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Right heart catheterization: Difference between revisions
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After placement of the sheath, the flushed catheter is introduced into the vein and advanced into the inferior vena cava, superior vena cava, right atrium, right ventricle and pulmonary artery (figure 3). | After placement of the sheath, the flushed catheter is introduced into the vein and advanced into the inferior vena cava, superior vena cava, right atrium, right ventricle and pulmonary artery (figure 3). | ||
[[File:RightHeart_Technique_Fig3.jpg | left | 300px | Figure 3. Right heart catheterization from the femoral vein]] | [[File:RightHeart_Technique_Fig3.jpg | left | 300px | Figure 3. Right heart catheterization from the femoral vein<cite>Braunwald</cite>]] | ||
Top row: the PAC is placed in the right atrium aimed at the lateral wall. Counterclockwise rotation aims the catheter posteriorly and allows advancement into the superior vena cava. | Top row: the PAC is placed in the right atrium aimed at the lateral wall. Counterclockwise rotation aims the catheter posteriorly and allows advancement into the superior vena cava. | ||
Centre row: the catheter is then withdrawn into the right atrium and aimed laterally. Clockwise rotation causes the tip to cross the tricuspid valve. With the tip in a horizontal position, it is positioned below the right ventricular outflow tract. Additional clockwise rotation causes the catheter to point straight up, allowing it to advance into the pulmonary artery and from there into the right pulmonary artery. | Centre row: the catheter is then withdrawn into the right atrium and aimed laterally. Clockwise rotation causes the tip to cross the tricuspid valve. With the tip in a horizontal position, it is positioned below the right ventricular outflow tract. Additional clockwise rotation causes the catheter to point straight up, allowing it to advance into the pulmonary artery and from there into the right pulmonary artery. | ||
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=== Normal and abnormal waveforms === | === Normal and abnormal waveforms === | ||
The normal pressure waves in the cardiac chambers during right heart catheterization with normal values shown are shown in figure 4 and 5. After that, we discuss per chamber the pressure curve , normal values and causes of abnormal waveforms. | The normal pressure waves in the cardiac chambers during right heart catheterization with normal values shown are shown in figure 4 and 5. After that, we discuss per chamber the pressure curve<cite>Images</cite>, normal values and causes of abnormal waveforms. | ||
[[File:RightHeart_Waveforms_Fig1.png | left | 300px | Figure 4. Normal pressurewaves.]] | [[File:RightHeart_Waveforms_Fig1.png | left | 300px | Figure 4. Normal pressurewaves.]] | ||
[[File:RightHeart_Waveforms_Fig2.png | left | 300px | Figure 5. Normal values right heart catheterization ]] | [[File:RightHeart_Waveforms_Fig2.png | left | 300px | Figure 5. Normal values right heart catheterization<cite>Braunwald</cite>]] | ||
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[[File:RightAtrium_Fig3.png | left | 300px | Figure 9 Prominent y descent (with square root sign) and equalization of RA and RVEDP: tamponade, constrictive pericarditis, restrictive cardiomyopathy]] | [[File:RightAtrium_Fig3.png | left | 300px | Figure 9 Prominent y descent (with square root sign) and equalization of RA and RVEDP: tamponade, constrictive pericarditis, restrictive cardiomyopathy]] | ||
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== Right ventricle == | == Right ventricle == | ||
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== References == | == References == | ||
<biblio> | <biblio> | ||
# | #Braunwald Braunwald E et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th edition: page 445. | ||
#Images from Up tot date online: Pulmonary artery catheterization: Interpretation of tracings. | |||
</biblio> | </biblio> | ||