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Right heart catheterization: Difference between revisions
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A PAC is a 5-7 french catheter which consists of 2-5 lumina with different purposes: a lumen for inflation of the balloon, a proximal and distal lumen for infusion of fluid or extraction of blood, a temperature thermistor and one for RV pacing. | A PAC is a 5-7 french catheter which consists of 2-5 lumina with different purposes: a lumen for inflation of the balloon, a proximal and distal lumen for infusion of fluid or extraction of blood, a temperature thermistor and one for RV pacing. | ||
[[File:RightHeart_Technique_Fig1.jpg | 300px | right | Figure 1. Swan-Ganz catheter.]] | [[File:RightHeart_Technique_Fig1.jpg | thumb | 300px | right | Figure 1. Swan-Ganz catheter.]] | ||
Ports left to right: thermistor connector, medication portal, proximal injection hub, distal lumen hub, balloon inflation valve with syringe. | Ports left to right: thermistor connector, medication portal, proximal injection hub, distal lumen hub, balloon inflation valve with syringe. | ||
[[File:RightHeart_Technique_Fig2.jpg | right | 300px | Figure 2. Part of the venous and arterial system.]] | [[File:RightHeart_Technique_Fig2.jpg | thumb | right | 300px | Figure 2. Part of the venous and arterial system.]] | ||
Following local anesthesia, the femoral, jugular, brachial or subclavian vein is punctured, then a guidewire is introduced into the vein by Seldinger technique. Next a sheath is introduced. | Following local anesthesia, the femoral, jugular, brachial or subclavian vein is punctured, then a guidewire is introduced into the vein by Seldinger technique. Next a sheath is introduced. | ||
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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<cite>Braunwald</cite>]] | [[File:RightHeart_Technique_Fig3.jpg | thumb | 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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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. | 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 | thumb | left | 300px | Figure 4. Normal pressurewaves.]] | ||
[[File:RightHeart_Waveforms_Fig2.png | left | 300px | Figure 5. Normal values right heart catheterization<cite>Braunwald</cite>]] | [[File:RightHeart_Waveforms_Fig2.png | thumb | left | 300px | Figure 5. Normal values right heart catheterization<cite>Braunwald</cite>]] | ||
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== Right atrium == | == Right atrium == | ||
[[File:RightAtrium_Fig1.png | 300px | a = atrial systole | [[File:RightAtrium_Fig1.png | thumb | 300px | a = atrial systole | ||
x= atrial relaxation, decrease of pressure | x= atrial relaxation, decrease of pressure | ||
c= closure of the tricuspid valve | c= closure of the tricuspid valve | ||
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#Kussmaul sign (aspiratory rise of lack of decline in RA pressure): constrictive pericarditis, RV ischemia | #Kussmaul sign (aspiratory rise of lack of decline in RA pressure): constrictive pericarditis, RV ischemia | ||
[[File:RightAtrium_Fig2.png | left | 300px | Figure 8 Elevated v wave and prominent y descent in tricuspid regurgitation]] | [[File:RightAtrium_Fig2.png | thumb | left | 300px | Figure 8 Elevated v wave and prominent y descent in tricuspid regurgitation]] | ||
[[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 | thumb | 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 == | ||
[[File:RightVentricle_Fig1.png | left | 300px | sys= systole | [[File:RightVentricle_Fig1.png | thumb | left | 300px | sys= systole | ||
ed= end-diastolic pressure (RVEDP) | ed= end-diastolic pressure (RVEDP) | ||
RF= rapid filling fase (60% of RV filling) | RF= rapid filling fase (60% of RV filling) | ||
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== Pulmonary artery pressure == | == Pulmonary artery pressure == | ||
[[File:PulmonaryArtery_Fig1.png | 300px | left | sys= RV systole | [[File:PulmonaryArtery_Fig1.png | thumb | 300px | left | sys= RV systole | ||
D= dicrotic notch = closure of the pulmonic valve | D= dicrotic notch = closure of the pulmonic valve | ||
ed= end-diastolic pressure]] | ed= end-diastolic pressure]] | ||
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== Pulmonary capillary wedge pressure (PCWP) == | == Pulmonary capillary wedge pressure (PCWP) == | ||
[[File:PulmonaryCapillary_Fig1.png | 300px | left | a= atrial contraction | [[File:PulmonaryCapillary_Fig1.png | thumb | 300px | left | a= atrial contraction | ||
x= atrial relaxation | x= atrial relaxation | ||
v= atrial diastole (ventricular contraction) | v= atrial diastole (ventricular contraction) | ||
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[[File:PulmonaryCapillary_Fig2.png | 300px | left | Figure 10. Prominent v wave in mitral regurgitation.]] | [[File:PulmonaryCapillary_Fig2.png | thumb | 300px | left | Figure 10. Prominent v wave in mitral regurgitation.]] | ||
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