Cardiac Cath Lab Basics

Cardiac Cath Lab Basics   The two components that make up the cath lab are: X-ray System Recording System Adult Cath Lab Pediatric Cath Lab EP Lab Reasons for Investigation   •  Acquired heart defects Investigated Objects   •  Coronaries (stenosis)   •  Chambers (wall motion)   •  Valves (stenosis, insufficiency)   •  Big arteries (aneurysm) Atrial Septal Defect (ASD) A hole exists between the two upper chambers of the heart.  Blood flows from the left atrium into the right atrium. Ventricular Septal Defect (VSD) A hole exists between the two lower chambers of the heart.  Blood flows from the left ventricle to the right ventricle. Transposition The outflow tracts of the aorta and the pulmonary artery are switched during fetal development.  Oxygenated blood flows out to the body through the pulmonary artery and oxygenated blood flows back into the lungs through the aorta.   Normal                                L-Transposition of Great Arteries In the fetus with PDA, a connection occurs between the pulmonary artery and the aorta which does not close shortly after birth. This can lead to pulmonary congestion and an increased workload for the heart.      Reasons for Investigation  •  Arrythmias  Investigated Objects   •  Tachycardia   •  Bradycardia Reasons for Investigation  •  Heart problems Investigated Objects   •  Cardiac output       Arteries (shown in red) are high pressure vessels. Veins (shown in blue) are low pressure vessels. 1.  Superior Vena Cava (SVC) 2.  Right Atrium (RA) 3.  Tricuspid Valve 4.  Right Ventricle (RV) 5.  Ventricular Septum 6.  Pulmonary Veins 7.  Left Atrium (LA) 8.  Atrial Septum 9.  Mitral Valve 10.  Left Ventricle (LV)   1.  Aortic Arch   2.  Left Coronary Artery (LCA) 2a.  Circumflex (CX) 2b.  Left Anterior Descending (LAD)   3.  Right Coronary Artery (RCA) 4a.  Superior Vena Cava (SVC) 4b.  Inferior Vena Cava (IVC) Coronary stenosis can be caused by atheroma or thrombus. Atheromas can be caused by:   •  bad nutrition   •  smoking   •  illness Thrombus can be caused by:   •  atrial fibrillation   •  heart valve replacement   •  heart attack Step 1:  Sinus node Step 2:  Atrial myocardium Step 3:  Atrioventricular (AV) Node Step 4:  HIS Bundle Step 5:  Tawara Bundle Branch Step 6:  Purkinje Fibres Step 7:  Ventricular myocardium   1.  Patient Data Registration   2.  Patient Positioning   3.  Sterilization of the Puncture Site   4.  Electrode Fixation   5.  Adjustment and Balancing of the Pressure Membrane   6.  Catheter Introduction and Positioning   7.  Oxygen Measurement (Offline)   8.  Pressure Management   9.  LV Angiogram 10.  Catheter Re-positioning 11.  Coronary Angiograms 12.  Image Review, Archiving, and Reporting   1.  Patient Data Registration   2.  Patient Positioning   3.  Sterilization of the Puncture Site   4.  Electrode Fixation   5.  Adjustment and Balancing of the Pressure Membrane   6.  Catheter Introduction and Positioning   7.  Coronary Angiogram   8.  Quantitative Coronary Analysis (QCA)   9.  Percutaneous Transluminal Coronary Angioplasty (PTCA) 10.  Stenting (or different therapeutic means) 11.  Image Review, Archiving, and Reporting To prepare the pressure measurement system a special device which transforms a pressure wave into electrical signals has to be positioned to a certain level and balanced, i.e. normalized to atmospheric pressure. There are different ways to access the coronary system. The earliest one used was the Sones Technique.   A second, only seldom used, and dangerous method if not done properly, is the transseptal access.   Most common method used today. The groin provides an access site with larger vessels for higher flow rates during contrast media injection.   A.  Skin puncture until blood flow is obtained through needle. B.  Threading of a guidewire into the vessel. C.  Removal of the needle. D.  Tracking of arterial sheath. E.  Tracking of internal dilator. F.  Removal of guidewire and dilator. Catheters used with the Judkins Technique are all pre-shaped for easy access of the right or left coronary ostium. Here are additional examples of diagnostic coronary catheters. Oxygen measurements are done during the procedure to determine a shunt and to check the cardiac output The consequence of a shunt may be overload of the ventricular muscle or undernourishment of the body.   Systolic Diastolic Mean Ao (mmHg) 100 - 140 60 - 90 70 - 105 PA (mmHg) 15 - 30 4 - 12 9 - 18 LV (mmHg) 100 - 140 0 - 4 8 - 13 RV (mmHg) 20 - 30 0 - 4 8 - 12   Mean A-wave V-wave LV (mmHg) 5 - 13 3 - 15 3 - 15 RA (mmHg) 2 - 8 2 - 10 2 - 10 CO (I/min) 5 - 8   CI (I/min • m2) 2.6 - 4.2 Mitral Valve Opening 4 - 5 cm2 Gradients equate pressure differences at both sides of a valve. For example, in systole maximum pressure of the Left Ventricle (LV) and the Aorta are the same. Due to malformation of the Aortic Valve, the pressure in the LV may be higher than in the Aorta. The Aortic Valve shows a gradient. Comparison of Pressure and No Pressure gradients The left ventricle is seen almost in its full length which is important for the Typical Area Length Analysis method. The orthogonal view fits biplane analysis best. Positioning is of key importance so that the spine does not overlie vessels. Here are the orthogonal views for the RCA. Reasons for Investigation   •  Congenital heart defects Investigated Objects   •  Septal defects - ASD/VSD   •  Valves - Stenosis, insufficiency   •  Big arteries - Transposition   •  Lung vessels - Stenosis Patient Registration   •  Via HIS/RIS   •  Retrieve from Cathcor   •  Via Sensis   •  Manual Registration Patient Positioning   •  Isocentrically   •  Manually   •  Via Preprogrammed Positions