Problems and complications with the use of side-hole cardiac catheters

Abstract

W hen Forssman catheterized himself in 1928,’ he used a “well greased” urethral catheter. Since then, in order to improve the facility and safety of intravascular catheterization, a variety of catheters of different designs have been fabricated. One such modification was the incorporation of holes in the side of the catheter near its tip. The purpose of such side-hole catheters is to: (1) permit sampling or adequate recording of pressure when the tip is against the wall of a vessel or chamber, and (2) permit rapid and wide dispersion of contrast medium and minimize catheter recoil during the injection of contrast medium. Although the side holes usually serve these intended purposes, they may cause several problems and complications. Some of these problems and the suggested methods for obviating them will be presented in this report. Artifacts in pressure tracings. Although the side holes near the tip of the catheter prevent complete damping of the pressure tracing when the end hole becomes obstructed, they may result in erroneous pressure tracings under certain circumstances. When a catheter is advanced or withdrawn slowly across a cardiac valve or septum, a point can be reached at which some of the lateral pressure holes are exposed to pressures in one chamber while other side holes or the end hole are exposed to pressures in the adjacent chamber. Under these circumstances the pressure recorded by the manometer will be an artifactual average pressure somewhere between the actual pressures in the two chambers. A left atria1 pressure recorded at the time of transseptal catheterization might be considerably reduced by this technique if some of the lateral taps are still in the right atrium, or the recorded left ventricular systolic pressure might be incorrectly low in a patient with aortic stenosis if the openings of the transseptal catheter are simultaneously sensing pres-