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Pulmonary Artery Catheterization
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI,
FAPSC, FAPSIC, FAHA, FCCP, FRCPG
Associate Professor of CardiologyNational Institute of Cardiovascular Diseases(NICVD),
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova, Malibagh branch
Honorary Consultant, Apollo Hospitals, Dhaka and
STS Life Care Centre, Dhanmondi
CRT 2014Washington
DC, USA
History• First Cardiac catheterization –▫ According to Andre Cournand, it was first performed by Claude
Bernard in 1844, in a horse, both rt and lt ventrilces were entered by retrograde approach from the jugular vein and carotid artery
▫ Werner Forssmann is credited with performing the first cardiac catheterization of a living person himself, at the age of 25 yrs
• Forssmann for his contribution and foresight shared the Nobel Prize in Medicine with Andre Cournand and Dickinson Richards in 1956
History
• 1929- Dr. Warner Forssman proven that right heart catheterization is possible in humans
• 1964- Dr. Bradley introduced small diagnostic catheter
• 1970- Balloon Flotation Catheter by Doctor H.J.C Swan and William Ganz
Technique for vascular access:
The true “Seldinger™ technique” is not used for percutaneous puncture into vessels.
Vascular Sheath
Percutaneous introduction and then the use of an indwelling vascular sheath in vessels is the standard technique for catheterization of pediatric and congenital heart patients.
Ideal sheath should have:1. Dilator
1. long, fine and smoothly tapered tip. 2. inner lumen of the dilator tip should tightly fit over the guide wire 3. tip of the dilator should have a smooth, fine transitional taper onto
the surface of the wire.
2. female Lure™ lock connecting hub at the proximal end 3. back-bleed valve4. Lateral tube / flush port
Vascular Sheath
When introduced from the inguinal area, the sheath should be long enough to extend into the common iliac vein.
In small infants a sheath into the femoral vein should extend proximal to the formation of the inferior vena cava.
Vascular Sheath
Ideal short sheath (7.5 cm long) for venous site – 5 Fr for an infant or child (<15– 20 Kg) and 7 Fr for a larger child or adult
Extra long sheaths (45 to 90 cm ) are used to –1. guide catheters directly and repeatedly to an area
within the heart itself (biopsies, blade catheters), 2. for trans septal procedures, 3. to deliver special devices within the heart or great
vessels (stents, occlusion devices), and 4. for the withdrawal of foreign bodies from the vascular
system.
Swan-Ganz Catheter(Pulmonary
Artery Catheterization)• Swan-Ganz Catheter-
Balloon flotation Pulmonary Artery catheter
• Use for monitoring critically ill patients (mostly in the ICU)
• Catheterization only possible on the right side of the heart
• Catheter is hooked up to a Cardiac Output computer
Thank [email protected]
Asia Pacific Congress of Hypertension, 2014, February
Cebu city, Phillipines
Seminar on Management of Hypertension,
Gulshan, Dhaka