Chapter

Invasive investigation

Roy S. Gardner

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0024

Series: Oxford Textbooks

Invasive investigation

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Despite advances in noninvasive imaging, there are frequent occasions when invasive investigation is required. This chapter aims to summarize these techniques and demonstrate how both right and left heart catheterization can offer valuable information about the patient. The technique for human cardiac catheterization was first developed by Werner Forssmann. In 1929, he inserted a cannula into his own antecubital vein, through which he passed a catheter for 65 cm and then walked to the X-ray department, where a photograph was taken of the catheter lying in his right atrium. The Seldinger technique is now used to place catheters in a variety of locations including veins, arteries, or body cavities such as pleural or pericardial spaces. Obtaining central venous access is a key skill in the management of an ill patient, allowing invasive pressure monitoring, infusion of therapy, and access for procedures such as temporary pacing, pulmonary artery catheterization, and endomyocardial biopsy. The three routes commonly employed are the internal jugular vein, thesubclavian vein, and the femoral vein. Complications include bleeding, inadvertentarterial puncture, vascular damage including late vesselstenosis, pneumothorax (particularly with subclavian access),infection (especially femoral vein access), arrhythmia, and airembolism.The pulmonary artery flotation catheter (PAC) can be used to measure pressures in the right heart (right atrium, right ventricle, pulmonary artery and pulmonary capillary wedge pressure), cardiac output (usingthermodilution), and to assess pulmonary and systemic vascular resistance. It can also be used to detect intracardiac shunts (e.g. VSDs), as well as measure mixed venous oxygen saturation. Left heart catheterization can also be used in the measurement of left ventricular end-diastolic pressure.

Coronaryangiography(which can help to clarify underlying aetiology and offer useful prognostic information), Contrast left ventriculography (which can provide important information regarding global and regional cardiac function and mitral regurgitation),endomyocardial biopsies (which are commonly taken after heart transplantation to assess allograft rejection) and other invasive investigations are also described.

Chapter.  8123 words.  Illustrated.

Subjects: Cardiovascular Medicine

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