title: Sheath placement in femoral artery during cardiac catheterization in children can influence pressure waveform.
abstract: BACKGROUND
  It is reported that pressure wave reflection is enhanced by external compression of the femoral artery. Therefore, it is possible that cardiac catheterization itself can influence the aortic pressure waveform.
  
  
  OBJECTIVE
  The purpose of this study is to clarify the influence of sheath placement in a femoral artery on the pressure waveform.
  
  
  METHODS
  This study enrolled 21 pediatric patients (5.1±4.0years) who underwent cardiac catheterization. A sheath was placed in the femoral arteries of all patients. The change in the pressure waveform induced by the placement of the sheath was investigated using the b/a and d/a ratio of second derivative of a fingertip photoplethysmogram. A high b/a ratio means a stiff aorta and a low d/a ratio represents an enhancement of the aortic pressure wave reflection.
  
  
  RESULTS
  By the placement of the sheath in their femoral arteries, the b/a ratio was not influenced (sheath (-): -0.556±0.081 vs. sheath (+): -0.558±0.072; p=0.896). However, the d/a ratio was significantly decreased (-0.150±0.074 vs. -0.185±0.084; p=0.0003).
  
  
  CONCLUSIONS
  The placement of the femoral arterial sheath enhances the pressure wave reflection and would lead to a change in the central aortic pressure waveform.
authors.affiliation: Department of Cardiology, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba 266-0007, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shiraishi
authors.affiliation: Department of Cardiology, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba 266-0007, Japan. Electronic address: murat@seagreen.ocn.ne.jp.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Cardiology, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba 266-0007, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nawa
authors.affiliation: Department of Cardiology, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba 266-0007, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Higashi
authors.affiliation: Department of Cardiology, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba 266-0007, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Cardiology, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba 266-0007, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Aotsuka
mesh_terms: D001011:Aorta / Q000503:physiopathology*; D062186:Arterial Pressure / Q000502:physiology; D006328:Cardiac Catheterization; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008297:Male; D017156:Photoplethysmography
keywords: Augmentation index; Cardiac catheterization; Children; Photoplethysmogram; Pressure wave reflection; Second derivative of photoplethysmogram