Studies of the coronary arteries and heart chambers
VASCULAR SURGERY – EURODOCTOR.RU – 2007
Coronary catheterization – a minimally invasive procedure designed to study the coronary arteries and heart chambers. It is performed as a diagnostic and therapeutic purposes.
Coronary catheterization is one of the procedures in cardiac surgery. This method allows to visualize such changes of the coronary vessels, as blockage, narrowing, re-narrowing, thrombosis or aneurysmal enlargement of the lumen of these vessels, the size of the chambers of the heart, the contractility of the heart muscle, as well as some aspects of the functioning of the heart valves. In addition, this method allows to determine such important parameters of the heart as the blood pressure in the cavities of the heart and pulmonary artery, which is impossible to carry out non-invasive methods.
Narrowing of the coronary artery blood flow to the violation of the tissues of the heart, which is the basis for the symptoms of angina. Blockage of the lumen of the arteries leads to myocardial infarction. However, coronary catheterization does not allow to discern whether the walls of blood vessels affected by atherosclerosis or not, but a significant narrowing of the lumen, which occurs in the final stages of atherosclerosis.
Historical information on coronary catheterization
The method of coronary catheterization was introduced in the late 1950s and first applied in practice in 1960 and Sounsom Shire. The opening of the coronary catheterization method was discovered by chance from a child's cardiologist at the Cleveland Clinic Sounsom when he accidentally entered radiopaque substance into the coronary artery instead of the left ventricle. Although the patient appeared reversible cardiac arrest, and the Shire have Souns funding further research into this method. In 1966 they published a report on coronary catheterizations performed in 1000.
Beginning in the late 1970s based on the research of Charles Dottera in 1964 and especially Andreas Gryuntsiga in 1977, coronary catheterization was more widely used in less invasive treatment of angina pectoris, and some complications of atherosclerosis, as well as in the prevention of myocardial infarction and in research activities in terms of better understanding of the pathogenesis of coronary heart disease and atherosclerosis.
Patient participation in the procedure
Usually, the method of coronary catheterization, requires only local anesthesia in the catheter insertion site and a minimum total of sedation (ie, the application of calming drugs), that is, during the procedure the patient is conscious. This method is more secure because in case of any problems or discomfort to the patient can just say this, that facilitates the rapid removal of unwanted effects. Even the most modern devices that monitor the condition of the patient, do not give complete information, being patient is often the most reliable indicator of ongoing security procedures.
At the dawn of the method in the early 1960s, coronary catheterization lasted several hours and was accompanied by complications in 2-3% of patients. Over time, the method has been improved and is now a simple procedure for coronary catheterization takes no more than 5-8 minutes at a frequency of complications of 0.1%. However, compliance with patient safety at the time of preparation method requires approximately 20-45 minutes.
The procedure for coronary catheterization
See also an article on angioplasty
The method of coronary catheterization is introduced into the lumen of the coronary arteries, thin tube – a catheter is usually a thickness of about 2 mm. A catheter is inserted through the access to the femoral artery at the site of the inguinal crease (ie, where you can easily test the pulsation of the arteries). Catheter is inserted so that its tip is located at the entrance of the coronary artery. At the same time is continuously measured intraarterial pressure to make sure that the catheter lumen is not closed.
Typically, the catheter is made of radiopaque material so that you can control its position in the vessel. After the catheter is introduced into the bloodstream special radiopaque substance. Usually, this substance is applied in an amount of 3.8 ml to visualize blood flow within 3-5 seconds, as the radiopaque rapidly dissolves in the blood.
If the lumen of a coronary artery narrowed by atherosclerotic plaque or thrombus, it can be seen in the narrowing of the coronary vessels of this site, or blur, uneven contours of the X-ray shadow. If the vessel lumen is completely obstructed, there was a so-called "cliff effect" that is, staining of the vessel suddenly stopped, as it chops off.
If the calcified atherosclerotic plaque (ie, "soaked" with lime), then it can be visualized with conventional radiography and without contrast medium.
Coronary catheterization is also used to perform transluminal coronary angioplasty. With this method, into the narrowed coronary artery catheter with a special balloon inflated at the end. In the place of constriction balloon is inflated and the artery expands. However, often in the expansion of the narrowed section of the site indicated the formation of endothelial tissue (normal tissue lining of the arteries). This is the re-narrowing of the lumen of the artery. Therefore, at present, angioplasty is often supplemented in such a highly effective method, as stenting. It lies in the fact that during the performance of angioplasty with balloon inflates it is a stent – a cylindrical wire frame, which does not allow the artery to narrow.
Complications of coronary catheterization
One of the most serious complication of coronary catheterization is the occurrence of an allergic reaction to the introduction of radiopaque substance into the blood. Typically, these drugs are made on the basis of iodine. Therefore, the intolerance of iodine is contraindicated for the this method. Other complications of the method, as with any other surgical procedures are bleeding from the puncture site, infection. Other complications are more likely to clinical status and anatomical features of the patient, rather than the procedure itself.
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AID IN THE TREATMENT –