Inferior vena cava occlusion catheter for pediatric patients with heart disease: For more detailed cardiovascular assessments

Abstract

Traditional evaluation of cardiac function is too often limited by reliance on measurements with complex interdependence between cardiac properties and loading factors. Analysis by ventricular pressure-volume (P-V), -area (P-A), or -dimension (P-D) relations during inferior vena caval (IVC) occlusion independently quantifies ventricular properties and loading conditions, providing detailed information about cardiovascular dynamics. However, there has been no appropriate size of balloon catheter that can effectively occlude IVC of pediatric patients, hindering the application of P-V (P-A, or P-D) analysis to children with heart disease despite its potential benefit. To address this problem, we have developed a new balloon catheter for IVC occlusion in children. The catheter effectively occluded IVC in 92 pediatric patients with varying forms of heart disease who underwent cardiac catheterization, yielding end-systolic pressure-area relations. Thus a newly developed balloon catheter would contribute to establishing more accurate and detailed cardiovascular assessments in children with heart disease. Cathet Cardiovasc Intervent 2001;53:392-396.

Pathophysiology of Pulmonary Circulation in Congenital Heart Disease

“…An instantaneous plot of ventricular pressure and volume change yields a pressure-volume loop [12]. We can further construct successive ventricular pressure-volume loops during transient preload reduction with inferior vena cava occlusion [11,13,14]. The slope of the end-systolic pressure-volume relationship, called end-systolic elastance (Ees), represents ventricular contractility, whereas arterial elastance (Ea) represents ventricular afterload and provides information on PA impedance [14,15].…”

Cardiac Rest and Reserve Function in Patients With Fontan Circulation

“…After routine cardiac catheterization and before angioventriculography, ventricular P-A relations were constructed by simultaneously measuring ventricular chamber pressure and area both at rest and during preloads varied by transient inferior vena caval (IVC) balloon obstruction. Details of this procedure have previously been reported (10,12,13). Briefly, ventricular pressure was measured with a high-fidelity pressure transducer mounted on a 0.014-inch diameter guidewire (Radi Medical Systems, Inc., Wilmington, Massachusetts) in a 4-or 5-F pigtail catheter.…”

Assessment of Ventricular Function Using the Pressure-Volume Relationship

“…Moreover, based on the measurement principle and its geometric assumption of the conductance catheter, it should Occlusion balloon catheter that can be inserted in a regular sheath for pediatric catheterization (5-7 Fr). Reprinted with permission from Senzaki et al [15] be difficult to accurately measure ventricular volume in patients with large ventricular septal defects or a single right ventricle.…”

“…A balloon catheter is usually introduced from the femoral vein through an appropriately sized sheath and advanced into the right atrium under fluoroscopic guidance. The balloon is inflated with CO 2 gas in the right atrium and then withdrawn toward the IVC, thus obstructing venous inflow [15]. Blood pressure recovers quickly enough after the procedure.…”

“…Newly developed balloon catheters for IVC occlusion with a reasonable size (5-7 Fr) for use in all pediatric and adult patients [11,15] have contributed to the safety and easy applicability of this procedure (Fig. 5.7).…”