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Global Translational Medicine Modified cardiac catheterization

case of difficult echocardiography or complex shunts the performance of interventional procedures such as
and the detection and assessment of the severity of the diagnostic catheterization. The cardiac catheterizations
complications of these cardiac diseases [1-4] . It is also useful were performed in the main operating theater of LASUTH
in evaluating the hemodynamics of the right and left sides using the C-arm fluoroscopy machine, invasive blood
of the heart, as well as in measuring pulmonary pressures . pressure monitor, and transducer.
[5]
Pulmonary pressure evaluation is important in patients’ 2.2. Study population
workup for open heart surgery because pulmonary
hypertension is a major complication of both congenital All patients who had diagnostic cardiac catheterization
and acquired heart diseases in children and adults [5,6] . during the study period were recruited into the study,
The prevalence of pulmonary artery hypertension has while patients with incomplete data were excluded.
been reported to range from 28% to 80% [5,6] . Diagnosis 2.3. Data collection
of pulmonary artery hypertension can be made through
echocardiography; nonetheless, diagnostic catheterization A self-designed pro forma was used to collect the
[6]
is the gold standard . Furthermore, diagnostic information from the recruited subjects’ case files.
catheterization is also a pre-operative assessment tool to The extraction of data from case files was carried out
verify the fitness for surgical treatment of complex cardiac by two independent senior registrars in the unit. Any
lesions [6,7] . disparity between the extracted data of the two senior
registrars was checked and verified by the interventional
Congenital and acquired heart diseases are the cardiologist. Socio-demographics (age, sex, and tribe),
major disease burdens in Nigeria [7–14] . The prevalence primary diagnosis/indications for diagnostic cardiac
of congenital heart disease varies from 4.6 to 18.1/1000 catheterization, hemodynamics, untoward complications,
children and 2.5/1000 adults, as reported in tertiary and outcome were documented.
health-care centers in Nigeria [7,8,14] . On the other hand,
the prevalence of acquired heart disease varies from 0.7 to The diagnostic cardiac catheterizations were done at
3/1000 children [6-8] . the main theater of LASUTH, which had a C-arm machine
adapted for cardiac catheterization procedures. The
Diagnostic catheterization is usually performed in a pediatric subjects did not have solid food for 8 h. Milk or
standard catheterization laboratory; however, this is not infant formula was given for 4 – 6 h, and clear liquids for 2 h
readily available nationwide due to the challenges of the prior to the procedure. At the time of the procedure, general
cost of setup, logistics of personnel, and technicality of anesthesia was induced by intravenous administration of
maintenance [2-4] . Modified laboratories have been proposed midazolam and maintained by inhalation of isoflurane. The
as an alternative to a standard catheterization laboratory adult subjects had only local anesthesia with 2% lidocaine
for diagnostic cardiac catheterization [2-4] . Modifying at the site of catheterization. Venous and arterial accesses
the existing operating theaters with C-arm fluoroscopy were obtained after the puncture of femoral vessels by
machines and invasive blood pressure monitors can the Seldinger technique. Following the advancement of
be adopted as a start-up for simple diagnostic cardiac the sheaths and dilators (no.5–6 Fr), intravenous heparin
catheterization procedures [2,3] .
(100 U/kg) was given. Multipurpose angiographic (MPA)
This study aimed to review the experiences, outcomes, and Judkin’s left (JR) 4 catheters were used for the right
and challenges of diagnostic cardiac catheterization in heart catheterization, while a pigtail catheter was used for
the modified catheterization laboratory of Lagos State the left side of the heart. The hemodynamic state of the
University Teaching Hospital (LASUTH), Ikeja, Lagos, heart was assessed by obtaining pressures and samples for
Nigeria. blood gases. Pulmonary artery hypertension was defined
as mean pulmonary artery pressure ≥20 mmHg and
2. Methods pulmonary vascular resistance as ˃2 Wood units.
2.1. Study design and study site After the procedure, children were given antibiotics as
The study is a retrospective study of the diagnostic cardiac a routine prophylactic measure, monitored for the next 48
catheterization done at the cardiology unit of Lagos – 72 h and discharged. The adult patients were discharged
State University Teaching Hospital (LASUTH), Ikeja, home 6 h after the procedure.
from January 2022 to May 2022. LASUTH is a tertiary
health-care centers that receives referrals from all parts 2.4. Ethical considerations
of Lagos State and its environs. The adult cardiology Adult patients and parents/caregivers of the children for the
unit of LASUTH runs various activities, including study gave consent for diagnostic cardiac catheterization to

Volume 2 Issue 2 (2023) 2 https://doi.org/10.36922/gtm.249