Sağ Kalp Kateterizasyonu
Özet
Sağ kalp kateterizasyonu (SKK), kardiyopulmoner hastalıklarda hemodinamik değerlendirme için altın standart invazif yöntemdir. Sağ atriyum, sağ ventrikül, pulmoner arter ve pulmoner kapiller uç basınçlarının doğrudan ölçülmesine olanak sağlayarak kardiyak debi, pulmoner vasküler direnç ve sol kalp dolum basınçları hakkında güvenilir bilgiler sunar. Bu bölümde SKK’nin temel prensipleri, endikasyonları, hasta hazırlığı, venöz erişim teknikleri ve basınç ölçüm yöntemleri özetlenmiştir. Ayrıca kardiyak debi hesaplamaları, vasküler direnç formülleri, intrakardiyak şant değerlendirmesi ve vazoreaktivite testi ele alınarak işlem sırasında elde edilen hemodinamik verilerin doğru yorumlanması vurgulanarak klinik uygulamaya yönelik pratik bilgiler sunulmuştur.
Right heart catheterization (RHC) is the gold standard invasive method for hemodynamic assessment in cardiopulmonary diseases. By enabling direct measurement of right atrial, right ventricular, pulmonary arterial, and pulmonary capillary wedge pressures, it provides reliable information on cardiac output, pulmonary vascular resistance, and left heart filling pressures. This chapter summarizes the basic principles of RHC, its indications, patient preparation, venous access techniques, and pressure measurement methods. In addition, cardiac output calculations, vascular resistance formulas, assessment of intracardiac shunts, and vasoreactivity testing are discussed, with an emphasis on the accurate interpretation of the hemodynamic data obtained during the procedure, offering practical information for clinical application.
Referanslar
Nossaman BD, Scruggs BA, Nossaman VE, Murthy SN, Kadowitz PJ. History of right heart catheterization: 100 years of experimentation and methodology development. Cardiol Rev 2010;18:94–101.
Forssmann W. Die Sondierung des rechten Herzens. Klin Wochenschr. 1929;8(45):2085-2087.
Cournand A, Ranges HA. Catheterization of the right auricle in man. Proc Soc Exp Biol Med. 1941;46(3):462-466.
Cournand A, Riley RL, Breed ES, Baldwin EF, Richards DW Jr, Lester MS, et al. Measurement of cardiac output in man using the technique of catheterization of the right auricle or ventricle. J Clin Invest. 1945;24(1):106-116.
Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970;283(9):447-451.
Forrester JS, Ganz W, Diamond G, McHugh T, Chonette DW, Swan HJ. Thermodilution cardiac output determination with a single flow-directed catheter. Am Heart J. 1972;83(3):306-311.
Chen Y, Shlofmitz E, Khalid N, Bernardo NL, Ben-Dor I, Weintraub WS, et al. Right Heart Catheterization-Related Complications: A Review of the Literature and Best Practices. Cardiol Rev. 2020 Jan/Feb;28(1):36-41.
Hill JA, Liporace RJ, Roy LJ, Joseph A. Safety of right-heart catheterization in patients with elevated INR. Catheter Cardiovasc Interv. 2009;73(1):106-109.
Locatelli G, Donisi L, Mircoli L, Colombo F, Barbieri L, Tumminello G, et al. Right heart catheterization: an antecubital vein approach to reduce fluoroscopy time, radiation dose, and guidewires need. Diagnostics (Basel). 2023;13(16):2643.
Oh C, Lee S, Jeon S, Park H, Chung W, Shim MS, et al. Errors in pressure measurements due to changes in pressure transducer levels during adult cardiac surgery: a prospective observational study. BMC Anesthesiol. 2023;23:9.
Naeije R, Vachiery JL, Yerly P, Vanderpool R. The transpulmonary pressure gradient for the diagnosis of pulmonary vascular disease. Eur Respir J. 2013;41(1):217-223.
Stewart GN. Researches on the circulation time and on the influences which affect it. J Physiol. 1897;22(3):159-183.
Hoeper MM, Lee SH, Voswinckel R, Palazzini M, Jais X, Marinelli A, et al. Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol. 2006;48(12):2546-2552.
Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Eur Heart J. 2022;43(38):3618-3731.
Lairez O, Delmas C, Boudou N, Carrié D, Galinier M. Should right heart catheterization be realized in patients with a mechanical tricuspid valve? Interv Cardiol. 2013;5(3):275-277.
Morris AH, Chapman RH. Wedge pressure confirmation by aspiration of pulmonary capillary blood. Crit Care Med. 1985;13(9):756-759.
Rajagopalan N, Borlaug BA, Bailey AL, Eckman PM, Guglin M, Hall S, et al. Practical Guidance for Hemodynamic Assessment by Right Heart Catheterization in Management of Heart Failure. JACC Heart Fail. 2024;12(7):1141-1156.
Geerts BF, Aarts LP, Jansen JR. Methods in pharmacology: measurement of cardiac output. Br J Clin Pharmacol. 2011;71(3):316-330.
Dehmer GJ, Firth BG, Hillis LD. Oxygen consumption in adult patients during cardiac catheterization. Clin Cardiol. 1982;5(8):436-440.
Naeije R, Vanderpool R, Dhakal BP, Saggar R, Saggar R, Vachiery JL, et al. Exercise-induced pulmonary hypertension: physiological basis and methodological concerns. Am J Respir Crit Care Med. 2013;187(6):576-583.
Kovacs G, Avian A, Olschewski H. Right heart catheterization in clinical practice: a review of basic physiology and important issues relevant to interpretation. Eur Respir Rev. 2022;31(165):220169.
Lopes AA, Barst RJ, Haworth SG, Rabinovitch M, Al Dabbagh M, Del Cerro MJ, et al. Repair of congenital heart disease with associated pulmonary hypertension in children: what are the minimal investigative procedures? Consensus statement from the Congenital Heart Disease and Pediatric Task Forces, Pulmonary Vascular Research Institute (PVRI). Pulm Circ. 2014;4(2):330-341.
Kovacs G, Avian A, Olschewski A, Olschewski H. Monitoring pulmonary vascular resistance during pulmonary vasoreactivity testing. Eur Respir J. 2014;43(2):599-602.
Grossman's Cardiac Catheterization, Angiography, and Intervention. Baim DS, Kern MJ, Lim MJ, editors. Philadelphia: Wolters Kluwer; 2021.
Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645.
Sheppard MN, Davies MJ, Crocker J, Crocker J. Intra-procedural arrhythmia during cardiac catheterization: a systematic review of literature. World J Cardiol. 2020;12(6):283-293.
