Harvest of Endothelial Cells from the Balloon Tips of Swan-Ganz Catheters after Right Heart Catheterization
3
Citation
10
Reference
10
Related Paper
Citation Trend
Abstract:
A variety of pathologies lead to pulmonary hypertension (PH), which is defined as a mean pulmonary artery pressure exceeding 25 mmHg at rest. To further diagnose and manage PH, patients undergo repeated right heart catheterizations (RHC) wherein a Swan-Ganz catheter is advanced into a branch of the pulmonary artery and a balloon is inflated to wedge the catheter tip. This article illustrates a protocol whereby pulmonary artery endothelial cells (PAECs) may be harvested from the balloon tips of Swan-Ganz catheters after RHC, and purified with an anti- CD146 affinity column technique to purify putative PAECs. These cells might be used to provide an in situ snapshot of the biological state of the pulmonary vasculature endothelium to complement hemodynamic measurements obtained during RHC. Harvested and purified PAECs may be used for either cell culture or for subsequent analytical assays such as flow cytometery.Keywords:
Pulmonary wedge pressure
Balloon catheter
Right heart catheterization
Cite
Right heart catheterization
Portopulmonary hypertension
Gold standard (test)
Cardiac catheterization
Heart catheterization
Cite
Citations (19)
Right heart catheterization is a unique tool not only in the diagnosis but also in the management of patients with a wide range of cardiovascular diseases. The technique dates back to the 18th century, but the biggest advances were made in the 20th century. This review focuses on pulmonary hypertension for which right heart catheterization remains the diagnostic gold standard. Right heart catheterization-derived parameters help classify pulmonary hypertension into several subgroups, assess risk of adverse events or mortality and make therapeutic decisions. According to the European Society of Cardiology guidelines pulmonary hypertension (PH) is defined as an increase in mean pulmonary artery pressure (PAPm) > 25 mmHg, whereas a distinction between pre- and post-capillary PH is made based on levels of pulmonary artery wedge pressure (PAWP). Moreover, right atrial pressure (RAP), cardiac index (CI) and mixed venous oxygen saturation (SvO2) are the only parameters recommended to assess prognosis and only in patients with pulmonary arterial hypertension (PAH). Patients with RAP > 14 mmHg, CI < 2.0 l/min/m2 and SvO2 < 60% are at high (> 10%) risk of death within the next year. The purpose of this paper is to show that RHC-derived parameters can be used on a considerably larger scale than currently recommended. Several prognostic parameters, with specific thresholds have been identified for each subtype of pulmonary hypertension and can be helpful in everyday practice for treatment of PH.
Right heart catheterization
Pulmonary wedge pressure
Cardiac catheterization
Gold standard (test)
Cite
Citations (5)
Abstract Artifactual pulmonary wedge pressure measurements were encountered during bedside use of Swan‐Ganz catheters. These values were higher than pulmonary artery end diastolic pressure and devoid of typical phasic contours. Utilizing fluoroscopy these artifacts were reproduced by advancing the catheter tip 2–4 cm beyond the site of initial wedging and reinflating the balloon. Spurious increases of pulmonary wedge pressure of up to 15 mm Hg were thus obtained. In vitro catheter testing demonstrated overlapping of the catheter tip by the deformed balloon when it was fully inflated in a channel too small to accomodate it. These measurement artifacts are thus attributed to distal migration of the catheter tip into relatively small pulmonary artery branches and to subsequent occlusion of the catheter lumen by the balloon when it is reinflated. This can readily be avoided by routinely inflating the balloon with the minimum volume of air sufficient to yield a pulmonary wedge pressure tracing.
Pulmonary wedge pressure
Balloon catheter
Heart catheterization
Wedge (geometry)
Lumen (anatomy)
Cite
Citations (3)
Background Different pulmonary hypertension (PH) mechanisms are associated with hereditary haemorrhagic telangiectasia (HHT). Methods and results We conducted a retrospective study of all suspected cases of PH (echocardiographically estimated systolic pulmonary artery pressure [sPAP] ≥ 40 mmHg) in patients with definite HHT recorded in the French National Reference Centre for HHT database. When right heart catheterization (RHC) was performed, PH cases were confirmed and classified among the PH groups according to the European guidelines. Among 2,598 patients in the database, 110 (4.2%) had suspected PH. Forty-seven of these 110 patients had RHC: 38/47 (81%) had a confirmed diagnosis of PH. The majority of these had isolated post-capillary PH (n = 20). We identified for the first time other haemodynamic profiles: pre-capillary pulmonary arterial hypertension (PAH) cases (n = 3) with slightly raised pulmonary vascular resistances (PVR), and combined post- and pre-capillary PH cases (n = 4). Compared to controls, survival probability was lower in patients with PAH. Conclusion This study revealed the diversity of PH mechanisms in HHT. The description of combined post- and pre-capillary PH with/or without high cardiac output (CO) suggests either a continuum between the pre- and post-capillary haemodynamic profiles or a different course in response to high CO.
Right heart catheterization
Pulmonary wedge pressure
Cardiac catheterization
Heart catheterization
Cite
Citations (27)
A retrospective study of our experience in the placement of 19 consecutive balloon-tipped catheters in the pulmonary artery of 18 children disclosed that the procedure can be performed with relative ease in the intensive care unit without the aid of fluoroscopy. Insertion of the catheters was not associated with any serious complications. Catheter malfunction, however, occurred in 9 of 18 patients: balloon rupture in 6 and clot formation in 3. Comparison of pulmonary capillary pressure through a balloon-tipped catheter and venous pressure through a central venous line indicates that, in the absence of significant pulmonary disease requiring high positive end expiratory pressure, or significant left heart dysfunction, a central venous pressure line is frequently adequate for monitoring right heart pressures and as a guidance to fluid therapy.
Pulmonary wedge pressure
Pulmonary artery catheter
Balloon catheter
Central venous catheter
Arterial line
Cite
Citations (7)
Pulmonary wedge pressure
Right heart catheterization
Cardiac catheterization
Cite
Citations (52)
A microcomputer program is described which facilitates the calculation of data from physiological variables measured using a flow directed, balloon-tipped thermal dilution pulmonary artery catheter. Eleven variables may be calculated and left ventricular function may be displayed graphically using as coordinates left ventricular stroke work index and pulmonary artery wedge pressure. Successive measurements may be easily compared and the program has proved valuable in the management of patients monitored with a right heart catheter.
Pulmonary artery catheter
Pulmonary wedge pressure
Micro computer
Cardiac index
Balloon catheter
Heart catheterization
Cite
Citations (0)
Pulmonary wedge pressure
Cite
Citations (72)
Pulmonary hypertension (PH) is a haemodynamic and pathophysiological condition defined as mean pulmonary artery pressure ≥25 mm Hg at rest, assessed by right-heart catheterization (8–20 mm Hg is considered normal). A pulmonary capillary wedge pressure measurement of >15 mm Hg indicates a significant pulmonary venous component. PH is associated with a variety of causes. The current PH classification is helpful in understanding the different etiological, pathological, and treatment approaches.
Pulmonary wedge pressure
Right heart catheterization
Etiology
Pathophysiology
Cardiac catheterization
Cite
Citations (4)
Abstract Hemoptysis is an unusual complication of flow‐directed (Swan‐Ganz) catheters. Over‐inflation of the balloon with a shearing‐induced rupture of a small pulmonary artery, and the spear effect of the catheter tip appear to be the mechanisms in the two cases presented. Diligent care to avoid overinflation of the balloon in the pulmonary capillary wedge position by observation of the pressure waveform is critical. The spear effect that is frequently seen during insertion may be eliminated by deflating the balloon at the first appearance of the pulmonary artery waveform and gradual advancement of the catheter five to eight cm, when the balloon is then reinflated to obtain the wedge.
Pulmonary wedge pressure
Balloon catheter
Cite
Citations (28)