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CARDIAC CATHETERIZATIONS Cao Việt Tùng MD National Hospital of Pediatrics Part I Basic concept Indications Diagnostic Intervention Which Catheter should be used ? • End hole catheter- to measure wedged pressures and to precisely localized gradients • Side hole catheters - for angiography prevent clot/tissue obstruction during pressure measurement Type of catheter Size of catheter Patient weight 2-4 kg 3-10 kg 8-20 kg 15-20 kg 30-60 kg 50-90 kg Catheter size (PG) 4F 4F 5F 6F 7F 8F HOW MUCH CONTRAST Chamber/ vessel Normal size (cc/kg) Increase volume, normal flow (cc/kg) Marked increase Volume & flow Aorta LV LA PA RV RA 1.0 1.2 1.0 1.0 1.2 1.0 1.5 2.0 1.5 1.2 2.0 1.5 1.8 2.5 2.0 1.5 2.5 2.0 Part II Hemodynamic Normal pressure & Saturation PV SVC 75 75% 98-99% 98-99% RA m=3mmHg RV: 25/3 mmHg 75% 75% LA: Mean=8 mmHg 98% LV: 100/ mmHg 75% 98% PA: 25/10 (15)mmHg Ao: 100/ 60 (75)mmHg PRESSURE – VOLUME LOOP LV • Early diastolic pressure (EDP) should be at or near zero • Longer , flatter plateau phase at maximum systolic pressure LV • EDP can be as high as 10-12mmHg in children • Increased EDP: – Heart failure – Restrictive pericardial – Myocardial disease – Large left to right shunt INTRACARDIAC SHUNT • An increase saturation in between different sites in right heart suggest presence and magnitude of left to right shunt • Decrease saturation in between different sites in left heart suggest presence and magnitude of right to left shunt • A step up of less than 6% at atrial level, 4% at ventricular level and 4% at great vessel level – can be consider as normal RA • Step up of more than 9% is highly suggestive of Left to right shunt: – ASD with or without mitral valve disease – Left ventricular to right atrial shunt – VSD defect with TR – Coronary AV fistula – Ruptured sinus valsava into RA RV • Step up of more than 6% suggest of left to right shunt – Low ASD level – VSD defect – Coronary AV fistula – Ruptured sinus valsava into RV PA • Step up of more than 6% at Pulmonary suggest of left to right shunt: – High VSD – PDA – AP window – Anomalous origin of CA to PA RIGHT TO LEFT SHUNT • Suspicious if   the aortic saturation is 20%? – Acute reduction of the mean PAP of > 10 mm Hg with a resultant mean PAP of 40mmHg or less without a fall in cardiac output is considered a positive vasoreactivity response