Spivack, Alfred P.; Kahn, Kenneth A.; Hultgren, Herbert N.
March 1962
Angiology;Mar1962, Vol. 13 Issue 3, p110
Academic Journal
Right heart catheterization continues to be an important technique of cardiac diagnosis, particularly for congenital lesions. This study has examined some of its potential errors and the variation of findings in several common congenital lesions. The following general points will contribute to increased diagnostic accuracy in the employment of right heart catheterization: 1. Experienced operators will produce more accurate, complete studies. This is not a technique to be relegated to an inexperienced person without supervision. 2. Multiple blood samples should be obtained within a short space of time from carefully identified sites. Frequent instantaneous �spot-check� blood-oxygen analysis by means of a photocell cuvette are helpful in planning additional studies to be made during the procedure. Patient disturbance, apprehension or unduly deep sedation should be avoided. 3. Common errors in the interpretation of right heart catheterization data have been described. Awareness of such errors will improve accuracy, 4. Variations of cardiac catheterization findings in the following cardiac lesions have been described: atrial septal defect, ventricular septal defect, patent ductus arteriosus and pulmonic stenosis. 5. Ancillary diagnostic techniques should be employed when indicated to clarify the diagnosis in certain situations. The most commonly employed techniques are: (a) Selective angiocardiography with injection of contrast medium into specific parts of the right or left heart or great vessels. In some laboratories all diagnostic investigations consist of a complete cardiac cathoterization study followed by a planned angiocardiographic angiocardiographic study. This is valuable in collecting information and gaining experience. However, if the clinical study of the patient has been competently done, angiocardiography may be reserved for selected problems only, (b) Dye curve studies including selective injection into right and left heart and great vessels with selective sampling. (c) Left heart and aortic catheterization in techniques such as left ventricular puncture, transseptal left atrial puncture and retrograde arterial catheterization. (d) Miscellaneous techniques such as arterial oxygen studies during exercise, simultaneous pressure recording during a Valsalva maneuver, phonocatheter studies and the amyl nitrite test. 6. Probably most important is the proper approach to the patient's problem. Specialized diagnostic studies should not be performed by physicians who are unfamiliar with the clinical findings. Before any specialized study, a careful and thorough clinical work-up should be made. The study should be carefully planned on the basis of the clinical findings. The cardiac catheterization data should then be evaluated together with the clinical findings in developing a final diagnosis and planning future management.


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