By Lisa Bergersen, Susan Foerster, Audrey C. Marshall, Jeffery Meadows
This guide presents a accomplished evaluate of the way the cardiac catheterization laboratory in a pediatric cardiology department works. Chapters are geared up within the order within which a case progresses. particular forms of situations are mentioned intimately and hemodynamics is roofed intensive. info tables and line illustrations are used during the textual content to additional emphasize very important thoughts and information.
Lisa Bergersen, M.D. is affiliated with the kid's health center Boston, division of Cardiology, Boston, MA.
Susan Foerster, M.D. is affiliated with the St. Louis kid's health center, department of Cardiology, St. Louis, MO.
Audrey C. Marshall, M.D. is affiliated with the kid's clinic Boston, division of Cardiology, Boston, MA.
Jeffery Meadows, M.D. is affiliated with the college of California, San Francisco clinical heart, San Francisco, CA.
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Additional info for Congenital Heart Disease: The Catheterization Manual
Angiography 35 Table 1. Frontal ‘‘Camera’’ Frontal/posteroanterior (PA) Right anterior oblique (RAO) ‘‘Sitting Up’’ ‘‘Laid Back’’ Lateral ‘‘Camera’’ 08 Straight lateral 908 Usually –20–308 Left anterior oblique (LAO) Long axial oblique (not LAO) Hepatoclavicular (4-chamber) Aortic orifice view 20–708 08 frontal þ20–308 cranial 08 frontal þ308 caudal Standard Angiographic Projections Before you can learn the standard angiographic projections you need to confront some minor confusion about the reference points for the ‘‘camera’’ angles.
5, 15, and 30/sec. 5/sec can be maddeningly stutter-like, but you can get used to it. A rate of 15/sec will provide sufficient temporal resolution for most tasks. A rate of 30/ sec provides the best images, but at an obvious cost. Increase distance: Be aware of situations where you can increase distance, such as stepping back when performing cine-angiography. ) Make sure that other staff members are aware when a cine is about to be taken, so they can step back. , four times less exposure at two feet vs.
Positioning If positioning is important for femoral access, it is even more so for subclavian access! Position the patient with the ipsilateral arm down by the side of the patient. A small towel roll between the scapulae will allow the shoulder to fall back to get it out of the way in a well-sedated patient. Be sure the shoulder is not ‘‘shrugged’’ as this lifts the vessel, changes the expected anatomy, and makes things much more difficult. Turn the chin away. There is no substitute for good landmarks.