Title
Copyright
Dedication
Contributors
Preface
Acknowledgments
Contents
Online Cases
Section I General Principles
1. Cardiac Catheterization History and Current Practice Standards
2. Cineangiographic Imaging, Radiation Safety, and Contrast Agents
3. Integrated Imaging Modalities in the Cardiac Catheterization Lab
4. Complications
5. Adjunctive Pharmacology for Cardiac Catheterization
Section II Basic Techniques
06. Percutaneous Transfemoral, Transseptal, Transcaval, and Apical Approach
7. Radial Artery Approach
8. Cutdown Approach: Brachial, Femoral, Axillary, Aortic, and Transapical
9. Diagnostic Catheterization in Childhood and Adult Congenital Heart Disease
Section III Hemodynamic Principles
10. Pressure Measurement
11. Blood Flow Measurement: Cardiac Output and Vascular Resistance
12. Shunt Detection and Quantification
13. Calculation of Stenotic Valve Orifice Area
14. Pitfalls in the Evaluation of Hemodynamic Data
Section IV Angiographic Techniques
15. Coronary Angiography
16. Coronary Artery Anomalies
17. Cardiac Ventriculography
18. Pulmonary Angiography
19. Angiography of the Aorta and Peripheral Arteries
Section V Evaluation of Cardiac Function
20. Stress Testing During Cardiac Catheterization: Exercise, Pacing, and Dobutamine Challenge
21. Measurement of Ventricular Volumes, Ejection Fraction, Mass, Wall Stress, and Regional Wall Motion
22. Evaluation of Systolic and Diastolic Function of the Ventricles and Myocardium
23. Evaluation of Tamponade, Constrictive, and Restrictive Physiology
Section VI Special Catheter Techniques
24. Evaluation of Myocardial and Coronary Blood Flow and Metabolism
25. Intravascular Imaging Techniques
Intravascular Ultrasound
Imaging Systems
FIGURE 25.1 Common IVUS image artifacts. Air bubblescan cause a highechoic noise around the imaging catheter with image deterioration. Ring--downartifacts seen as a series of bright rings around the mechanical IVUScatheter (arrow) can also be caused by air bubbles, which need to be flushedout. Nonuniform rotational distortion (NURD)results in a wedge- shaped,smeared appearance in one or more segments of the image (between 9 and 4o’clock in this example). White capartifacts caused by side- lobe echoes(arrows) originate from a strong reflecting surface, such as metal stent struts orcalcification. Smearing of the strut image can lead to the mistaken impressionthat the struts are protruding into the lumen. Radiofrequency noise(arrows)appears as alternating radial spokes or random white dots in the far- field. Theinterference is usually caused by other electrical equipment in the cardiaccatheterization laboratory. IVUS, intravascular ultrasound.
Image Acquisition Procedures
Image Interpretation
FIGURE 25.2 Cross- sectional format of a typical IVUS image. The bright- dark--bright, 3- layered appearance is seen in the image with corresponding anatomyas defined. “IVUS” represents the imaging catheter in the blood vessel lumen.Histologic correlations with intima, media, and adventitia are shown. The mediahas lower ultrasound reflectance owing to less collagen and elastin ascompared with the neighboring layers. Because the intimal layer reflectsultrasound more strongly than does the media, there is a spillover in the image,which results in a slight overestimation of the thickness of the intima and acorresponding underestimation of the medial thickness. IVUS, intravascularultrasound.
26. Endomyocardial Biopsy
Historical Perspective
FIGURE 26.1 Stanford (Caves- Schulz) bioptome. The surgical clamp drives acontrol wire to which it is connected via 2 adjustable nuts, thereby controlling theposition of the single mobile jaw at the distal end of the catheter.
FIGURE 26.2 The Kawai flexible endomyocardial biopsy catheter.
Modern Bioptomes
FIGURE 26.3 Flexible bioptome.
Vascular Access for Endomyocardial Biopsy
Table 26.1Equipment for Endomyocardial Biopsy
Internal Jugular Access
FIGURE 26.4 Regional anatomy for internal jugular puncture. With the patient’shead rotated to the left, the sternal notch and clavicle, as well as the sternal andclavicular heads of the sternocleidomastoid muscle, are identified. A skin nick ismade between the 2 heads of this muscle, and 2 fingerbreadths above the top ofthe clavicle (near the top of the anterior triangle). The needle is inserted at anangle of 30°- 40° from vertical, at 20°- 30° right of sagittal, aiming the needle awayfrom the more medially located carotid artery.
FIGURE 26.5 Two- dimensional echo of the carotid artery and the right internaljugular vein (RIJ) at rest (A)and during Valsalva maneuver (B), showing themarked enlargement in jugular venous caliber with increased distendingpressure.
FIGURE 26.6 Micropuncture apparatus: 21- gauge micropuncture needle,0.018- inch guidewire, 5F guided sheath, and obturator.
Right Subclavian Vein Access
Femoral Vein and Femoral Artery Access
Biopsy Methods
Right Internal Jugular Venous Approach—PreshapedBioptome
FIGURE 26.7 Cineangiographic frames obtained during right ventricularendomyocardial biopsy using the Stanford bioptome. From leftto right,the toprow shows A.the bioptome in the right atrium and B.then in the right ventricleafter crossing the tricuspid valve. In the bottom row, C.the jaws are open andD.the jaws are closed and the bioptome is withdrawn from the septum with thesample contained.
FIGURE 26.8 Postmortem specimen shows heavy trabeculation of the interiorsurface of the right ventricle and the thinness of the right ventricular free wall.
Right Internal Jugular—Preformed Sheath
Left Internal Jugular Vein Approach—Flexible Sheath
Femoral Vein Approach—Preformed Sheath
Left Ventricular Biopsy—Femoral Artery PreformedSheath
Left Ventricular Biopsy—Femoral Artery GuidingCatheter Approach
Left Ventricular Biopsy— Radial Artery SheathlessApproach
Biopsy Complications
Perforation
Malignant Ventricular Arrhythmias
Supraventricular Arrhythmias
Heart Block
Pneumothorax
Puncture of the Carotid Artery or Subclavian Artery
Pulmonary Embolization
Nerve Paresis
Venous Hematoma
Arterial Venous Fistula
Postprocedure Care
Tissue Processing
Table 26.2Myocardial Biopsy Processing
Table 26.3Myocardial Biopsy Indications and Findings
Biopsy in Myocardial Disease
Transplant Rejection
Table 26.4International Society for Heart and Lung TransplantationStandardized Cardiac Biopsy Grading
27. Percutaneous Mechanical Circulatory Support: Impella, Intra-aortic Balloon Counterpulsation, TandemHeart, Extracorporeal Bypass, and Right Ventricular Support Devices
Section VII Interventional Techniques
28. Percutaneous Balloon Angioplasty and General Coronary Intervention
29. Atherectomy, Thrombectomy, and Distal Protection Devices
30. Intervention for Acute Myocardial Infarction
31. Coronary Stenting
32. Peripheral Intervention
33. General Overview of Interventions for Structural Heart Disease
34. Nonvalvular Interventions: Left Atrial Appendage Closure and Alcohol Septal Ablation
35. Percutaneous Therapies for Aortic and Pulmonary Valvular Heart Disease
36. Percutaneous Therapies for Mitral and Tricuspid Valve Disease
37. Intervention for Pediatric and Adult Congenital Heart Disease
38. Cardiac Cell-Based Therapy: Methods of Application and Delivery Systems
39. Endovascular Aortic Repair
40. Pericardial Interventions: Pericardiocentesis, Balloon Pericardiotomy, and Epicardial Approach to Cardiac Procedures
41. Interventions for Cardiac Arrhythmias
Section VIII Clinical Profiles
42. Profiles in Valvular Heart Disease
43. Profiles in Coronary Artery Disease
44. Profiles in Pulmonary Hypertension and Pulmonary Embolism
45. Profiles in Cardiomyopathy and Heart Failure
46. Profiles in Pericardial Disease
47. Profiles in Congenital Heart Disease
48. Profiles in Peripheral Arterial Disease
Index