Event Rates for Commonly Performed Cardiovascular Procedures

1
Event Rates for Commonly Performed Cardiovascular
Procedures
2
Complete List of Contraindications to Ultrasound
Contrast Agents

• Right-to-left, bi-directional, or transient
  right-to-left cardiac shunts
• Worsening or clinically unstable heart failure
• Acute myocardial infarction or acute coronary
  syndromes
• Serious ventricular arrhythmias or high risk for
  arrhythmias due to prolongation of the QT
  interval
• Respiratory failure, as manifest by signs or
  symptoms of carbon dioxide retention or hypoxemia
• Severe emphysema, pulmonary emboli or other
  conditions that cause pulmonary hypertension due
  to compromised pulmonary arterial vasculature
• Hypersensitivity to perflutren

3
Complete List of Absolute Contraindications to
Cardiac Catheterization
The only absolute contraindication to cardiac
catherization is refusal of a mentally competent
patient to consent to the procedure Grossman W.
Current practice standards. In Baim DS and
Grossman W, editors. Cardiac Catheterization,
Angiography and Intervention. Baltimore, MD
Williams and Wilkins, 19969-16
4
Pseudocomplication

• Complications occurring after any
• medical pocedure may be attributable to
• the procedure itself
• progression of underlying disease state
  (pseudocomplication)

5
Pseudocomplication
Hildner et al. Pseudocomplications of cardiac
catherization. Chest 19736315-17
Serious adverse events are relatively common in
patients who are sick enough to warrant
invasive testing
6
ACC/AHA/ASE 2003 Guidelines Update for the
Clinical Application of Echocardiography
7
ACC/AHA/ASE 2003 Guidelines Update for the
Clinical Application of Echocardiography
Echocardiographic contrast agents may improve
diagnosis in free wall rupture and in
identifying intracardiac thrombus.
8
Contrast Echocardiography is Superior to Tissue
Harmonics for Assessment of Left Ventricular
Function in Mechanically Ventilated Patients
Conversion of non-diagnostic to diagnostic study

Kornbluth et al. Am Heart J 2000140291-6
9
Contrast Echocardiography is Superior to Tissue
Harmonics for Assessment of Left Ventricular
Function in Mechanically Ventilated Patients
Wall motion scoring possible
1/5 of mechanically ventilated patients will
require TEE if contrast contraindicated

Kornbluth et al. Am Heart J 2000140291-6
10
Contrast Echocardiography Clarifies
Uniterpretable Wall Motion in Intensive Care Unit
Patients
of patients with uniterpretable left
ventricular function

Reilly JP et al. J Am Coll Cardiol 200035485-90
11
Diagnostic Accuracy and Cost-Effectiveness of
Contrast Echocardiography on Evaluation of
Cardiac Function in Technically Very Difficult
Patients in the Intensive Care Unit
Excellent or Adequate Endocardial Visualization

Yong et al. Am J Cardiol 200289711-718
12
Complications of Transesophageal Echocardiography
Seward JB et al. J Am Soc Echocardiogr
19925228
13
Complications of Transesophageal Echocardiography
Mortality rate 1/10,000
Daniel WG et al. Circulation 19918317-821