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Left Brachiocephalic Perforation During Right Heart Catheterization.

ABSTRACT: Right heart catheterization is overall considered a safe procedure, although complications can arise from venous access injuries, arrhythmias, vasovagal episodes, and pulmonary artery rupture. We present a case of left brachiocephalic vein perforation during a diagnostic right heart catheterization, which was managed conservatively. (Level of Difficulty: Beginner.).

SUBMITTER: Farooqui SM

PROVIDER: S-EPMC9044287 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Left Brachiocephalic Perforation During Right Heart Catheterization.

Farooqui Samid M SM North Justin J Bernardo Roberto J RJ

JACC. Case reports 20220420 8

Right heart catheterization is overall considered a safe procedure, although complications can arise from venous access injuries, arrhythmias, vasovagal episodes, and pulmonary artery rupture. We present a case of left brachiocephalic vein perforation during a diagnostic right heart catheterization, which was managed conservatively. (<b>Level of Difficulty: Beginner.</b>). ...[more]

PMID: 35493800

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Project description:BackgroundImprovements in outcomes for patients with congenital heart disease (CHD) have increased the need for diagnostic and interventional procedures. Cumulative radiation risk is a growing concern. MRI-guided interventions are a promising ionizing radiation-free, alternative approach.PurposeTo assess the feasibility of MRI-guided catheterization in young patients with CHD using advanced visualization passive tracking techniques.Study typeProspective.PopulationA total of 30 patients with CHD referred for MRI-guided catheterization and pulmonary vascular resistance analysis (median age/weight: 4 years / 15 kg).Field strength/sequence1.5T; partially saturated (pSAT) real-time single-shot balanced steady-state free-precession (bSSFP) sequence.AssessmentImages were visualized by a single viewer on the scanner console (interactive mode) or using a commercially available advanced visualization platform (iSuite, Philips). Image quality for anatomy and catheter visualization was evaluated by three cardiologists with >5 years' experience in MRI-catheterization using a 1-5 scale (1, poor, 5, excellent). Catheter balloon signal-to-noise ratio (SNR), blood and myocardium SNR, catheter balloon/blood contrast-to-noise ratio (CNR), balloon/myocardium CNR, and blood/myocardium CNR were measured. Procedure findings, feasibility, and adverse events were recorded. A fraction of time in which the catheter was visible was compared between iSuite and the interactive mode.Statistical testsT-test for numerical variables. Wilcoxon signed rank test for categorical variables.ResultsNine patients had right heart catheterization, 11 had both left and right heart catheterization, and 10 had single ventricle circulation. Nine patients underwent solely MRI-guided catheterization. The mean score for anatomical visualization and contrast between balloon tip and soft tissue was 3.9 ± 0.9 and 4.5 ± 0.7, respectively. iSuite provided a significant improvement in the time during which the balloon was visible in relation to interactive imaging mode (66 ± 17% vs. 46 ± 14%, P < 0.05).Data conclusionMRI-guided catheterizations were carried out safely and is feasible in children and adults with CHD. The pSAT sequence offered robust and simultaneous high contrast visualization of the catheter and cardiac anatomy.Level of evidence2 TECHNICAL EFFICACY STAGE: 1.

Project description:AimsRight heart catheterization (RHC) is indicated in all candidates for heart transplantation (HT). An acute vasodilator challenge is recommended for those with pulmonary hypertension (PH) to assess its reversibility. The effects of inhaled nitric oxide (iNO) on pulmonary and systemic haemodynamics have been reported only in small series. Our purpose was to describe the response to iNO in a larger population and its potential clinical implications.Methods and resultsFrom 210 RHC procedures performed between 2010 and 2019, vasodilator challenge with iNO was used in 108 patients, of which 66 had advanced heart failure undergoing assessment for HT (55±11 years old; 74.2% male gender; 43.9% ischaemic cardiomyopathy; left ventricular ejection fraction 28.4 ± 11,4%; and peak VO2 12.1 ± 3.0 mL/kg/min). iNO was administered through a tight-fitting facial mask regardless of baseline pulmonary pressures. Clinical endpoints (all-cause mortality and acute right heart failure) were assessed according to baseline haemodynamic findings over the available follow-up period. There were no side effects from iNO administration. Typical response consisted of a reduction in pulmonary vascular resistance, consequent to an increase in left ventricular filling pressures, no significant change in mean pulmonary artery pressure (resulting in a lower mean transpulmonary gradient) and a mild increase in cardiac ouput. Pulmonary arterial compliance increased significantly, whereas systemic vascular resistance was only mildly affected. In five cases (7.6%), pulmonary vascular resistance increased paradoxically. All-cause mortality and post-HT right heart failure events were overall low and similar in patients without PH or reversible PH.ConclusionsVasodilator challenge with iNO is safe in advanced heart failure patients undergoing RHC prior to HT listing. It produces a reasonably predictable haemodynamic response, which occurs predominantly at the pulmonary circulation level. Clinical implications of iNO-induced reversibility may be relevant, but further systematic validation is warranted in larger cohorts.

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Left Brachiocephalic Perforation During Right Heart Catheterization.

Publications

Left Brachiocephalic Perforation During Right Heart Catheterization.

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