[Transthoracic catheterization under monitoring by ultrasono-cardiotomography and its clinical usefulness].
When serious postoperative complications such as mechanical malfunction of the implanted valve occur in patients with multiple valvular replacements, it is very urgent to evaluate the function of the valve and heart and to establish an accurate diagnosis as to the damaged prosthetic valve, while giving intensive life-saving bed-side care. Under such circumstances, transvascular heart catheterization necessary for obtaining hemodynamic data or for angiocardiography can not be applied because it is almost impossible for a catheter to pass through a prosthetic valve without potential danger. Then, the present authors have introduced a method of cardiac catheterization by a direct transthoracic route during which cardiac structures are monitored by ultrasono-cardiotomography. This method is called "transthoracic catheterization monitored by ultrasono-cardiotomography," and was applied to cases of double (aortic and mitral) valve replacements. The immobile adhesive area in the vicinity the right ventricular wall is detected from the longitudinal or horizontal cross-section pictures, through which a polyethylene catheter with stylet was introduced from the subxiphoid region and was advanced toward the left ventricle. After introduction of the catheter into the right ventricle, the catheter tip was advanced to the midportion of the ventricular septum, which was selected to avoid the penetration of the tricuspid valve and coronary arteries. Then, the catheter was passed into the left ventricle on the ultrasonic scanning plane along the direction of the short axis of the heart. After placing the catheter into the left ventricle, a small amount of contrast material was injected to confirm the precise positioning of the catheter tip in the left ventricle. Thus, the hemodynamic measurement and angiocardiograpy were performed easily. By utilizing contrast cardiotomography, valvular function was evaluated easily without any side effects as in case of angiocardiography. Furthermore, ultrasono-cardiotomography was sensitive in detecting cardiac tamponade if appeared during direct heart catheterization, making immediate treatment possible. Thus, transthoracic catheterization monitored by ultrasono-cardiotomography was useful for the evaluation of the function of the prosthetic valve, especially in cases with double valve prostheses.
D000328:Adult; D001022:Aortic Valve Insufficiency / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000601:surgery; D011182:Postoperative Care