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Cardiac Catheterization: Objectives, Diseases, and Procedures, Exams of Medicine

The objectives of Cardiac Catheterization, focusing on vascular access, right and left heart catheterization, and related procedures. It covers normal and abnormal hemodynamics, disease states, and measurements. Skills include vascular access, right and left heart catheterization, left ventriculography, coronary angiography, aortography, and intra-aortic balloon pump placement. References are provided for further study.

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2021/2022

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Cardiac Catheterization Objectives:
Knowledge
Vascular Access:
Basic understanding of access site anatomy, including femoral artery and vein,
internal jugular vein, and brachial artery
Basic Understanding of disease conditions (and surgical correction) involving
these anatomic structures
Appreciate atherosclerotic disease of the ileo-femoral system and knowledge of
surgical revascularization anatomy, including Aorto-bifemoral graft, Fem-fem
bypass, and Fem-pop bypass
Right Heart Catheterrization (Hemodynamics):
Basic understanding of normal and abnormal right heart hemodynamics with specific
attention to the following disease states.
Congenital ASD
Congenital VSD
1° Pulomonary Hypertension
Congestive Heart Failure
Constrictive physiology
Cardiac Tamponade
Left Heart Catheterization (Hemodynamic):
Basic understanding of normal and abnormal left heart hemodynamics with specific
attention to the following disease states.
Aortic Insufficiency
Aortic Stenosis
Gorlin Equation
Hypertrophic Cardiomyopathy
Mitral Insufficiency
Mitral Stenosis
Gorlin Equation
Cardiomyopathy
Constrictive physiology
Cardiac Tamponade
Measurements of Cardiac Output: Fick, Thermodilution
Left Ventriculography:
Basic understanding of normal and abnormal left ventricular function with specific
attention to the following disease states:
Coronary Artery Disease
Mitral Insufficiency
Hypertrophic Cardiomyopathy
Estimation of Ejection Fraction
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Cardiac Catheterization Objectives:

Knowledge Vascular Access:

  • Basic understanding of access site anatomy, including femoral artery and vein, internal jugular vein, and brachial artery
  • Basic Understanding of disease conditions (and surgical correction) involving these anatomic structures
  • Appreciate atherosclerotic disease of the ileo-femoral system and knowledge of surgical revascularization anatomy, including Aorto-bifemoral graft, Fem-fem bypass, and Fem-pop bypass

Right Heart Catheterrization (Hemodynamics): Basic understanding of normal and abnormal right heart hemodynamics with specific attention to the following disease states.

  • Congenital ASD
  • Congenital VSD
  • 1° Pulomonary Hypertension
  • Congestive Heart Failure
  • Constrictive physiology
  • Cardiac Tamponade

Left Heart Catheterization (Hemodynamic): Basic understanding of normal and abnormal left heart hemodynamics with specific attention to the following disease states.

  • Aortic Insufficiency
  • Aortic Stenosis
  • Gorlin Equation
  • Hypertrophic Cardiomyopathy
  • Mitral Insufficiency
  • Mitral Stenosis
  • Gorlin Equation
  • Cardiomyopathy
  • Constrictive physiology
  • Cardiac Tamponade
  • Measurements of Cardiac Output: Fick, Thermodilution

Left Ventriculography: Basic understanding of normal and abnormal left ventricular function with specific attention to the following disease states:

  • Coronary Artery Disease
  • Mitral Insufficiency
  • Hypertrophic Cardiomyopathy
  • Estimation of Ejection Fraction

Coronary Angiography: Basic understanding of normal anatomy, pathologic impact on anatomy and surgical impact. with specific attention on the following:

  • Normal Coronary Anatomy
  • Common Congenital Abnormalities
  • Anomalous Origins of the major Coronary Arteries
  • Coronary Artery Disease
  • Saphenous Vein Grafts
  • Internal Mammary Arteries

Aortography & Ileo-femoral angiography: Basic understanding of normal anatomy, pathologic impact on anatomy and surgical impact. with specific attention on the following:

  • Aortic Insufficiency
  • Aneurysm
  • Ascending Aorta
  • Descending Aorta
  • Abdominal Aorta
  • Aortic Dissection
  • Surgical Repair of Aortic Dissection

Right Ventricular Biopsy: Basic understanding of cardiomyopathic conditions in which right ventricular biopsy plays a role in diagnosis and/or management:

  • Allograft Rejection
  • Infiltrative Cardiomyopathy
  • Anthracycline Cardiomyopathy

Intra-aortic Balloon Pump: Basic understanding of the indications, contraindications, insertion techniques, and troubleshooting.

Cardiac Catheterization Laboratory Equipment: Basic understanding of the equipment and devices used in the Catheterization Laboratory

  • x-ray/fluoroscopic equipment
  • Pressure Manometers
  • Digital Storage System

Teaching Methods

  • Pre-cath evaluation : Fellows are responsible for the pre-procedure evaluation of each patient scheduled for cardiac catherization. They present their findings to the attending physician. During the case presentation, the workup is critiqued by the attending. When warranted, discussion of recent literature pertaining to patient management occurs at this time.
  • Cath Procedure : Direct observation.All cases are closely supervised by the attending.Early in the year, the attending performs the majority of the procedure and explains the techniques ‘in real time’.By the second week of their first cath rotation, fellows are the primary operators during each diagnostic procedure but continue to receive close supervisition from the attendings.
  • Post Procedure Care : Fellows are responsible for the post-procedure care and evaluation of patients undergoing diagnostic cardiac catherizations.All complications should be reviewed with the attendings.

Methods of Evaluation

  • Direct observation by the faculty
  • Chart review by faculty

References

Vascular Access

  • Baim DS and Grossman W.Percutaneous approach and transseptal catheterization. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 59-75.

Right Heart Catheterization (Hemodynamic)

  • Ganz P, Swan HJC & Grossman W.Balloon-Tipped Flow-Directed Catheters. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 88-100. Grossman W.Blood Flow Measurements:The Cardiac Output. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 101-117. Grossman W.Clinical Measurement of Vascular Resistance and Assessment of Vasodilator Drugs.Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 135-142.
  • Grossman W.Shunt Detection and Measurement. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 155-172.

Left Heart Catheterization (Hemodynamic)

  • Carabello BA and Grossman W.Calculation of Stenotic Valve Area.Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 143-154.

Left Ventriculography

  • Hillis LD, Grossman W. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 200-212.

Coronary Angiography

  • Silverman JF. Coronary Angiography.An introduction to interpretation and technique.1984.
  • ACC/AHA Practice Guidelines for Coronary Angiography.J Am Coll Cardiol 1999;33:1756-1824.

Aortography &Ileo-femoral angiography

  • Paulin S. Aortography. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 227-251.

Right Ventricular Biopsy

  • Fowels RE, Baim DS. Endomyocardial Biopsy. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 506-516.

Intra-aortic Balloon Pump

  • Aroesty JM.Percutaneous Intraaortic Balloon Insertion. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 493-

Percutaneous Coronary Interventions

  • ACC/AHA Practice Guidelines for Percutaneous Coronary Interventions.J Am Coll Cardiol2001;37:2239.

Coronary Bypass Surgery

  • ACC/AHA Practice Guidelines for Coronary Artery Bypass Graft Surgery.J Am Coll Cardiol1999;47:1262-347.

Aortic Valve Disease

  • ACC/AHA Practice Guidelines for the Management of Patients with Valvular Heart Disease.J Am Coll Cardiol1998;32:1486-588.

Mitral Valve Replacement/Repair

ACC/AHA Practice Guidelines for the Management of Patients with Valvular Heart Disease.J Am Coll Cardiol1998;32:1486-588.