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Catheterization and Angiography

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  1. Indications
  2. Contraindications and Risks
  3. Technique
  4. Hemodynamic Assessment
  5. Cardiac output
  6. Valve areas and resistance
  7. Conclusions
  8. Bibliography

A significant reduction in coronary flow reserve is present when the ratio of flow at rest to flow after vasodilation is less than 2 : 1. Measurement of the pressure gradient across a stenosis using a small wire transducer also can assess functional severity. Fractional flow reserve is the ratio of the distal pressure to proximal pressure after maximum vasodilation. A fractional flow reserve of less than 0.75 indicates a significant stenosis.

[...] Right-Sided Heart Catheterization The most commonly used catheter is a balloon flotation catheter that is introduced into the femoral, brachial, subclavian, or internal jugular vein, then passed with or without fluoroscopic guidance into the right atrium, right ventricle, and pulmonary artery. If necessary, hemodynamic measurement of oxygen saturations can be obtained as the catheter is passed into the pulmonary artery. When in the pulmonary artery, inflation of the balloon at the tip of the catheter occludes the smaller pulmonary arteries and allows for measurement of the pulmonary capillary wedge pressure, which is nearly always an accurate reflection of left atrial pressure. [...]

[...] Capsulas CATHETERIZATION AND ANGIOGRAPHY Cardiac catheterization and angiography provide the detailed assessment of anatomy and physiology of the heart and vasculature and are the gold standard for assessment of cardiac disease. The technique first was applied to humans by Forssmann in 1929, but it was expanded into a diagnostic tool by Cournard and Richards; in 1956, all three physicians shared the Nobel Prize for their discovery. Selective coronary angiography was introduced by Sones in 1963 and modified further by Judkins. [...]

[...] LEFT VENTRICULOGRAPHY Left ventriculography frequently is performed with coronary angiography because it allows for assessment of left ventricular size and function and the presence and extent of mitral regurgitation. Left ventricular volume in end-diastole and end-systole can be calculated by the area-length method (normal = 70 20 mL and 25 10 mL). The difference between end-diastole and end-systole is the stroke volume. Cardiac output is calculated by multiplying the stroke volume by the heart rate. The ratio of angiographic stroke volume to end-diastolic volume is the ejection fraction, which is an estimate of contractile function. [...]

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