Assessing the Impact of Transcatheter Aortic Valve Implantation on Cardiac Catheterisation: A Multicentric Study
Yinghao LimCarlo Francisco Santos GochuicoFabrizio D’AscenzoKay Woon HoMao‐Shin LinIván J. Núñez‐GilAlfonso IelasiMaurizio TespiliAlex F. Castro‐MejíaAlessandro DepaoliJonathan YapHsien‐Li KaoMichael LeeEdgar Tay
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Cardiac catheterization has been the major tool of the pediatric cardiologist in the assessment of congenital heart disease. Intracardiac shunts and pressure gradients are specifically meaasured, and anatomic features are visualized by means of angiography. The risk of such studies in experienced laboratories is extremely low even among small, severely ifi infants. In recent years, with the increasing effectiveness of surgical techniques for repair of complex congenital cardiac lesions, the importance of obtaining detailed anatomic description has become magnified. In parallel with the greater need for information, angiographic techniques have improved to a remarkable degree over the past decade. Sophisticated angle cineangiography has replaced the standard anterior-posterior and lateral projections of the past.1
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When I began my cardiology training in 1965, my instructors in the cardiac catheterization laboratory made it clear to me that many things other than anatomic assessment by angiography could be accomplished in the cardiac catheterization laboratory. For example, at that time cardiac output, pressure gradients, valvar insufficiency, shunts, assessment of contractility, assessment of myocardial blood flow using radioactive techniques, lactate metabolism, and assessment of ventricular function were the principal physiologic parameters measured.
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Data obtained by cardiac catheterization, properly interpreted, are an extremely useful supplement to information obtained from the medical history, physical examination, electrocardiography, chest x-ray examination, and other noninvasive diagnostic techniques. Elevations of pressure in the cardiac chambers and great vessels and corresponding patterns of pressure curves are discerned in the presence of various pathologic conditions affecting the heart. Blood samples are taken during cardiac catheterization for measurement of cardiac output and to detect intracardiac shunting. Attempts have been made to estimate the magnitude of shunts from abnormal dye-dilution curves. Exercise stress is often used during cardiac catheterization to evaluate overall cardiovascular performance. Angiocardiography gives a permanent graphic record of structural abnormalities. Myocardial lactate metabolism provides a means of evaluating the adequacy of coronary blood flow.
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Since diagnostic cardiac catheterization in children with congenital heart disease was first reported in 1947, echocardiography has been used as a non-invasive diagnostic tool in congenital heart disease, resulting in a decrease in diagnostic cardiac catheterizations. However, the total number of cardiac catheterizations remained at a steady level until the mid-1980s and has since increased progressively. This is a result of the introduction of interventional transcatheter techniques to improve or correct congenital heart malformations. Since the first description of balloon atrial septostomy, the range of indications for such techniques has steadily increased, particularly in the past 15 years. 'Deep' sedation or general anaesthesia is essential for the conduct of cardiac catheterization in children, particularly in the younger age group.
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Interventional cardiac catheterization has become a standard part of the practice of pediatric cardiology. In this review, articles on pediatric interventional catheterization that have been published over the past 2 years are summarized. The interventional procedures have been divided into the following: lesions, pulmonary valve, aortic valve, mitral valve, coarctation of the aorta, branch pulmonary artery stenosis, device closure of septal defects, and miscellaneous lesions. In addition, within these lesions the articles have been further categorized in the following manner: 1) large collaborative studies defining the short-term efficacy and complications associated with many of the interventional procedures; 2) follow-up studies that now define the intermediate (1 to 8 years) hemodynamic results and complications associated with the various interventional procedures; 3) the reports of new cardiac lesions that can be treated within the catheterization laboratory; and 4) the description of new technologies that have improved the results or expanded the scope of interventional pediatric cardiology.
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Қaй уaқыттa болмaсын мәдениетaрaлық қaрым-қaтынaстaрдың жaқсы деңгейде жүзеге aсуы не құлдырaуы бaстaпқы мәтіннің бaсқa тілдегі aудaрмaсымен aдеквaтты не бaлaмaлы болуынa тікелей бaйлaнысты. Осығaн орaй, көптеген ғaлымдaр aдеквaттылық пен бaлaмaлылық терминдерін зерттеуге жітінaзaр aудaрудa. Сондықтaн осы тaқырыпты зерттейтін теориялaрдың сaны күн-нен күнге aртып келеді. Кей ғaлымдaрдың есептеуінше, aдеквaттық және бaлaмaлық ұғымдaры бір мaғынaны білдіреді, aл бaсқaлaры олaрдың ұқсaстықтaры көп болғaнымен оны екі бөлек ұғым ретінде қaрaстыру керек деп пaйымдaйды. Сол себептібұл жұмыстың мaқсaты – aдеквaттылық және бaлaмaлылық ұғымдaрыныңмәнің aдевaтты және бaлaмa aудaрмaлaры турaлы теориялaрды жүйелеу және топтaстырып, сaрaлaу aрқылы aжырaту. Бір жaғынaн, бұл оқырмaнғa удaрмaтaнымындaғы aдеквaттылық және бaлaмaлық ұғымдaрын оңaй түсінуге,екінші жaғынaн бұл бізге екі ұғымның aйырмa шылықтaры мен ұқсaстықтaрынaнықтaуғa мүмкіндік береді. Зерттеу мaқсaтын жүзеге aсыру үшін жұмысбaрысындa сaлыстырмaлытaлдaу әдісі қолдaнылды. Шетелдік ғaлымдaрдың зерттеулерінің негізінде бұл жұмыстa aдеквaтты және бaлaмaлы aудaрм aның ұқсaс тұстaры мен aйырмaшылықтaры тaлдaнды. Тaлдaуғa сәйкес біз aдеквaтты aудaрмa ретінде күтілетін коммуникaтивтік әсерді қaмтaмaсыз етеді, сондaй-aқ оның бaсты тaлaптaрының бірі түпнұсқaның мaғынaсын толықтaй жеткізу үшін бaлaмaлaрды қолдaну деп қaрaстырaмыз. Бірaқ бaлaмaлы aудaрмa өз тaрaпындa прaгмaтикaлық мaқсaтты әрдaйым қaмтaмaсыз ете aлмaйды, әрі әрқaшaн aудaрмaның конвенционaлды нормaтивті тaлaптaрынa сәкес болa бермейді.
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Four infants are described in whom cardiac catheterization and angiocardiography performed in V-the first week of life established a diagnosis of aortic atresia, confirmed at subsequent necropsy.Contrary to previous reports of non-specific haemodynamic findings in this condition, all four infants had an identical and diagnostic haemodynamic disturbance.A strikingfinding was that a severe bradycardia occurred when the catheter crossed the ductus arteriosus or entered the hypo- plastic ascending aorta.This bradycardia, presumably due to obstruction to coronary flow, was abolished when the catheter was withdrawn.Unless the possibility of this occurrence is known its diagnostic significance may be missed; failure to withdraw the catheter could lead to an immedi- J ately fatal outcome.
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