End Hole Research Articles

Percutaneous transfemoral right heart catheterization: The pulmonary wedge catheter

A simple catheter design is presented which allows obtaining the wedge position in the pulmonary lung field with a catheter passed from the femoral route. The catheter is made from very flexible polyethylene tubing in which a reverse curve is positioned 2.5 cm from its single, end hole tip. This catheter deserves trial by those physicians desiring to perform total right heart catheterization from the femoral route.

Large volume translumbar aortography in aortic occlusion.

LARGE VOLUME TRANSLUMBAR AORTOGRAPHY IN AORTIC OCCLUSIONM. LEA THOMAS and E. W. L. FLETCHERAudio Available | Share

Cardiac Tamponade as a Result of Infusion

A possible complication with open-end pacemaker catheters can arise when silent perforation of the myocardium occurs. Continued intravenous administration of solutions and medication may lead to pericardial effusion or potentially to lethal cardiac tamponade. Simple methods for detection are available. If prolonged pacing is intended, the end hole should be sealed by an obturator or the catheter should be replaced to avoid this complication.

Vascular jet collapse in selective angiocardiography.

Pressures exerted by the jet coming from an end hole catheter may be positive or negative, depending on the direction of measurement. Maximal positive pressure occurs if the catheter is in direct contact with the structure at a right angle position. Under such circumstances, the pressure in the injection syringe is transmitted, usually resulting in disruption of intima and media of the blood vessel.Negative forces may cause collapse of an injected blood vessel resulting in an angiographic artefact termed jet collapse. At effective injection pressures of 800 lb./sq. in. and more, vascular jet collapse is the cause of disruption of the vessel wall in animal experiments. Vascular jet collapse is more commonly seen in venography and arteriography in younger persons with elastic vessels. Vascular jet collapse is an important angiographic arte-fact, since it may be confused with organic narrowing or vascular spasm.

Modified cardiac catheter for neonate and infant

<h3>To the Editor:—</h3> Cardiac catheterization and selective angiocardiography carry an increased risk in the neonatal period and early infancy.^1,2This communication reviews some of the problems associated with the use of cardiac catheters for diagnostic procedures, and describes a new modified pediatric NIH catheter designed to reduce the risks and increase the accuracy of those procedures in the neonate and small infant. Two principal types of catheter are in use for cardiac catheterization and angiocardiography. The first type, with an end hole, such as the Lehman catheter, has certain disadvantages for selective angiocardiography because of its tendency to recoil during injections. In addition, it is stiff and this increases the difficulties and dangers of intracardiac manipulation. Undesirable damping and difficulty with sampling may also occur with this catheter. The second type is the side-hole catheter which overcomes these difficulties and permits sampling and pressure recording as well as rapid

Modified Cardiac Catheter For Neonate and Infant

<h3>To the Editor:—</h3> Cardiac catheterization and selective angiocardiography carry an increased risk in the neonatal period and early infancy.^1,2This communication reviews some of the problems associated with the use of cardiac catheters for diagnostic procedures, and describes a new modified pediatric NIH catheter designed to reduce the risks and increase the accuracy of those procedures in the neonate and small infant. Two principal types of catheter are in use for cardiac catheterization and angiocardiography. The first type, with an end hole, such as the Lehman catheter, has certain disadvantages for selective angiocardiography because of its tendency to recoil during injections. In addition, it is stiff and this increases the difficulties and dangers of intracardiac manipulation. Undesirable damping and difficulty with sampling may also occur with this catheter. The second type is the side-hole catheter which overcomes these difficulties and permits sampling and pressure recording as well as rapid

Considerations regarding the technique for transseptal left heart catheterization.

Improvements in the equipment and technique for transseptal left heart catheterization appear to have largely overcome the major problems and complications that have been encountered in recent years with this procedure. Improvements in equipment have included the addition of a stylet for the needle, modifications in the design of the catheter, and the use of a catheter tip occluder both for manipulation of the catheter within the left heart and to close the end hole during selective angiography. The steps employed for insertion of the catheter and needle were described in detail, and the use of landmarks such as the left main-stem bronchus, the spine, the left atrial shadow, and the aortic bulge was discussed. The indications for, and relative contraindications to, transseptal catheterization currently applied in this laboratory were also described. The relative contraindications consist of (1) a giant right atrium, (2) severe rotational anomalies of the heart or great vessels, and kyphoscoliosis; (3) marked dilation of the ascending aorta; (4) anticoagulant therapy, and (5) a history of recent systemic arterial embolization. Since the introduction of these technical changes and precautions, with the exception of one nonfatal aortic puncture, the problems previously encountered during transseptal catheterizations have been avoided in more than 350 consecutive transseptal left heart studies in this laboratory.

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

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-

A Bronze Mount from the Roman Villa at Lullingstone, Kent

An unusual little bronze mount (fig. 1, pl. XXII, 1a, b) has been found on the site of the Roman villa at Lullingstone, Kent, and is published here by kind permission of the excavator, Lt.-Col. G. W. Meates. It comes from the black level spreading over the filling of the bath block, a level which contained much late Roman material but which must be regarded as unstratified. The mount is of cast bronze and 3·6 cm. long. It is basically a bar which is flat underneath for a length of 2·3 cm., and perforated at each end; it then stretches further in one direction, rising into a curved surface underneath, with a deeply chip-carved animal head terminal on the top. A similar animal head, facing the opposite way, decorates the upper surface of the flat bar between the two perforations. The terminal animal has open jaws, and the ears stand up in relief, but the other animal head ends in a blunt nose and the ears are indicated by recessed lentoid shapes. When found, a dome-headed iron rivet was present in the middle hole, and iron rust in the end hole. These iron traces disappeared in the cleaning process.

A Simplified Catheter End Hole Closing Assembly for Flush Renal Angiography

A Simplified Catheter End Hole Closing Assembly for Flush Renal Angiography

ANEURYSM OF THE RIGHT VENTRICLE CAUSED BY SELECTIVE ANGIOCARDIOGRAPHY.

Two cases are reported of aneurysm formation in the outflow tract and body of the right ventricle following selective angiocardiography. The technic and complications of angiocardiography in our hands have been reviewed, and it is concluded that there is no absolute means of preventing injections of contrast material into the wall of the ventricle, if multiple side hole catheters are used. It seems probably that single end hole catheters are safer than multiple side hole catheters for selective ventriculography. The first patient developed a marked pulsation in the second and third left intercostal spaces together with changes in the plain x-ray that permitted a preoperative diagnosis of aneurysm. The second case was diagnosed at operation. The first patient developed variable cyanosis preoperatively, and during operative correction arterial desaturation together with hypotension. These changes were attributed to outflow tract obstruction by the aneurysm.

A NEW TEFLON CATHETER FOR PERCUTANEOUS CATHETERIZATION AND CONTRAST MATERIAL INJECTION.

The percutaneous introduction of catheters in the cardiovascular system (Fig. 1) has multiplied in application and scope in the last few years, rapidly becoming one of the most popular catheterization technics (1–8). Since 1959 we have used this method in 650 clinical cases for a total of over 1,500 visualizations or hemodynamic studies of the cardiovascular system. As experience was gained during a three-year period, we became more and more dissatisfied with the polyethylene tubings, which we had used initially, as well as with commercially available catheters. The disadvantages of the polyethylene tubings were the complete absence of radiopacity, the inability to withstand high-pressure injection, the difficulties encountered in flaring, tapering, and punching side-holes of appropriate sizes. Even less desirable than the polyethylene tubings were the Kifa catheters because of the vascular spasm often encountered with this brand, perhaps caused by the roughness of the external wall. The Lehman catheters would obviate a great many of these disadvantages, but the absence of tapering and of multiple side-holes makes them inadequate for this technic because of the difficulty in inserting the blunt end into the vessel and extreme recoil during pressure injection. The present catheter, made of Teflon, has an extremely low coefficient of friction, a completely water-repellent surface, and radiopacity which equals or is superior to the Lehman catheters. It is available in sizes 5F to 9F, in lengths of 80, 100, and 125 cm., and with an end-hole of either 0.035 in. (for use with an infant spring) or 0.045 in. (for use with an adult-size spring). This instrument is easily cleaned and can be steam-autoclaved for sterilization. If desired, the tip may be bent to various shapes and this shape will be retained by introducing a short wire into the distal end, heating the catheter in the autoclave at 270° F. for ten minutes, and then cooling it. A more permanent molding of the curved tip can be obtained by oven heating at 500–F. The main feature of this instrument is the tip. The tapering of its distal part makes the catheter easy to insert because of reduced friction between it and the vessel (Fig. 2). Furthermore, the end hole is a few thousandths of an inch larger than the diameter of the spring guide and it is possible to slide the catheter over the spring as a sleeve. There are 4 or 6 side-holes with a total area greater than 4 times the end opening and the flow of the contrast material is greatest through the side-holes. This minimizes recoil, improves instantaneous mixing, and avoids injection of small vessels due to accidental wedging of tip. Figure 2 demonstrates how approximately four-fifths of the injected fluid is ejected from the side-holes.

Transthoracic left heart catheterization and angiocardiography for combined assessment of mitral and aortic valves.

Retrograde left heart catheterization combined with selective ventriculography and aortography is essential for precise assessment of aortic and mitral stenosis or insufficiency (1). The type and degree of involvement, predominant lesion, and decision as to whether the disease is isolated or combined, are among the problems in preoperative evaluation and choice of treatment. A simple one-act technic is described for left heart catheterization combined with selective angiocardiography by which both valves (mitral by retrograde and aortic by antegrade study) are assessed in left-sided valvular disease where other methods have been inadequate or complicated. The equipment is shown in Figure 1. The patient is placed in a supine position. Children up to ten to twelve years are catheterized under light general anesthesia. Above that age local anesthesia is used. The apex of the heart is located when visible or palpable or is estimated by fluoroscopy or radiography, and after local procaine infiltration of the skin, subcutaneous tissue, and intercostal groove, a 1- to 2-mm. stab wound is made at this site. a. The needle, enclosed in a Teflon tube and containing a stiff diamond-shaped stilet, is inserted into the left ventricle through the apex of the heart (Fig. 1, D) b. The stilet is then removed. A stream of red blood under pressure indicates insertion into the ventricle. The needle is then pulled back, leaving the Teflon catheter in place. c. A metal spiral-wound stilet is then introduced through the Teflon tube, which is attached to a flushing chamber and syringe containing heparinized solution. d. Under fluoroscopic guidance, the flexible stilet is advanced across the mitral valve into the left atrium (Fig. 2), followed by advancement of the Teflon catheter until its end portion is well in the atrium. The stilet is then removed and continuous pressure is recorded while the catheter is slowly pulled back into the left ventricle. Contrast medium may be injected into the left atrium if desired. e. Next, the metal guide is again inserted through the catheter into the left ventricle and, under fluoroscopy, introduced into the ascending aorta. The catheter is then advanced across the aortic valve, pressure is recorded, and selective aortography is performed (Fig. 3). After the injection, the catheter is slowly pulled back and placed at the apical portion of the left ventricle, while continuous pressure is recorded (Fig. 4). This is followed by selective left ventriculography (Fig. 5). An adequate sized Teflon catheter, with end hole and two side holes at its distal portion, provides rapid injection of the medium. The short length of tubing (approximately 20 cm.) connecting the catheter and injector substantially decreases the resistance to the viscous contrast material. These two factors are valuable adjuncts to angiocardiography by this method.