Cardiac Catheterization Objectives - Stanford Medicine

[Pages:5]Cardiac Catheterization Objectives:

Knowledge Vascular Access:

? Basic understanding of access site anatomy, including femoral artery and vein, internal jugular vein, and brachial artery

? Basic Understanding of disease conditions (and surgical correction) involving these anatomic structures

? Appreciate atherosclerotic disease of the ileo-femoral system and knowledge of surgical revascularization anatomy, including Aorto-bifemoral graft, Fem-fem bypass, and Fem-pop bypass

Right Heart Catheterrization (Hemodynamics): Basic understanding of normal and abnormal right heart hemodynamics with specific attention to the following disease states.

? Congenital ASD ? Congenital VSD ? 1? Pulomonary Hypertension ? Congestive Heart Failure ? Constrictive physiology ? Cardiac Tamponade

Left Heart Catheterization (Hemodynamic): Basic understanding of normal and abnormal left heart hemodynamics with specific attention to the following disease states.

? Aortic Insufficiency ? Aortic Stenosis ? Gorlin Equation ? Hypertrophic Cardiomyopathy ? Mitral Insufficiency ? Mitral Stenosis ? Gorlin Equation ? Cardiomyopathy ? Constrictive physiology ? Cardiac Tamponade ? Measurements of Cardiac Output: Fick, Thermodilution

Left Ventriculography: Basic understanding of normal and abnormal left ventricular function with specific attention to the following disease states:

? Coronary Artery Disease ? Mitral Insufficiency ? Hypertrophic Cardiomyopathy ? Estimation of Ejection Fraction

Coronary Angiography: Basic understanding of normal anatomy, pathologic impact on anatomy and surgical impact. with specific attention on the following:

? Normal Coronary Anatomy ? Common Congenital Abnormalities ? Anomalous Origins of the major Coronary Arteries ? Coronary Artery Disease ? Saphenous Vein Grafts ? Internal Mammary Arteries

Aortography & Ileo-femoral angiography: Basic understanding of normal anatomy, pathologic impact on anatomy and surgical impact. with specific attention on the following:

? Aortic Insufficiency ? Aneurysm ? Ascending Aorta ? Descending Aorta ? Abdominal Aorta ? Aortic Dissection ? Surgical Repair of Aortic Dissection

Right Ventricular Biopsy: Basic understanding of cardiomyopathic conditions in which right ventricular biopsy plays a role in diagnosis and/or management:

? Allograft Rejection ? Infiltrative Cardiomyopathy ? Anthracycline Cardiomyopathy

Intra-aortic Balloon Pump: Basic understanding of the indications, contraindications, insertion techniques, and troubleshooting.

Cardiac Catheterization Laboratory Equipment: Basic understanding of the equipment and devices used in the Catheterization Laboratory

? x-ray/fluoroscopic equipment ? Pressure Manometers ? Digital Storage System

Skills

Vascular Access: Obtain access via the Modified Seldinger Technique without assistance from others:

? Femoral Artery & Vein ? Internal Jugular Vein ? Brachial Artery (2nd year Only)

Remove sheaths and obtain hemostasis by manual compression and use of femoral closure device (femoral artery only)

Right Heart Catheterization (Hemodynamic): perform right heart catheterization without assistance.

Left Heart Catheterizatization (Hemodynamic): perform left heart catheterization with assistance.

Left Ventriculography: perform left heart catheterization with assistance

Coronary Angiography

? Perform coronary angiography with assistance (1st year) ? Perform coronary angiography without assistance (2nd year)

Aortography & Ileo-femoral angiography

? Perform Aortography & Ileo-femoral angiography with assistance (1st year) ? Perform Aortography & Ileo-femoral angiography without assistance (2nd year)

Right Ventricular Biopsy: perform right ventricular biopsy in patients s/p heart transplantation with assistance

Intra-aortic Balloon Pump

? Place an Intra-aortic Balloon Pump in an elective manner (1st year) ? Place an Intra-aortic Balloon Pump in an emergent manner (2nd year)

Cardiac Catheterization Laboratory Equipment: Trouble shoot common problems with equipment

Teaching Methods

? Pre-cath evaluation: Fellows are responsible for the pre-procedure evaluation of each patient scheduled for cardiac catherization. They present their findings to the attending physician. During the case presentation, the workup is critiqued by the attending. When warranted, discussion of recent literature pertaining to patient management occurs at this time.

? Cath Procedure: Direct observation.All cases are closely supervised by the attending.Early in the year, the attending performs the majority of the procedure and explains the techniques `in real time'.By the second week of their first cath rotation, fellows are the primary operators during each diagnostic procedure but continue to receive close supervisition from the attendings.

? Post Procedure Care: Fellows are responsible for the post-procedure care and evaluation of patients undergoing diagnostic cardiac catherizations.All complications should be reviewed with the attendings.

Methods of Evaluation

? Direct observation by the faculty ? Chart review by faculty

References

Vascular Access

? Baim DS and Grossman W.Percutaneous approach and transseptal catheterization. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 59-75.

Right Heart Catheterization (Hemodynamic)

? Ganz P, Swan HJC & Grossman W.Balloon-Tipped Flow-Directed Catheters. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 88-100. Grossman W.Blood Flow Measurements:The Cardiac Output. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 101-117. Grossman W.Clinical Measurement of Vascular Resistance and Assessment of Vasodilator Drugs.Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 135-142.

? Grossman W.Shunt Detection and Measurement. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 155-172.

Left Heart Catheterization (Hemodynamic)

? Carabello BA and Grossman W.Calculation of Stenotic Valve Area.Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 143-154.

Left Ventriculography

? Hillis LD, Grossman W. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 200-212.

Coronary Angiography

? Silverman JF. Coronary Angiography.An introduction to interpretation and technique.1984.

? ACC/AHA Practice Guidelines for Coronary Angiography.J Am Coll Cardiol 1999;33:1756-1824.

Aortography &Ileo-femoral angiography

? Paulin S. Aortography. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 227-251.

Right Ventricular Biopsy

? Fowels RE, Baim DS. Endomyocardial Biopsy. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 506-516.

Intra-aortic Balloon Pump

? Aroesty JM.Percutaneous Intraaortic Balloon Insertion. Cardiac Catheterization and Angiography(Grossman W Editor).Lea & Febiger, Philadelphia 1985.pp. 493505.

Percutaneous Coronary Interventions

? ACC/AHA Practice Guidelines for Percutaneous Coronary Interventions.J Am Coll Cardiol2001;37:2239.

Coronary Bypass Surgery

? ACC/AHA Practice Guidelines for Coronary Artery Bypass Graft Surgery.J Am Coll Cardiol1999;47:1262-347.

Aortic Valve Disease

? ACC/AHA Practice Guidelines for the Management of Patients with Valvular Heart Disease.J Am Coll Cardiol1998;32:1486-588.

Mitral Valve Replacement/Repair

ACC/AHA Practice Guidelines for the Management of Patients with Valvular Heart Disease.J Am Coll Cardiol1998;32:1486-588.

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