Cardiac Catheterization Procedures Research Articles

Medical staff dose estimation during pediatric cardiac interventional procedures.

The purpose of this study is to evaluate the occupational doses (eye lens, extremities and whole body) in paediatric cardiac interventional and diagnostic catheterization procedures performed in a paediatric reference hospital located in Recife, Pernambuco. For eye lens dosimetry, the results show that the left eye receives a higher dose than the right eye, and there is a small difference between the doses received during diagnostic (D) and therapeutic (T) procedures. The extrapolated annual values for the most exposed eye are close to the annual limit. For doses to the hands, it was observed that in a significant number of procedures (37 out of 45 therapeutic procedures, or 82%) at least one hand of the physician was exposed to the primary beam. During diagnostic procedures, the physician's hand was in the radiation field in 11 of the 17 catheterization procedures (65%). This resulted in a 10-fold increase in dose to the hands. The results underscore the need for optimization of radiation safety and continued efforts to engage staff in a radiation safety culture.&#xD.

OR12-2 | In-Practice Measurement of Radiation Exposure and Protection for (assumed) Pregnant Cardiologists Performing Cardiac Catheterization and Electrophysiology Procedures

OR12-2 | In-Practice Measurement of Radiation Exposure and Protection for (assumed) Pregnant Cardiologists Performing Cardiac Catheterization and Electrophysiology Procedures

Correlation between pressure gradient from echocardiography and peak-to-peak pressure gradient from cardiac catheterization or surgery in patients with coarctation of aorta.

The gold standard for assessing pressure gradients (PG) across coarctation involves measurements obtained through cardiac catheterization or surgical intervention. There has been ongoing discussion regarding the accuracy of non-invasive methods for estimating these gradients. This study sought to establish the correlation and agreement between the systolic blood pressure (SBP) gradient between the upper and lower extremities, as well as, the mean and maximum PG derived from echocardiography, in comparison to the peak-to-peak pressure gradient obtained from either cardiac catheterization or surgery. We conducted a retrospective study on patients < 18 years diagnosed with coarctation at Chiang Mai University Hospital from 2011 to 2022. The study involved the measurement of the SBP gradient between the upper and lower extremities, mean and maximum PG using echocardiography, peak-to-peak pressure gradient obtained from cardiac catheterization, and pressure gradient recorded during surgical procedures. The Spearman's correlation and Bland-Altman analysis were employed to assess correlation and agreement. Fifty-four patients with aortic coarctation were enrolled. The mean PG measured by echocardiography showed a significantly moderate correlation (r = 0.78, p < 0.001) and the highest level of agreement according to Bland Altman plots, in comparison to the peak-to-peak pressure gradient measured during both cardiac catheterization and surgical procedure. The max PG demonstrated a notable overestimation compared to the gold standard (mean difference + 13.14 with a slope of biases + 0.64, p < 0.001). The mean PG obtained through echocardiography has more potential to be applied in practical application in predicting pressure gradient in patients with coarctation.

Evaluation of Practices about Pediatrics Cardiac Catheterization among Nurses at District Head Quarter Hospital

Pediatric cardiac catheterization is a critical procedure that plays a vital role in diagnosing and treating congenital heart defects and other cardiac conditions in children. This procedure involves inserting a catheter into the heart chambers or vessels through a vein or artery. Nurses play multifaceted roles throughout the continuum of cardiac catheterization. Objective: To evaluate the practices of nurses about pediatrics cardiac catheterization. Methods: This study employed cross-sectional descriptive design at pediatric department of a District Head Quarter (DHQ) Hospital. Target population was registered nurses of age above 20 years and who had at least 6 months of practical experience with cardiac pediatric patients. Data were collected conveniently through observational checklist and analysis was done through SPSS Version 24.0. Results: Majority nurses were not encouraging bed rest to the pediatric patients nor keep affected extremity bend for 2-4 hours (80%) after catheterization. Moreover, they did not regularly check the vitals of the children and unable to monitor in every 15 minutes /hour or 30 minutes for next hour (81%). Nurses were unable to educate the pediatric parents for the removal of pressure dressing and nor assess the dressing site appropriately (92%). Conclusions: The present study findings suggested that majority nurses have poor practices before and after cardiac catheterization procedure while some have an average level of practices during the procedure. So, training programs should be arranged to enhance the practices of nurses about cardiac catheterization in pediatric population.

Exploring the correlation between radial artery access and decreased occurrence of contrast-induced nephropathy.

Objective: To Investigate the Impact of Radial Artery Access on Contrast-Induced Nephropathy (CIN) Incidence. Study Design: Retrospective study. Setting: Department of Cardiology, Hayatabad Medical Complex in Peshawar. Period: January 2021 to June 2022. Material &amp; Methods: Patients aged ≥ 30 who have undergone cardiac catheterization procedures, with a focus on those who have undergone the procedure using radial artery access. Those patients who had pre-existing renal impairments or kidney diseases, with a history of contrast allergies, were included in the study. However, those patients who were under the age of &lt; 30, had undergone cardiac catheterization procedures using femoral artery access, and with incomplete medical records were excluded. All the data were analyzed in SPSS version 26. Results: In our study involving 164 participants. Individuals who experienced CIN exhibited a considerably greater average age of 69.89 years when contrasted with the 66.86 years of those in the non-CIN category (p=0.03). Furthermore, a higher percentage of patients in the CIN group were aged 65 or older (35.1% vs. 11%, p&lt;0.001), highlighting the increased vulnerability of older individuals to CIN. The timing of reperfusion therapy, indicated by the time-to-reperfusion, was significantly longer in the CIN group (6.2 ± 3.3 hours) compared to the non-CIN group (4.9 ± 3.7 hours, p=0.001), suggesting that delayed reperfusion may be a risk factor for CIN. Conclusion: Patients with anterior infarction, delayed reperfusion, lower left ventricular ejection fraction (LVEF), and higher serum creatinine levels were also more likely to develop CIN.

Hematological and Cytogenetic Effects of X-rays in Cardiac Unit Workers and Catheterization Patients.

Introduction X-rays are widely used in medicine for diagnosis and treatment. Such beneficial uses may cause potentially hazardous situations for patients andworkers in the cardiac catheterization laboratory. The present study aims to estimate the radiation dose scattered in different parts of the catheterization units and doses absorbed by workers in thisunit, and patients who underwent cardiac catheterization procedures to evaluate all changes in hematological parameters and damaged cells (the cells that contain a number of chromosomal aberrations) after exposure to radiation at Azadi Teaching Hospital in the Duhok City of Iraq. Methodology Thestudy was conducted in one year and involved 19 male workers chronically exposed to X-ray machines in the cardiac catheterization laboratory, and 45 patients, 20 males and 25 females, who have been exposed to lower doses of X-ray during the cardiac catheterization process. There were 32 healthy individuals, 19 males and 13 females, as a control. Scattered radiation was calculated using an area monitoring detector.Optically Stimulated Luminescence (OSL) dosimeter andFlat Panel Detector (FPD)were used to calculate absorbed doses by workers and patients, respectively. Twelve hematological parameters before and after radiation were examined between study groups; the cytogenetic effects, damagedcells, and chromosomal aberrations of the white blood cells of workers, patientsin the catheterization unit, and individuals of the control group were analyzed. Results The results showed that the scattered X-rays in the catheterization unit after one year of continuous detection did not change significantly compared to the data before the start of the trial. The results of all blood parameters looked to be significantly different (p<0.05) compared to the controls but within the normal range.There is no significant difference (p>0.05) in corpuscular hemoglobin, white blood cells, red distribution width, and neutrophilvalues for workers after one year of exposure as compared with the control. Also, there was no significant difference (p>0.05) in white blood cells, neutrophils, and monocyte values for patients after the operation. The current study showed the damaged cells in workerswere significantlydifferent compared to the control. At the same time, the differences were non-significant for all workers (p=0.0962) after one year of exposure.The differences in damaged cells in patients were highly significant after the operation (p=0.0003). The present study demonstrated that the inductions of dicentrics, acentric, chromosome break, and ring chromosomes in human lymphocytes were intimately related to the irradiation dose. Conclusions The presentstudy found that the scattered X-rays in the catheterization unit after the end of the experiment did not change significantly. The current study also revealed that the exposure to X-rays had no significant effects on the blood indicators of workers and patients in the catheterization unit, whereas the damaged cells in patients did not change significantly compared with the control group at the beginning of the experiment.In patients, these cells were increased after the operation but were present at a high level in the workers, as compared with controls.The damaged cells in workers remained constant from the beginning of the experiment till the end.Finally, patients had increased damaged cells after the end of the trial period compared to workers.

Utility of simultaneous triple balloon inflation technique through a single 6-French sheath in treating pulmonary vein stenosis.

Pulmonary vein stenosis continues to pose significant challenges in children, frequently requiring repeated cardiac catheterisation procedures. This report describes a successful application of a "triple kissing balloon" technique to treat complex pulmonary vein stenosis in two patients, all accomplished with the use of a single 6-French sheath.

Percutaneous Liver Biopsy Adverse Events in Stable Fontan Patients

Background:In patients who have undergone a Fontan operation, altered cardiac circulation can lead to several organ pathologies, including Fontan-associated liver disease. Transjugular liver biopsies are the standard for assessing liver disease in these patients, however data for a percutaneous approach in these patients is limited. Percutaneous liver biopsies are the preferred method in the general population. The objective of this study was to compare the rate of adverse events for percutaneous liver biopsies in Fontan patients to the general pediatric population.&#x0D; Methods:A retrospective chart review was conducted on percutaneous liver biopsy patients over a five-year period. For each patient, a 90-day period post-biopsy was investigated to look for any indications of adverse events (pain, hemorrhage) and related work-up (imaging, hospital admission), scoring the severity of these events based on SIR adverse event classification. Patients were stratified based on if they underwent a cardiac catheterization procedure immediately prior to biopsy or not.&#x0D; Results:A total of 412 biopsies were reviewed, 367 without cardiac catheterization and 45 with catheterization. Across the entire population, 38 adverse events were found, giving an overall adverse event rate of 9.2%. Comparing populations, non-catheterized patients were found to have an adverse event rate of 9.0%, with a minor rate of 7.2% and a major rate of 1.8%. The catheterized group had an adverse event rate of 11.1%, with a minor rate of 8.8% and a major rate of 2.3%. There were no lethal events. These rates align with reported literature.&#x0D; Conclusion and Potential Impact:There was no significant difference in adverse event rates between Fontan patients and the general population after a percutaneous liver biopsy. This information can guide clinical decisions, as these biopsies are cheaper, less invasive, and do not expose patients to ionizing radiation.

A case of persistent left superior vena cava: an anatomical rarity with clinical implications

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly characterised by the presence of a persistent left-sided SVC in addition to the normal right-sided SVC. This case report presents a unique instance of PLSVC in a 13-year-old male patient who was incidentally diagnosed during routine cardiac imaging for an unrelated condition. The diagnostic journey, including imaging modalities such as echocardiography and computed tomography, revealed the presence of this anatomical variation. Despite being asymptomatic, the case highlights the importance of recognising PLSVC, as it can have clinical implications in various medical and surgical scenarios, particularly in cardiac catheterization, pacemaker implantation, and central venous access procedures. This report discusses the clinical significance, diagnostic challenges, and management considerations associated with PLSVC, emphasising the need for increased awareness among healthcare professionals to ensure safe and effective patient care.

Electrocardiographic deep learning for predicting post-procedural mortality: a model development and validation study

Preoperative risk assessments used in clinical practice are insufficient in their ability to identify risk for postoperative mortality. Deep-learning analysis of electrocardiography can identify hidden risk markers that can help to prognosticate postoperative mortality. We aimed to develop a prognostic model that accurately predicts postoperative mortality in patients undergoing medical procedures and who had received preoperative electrocardiographic diagnostic testing. In a derivation cohort of preoperative patients with available electrocardiograms (ECGs) from Cedars-Sinai Medical Center (Los Angeles, CA, USA) between Jan 1, 2015 and Dec 31, 2019, a deep-learning algorithm was developed to leverage waveform signals to discriminate postoperative mortality. We randomly split patients (8:1:1) into subsets for training, internal validation, and final algorithm test analyses. Model performance was assessed using area under the receiver operating characteristic curve (AUC) values in the hold-out test dataset and in two external hospital cohorts and compared with the established Revised Cardiac Risk Index (RCRI) score. The primary outcome was post-procedural mortality across three health-care systems. 45 969 patients had a complete ECG waveform image available for at least one 12-lead ECG performed within the 30 days before the procedure date (59 975 inpatient procedures and 112 794 ECGs): 36 839 patients in the training dataset, 4549 in the internal validation dataset, and 4581 in the internal test dataset. In the held-out internal test cohort, the algorithm discriminates mortality with an AUC value of 0·83 (95% CI 0·79-0·87), surpassing the discrimination of the RCRI score with an AUC of 0·67 (0·61-0·72). The algorithm similarly discriminated risk for mortality in two independent US health-care systems, with AUCs of 0·79 (0·75-0·83) and 0·75 (0·74-0·76), respectively. Patients determined to be high risk by the deep-learning model had an unadjusted odds ratio (OR) of 8·83 (5·57-13·20) for postoperative mortality compared with an unadjusted OR of 2·08 (0·77-3·50) for postoperative mortality for RCRI scores of more than 2. The deep-learning algorithm performed similarly for patients undergoing cardiac surgery (AUC 0·85 [0·77-0·92]), non-cardiac surgery (AUC 0·83 [0·79-0·88]), and catheterisation or endoscopy suite procedures (AUC 0·76 [0·72-0·81]). A deep-learning algorithm interpreting preoperative ECGs can improve discrimination of postoperative mortality. The deep-learning algorithm worked equally well for risk stratification of cardiac surgeries, non-cardiac surgeries, and catheterisation laboratory procedures, and was validated in three independent health-care systems. This algorithm can provide additional information to clinicians making the decision to perform medical procedures and stratify the risk of future complications. National Heart, Lung, and Blood Institute.

Cardiac Catheterization in Port Harcourt: Initial Two Years’ Experience

Introduction: Cardiac catheterization for diagnostic and therapeutic purposes is now routinely done at the Save a Life Port Harcourt, since last two years. Also included are cardiac devices which include pacemakers, Implantable Cardiac Defibrillators and Cardiac Resynchronization Therapy. In this retrospective study, we review our initial two years’ experience of Cardiac Catheterization at the Save a Life Mission Hospital, Port Harcourt. Methods: This is a retrospective study over a period of two years, form 1st February, 2021 to 31st March, 2023. A total of 216 consecutive diagnostic and therapeutic cardiac catheterization including cardiac devices performed in Save a life Mission Hospital between 1st February 2021 to 31st March 2023 were evaluated. Among them 88; (40.7%) were coronary angiogram, 41 (18.98%) percutaneous transluminal coronary angioplasty (PTCA) and stenting, 59(27.3%) permanent pacemaker insertion, 29 (13.4%) Implantable cardioverter defibrillators, 14 (6.5%) cardiac resynchronization therapy and 26 (12.1%) with peripheral angiography. Six patients were referred for coronary artery bypass surgery. Vascular complications [groin hematoma] occurred in two patients (0.9%). Conclusion: Both diagnostic and therapeutic cardiac catheterization procedures are safe with very low risk of complications even in its initial experience. The optimate goal of these procedures is to ensure the safety of the patients.

Abstract 12712: Safety of Latex Containing Swan-Ganz Catheters in Patients With Cutaneous Hypersensitivity to Latex

Introduction: Hypersensitivity to latex is common. Balloon-tipped right heart catheters are typically made from latex. Latex-free catheters while available have limitations including the need for large sized vascular sheaths. It is unknown if latex balloon catheters can be safely used in patients who have cutaneous reactions to latex. Goals: The goal of this study was to assess the safety of using latex-containing catheters for right heart catheterization (RHC) in patients with a prior history of cutaneous allergy to latex. Methods: Electronic medical records and cardiac catheterization procedure database identified 127 consecutive patients with a history of cutaneous hypersensitivity (rash, urticaria) to latex who underwent RHC with balloon-tipped catheters. Patients with known anaphylaxis to latex were excluded. The primary outcome was the occurrence of periprocedural hypersensitivity reactions. Outcomes of patients with latex-containing catheters (LC Group, n=99) were compared to patients with latex-free catheters (LF Group, n=28). Results: The study population consisted of 28 men and 99 women, aged 65 + 14 years. Indications for RHC were heart failure in 48 (38%), pulmonary hypertension in 25 (20%), cardiomyopathy in 19 (15%), valvular heart disease in 19 (15%), unexplained dyspnea in 13 (10%), and heart transplant in 2 (2%). LC and LF patients had comparable demographics, cardiac risk factors, and indications for RHC. In-body catheter exposure times in the LC and LF groups were 8.6 + 5.0 and 9.7 + 6.1 minutes, respectively (p=ns). Venous sheath sizes were smaller in the LC group; sheaths &lt; 5 Fr were used in 52/99 (53%) of the LC group vs. 0/28 in the LF group (p&lt;0.001). Antecubital vein access was used in 42/99 (42%) of the LC group but in none of the LF group (p&lt;0.001). There were no procedural hypersensitivity reactions in either the LC or LF groups. Repeat procedures were common; in total, 149 RHC were performed using latex catheters with no reactions. Conclusions: In patients with a history of non-anaphylactic cutaneous hypersensitivity to latex, the use of latex balloon-tipped catheters was not associated with allergic reactions. Latex catheters offer technical advantages including smaller sized vascular sheaths and more options for venous access.

Cardiac healthcare disparities and electrocardiography (ECG) differences in schizophrenia at end of life

Schizophrenia is associated with early mortality of 15 to 20 years, and 80 % of deaths are due to cardiovascular disease with a three-times greater risk of sudden-cardiac-death. While lifestyle, medications, genetics, and healthcare disparities are contributing factors, the etiology of this complex process is not fully understood. The aim of this study is to examine cardiac-related healthcare utilization and electrocardiogram (ECG) outcomes in schizophrenia at the end of life (EOL). A cohort of individuals with schizophrenia (SG) (n = 610, ≥50 years) were identified retrospectively from a unified clinical data platform and measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Similarly, a control group (n = 610) was randomly identified and matched by gender (53 % females) and age of death (72.8 ± 12.4 years). Statistical methods included Cochran-Mantel-Haenszel and mixed-effects logistic & linear regression tests with adjustments for match strata and marital status, race, age, and gender as covariates. Results indicate that SG was more likely to be unmarried, unemployed, or from minority groups (all p < 0.001), and more likely to have diabetes and/or cardiovascular disease (p < 0.001). SG was less likely to receive an ECG (p = 0.001) or cardiac catheterization procedure (p < 0.001). SG had a greater mean QTc (447.2 ms vs. 434.6 ms; p = 0.001) and were twice as likely to have “prolonged QT” on ECG report (p = 0.006). In conclusion, SG had reduced likelihood of cardiac-related healthcare interventions, and despite greater likelihood of prolonged QTc, a recognized biomarker of cardiac risk, ECG was less likely at EOL. Given greater cardiac comorbidity and risk of sudden cardiac death in schizophrenia, improved practice guidelines are needed.

Safety and care of no fasting prior to catheterization laboratory procedures: a non-inferiority randomized control trial protocol (SCOFF trial).

Cardiac catheterization procedures are typically performed with local anaesthetic and proceduralist guided sedation. Various fasting regimens are routinely implemented prior to these procedures, noting the absence of prospective evidence, aiming to reduce aspiration risk. However, there are additional risks from fasting including patient discomfort, intravascular volume depletion, stimulus for neuro-cardiogenic syncope, glycaemic outcomes, and unnecessary fasting for delayed/cancelled procedures. This is an investigator-initiated, multicentre, randomized trial with a prospective, open-label, blinded endpoint (PROBE) assessment based in New South Wales, Australia. Patients will be randomized 1:1 to fasting (6 h solid food and 2 h clear liquids) or to no fasting requirements. The primary outcome will be a composite of hypotension, hyperglycaemia, hypoglycaemia, and aspiration pneumonia. Secondary outcomes will include patient satisfaction, contrast-induced nephropathy, new intensive care admission, new non-invasive or invasive ventilation requirement post procedure, and 30-day mortality and readmission. This is a pragmatic and clinically relevant randomised trial designed to compare fasting verse no fasting prior to cardiac catheterisation procedures. Routine fasting may not reduce peri-procedural adverse events in this setting.

Design and Validation of a Soft Robotic Simulator for Transseptal Puncture Training.

Transseptal puncture (TP) is the technique used to access the left atrium of the heart from the right atrium during cardiac catheterization procedures. Through repetition, electrophysiologists and interventional cardiologists experienced in TP develop manual skills to navigate the transseptal catheter assembly to their target on the fossa ovalis (FO). Cardiology fellows and cardiologists that are new to TP currently train on patients to develop this skill, resulting in increased risk of complications. The goal of this work was to create low-risk training opportunities for new TP operators. We developed a Soft Active Transseptal Puncture Simulator (SATPS), designed to match the dynamics, static response, and visualization of the heart during TP. The SATPS includes three subsystems: (i) A soft robotic right atrium with pneumatic actuators mimics the dynamics of a beating heart. (ii) A fossa ovalis insert simulates cardiac tissue properties. (iii) A simulated intracardiac echocardiography environment provides live visual feedback. Subsystem performance was verified with benchtop tests. Face and content validity were evaluated by experienced clinicians. Subsystems accurately represented atrial volume displacement, tenting and puncture force, and FO deformation. Passive and active actuation states were deemed suitable for simulating different cardiac conditions. Participants rated the SATPS as realistic and useful for training cardiology fellows in TP. The SATPS can help improve catheterization skills of novice TP operators. The SATPS could provide novice TP operators the opportunity to improve their TP skills before operating on a patient for the first time, reducing the likelihood of complications.

Effects of aprepitant on post-operative nausea and vomiting in patients with congenital heart disease undergoing cardiac surgery or catheterization procedures: a retrospective study with subjects as their own historical control

IntroductionFor patients undergoing cardiac surgery and catheterization procedures, severe post-operative nausea and vomiting (PONV) can occur despite standard anti-emetic interventions. Aprepitant, a neurokinin-1 (NK-1) receptor blocker, is safe and effective at preventing PONV resistant to standard therapies.MethodsPatients with a history of severe PONV presenting for cardiac surgery or catheterization procedures from January 1, 2018 to January 6, 2021 were identified. After pharmacist approval, patients received aprepitant pre-operatively (Dose: 80 mg for weight &amp;gt;50 kg, 40 mg for weight 30–50 kg). A retrospective chart review was performed. Primary outcomes of the incidence of PONV and PONV-related complications were evaluated.ResultsSeventeen patients were included with a mean age of 16.0 years at the time of their initial procedure, which acted as the “control” procedure, and 17.5 years when they received aprepitant. After the control procedure 64.7% of patients required rescue anti-emetics. When this group of patients received aprepitant pre-operatively at their subsequent procedure, only 17.6% required rescue medication (p = 0.005). Similarly, 64.7% of patients suffered at least one PONV-related complication after the control procedure. With aprepitant use pre-operatively, 5.9% of the same patients experienced a PONV-complication (p = 0.0003). Specifically, unplanned ICU admission due to severe PONV after catheterization procedures decreased from 55.6% (5/9) in the control group to 0 after these patients were treated pre-emptively with aprepitant (p = 0.01). For surgical patients, there were significant decreases in PONV-related complications including delayed oral intake and delayed ambulation (p = 0.04) in the aprepitant group compared to the control group.DiscussionThis small, retrospective study supports the conclusion that preoperative aprepitant administration in patients undergoing cardiac catheterization or cardiac surgery with a history of congenital heart disease and severe PONV significantly reduces the incidence of PONV and PONV-related complications. Decreasing these complications will likely improve the surgical experience for patients and families while also decreasing hospital costs and improving efficiency.

Automatic image-based tracking of gadolinium-filled balloon wedge catheters for MRI-guided cardiac catheterization using deep learning.

Magnetic Resonance Imaging (MRI) is a promising alternative to standard x-ray fluoroscopy for the guidance of cardiac catheterization procedures as it enables soft tissue visualization, avoids ionizing radiation and provides improved hemodynamic data. MRI-guided cardiac catheterization procedures currently require frequent manual tracking of the imaging plane during navigation to follow the tip of a gadolinium-filled balloon wedge catheter, which unnecessarily prolongs and complicates the procedures. Therefore, real-time automatic image-based detection of the catheter balloon has the potential to improve catheter visualization and navigation through automatic slice tracking. In this study, an automatic, parameter-free, deep-learning-based post-processing pipeline was developed for real-time detection of the catheter balloon. A U-Net architecture with a ResNet-34 encoder was trained on semi-artificial images for the segmentation of the catheter balloon. Post-processing steps were implemented to guarantee a unique estimate of the catheter tip coordinates. This approach was evaluated retrospectively in 7 patients (6M and 1F, age = 7 ± 5 year) who underwent an MRI-guided right heart catheterization procedure with all images acquired in an orientation unseen during training. The overall accuracy, specificity and sensitivity of the proposed catheter tracking strategy over all 7 patients were 98.4 ± 2.0%, 99.9 ± 0.2% and 95.4 ± 5.5%, respectively. The computation time of the deep-learning-based segmentation step was ∼10 ms/image, indicating its compatibility with real-time constraints. Deep-learning-based catheter balloon tracking is feasible, accurate, parameter-free, and compatible with real-time conditions. Online integration of the technique and its evaluation in a larger patient cohort are now warranted to determine its benefit during MRI-guided cardiac catheterization.

Real-time automatic image-based slice tracking of gadolinium-filled balloon wedge catheter during MR-guided cardiac catheterization: A proof-of-concept study.

MR-guided cardiac catheterization procedures currently use passive tracking approaches to follow a gadolinium-filled catheter balloon during catheter navigation. This requires frequent manual tracking and repositioning of the imaging slice during navigation. In this study, a novel framework for automatic real-time catheter tracking during MR-guided cardiac catheterization is presented. The proposed framework includes two imaging modes (Calibration and Runtime). The sequence starts in Calibration mode, in which the 3D catheter coordinates are determined using a stack of 10-20 contiguous saturated slices combined with real-time image processing. The sequence then automatically switches to Runtime mode, where three contiguous slices (acquired with partial saturation), initially centered on the catheter balloon using the Calibration feedback, are acquired continuously. The 3D catheter balloon coordinates are estimated in real time from each Runtime slice stack using image processing. Each Runtime stack is repositioned to maintain the catheter balloon in the central slice based on the prior Runtime feedback. The sequence switches back to Calibration mode if the catheter is not detected. This framework was evaluated in a heart phantom and 3 patients undergoing MR-guided cardiac catheterization. Catheter detection accuracy and rate of catheter visibility were evaluated. The automatic detection accuracy for the catheter balloon during the Calibration/Runtime mode was 100%/95% in phantom and 100%/97 ± 3% in patients. During Runtime, the catheter was visible in 82% and 98 ± 2% of the real-time measurements in the phantom and patients, respectively. The proposed framework enabled real-time continuous automatic tracking of a gadolinium-filled catheter balloon during MR-guided cardiac catheterization.

Use of Prophylactic High-Dose Statin Therapy to Reduce Contrast-Induced Acute Kidney Injury in Adults Undergoing Acute Coronary Angiography: Evaluation of a Practice Change.

Development of contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity, mortality, hospital length of stay, and overall health care costs. The purpose of this project was to evaluate a clinical practice change-the addition of high-dose statin therapy to standard renal protection measures-in adults undergoing acute cardiac catheterization procedures and assessing its effect on CI-AKI. The evaluation was a pretest/posttest descriptive design. Adult patients undergoing acute cardiac catheterization procedures were evaluated for the rate of CI-AKI before (10 months preimplementation, N = 283) and after (10 months postimplementation, N = 286) a recent practice change that added high-dose statin therapy (within 24 hours of dye exposure) to a standard renal protection bundle (intravenous fluids, maximum dye calculations, and avoidance of nephrotoxic medications). Outcomes included the rate of CI-AKI, stage of acute kidney injury, need for new hemodialysis, discharge disposition (alive or died in the hospital), and hospital length of stay. Patients in the postintervention group that received renal protection bundle with high-dose statin had significantly lower incidence of CI-AKI (10.1% pre vs 3.2% post; P < .001). There were no significant differences in hospital length of stay, need for new hemodialysis, or mortality. Administration of high-dose statin within 24 hours of the cardiac catheterization procedure improved significantly (19.4% pre vs 74.1% post; P < .001). Adherence to all 5 components of the renal bundle improved post intervention (17% pre vs 73.4% post; P < .001). The addition of a high-dose statin in addition to existing renal protective measures in patients with acute cardiac procedures is associated with a decreased incidence of CI-AKI.

Safety of pediatric cardiac catheterisation procedures performed in rural India in a catheterisation lab setup for adult work.

Safety of pediatric cardiac catheterisation procedures performed in rural India in a catheterisation lab setup for adult work.