Hello laddie33,
The concern you express over your wife?s medical care is very
touching, and I hope my answer will ease some of your fears. Please
keep in mind that this answer is for informational purposes only, and
not intended to replace the advice of a licensed physician. If my
answer is not precisely what you were seeking, please utilize the
Answer Clarification button, before rating. This will allow me to
assist you further, if possible.
You probably already know that a cardiac catheterization involves
threading a thin flexible tube, inserted into the right femoral vein,
or occasionally the brachial artery (arm) up into the heart. X-rays
using a contrast media, called fluoroscopic angiograms, are used to
monitor the procedure, and allow the doctor to visualize the heart and
blood vessels. The procedure usually lasts 1-2 hours, depending of
course, on each patient?s condition.
?Transseptal catheterization involves passing a catheter from the
right femoral vein to the right atrium, through the atrial septum into
the left atrium, and then across the mitral valve into the left
ventricle. Rarely, the left ventricle cannot be entered via retrograde
or transseptal technique, and a direct percutaneous puncture is
needed.?
http://www.merck.com/mrkshared/mmanual/section16/chapter198/198c.jsp
The fact that your wife?s skin does not heal well now due to previous
radiation therapy (RT), likely will have no effect on the closing of
the small hole left from catheterization. I found no articles, after
extensive searching, describing risk of atrial septum healing
problems in patients that had received RT, confirming the
radiologist?s statement. Forty years ago, the kinds and amounts of
radiation were much harsher than the low-dose and efficient radiation
used today, and many people do indeed now suffer late complications
such as skin discoloration and healing problems, and worse, cardiac
valve scarring. Tissues that divide rapidly, such as skin, hair, and
mucous membranes are much more susceptible to radiation?s damaging
effects, than is muscle, and heart is a form of muscle.
http://www.oncologychannel.com/hodgkins/radiation.shtml
You can see the catheter size, which is fairly small in diameter, on
this 6 minute video, outlining the procedure. This video does not
include atrial septum catheterization.
http://healthcommunities.com/videos/cardiac_catheterization.ram
?Any area of the body that has received radiation treatment should be
treated "gently" for the rest of the patient's life.?
http://www.healthcastle.com/se_radiation.shtml
?Radiation, especially as it was used 10 to 20 years ago, can lead to
heart valve damage such as leaking of the valve. This may require
surgery to fix the valve, if the damage is significant. In addition,
radiation can cause coronary artery narrowings and blockages,
potentially also requiring a cardiac catheterization and surgery. Open
heart surgery in patients who have had radiation can be difficult, as
they often have lots of scar tissue that the surgeon must tackle. An
experienced cardiologist and cardiac surgeon at a reputable medical
center are critical.?
http://www.medhelp.org/forums/cardio/archive/9431.html
?I had additional risk from a history of radiation treatments for
Hodgkins? Disease 22 years previous. Radiation can cause scarring of
the valves and coronary arteries.? And ?It now turns out that this
radiation can cause scarring of the valves on the left side of the
heart, and damage to the lymphatic drainage system from the lungs.
This is apparently what caused both my valve damage, and the damage to
the pulmonary system.?
http://www.valvereplacement.com/stories/johnny_stephens.htm
This abstract from Division of Radiation Oncology, University of Utah
Medical Center, Salt Lake City
The most common effects present as pericardial disease, however, it is
becoming more clear that precocious or accelerated coronary artery
disease is an important late effect, especially in patients treated
with radiation before the age of 21 years. To the extent it is known,
the pathophysiology of the various syndromes is described and the
extensive literature on dose, volume, and fractionation factors is
reviewed.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=95229473
?It is necessary to puncture the wall between the two receiving
chambers (the atrial septum between the right atrium and the left
atrium to gain access to the mitral valve). There is a risk that
sometimes a needle puncture may not end up in the correct place and
the wall of the heart be punctured and bleeding occurs into the heart
sack. This might require emergency surgery. The total risk of
emergency surgery is approximately 2%?
http://www.yourheart.org.uk/mitralvalvuloplasty.php
This article from the International Journal of Radiation Oncology,
Biology and Physics discusses a study of Hodgkin?s patients and
cardiac problems following radiation therapy.
?Conclusions: In our institution, 5.5% of patients treated for
Hodgkin's disease experienced a morbid cardiac event following RT to
the central cardiac volume. The doses given were greater than commonly
used today. Some patients experienced events at a young age, and the
likelihood of experiencing CD was increased compared to the general
population. This observation is consistent with RT as an additional
risk factor in the induction of morbid cardiac events. Appropriate
cardiac shielding and radiation doses, careful follow-up, which
includes monitoring of cardiac function, and a preventative program of
sensible dietary habits, exercise, and nonsmoking may be beneficial in
reducing cardiac morbidity in long-term survivors of Hodgkin's
disease.?
http://www.osti.gov/energycitations/product.biblio.jsp?osti_id=20392206
Your wife?s cardiologist is correct about most people healing well
after atrial septum catheterization. In the rare event that this does
not happen, there are several devices that are utilized to seal the
puncture. The cardiologist may or may not feel the need to utilize
some kind of plug. Generally plugs, devices, and mesh are used to
repair defects however, and not small holes following catheterization.
?The transcatheter closure device - typically a single or double wire
frame covered by fabric - is placed in the heart through a catheter
(tube) that is inserted through a vein in the groin.
Half of the device is connected to one side of the atrial septum (wall
between the two upper chambers of the heart), and the other half of
the device is attached to the other side of the atrial septum, forming
a sort of "sandwich" of the hole in the heart.
Within six to eight weeks, the device acts as a skeleton, stimulating
normal tissue to grow in and over the hole. These devices can be
safely used in growing children because while the device does not
grow, the tissue that covers the device does, and will continue to
grow with the child.?
http://www.csmc.edu/2363.html
Other devices include a Dacron mesh device, or a clam shaped plug.
Using the same kind of catheter as is used for the catheterization,
the cardiologist inserts a ?plugging device? and flattens it against
the septum. Natural blood pressure holds the device in place, and
with time, tissue grows over the device.
Animation depicting placement of one kind of atrial seal:
http://web1.tch.harvard.edu/cardioseal/Animation.html
Pictures of different types of mesh
http://www.tchin.org/resource_room/c_art_14.htm
VasoSeal may be used to seal the puncture site in the femoral or
brachial artery, after surgery.
?Recently, a vascular hemostatic device, VasoSeal (Datascope
Corporation, Montvale, NJ), was developed to deliver purified,
absorbable bovine collagen into the supra-arterial space through a
preloaded, syringelike system to promote hemostasis at the arterial
puncture site.6 This product is a device approved by the Food and Drug
Administration that provides an alternative method for sealing the
puncture in an artery made during cardiac catheterization.
Collagen is a protein that facilitates hemostasis by binding with
platelets and hastening the body?s natural clotting process even when
the patient is receiving high levels of anticoagulants. The use of
this device involves the deployment of collagen by a trained
physician, nurse, or technologist at the time of sheath removal.
Gentle nonocclusive pressure is maintained over the puncture site
until hemostasis is achieved, usually about 5 minutes. The puncture
site is dressed with a sterile dressing, and patients may ambulate
after 1 hour. Patients are usually discharged once they ambulate
without complication.?
http://www.aacn.org/AACN/jrnlajcc.nsf/0/344c9f47a82c003488256888007bf5c0?OpenDocument
?The wall between the ventricles is much thicker than the one
separating the atria, primarily because of the higher pressures that
blood inside the ventricles is subjected to. The greater portion of
the IVS is made of heart muscle, which is 12 to 16 mm. thick. In
structure, the IVS appears different on the two sides. While the left
ventricular side is smooth, the right side has many irregular ridges,
called trabeculations. A consistently seen muscular band is called the
TRABECULUM SEPTO-MARGINALIS, and is a valuable sign in determining the
ventricular morphology using echocardiography tests in cases of birth
defects of the heart.?
http://heartdisease.about.com/library/weekly/aa042097.htm
An informative article by Beth A. Kapes, all about Cardiac Catheterization:
http://www.findarticles.com/cf_dls/g2601/0002/2601000264/p1/article.jhtml?term=
Illustration of cardiac catheterization (Not a trans-atrial septum cath)
http://www.prodigy.nhs.uk/clinicalguidance/releasedguidance/webBrowser/pils/PL597.htm
Illustration of a cardiac catheterization:
http://www.med.umich.edu/1libr/aha/aha_hrtcath_art.htm
Photos of a procedure (non-graphic) and an animated angiogram of a beating heart.
http://www.cardiologysite.com/html/cath4.html
Transcatheter Hole Closure
http://www.nmtmedical.com/products/ci/vsdguide.html
One form of transseptal sheath(needle)
http://www.medtronic.com/epsystems/trans_sheaths_needles.html
Photo of a kind of catheter
http://www.cryocor.com/products/#catheter
**Warning**
People who are allergic to shellfish such as shrimp, lobster or crab,
may also be allergic to the dye used in catheterization. If you have
such an allergy, make sure the doctor is aware of it.
There you go, Laddie33. I hope this answers your question. Before
proceeding with the catheterization, please discuss any fears with
your wife's cardiologist, as s/he knows your wife's medical history.
I wish your wife the best!
Sincerely,
crabcakes
Search Terms
cardiac catheterization complications
atrial septum recovery catheterization
cardiac muscle heal post catheter
Trans-Catheter Closure of Holes catheterization
cardiac catheterization + hodgkins radiation |
Clarification of Answer by
crabcakes-ga
on
18 May 2004 10:23 PDT
Hi again Laddie33,
Thank you for requesting a clarification. No need to post another
question on this topic, as your question was perfectly clear. :-)
When I first answered your question, I was unable to locate anything
addressing the risks of atrial ?hole healing?. It appears that the
risk of an atrial septum hole from catheterization not closing is
negligible. Searching repeatedly for risks of cardiac catheterization
does not list ?catheter hole closure? as a risk or complication. 2mm
equals 0.08 inches, quite a small hole. Think how quickly we heal when
donating blood at the American Red Cross or United Blood Services, and
this uses a 14 gauge needle (0.07 inches)
MM to Inches converter:
http://www.sarraf.com/pages/convertmmtoinches.asp?pTopPage=convertmmtoinches
Today, I found *one* article addressing one of several techniques for
correcting mitral valve stenosis, that mentions atrial septum sealing.
PTMC (Percutaneous Transluminal Mitral Commisurotomy), a technique
that uses a balloon to dilate the stenosed mitral valve. I, of course
have no way of knowing what the cardiologist will find, and how s/he
will treat the stenosis, but ?The hole created in the inter-atrial
septum will usually close off by itself. Even if it is not sealed,
such a small hole should not cause any problem to the heart.?
http://www.pah.com.my/specialties/cardiology/PTMC.asp
?One type of repair is a procedure called mitral commisurotomy. Mitral
commisurotomy can be performed for some valves that are narrow or
"stenotic" either from birth or from damage by rheumatic fever. Most
often today, rheumatic mitral stenosis is treated by balloon
valvuloplasty, a procedure performed in the cardiac catheterization
laboratory by interventional cardiologists. Using a catheter with a
balloon on the end, the balloon is expanded inside the valve
"stretching" it open.
More often mitral valve repair is performed to correct a leaking or
regurgitant valve. Congenital mitral regurgitation may be due to a
cleft mitral valve (a valve with a separation or cleft down the
middle) associated with an atrial septal defect, a type of hole in the
heart between the low pressure chambers or atria. Such valves can
sometimes be repaired simply by closing the cleft with sutures. Valves
regurgitant due to bacterial endocarditis can occasionally be
repaired, however the majority of mitral valve repairs are performed
for degenerative disease.?
http://www.sts.org/doc/8783
The following article refers to atrial septal defects (ASD), and not
an atrial septum hole that was made surgically. However, it
illustrates what happens when blood flows from the left atrium into
the right atrium, and possibly back into the lungs, and causing
additional stress on the heart. Many people are born with ASD and live
without knowing it is present until they reach middle age. Symptoms of
ASD include shortness of breath, feeling very tired on exertion, and
fainting. Untreated ASD can lead to irregular heartbeat, heart
failure, and stroke.
http://www.clevelandclinic.org/heartcenter/pub/guide/disease/congenital/septal.htm
?An Atrial Septal Defect, or ASD, is a hole in the wall between the
right and left atria (atrial septum). In the presence of an ASD, blood
flows from the higher pressure left atrium to the lower pressure right
atrium. When this happens, the oxygen-rich blood of the left atrium is
redirected through the right side of the heart and back to the lungs.
The right atrium, right ventricle, and pulmonary artery may enlarge
due to the increased blood flow through these structures. Long-term
side effects of an untreated ASD include atrial arrythmias (loss or
abnormality of rhythm), ventricular dysfunction, and pulmonary
vascular obstructive disease (a condition in which the pulmonary
arteries become thickened due to high blood flow). For these reasons,
it is preferential to close even small ASDs early in life to prevent
complications later in life.?
http://www.nemours.org/no/ncc/cardiac/crd1521.html
Cardiac catheterization is not without risk, and I ?m sure your
cardiologist has reviewed the procedure and it?s risks with you and
your wife. However, it does appear that concerns over the inter-atrial
septum hole sealing, and the effects or prior radiation should not
occupy much space on your ?worry? list! Remember, your wife will be
under constant medical supervision while undergoing the procedure.
Wishing your wife the best throughout her catheterization procedure!
Please don't hesitate to request another clarification if you have any
other questions.
Sincerely, crabcakes
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