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3.
Arch Cardiovasc Dis ; 112(8-9): 532-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31378692

RESUMO

BACKGROUND: Unlike previous randomized clinical trials (RCTs), recent trials and meta-analyses have shown that transcatheter closure of patent foramen ovale (PFO) reduces stroke recurrence risk in young and middle-aged adults with an otherwise unexplained PFO-associated ischaemic stroke. AIM: To produce an expert consensus on the role of transcatheter PFO closure and antithrombotic drugs for secondary stroke prevention in patients with PFO-associated ischaemic stroke. METHODS: Five neurologists and five cardiologists with extensive experience in the relevant field were nominated by the French Neurovascular Society and the French Society of Cardiology to make recommendations based on evidence from RCTs and meta-analyses. RESULTS: The experts recommend that any decision concerning treatment of patients with PFO-associated ischaemic stroke should be taken after neurological and cardiological evaluation, bringing together the necessary neurovascular, echocardiography and interventional cardiology expertise. Transcatheter PFO closure is recommended in patients fulfilling all the following criteria: age 16-60 years; recent (≤6 months) ischaemic stroke; PFO associated with atrial septal aneurysm (>10mm) or with a right-to-left shunt>20 microbubbles or with a diameter≥2mm; PFO felt to be the most likely cause of stroke after thorough aetiological evaluation by a stroke specialist. Long-term oral anticoagulation may be considered in the event of contraindication to or patient refusal of PFO closure, in the absence of a high bleeding risk. After PFO closure, dual anti-platelet therapy with aspirin (75mg/day) and clopidogrel (75mg/day) is recommended for 3 months, followed by monotherapy with aspirin or clopidogrel for≥5 years. CONCLUSIONS: Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists.


Assuntos
Isquemia Encefálica/prevenção & controle , Cateterismo Cardíaco/normas , Cardiologia/normas , Forame Oval Patente/terapia , Prevenção Secundária/normas , Acidente Vascular Cerebral/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Consenso , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Medição de Risco , Fatores de Risco , Dispositivo para Oclusão Septal/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento , Adulto Jovem
4.
J Cardiothorac Vasc Anesth ; 33(5): 1197-1204, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30655202

RESUMO

OBJECTIVE: To compare myocardial protection with retrograde cardioplegia alone with antegrade and retrograde cardioplegia in minimally invasive mitral valve surgery (MIMS). DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: The authors studied 97 MIMS patients using retrograde cardioplegia alone and 118 MIMS patients using antegrade and retrograde cardioplegia. INTERVENTIONS: The data from patients admitted for MIMS using retrograde cardioplegia (MIMS retro) between 2009 to 2012 were compared with the data from patients undergoing MIMS with antegrade and retrograde cardioplegia (MIMS ante-retro) between 2006 and 2010 (control group). Cardioplegia in the MIMS retro group was delivered solely through an endovascular coronary sinus (CS) catheter positioned under echographic and fluoroscopic guidance. Antegrade and retrograde cardioplegia was used in the MIMS ante-retro group. Data regarding myocardial infarction (MI; creatine kinase Mb, troponin T, electrocardiogram), myocardial function, and hemodynamic stability were collected for comparison. MEASUREMENTS AND MAIN RESULTS: Adequate cardioplegia administration (CS pressure >30 mmHg and asystole) was attained in 74.2% of the patients with retrograde cardioplegia alone. In 23.7% of the patients, the addition of an antegrade cardioplegia was necessary. No difference was observed in the incidence of MI (0 MIMS retro v 1 for MIMS ante-retro, p = 0.3623), difficult separation from cardiopulmonary bypass, and postoperative malignant arrhythmia. No difference was found for maximal creatine kinase Mb (39.1 [28.0-49.1] v 37.9 [28.6-50.9]; p = 0.8299) and for maximal troponin T levels (0.39 [0.27-0.70] v 0.47 [0.32-0.79]; p = 0.1231) for MIMS retro and MIMS ante-retro, respectively. However, lactate levels in the MIMS retro group were significantly lower than in the MIMS ante-retro group (2.1 [1.4-3.05] v 2.4 [1.8-3.3], respectively; p = 0.0453). No difference was observed in duration of intensive care unit stay and death. MIMS retro patients had a shorter hospital stay (7.0 [6.0-8.0] v 8.0 [7.0-9.0] days; p = 0.0003). CONCLUSION: Retrograde cardioplegia administration alone provided comparable myocardial protection to antegrade and retrograde cardioplegia during MIMS, but was not sufficient to achieve asystole in one-fifth of patients.


Assuntos
Cateterismo Cardíaco/métodos , Seio Coronário/cirurgia , Procedimentos Endovasculares/métodos , Parada Cardíaca Induzida/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Adulto , Idoso , Cateterismo Cardíaco/normas , Soluções Cardioplégicas/administração & dosagem , Terapia Combinada/métodos , Terapia Combinada/normas , Procedimentos Endovasculares/normas , Feminino , Parada Cardíaca Induzida/normas , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Estudos Retrospectivos
5.
Int J Cardiol ; 279: 47-50, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30344060

RESUMO

BACKGROUND: Patent foramen ovale (PFO) closure after a cryptogenic cerebral ischemic event is a routinely procedure. The most used device is Amplatzer™ PFO Occluder 25 mm, but PFOs with complex anatomy require larger device for closure. We compared Amplatzer™ Septal Occluder (ASO) device versus Amplatzer™ PFO Occluder 30 or 35 mm (A-PFO 30/35) about the safety of procedure and the presence of residual shunt during the follow-up. METHODS: From June 2002 to July 2016, 355 patients (pts) with PFO undergone closure at our institution. Among these ones, 70 pts (19.7%) had a PFO with complex anatomy and a single device with greater diameter was implanted. In these cases, the following devices were used: Gore® Septal Occluder (GSO) in 4 pts; ASO device in 33 pts (group I) and A-PFO 30/35 in 33 pts (group II). Patients treated with GSO device were excluded by our analysis. RESULTS: Comparing group I and group II, there weren't complications during the procedures. Two patients of group II were lost at follow-up. At last follow-up, 1 pt of group I (3%) and 10 pts of group II (32.3%) had a residual shunt (p < 0.01). 7 of 10 pts of group II and the only 1 of group I with residual shunt underwent a complete closure by Amplatzer™ Vascular Plug (AVP) devices. CONCLUSIONS: ASO devices and A-PFO 30/35 devices are both safe to close complex PFO; but A-PFO 30/35 is associated with a more incidence of residual shunt.


Assuntos
Cateterismo Cardíaco/normas , Desenho de Equipamento/normas , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Dispositivo para Oclusão Septal/normas , Adulto , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Ecocardiografia Transesofagiana/métodos , Ecocardiografia Transesofagiana/normas , Desenho de Equipamento/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dispositivo para Oclusão Septal/tendências , Resultado do Tratamento
6.
J Cardiothorac Vasc Anesth ; 33(3): 796-807, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30064851

RESUMO

The development of transcatheter interventions to provide a minimally invasive alternative to open surgical repair has revolutionized the care of patients with valvular heart disease. Recently, this technology has been expanded to allow for the treatment of pathology of the mitral valve. This review discusses the anesthetic considerations for patients presenting for transcatheter management of mitral valve disease, including transcatheter mitral valve replacement (TMVR) and transcatheter mitral valve repair (TMVRep). The initial focus is on the current literature on transcatheter interventions for mitral valve pathologies as well as current and developing technology for TMVR and TMVRep. The authors' institutional experience with anesthetic management for the TMVR and TMVRep procedures is described, including potential pitfalls and complications, concluding with a discussion of the role of transesophageal echocardiography in the care of this patient population.


Assuntos
Anestesia/métodos , Anestésicos/administração & dosagem , Estenose da Valva Aórtica/diagnóstico por imagem , Cateterismo Cardíaco/métodos , Insuficiência da Valva Mitral/diagnóstico por imagem , Anestesia/normas , Anestésicos/normas , Estenose da Valva Aórtica/tratamento farmacológico , Estenose da Valva Aórtica/cirurgia , Cateterismo Cardíaco/normas , Próteses Valvulares Cardíacas/normas , Humanos , Insuficiência da Valva Mitral/tratamento farmacológico , Insuficiência da Valva Mitral/cirurgia
7.
Indian Heart J ; 70(6): 922-933, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30580867

RESUMO

Radial access for cardiac catheterization and intervention in India has been growing steadily over the last decade with favorable clinical outcomes. However, its usage by interventional cardiologists varies greatly among Indian operators and hospitals due to large geographic disparities in health care delivery systems and practice patterns. It also remains unclear whether the advantages, as well as limitations of transradial (TR) intervention (as reported in the western literature), are applicable to developing countries like India or not. An evidence-based review involving various facets of radial procedure for cardiac catheterization, including practical, patient-related and technical issues was conducted by an expert committee that formed a part of Advancing Complex CoronariES Sciences through TransRADIAL intervention (ACCESS RADIAL™) Advisory Board. Emerging challenges in redefining TR management based on evidence supporting practices were discussed to formulate these final recommendations through consensus.


Assuntos
Cateterismo Cardíaco/normas , Cardiologia , Consenso , Intervenção Coronária Percutânea/normas , Guias de Prática Clínica como Assunto , Sociedades Médicas , Humanos , Índia , Artéria Radial
8.
J Am Coll Cardiol ; 72(20): 2507-2517, 2018 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-30442293

RESUMO

Operational efficiency is a core business principle in which organizations strive to deliver high-quality goods or services in a cost-effective manner. This concept has become increasingly relevant to cardiac catheterization laboratories, as insurers move away from fee-for-service reimbursement and toward payment determined by quality measures bundled per episode of care. Accordingly, this review provides a framework for optimizing efficiency in the cardiac cath lab. The authors outline a management method based on the Nadler-Tushman Congruence Model, a commonly used business tool by which a company can assess whether its key elements are aligned with its strategy. Standardized metrics of cath lab efficiency are proposed, which can be used in public reports on this topic moving forward. Attention is paid to understanding balance sheets to track the financial health of the cath lab. Specific cost-saving measures are described, and examples of strategies used to save supply expenses are provided.


Assuntos
Cateterismo Cardíaco/normas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Gerenciamento Clínico , Local de Trabalho/normas , Cateterismo Cardíaco/métodos , Humanos , Satisfação do Paciente , Resultado do Tratamento
9.
Catheter Cardiovasc Interv ; 92(7): 1356-1364, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30260064

RESUMO

The present-day cardiac catheterization laboratory (CCL) is home to varied practitioners who perform both diagnostic, interventional, and complex invasive procedures. Invasive, non-interventional cardiologists are performing a significant proportion of the work as the CCL environment has evolved. This not only includes those who perform diagnostic-only cardiac catheterization but also heart failure specialists who may be involved in hemodynamic assessment and in mechanical circulatory support and pulmonary hypertension specialists and transplant cardiologists. As such, the training background of those who work in the CCL is varied. While most quality metrics in the CCL are directed towards evaluation of patients who undergo traditional interventional procedures, there has not been a focus upon providing these invasive, noninterventional cardiologists, hospital/CCL administrators, and CCL directors a platform for quality metrics. This document focuses on benchmarking quality for the invasive, noninterventional practice, providing this physician community with guidance towards a patient-centered approach to care, and offering tools to the invasive, noninterventionalists to help their professional growth. This consensus statement aims to establish a foundation upon which the invasive, noninterventional cardiologists can thrive in the CCL environment and work collaboratively with their interventional colleagues while ensuring that the highest quality of care is being delivered to all patients.


Assuntos
Benchmarking/normas , Cateterismo Cardíaco/normas , Cardiologistas/normas , Prestação Integrada de Cuidados de Saúde/normas , Padrões de Prática Médica/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Cateterismo Cardíaco/efeitos adversos , Cardiologistas/educação , Certificação/normas , Competência Clínica/normas , Consenso , Educação de Pós-Graduação em Medicina/normas , Humanos , Especialização/normas
13.
Cardiovasc Revasc Med ; 19(8): 980-984, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30056020

RESUMO

The aim of this article is to focus on the utilization of forearm approach for cardiac catheterization in challenging groups of patients. Radial and ulnar approaches have gained significant popularity among the majority of interventional cardiologists. Multiple studies have demonstrated the feasibility, safety and efficacy of forearm route for cardiac catheterization and have highlighted the significant reduction in bleeding complications by avoiding the puncture of the groin. In this review we present the strategies need to be followed in order to apply the forearm approach in challenging group of patients.


Assuntos
Cateterismo Cardíaco/normas , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Antebraço/irrigação sanguínea , Intervenção Coronária Percutânea/métodos , Guias de Prática Clínica como Assunto , Doença da Artéria Coronariana/cirurgia , Humanos , Artéria Radial , Artéria Ulnar
15.
Cardiovasc Eng Technol ; 9(3): 301-338, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29951830

RESUMO

Transcatheter Mitral Valve Replacement (TMVR) is currently under clinical investigation as a viable treatment option for mitral regurgitation (MR). Therefore, it is important to outline the key functional requirements of a TMVR prosthesis in order to provide an overall approach to assessing mitral valve replacement devices utilizing a combination of in vitro and preclinical methods. This article provides a review of the mitral valve disease as well as general considerations and guidance for developing a TMVR device based on International Industry Standards. Specific details pertaining to the mitral valve apparatus, morphology of mitral valve disease, assessment of specific patient population as well as hazard analysis to evaluate and develop a TMVR device to treat a specific patient population have been included. The details contained within this report are not all inclusive or explicate for every technology being developed but rather thought of as a general guide on how a TMVR technology could be developed in alignment with International Industry Standards. Key learnings from the Transcatheter Aortic Valve Replacement (TAVR) experience has also been considered and taken into account when outlining this general guidance for TMVR. Key learning points from the TAVR development experience included the following: quantification of acceptable levels of paravalvular leak, valve migration potential using various anchoring methods and overall implant frame failure modes when treating the native aortic valve. It should be noted that TAVR is over a decade further along in development and clinical experience compared to TMVR. These key learnings from the early experience with TAVR should be considered with all transcatheter development projects.


Assuntos
Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Teste de Materiais/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Animais , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/normas , Próteses Valvulares Cardíacas/normas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/normas , Humanos , Teste de Materiais/normas , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Modelos Anatômicos , Modelos Animais , Modelos Cardiovasculares , Desenho de Prótese
16.
J Invasive Cardiol ; 30(8): 296-300, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29906266

RESUMO

BACKGROUND: There is great variability in radiation safety practices in cardiac catheterization laboratories around the world. METHODS: We performed an international online survey on radiation safety including interventional cardiologists, electrophysiologists, interventional radiologists, and vascular surgeons. RESULTS: A total of 570 responses were received from various geographic locations, including the United States (77.9%), Asia (7.9%), Europe (6.8%), Canada (2.8%), and Mexico and Central America (2.1%). Most respondents (73%) were interventional cardiologists and 23% were electrophysiologists, with 14.4 ± 10.2 years in practice. Most respondents (75%) were not aware of their radiation dose during the past year and 21.2% had never attended a radiation safety course; 58.9% are "somewhat worried" and 31.5% are "very worried" about chronic radiation exposure. Back pain due to lead use was reported by 43.0% and radiation-related health complications including cataracts and malignancies were reported by 6.3%. Only 37.5% of respondents had an established radiation dose threshold for initiating patient follow-up. When comparing United States operators with the other respondents, the former were more likely to attend radiation safety courses (P<.001), wear dosimeters (P<.001), know their annual personal radiation exposure (P<.001), and have an established patient radiation dose threshold (P<.001). They were also more likely to use the fluoro store function, under-table shields, leaded glasses, ceiling lead glass, and disposable radiation shields, and were more concerned about the adverse effects of radiation. CONCLUSIONS: Radiation safety is of concern to catheterization laboratory personnel, yet there is significant variability in radiation protection practices, highlighting several opportunities for standardization and improvement.


Assuntos
Cateterismo Cardíaco/normas , Cardiologistas/normas , Exposição Ocupacional/efeitos adversos , Padrões de Prática Médica , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Proteção Radiológica/normas , Canadá/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/epidemiologia , Radiografia Intervencionista , Inquéritos e Questionários , Estados Unidos/epidemiologia
17.
JACC Cardiovasc Interv ; 11(15): 1482-1491, 2018 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-29803695

RESUMO

OBJECTIVES: The aims of the ERIS (Evolving Routine Standards of FFR Use) study are to describe the current use of invasive coronary physiology assessment and discern the reasons for its nonuse in daily practice. BACKGROUND: Adoption of coronary physiology guidance in the catheterization laboratory varies among countries, centers, and operators. METHODS: ERIS is an investigator-driven, nationwide, prospective, cross-sectional study involving 76 Italian catheterization laboratories. Each center had a 60-day window to include consecutive cases that fulfilled the inclusion and exclusion criteria. Two pre-specified groups were enrolled: 1) patients who had operators apply fractional flow reserve or instantaneous wave-free ratio assessment (physiology assessment group); and 2) patients who had operators decide not to perform fractional flow reserve or instantaneous wave-free ratio assessment, although the patients met the inclusion and exclusion criteria (visual estimation group). RESULTS: Overall, 1,858 cases were included (physiology assessment group, n = 1,177; visual estimation group, n = 681). Physiology-based guidance was used in 7% and 13% of the total volume of angiographic and percutaneous coronary interventions, respectively. Its use was in line with European and American guidelines in 48% of the cases (n = 569). Physiology guidance was used in a consistent number of patients with acute coronary syndromes (n = 529 [45%]). The main reason for not using physiology guidance was the operator's confidence that clinical and angiographic data alone were sufficient. CONCLUSIONS: Use of coronary physiology assessment in daily practice meets the current guideline indications in approximately 50% of cases. The major limiting factor for the adoption of physiology guidance was the operator's confidence in visual assessment alone. (Evolving Routine Standards of FFR Use [ERIS]; NCT03082989).


Assuntos
Cateterismo Cardíaco/normas , Estenose Coronária/diagnóstico , Reserva Fracionada de Fluxo Miocárdico , Padrões de Prática Médica/normas , Idoso , Competência Clínica/normas , Tomada de Decisão Clínica , Angiografia Coronária , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Intervenção Coronária Percutânea , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Resultado do Tratamento
18.
Clin Nucl Med ; 43(11): 815-817, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29762234

RESUMO

The IMPACT Registry is a repository of information for heart catheterizations for congenital heart disease regardless of age and also the catheterizations for acquired heart disease in children. The registry collects information on outcomes, provides quality improvement opportunities for participants, provides reports to participants comparing their results with national results, compares the volume of catheter work done at an institution with the frequency of adverse events, and provides information that may be helpful in evaluating the use of medical devices and treatment options.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/normas , Garantia da Qualidade dos Cuidados de Saúde , Sistema de Registros , Segurança , Cardiopatias Congênitas/terapia , Humanos
19.
Respir Med ; 137: 191-200, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29605204

RESUMO

Pulmonary hypertension has emerged as a major cause of morbidity and mortality in patients with hemoglobinopathies and chronic hemolytic anemias. These hematological diseases include - but are not limited to - sickle cell disease (SCD), thalassemia, paroxysmal nocturnal hematuria, and hereditary spherocytosis. Although most studies have been based on the use of echocardiography as a screening tool for pulmonary hypertension as opposed to the gold standard of right heart catheterization for definitive diagnosis, the association between chronic hemolytic anemia and pulmonary hypertension is evident. Studies have shown that patients with SCD and a tricuspid regurgitant velocity (TRV) ≥ 2.5 m/sec are at increased risk of pulmonary hypertension and are at increased mortality risk. Additional markers of risk of pulmonary hypertension and increased mortality include a pro-BNP >160 pg/mL combined with a 6-min walk distance of <333 m. There is currently a lack of concrete data to support the use of targeted oral pulmonary arterial hypertension therapy in chronic hemolytic anemia. As a result, management is generally targeted towards medical optimization of the underlying anemia. This literature review aims to discuss the pathophysiology, diagnostic and prognostic tools, recent studies and current protocols that are essential in guiding management of pulmonary hypertension in chronic hemolytic anemias.


Assuntos
Anemia Hemolítica/complicações , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Anemia Hemolítica/epidemiologia , Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Anemia Falciforme/fisiopatologia , Cateterismo Cardíaco/normas , Doença Crônica , Ecocardiografia/métodos , Tolerância ao Exercício/fisiologia , Humanos , Hipertensão Pulmonar/mortalidade , Peptídeo Natriurético Encefálico/metabolismo , Prognóstico , Fatores de Risco , Teste de Caminhada/métodos
20.
J Vet Intern Med ; 32(3): 956-961, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29528135

RESUMO

BACKGROUND: Different methods to perform reference calibration of an angiographic image exist; however, a prospective comparison of calibration methods has yet to be investigated in veterinary medicine. OBJECTIVE: To compare angiographic measurements using two commonly employed reference calibration methods, an esophageal pigtail marker catheter (EC) versus a radiopaque table ruler (TR). ANIMALS: Thirty-five client-owned dogs undergoing transcatheter intervention. METHODS: Prospective comparison study. Two reference calibration methods, EC and TR, were recorded in dogs undergoing transcatheter procedures from May 2016 to July 2017. Relevant measurements were performed in triplicate and averaged after image calibration to either EC or TR. Comparisons between methods were made by correlation, paired t-test, the method of Bland and Altman, and Passing-Bablok regression. RESULTS: A total of 39 angiographic structures were measured. Interventions included balloon pulmonary valvuloplasty (n = 21), patent ductus arteriosus occlusion (n = 11), subaortic or sub-pulmonary balloon dilatation (n = 4), and cor triatriatum membranostomy (n = 3). Angiographic measurements were larger when calibrated to EC versus TR (P < .0001). The mean bias was 0.86 mm, with greater bias for larger measurements. The EC measurements were ∼10% greater than TR based on regression analysis. Weight was correlated to the difference between methods (ρ = 0.55, P = .0003). CONCLUSIONS AND CLINICAL IMPORTANCE: Angiographic image calibration using a ruler placed on the fluoroscopy table underestimates the size of a structure by ∼10% as compared with a marker catheter placed within the esophagus. This effect is greatest when measuring larger structures such as the pulmonary valve annulus and in larger dogs.


Assuntos
Angiografia/veterinária , Angiografia/métodos , Angiografia/normas , Animais , Calibragem , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/normas , Cateterismo Cardíaco/veterinária , Doenças do Cão/diagnóstico por imagem , Cães , Fluoroscopia/veterinária , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/veterinária , Estudos Prospectivos , Reprodutibilidade dos Testes
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