Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Cardiac catheterization techniques: Normal hemodynamics

INTRODUCTION

Hemodynamic data have always been, and remain, an integral part of all cardiovascular observations. Significant advances in both surgical and nonsurgical techniques for heart disease have been established in the last decade, in large part due to innovations both within and outside the cardiac catheterization laboratory. Many difficult forms of heart disease can now be readily confirmed with the improvement in two-dimensional and Doppler echocardiographic techniques. However, given the nature of clinical testing, there will always be suboptimal noninvasive examinations or patients in whom such testing cannot be performed. Thus, the catheterization laboratory remains critical to accurate measurements and the establishment of diagnoses. The presence of coexisting hemodynamic abnormalities in patients with coronary artery disease, myocardial infarction, or peripheral vascular disease cannot be established without direct information.

VASCULAR ACCESS AND SPECIAL CATHETERIZATION TECHNIQUES FOR OBTAINING HEMODYNAMIC DATA

Routine catheter access is obtained from the femoral artery and vein in most situations. The radial artery (and when needed, brachial vein) approach has gained acceptance and demonstrated reduced bleeding complications relative to femoral artery access. Many laboratories now use radial access as the default approach for routine cardiac cath.

In addition to standard arterial and venous vascular access, there are a variety of special access techniques that may be required for optimal hemodynamic assessment (table 1) [1-3].

Transseptal access to the left atrium or ventricle is most often employed when prosthetic valves are located either in the aortic or mitral positions. Direct left atrial pressure measurement via the transseptal approach is also highly desirable, if not critical, to accurate decision making in conditions such as mitral stenosis, in which the pulmonary capillary wedge pressure is unreliable as a surrogate for the left atrial pressure. Under fluoroscopic guidance the transseptal access is obtained using a Brockenbrough catheter that is passed through the atrial septum over a needle that is used to puncture the septum at the fossa ovalis. This technique is commonly used for accurate assessment of mitral valve disease and as access for mitral balloon valvuloplasty.

Direct left ventricular puncture through the left ventricular apex via the fifth intercostal space using echo-guided needle positioning is rarely used, but needed in patients with both aortic and mitral prosthetic valves. This technique is rarely used and carries significant excess risk.

                  

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2014. | This topic last updated: Nov 3, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Cardiac Catheterization and Angiography, 3rd ed, Grossman, W (Ed) (Eds), Lea & Febiger, Philadelphia 1986.
  2. Diagnostic and Therapeutic Cardiac Catheterization, Pepine, CJ (Ed) (Eds), Williams & Wilkins, Baltimore 1989.
  3. Kern MJ, Feldman T, Bitar S. Hemodynamic Data. In: The Cardiac Catheterization Handbook, 5th ed, Kern MJ. (Ed), Mosby-Year Book, St. Louis 2011. p.126.
  4. Morgan BC, Abel FL, Mullins GL, Guntheroth WG. Flow patterns in cavae, pulmonary artery, pulmonary vein, and aorta in intact dogs. Am J Physiol 1966; 210:903.
  5. BRECHER GA, HUBAY CA. Pulmonary blood flow and venous return during spontaneous respiration. Circ Res 1955; 3:210.
  6. Willems, J, Roelandt, J, Kesteloot, H. The jugular venous pulse tracing. Proc Vth European Cong Cardiol Sept 1968. p.433.
  7. Tavel ME. Normal sounds and pulses: Relationships and intervals between the various events. In: Clinical Phonocardiography and External Pulse Recording, 2nd, Year Book Medical Publishers, Chicago 1972. p.35.
  8. Kern MJ. Avoiding pitfalls in hemodynamic diagnosis. In: ACC Current Journal Review, Knoebel SB (Ed) (Ed), 1997.
  9. Lorell BH, Paulus WJ, Grossman W, et al. Improved diastolic function and systolic performance in hypertrophic cardiomyopathy after nifedipine. N Engl J Med 1980; 303:801.
  10. Hayward CS, Kelly RP. Gender-related differences in the central arterial pressure waveform. J Am Coll Cardiol 1997; 30:1863.
  11. Smulyan H, Marchais SJ, Pannier B, et al. Influence of body height on pulsatile arterial hemodynamic data. J Am Coll Cardiol 1998; 31:1103.
  12. Kannam JP, Levy D, Larson M, Wilson PW. Short stature and risk for mortality and cardiovascular disease events. The Framingham Heart Study. Circulation 1994; 90:2241.
  13. Parker JO, Ledwich JR, West RO, Case RB. Reversible cardiac failure during angina pectrois: hemodynamic effects of atrial pacing in coronary artery disease. Circulation 1969; 39:745.
  14. Kern MJ. Hemodynamic Rounds: Interpretation of Cardiac Pathophysiology from Pressure Waveform Analysis, Wiley-Liss, New York 1993. p.41.
  15. Hemodynamic Rounds: Interpretation of Pathophysiology from Pressure Waveform Analysis, 3rd ed, Kern MJ, Goldstein J, Lim M (Eds), Wiley-Liss, New York 2010.