14.15
心臓カテーテル検査：手技前の概要
心臓カテーテル検査は、心臓および主要な血管の構造的および機能的な疾患を特定し、評価するための侵襲的な診断技術です。この技術は、先天性心疾患、冠動脈疾患、弁膜症、冠攣縮を診断し、心室機能を評価します。治療決定を支援し、経皮的冠動脈インターベンション（PCI）や冠動脈バイパス移植術（CABG）などの再血…
心臓カテーテル検査は、心臓や主要な血管の構造的および機能的な疾患を特定および評価するために使用される侵襲的な診断技術です。
これは、冠動脈バイパス移植などの血行再建術の必要性を判断するなど、治療の決定を導くのに役立ちます。
この手順では、大腿静脈などの大静脈と橈骨動脈などの大動脈にカテーテルを挿入し、多くの場合、放射線不透過性造影剤を使用します。
透視法は、これらのカテーテルを左右の心腔に導き、左右の心臓カテーテル法として知られています。
通常、両方を併用して行いますが、心筋生検などの処置には右心カテーテル法だけで十分な場合があります。
手順の前に、造影剤に対する以前の反応を確認してください。
患者は、血清電解質やクレアチニンレベルなど、代謝機能や腎機能を評価するためにさまざまな血液検査を受けます。
プロトロンビン時間や国際正規化比などのベースライン凝固研究は、処置中の抗凝固剤の投与量をガイドするために実施されます。
ヘマトクリット値を含む全血球計算も、処置後の失血を監視するために必要です。
View the full transcript and gain access to JoVE Core videos
Q1: What is cardiac catheterization used to diagnose?
Cardiac catheterization is an invasive diagnostic technique that identifies and evaluates structural and functional diseases of the heart and major blood vessels. It diagnoses conditions such as congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms. The procedure also assesses ventricular function and measures intracardiac pressures and oxygen levels directly, helping guide treatment decisions including revascularization procedures.
Q2: How are catheters guided during cardiac catheterization?
Fluoroscopy guides catheters through major blood vessels into the heart's right and left chambers. Radiopaque catheters are inserted through a major vein, such as the femoral vein, and a major artery, such as the radial artery. Using contrast media and fluoroscopy enables visualization of the coronary arteries, delineation of heart chambers, and assessment of wall motion throughout the procedure.
Q3: What blood tests are required before cardiac catheterization?
Patients undergo blood tests to assess metabolic and renal function, including serum electrolytes and creatinine levels. Baseline coagulation studies such as prothrombin time and international normalized ratio guide anticoagulation dosage during the procedure. A complete blood count including hematocrit levels is also necessary to establish baseline values and monitor for blood loss post-procedure.
Q4: Why is contrast agent history important before the procedure?
Before cardiac catheterization, healthcare providers check for previous reactions to contrast agents to prevent allergic complications. Patients at risk for contrast-induced nephropathy, a typically reversible acute kidney injury, include those with chronic kidney disease, nephrotoxic medication use, dehydration, heart failure, and hypotension. Identifying these risk factors allows for appropriate preventive measures and patient monitoring.
Q5: What is the difference between right and left heart catheterization?
Right heart catheterization typically precedes left heart catheterization during the procedure. Right heart catheterization alone may suffice for specific procedures like myocardial biopsies or pulmonary artery pressure evaluations. Left heart catheterization requires a contrast agent to visualize coronary artery patency and evaluate left ventricular function, making it essential for comprehensive cardiac assessment.
Q6: What monitoring is critical during cardiac catheterization?
Continuous monitoring for dyspnea, chest pain, blood pressure changes, and ECG alterations is critical during the procedure, as these may indicate myocardial ischemia, hemodynamic instability, or arrhythmias. Patients receive one or more IV catheters to administer fluids and medications like sedatives and heparin. Resuscitation equipment must be easily accessible and ready for advanced cardiac life support.
Q7: How long is bed rest required after cardiac catheterization?
Post-procedure, patients require bed rest for 2 to 6 hours before ambulating. The length of bed rest depends on factors including catheter size, insertion site (femoral or radial artery), anticoagulation status, age, and bleeding disorders. Individual patient factors determine the specific duration needed to minimize complications such as hematoma formation or bleeding at the puncture site.