Right heart catheters

diagnostic & angiographic right heart catheters

1. DR. ROHIT WALSE FELLOW INTERVENTION CARDIOLOGY SCTIMST KERALA Right Heart Catheters

2. SCOPE HISTORY INDICATIONS OF RHC GENERAL PURPOSE CATHETERS ANGIOGRAPHIC CATHETERS

3. HISTORY 1929- Werner Forssmann

4. 1964- Ronald Bradley F irst person to describe the use of a pulmonary-artery catheter in man Miniature catheter [extremely narrow portex catheter (0·63 mm diam )] having no balloon

5. 1970- Jeremy Swan & William Ganz Balloon floatation catheter Balloon tip was a modification of the simple portex tubing method developed by Bradley

6. INDICATIONS OF RHC Diagnostic indications Therapeutic indications

7. Diagnostic Indications Routine preop evaluation of VSD, ASD, TOF, CoA, other complex CHD High flow or low flow physiology associated with semilunar valves- Combined AS/AR, combined PS/PR To measure transvalvular pressure difference in PS, MS, AS BDG Cath prior to Fontan EP study Angiography

8. Diagnostic Indications Oxymetry - Shunt Quantification Calculate CO, CI Calculate PVR, SVR

9. Therapeutic Indication Closure of- ASD, VSD, PDA, MAPCA PTMC IVC filter BAS BPV

10. PARTS OF A CATHETER HUB BODY TIP HUB BODY TIP

11. TIP : Neither blunt nor too sharp, soft & flexible. Bullet nose tip- least trauma, Though too taper increased tip penetration. HUB : Metal or plastic, larger than catheter, tapered hubs – easier insertion of guidewire . TIP & HUB

12. Rt heart catheters- 100 to 125 cm. Lt heart catheters- 100 to 110 cm. 125 cm for very tall person. LENGTH

13. General purpose catheters Cournand Lehman Goodale-Lubin Multipurpose Catheter Balloon flotation catheters- Swan Ganz

14. Angiographic Catheters Pigtail angiographic catheter NIH Flow directed angiographic catheter(balloon flotation catheter ) Gensini Lehman Ventriculography Eppendorf

15. Cournand Catheter Designed by - Andre Cournand End hole radiopaque woven dacron catheter with outer coating of polyurethrane & nylon braiding Construction - Very gradual distal curve tapered tip Use - All purpose right heart catheter & wedge pressure recording Size - 5 to 8 F, Length- 100 & 125cm Disadv - needs frequent flushing, especially in those with thrombotic tendency like cyanotic CHD

16. Side Holes ADVANTAGES Prevent catheter damping [occlusion of coronary ostium ] Allow additional blood flow out of tip, to perfuse artery Avoid catastrophic dissections in the ostium of artery Avoid disengagement during injections DISADVANTAGES False sense of security becoz now aortic pressures & not the coronary pressure is being monitored Suboptimal opacification Makes catheter weak-kinking at side holes

17. Goodale-Lubin Catheter Birdseye catheter Construction - Woven dacron coated with polyurethane with nylon braiding Hole- Two laterally opposed oval shaped sidehole near the endhole Use - Right heart pressure measurements, Oxymetry Sampling Size - 4 to 8 F; length-80, 100 & 125 cm

18. GL Catheter

19. Multipurpose Catheter Designer : Dr. Fred W Schoomaker & King Relatively stiff, Single curve with straight tip Construction : Polyurethane with an inner wire braid Use - Right heart catheterization probing atrial septum, pressure measurements, Angiogram- RCA bypass graft, high LM take off for crossing different lesions PDA & MAPCA coiling Size- 5 & 6 F; length- 80-100 cm

20. Balloon Floatation Catheter- Swan Ganz Available with 2-3 lumens Balloon tipped-floats through the right side of the heart safely & easily Construction - Balloon- Latex; Shaft-PVC (a) Two lumen- Distal port for pressure monitoring & one lumen for balloon (b) Three lumen- additional proximal port for RAP monitoring Size - 5 to 7 F, Catheter length markings at every 10 cm, length-50-110 cm

21. Approx Balloon inflation 5 F  0.75 ml 6 F  1 ml 7 F  1.5 ml

22. Uses Wedge pressure measurement Occlusion Angiogram in CS prior to CRT To cross mitral valve in BMV To cross RSOV To cross PA in case of PS

23. ANGIOGRAPHIC CATHETERS

24. Pigtail Catheter Designer : Judkins Construction : Polyurethane or polyethylene with a tapered tip, terminal 5 cm of which is coiled back on itself in a tight loop with 3-6 pairs of side holes on shaft Use - LV, RV angiography, aortography & pulmonary angiography Size - 4 to 7 F; Length-65, 80, 100 & 110cm, side holes-6, 8 or 12

25. Pig tail Catheter The end hole permits insertion of a guide wire and hence can negotiate through tortious vessels and stenotic valves. The loop shape keeps the end hole away from the myocardium. Multiple side holes over several centimeters on the shaft provides stability to the catheter preventing recoil . Advantages : excellent contrast delivery , Atraumatic design, No endocardial staining, Less chance of VPCs , An end-hole catheter may be used for pressure monitoring

26. TYPES OF PIG TAIL CATHETER Quanticor ( Cardiomarker pigtail ) Pigtail Angiographic Van Tassel angled pigtail Grollman PA Elliptical or Oval Tennis Racquet

27. CARDIOMARKER PIG TAIL This is a standard pigtail with radiopaque markers set 2 cm apart. These act to calibrate distance for quantitative angiography. Exact LV distances, volumes and stroke volume can then be calculated using these markers as a “ruler.”

28. VAN TASSEL ANGLED PIGTAIL 8 N on-laterally opposed side hole near the end hole. Has a 145˚or 155 ˚angle that lifts the catheter off the inferior LV wall for a more centrally located LV gram Used for LV gram and aortography.

29. GROLLMAN PA It is an angled pigtail catheter with 60 bend and a curve generally on the reverse side . Has 12 non-laterally opposed side hole near the end hole. Used for RV & selective PA angiography .

30. PIGTAIL ANGIOGRAPHIC The pigtail catheter is the most commonly used LV gram catheter. With up to 12 side holes it evenly disperses the contrast within the LV . ELLIPTICAL OR OVAL Designed to pass small aortic valves or vessels with the curve intact. TENNIS RACQUET The central shaft was designed to reduce the risk of vessel wall extravasation.

31. NIH Catheter It is a side hole catheter without any endhole Construction : Made up of woven dacron with nylon reinforcement & especially stiff. Has 6 round side holes(3 pairs) COOK- polyethylene with stainless steel braid, 4 to 6 sideholes Polyurethane Cordis NIH cathter & Polyethylene Cook NIH Torcon blue catheter are much softer & less likely to cause dissection or perforation Use - Visualising RV, LV, arterial, pulmonary vasculature Size : 4 to 8 F, Length- 50 to 125 cm

32. NIH catheter

33. BALLOON FLOTATION ANGIOGRAPHIC CATHETER- Berman Standard Berman Reverse Berman Size- 4 to 8F Selected French sizes –lengths-50-110cm Identification- (Colour coded Injection port) Standard Berman-Pink Reverse Berman- Blue

34. Berman Angiography Catheter Large Lumen- flow rates similar to pigtail catheter Balloon tipped-increases the catheter stability during angiography No end hole-can’t measure wedge Multiple side holes-holes proximal to balloon Uses- Measurement of PA pressure Right Ventriculography

35. Reverse Berman Catheter Multiple side holes distal to the balloon Use- Pulmonary angiograghy

36. GENSINI CATHETER A type of straight tip catheter. Has 3 pairs of side holes and an end hole. Used for left and right angiographic studies. R ecoils at high pressure rates and is more arrhythmogenic and causes more staining.

37. LEHMAN CATHETER The lehman ventriculagraphy catheter has a multiple side holes and a tapered closed tip. The tapered tip helps in negotiating tortous vessels and in crossing stenosis aortic valves. The long tip reduces the chances of endocardial staining.

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