the waveform can be
easily distinguished from that of actual damping.
Figure 1: Aortic pressure and damping.
It is essential to choose an appropriate catheter for the
anatomical structure of the patient for both ensuring a safe
coronary angiography procedure and obtaining good image quality.
Factors such as aortic root, structure of the aortic arch, anatomy of
the coronary artery (transfemoral or transradial; right or left), body
shape and catheter aid should be taken into account while selecting
thecathetertobeused.Choosingtheappropriatecatheterfacilitates
the operator’s work and reduces the likelihood of complications.
A wide lumen catheter provides better support and image
quality. Besides, it allows the passage of multiple balloons/stents or
Mini Review
Open Journal of
Cardiology & Heart DiseasesC CRIMSON PUBLISHERS
Wings to the Research
1/3Copyright © All rights are reserved by Nuray Kahraman Ay
Volume 1 - Issue - 4
Abstract
The arterial pressure waveform to be included during coronary angiography makes procedure safer. At this point the sentience of angiographer,
detection and evaluation of abnormal pressure waves, will ensure the avoidance of complications that may occur. In this article, coronary pressure
waveforms, the mechanisms of damping and ventricularization and precautions have been presented.
Keywords: Pressure; Damping; Ventricularization
ISSN 2578-0204](https://image.slidesharecdn.com/ojchd-190926055444/85/Pressure-Damping-and-Ventricularization_Crimson-Publishers-1-320.jpg)
![Open J Cardiol Heart Dis Copyright © Nuray Kahraman Ay
2/3
How to cite this article: Nuray K A. Pressure, Damping and Ventricularization. Open J Cardiol Heart Dis. 1(4). OJCHD.000518.2018.
DOI: 10.31031/OJCHD.2018.01.000518
Volume 1 - Issue - 4
aguidingcatheterforintravascularultrasound(IVUS).Nevertheless,
larger catheters have higher risk for vascular complication and
damping induced by the blockage of antegrade perfusion. If the
vessel is small in diameter and the catheter is larger than the vessel
ostium, a side-hole catheter should be preferred [2]. Using a side-
hole large catheter not only decreases damping, but also lowers
the risk for vessel dissection that may be induced by contrast agent
injection. On the other hand, in cases when a side-hole catheter is
used, the opaque material may leak into the aortic root through
the holes of the catheter, causing suboptimal visualization of the
artery. It is not recommended to use side-hole catheters when the
fractional flow reserve (FFR) technique is used as it may cause
overestimation [2].
In general, pressure changes associated with arteriovenous
malformation, subselective engagement of the catheter into the
conus branch, and coronary artery spasm induced by catheter
placement are more common in the right coronary artery [1].
The catheter-induced spasm may not only be at the point of
catheterization, but also at the distal region. Changing the catheter
to a smaller one and not sitting deep in the coronary ostium may
be solve the problem. Infusion of intracoronary nitroglycerin 100-
200μg can help to remove spasm.
Especially in the presence of ostial stenosis, it is important
that the left coronary catheter is placed carefully and slowly in
the ostium of the left main coronary artery (LMCA) The operator
should check the press, if damping is observed, give as little as
1-2ml of opaque material during cineangiography and withdraw
the catheter quickly (hit and run). In this way, the first image of the
ostial stenosis can be obtained. It may be possible to evaluate the
ostial stenosis of LMCA if contrast agent is given in anteroposterior
(AP) or right anterior oblique (RAO) position when the catheter is
behind the ostium [3]. Entering and exiting of the catheter to the
ostium and contrast jet can increase spasm and stiffness. A LMCA
stenosis between 40-60% may require more images for evaluation,
and IVUS can be used to assess the stenosis in some cases.
Ventricularization
Suppose that you take a deep breath and inflate a balloon. Then,
you inspire the air from the balloon again and inflate the balloon for
the second time with the same air. Despite pressure changes, there
is no new air inflow into the balloon. Similarly, ventricularization
occurswhenthecoronaryarterydoesnotreceivefreshlyoxygenated
blood and the same blood circulates within the artery like in a
closed system. Ventricularization is the deformation of the aortic
pressure passing through the narrowed coronary artery. Pacold et
al. [4] observed alterations in the intracoronary arterial pressure
at various levels in 20 patients diagnosed with ventricularization.
Also, an alteration was observed in the pressure waveforms when
the stenosis of variable degrees was formed with a balloon-tip
catheter in the left main coronary artery on an animal model.
In case of aortic or ostial stenosis, the rate of pressure decrease
in the left main coronary artery varies depending the degree
of the stenosis [1]. Not only LMCA stenosis but also complete
blockage of the ostium by the catheter and deep or subselective
engagement of the catheter in a blocked coronary branch can result
in ventricularization. Additionally, a stenosis in the right coronary
artery (RCA) may also cause ventricularization. Such a change is
more significant when accompanied by the stenosis of the left main
coronary artery or severe left coronary arterial stenosis. Placing the
catheter in a narrowed coronary ostium reduces both systolic and
diastolic pressures. The decrease in diastolic pressure, however, is
sharper (Figure 2).
Figure 2: Ventricularization, during which aortic and
systolic pressures mildly decrease while diastolic pressure
significantly lowers.
Sometimes, a catheter may enter the left ventricle during
catheter manipulation. In such a case, during which ventricular
pressure is observed, catheter is re-manipulated by pulling the
catheter in the aortic root. Ventricularization is distinguished
from actual ventricular pressure with its some characteristics.
Left ventricular systolic pressure is equivalent to aortic pressure,
whereas diastolic pressure is significantly lower (<20mmHg) [1].
In ventricularization morphology, there is pre-systolic deviation
difference, and ventricularization resembles to the “a wave”
corresponding the atrial systole. The ascending pressure curve
of the ventricularization wave is slower compared to the aortic
pressure while and its descending curve is steeper [1].
In case of pressure ventricularization, evaluation is performed
by pulling the catheter into the aortic root. Subsequently, catheter
is carefully placed back into the coronary ostium and image can
be obtained with a small amount of opaque material by mildly
pulling the catheter back during cineangiography. The fact that the
test doses administered do not go back into the aortic root or that
the contrast agent accumulate in the proximal and mid regions of
the vessel refers to ostial stenosis. As with damping, it is possible
with another approach to prevent ventricularization and damping
through nonselective assessment of the ostial lesion at the level of
sinus valsalva or by ensuring the preservation of antegrade flow
through the replacement of a standard catheter with a side-hole
catheter [5].
Conclusion
In conclusion, in ventricularization and damping cases which
may have resulted from causes such as selection of catheter
incompatible with coronary ostium, ostial stenosis, coronary](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)