CA1333291C - Method for carrying out hemodynamic measurements on a patient and flow-directed balloon catheter used for this - Google Patents

Method for carrying out hemodynamic measurements on a patient and flow-directed balloon catheter used for this

Info

Publication number
CA1333291C
CA1333291C CA000570599A CA570599A CA1333291C CA 1333291 C CA1333291 C CA 1333291C CA 000570599 A CA000570599 A CA 000570599A CA 570599 A CA570599 A CA 570599A CA 1333291 C CA1333291 C CA 1333291C
Authority
CA
Canada
Prior art keywords
catheter
measuring
lumen
pressure
balloon
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Fee Related
Application number
CA000570599A
Other languages
French (fr)
Inventor
Joannes Hendricus Aloys Heuvelmans
Hieltje Goslinga
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
STICHTING FOUNDATION FOR ADMINISTRATION OF PATENT RIGHTS OF DR H GOSLINGA ET AL
Original Assignee
Joannes Hendricus Aloys Heuvelmans
Hieltje Goslinga
Stichting Foundation For The Administration Of Patent Rights Of Dr H. Goslinga Et Al.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Joannes Hendricus Aloys Heuvelmans, Hieltje Goslinga, Stichting Foundation For The Administration Of Patent Rights Of Dr H. Goslinga Et Al. filed Critical Joannes Hendricus Aloys Heuvelmans
Application granted granted Critical
Publication of CA1333291C publication Critical patent/CA1333291C/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/02Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/026Measuring blood flow
    • A61B5/0275Measuring blood flow using tracers, e.g. dye dilution
    • A61B5/028Measuring blood flow using tracers, e.g. dye dilution by thermo-dilution
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/02Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021Measuring pressure in heart or blood vessels
    • A61B5/0215Measuring pressure in heart or blood vessels by means inserted into the body
    • A61B5/02158Measuring pressure in heart or blood vessels by means inserted into the body provided with two or more sensor elements

Abstract

A method for carrying out hemodynamic measurements on a patient, using a flow-directed balloon catheter, which is connected to a measuring unit and is at least provided with a distal measuring lumen and a balloon-inflating lumen, comprising the steps of inserting the catheter by way of a suitable vein and further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the inflated balloon in wedge position is stuck in a branch thereof and closes off the latter. A proximal measuring lumen is provided a few centimetres apart from the distal measuring lumen. Then the pulmonary arterial pressure (PAP) is measured, as long as the catheter has not yet arrived in the wedge position, via both the proximal and distal measuring lumina and the two relevant, virtually identical pressure curves are simultaneously recorded.

In the wedge position of the catheter with the balloon inflated, the pulmonary arterial pressure (PAP) and the pulmonary capillary wedge pressure (PCWP) via both said measuring lumina are measured respectively.

A flow-directed balloon catheter for hemodynamic measurements for use with the above method, said catheter being provided with a distal measuring lumen, a balloon-inflating lumen, and a proximal measuring lumen a few centimetres apart from the distal measuring lumen.

Description

Method for carrying out hemodynamic measurements on-a patient and flow-directed balloon catheter used for this.

The invention relates to a method for carrying out hemodynamic measurements on a patient, using a flow-directed balloon catheter, which is connected to a control and pressure-measuring unit and is at least provided with a distal measuring lumen and a balloon-inflating lumen, comprising the steps of inserting the catheter by way of a suitable vein until the distal end is positioned inside the thorax, and of subsequently inflating the balloon and of inserting the catheter further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the balloon in wedge position is stuck in a branch thereof and closes off the latter. By measuring lumen, the opening end of a through tube is meant, which tube is connected at the other end to the control and pressure-measuring unit.
This method and the catheter used for this are known, inter alia, from the article "Hemodynamic Monitoring" by N. Buchbinder and W. Ganz in !'Anesthesiology", August 1976, vol 45, no. 2,.pages 146-155.
In this known method and catheter, a number of hemodynamic measurements are carried out in order to gain an impression therewith of the functioning of heart and circulation. The pulmonary arterial pressure (PA pressure) and the pulmonary capillary wedge pressure (PCW pressure) play a very important role here. The pulmonary capillary wedge pressure is regarded as being a good measure of the end-diastolic pressure in the left ventricle because there is a continuous head of fluid (blood) between the left atrium and the catheter end in wedge position. As a result the PCW
pressure can be designated as the filling pressure in the left atrium. The functioning of the left ventricle as a pump is determined to a considerable extent by the end-diastolic volume in the left ventricle. For a satisfactory approximation of this volume, the end-diastolic pressure in this left ventricle can be used. Catheterization of an artery would be necessary to measure this pressure directly. Instead of this, the PCW pressure, which can be assessed by routine measurement with hemodynamic monitors, is used. It is evident that a partial or unsatisfactorily controlled wedge position of the catheter makes the measurement unreliable. A
partial wedge position will generally be recognisable by the pressure curve shown on a monitor. However, this is not always the case because PCW pressure curves often do not show the "ideal picture" and, because there is great variability in PCW pressure curves.
Additionally, the known method of carrying out hemodynamic measurements has the problem that the PA pressure is measured during introduction of the catheter with the inflated balloon into the pulmonary artery and that the PCW pressure is measured at a subsequent instant when the wedge position of the catheter is reached. It also holds that the PA pressure is measured when the catheter has been brought into position without the balloon being inflated and that the PCW pressure is measured at a subsequent instant, after inflating the balloon. Due to the fact that these curves are recorded only at consecutive instants in this way they can therefore be assessed and evaluated on the monitor exclusively with consideration of the time difference. A further problem which occurs is that a catheter with non-inflated balloon may come in a wedge position which is displaced upwards, which may not be noticed or is not directly noticeable because the PCW pressure curve cannot always satisfactorily be distinguished from the PA pressure curve which is measured first. Such an upward displaced wedge position, which may be caused with a non-inflated balloon by some artefact or other, may have very adverse effects on the blood through-flow in the pulmonary artery of the patient.
The invention aims at overcoming the above-mentioned problems and at providing an exceptionally efficient and safe method and a catheter used for this, by which the safety of insertion and positioning of the catheter and the quality and control of the pulmonary pressure measurement are guaranteed.
In a first aspect of the invention there is provided a method for carrying out hemodynamic measurements on a patient, using a flow-directed balloon catheter, which is connected to a control and pressure-measuring unit and is at least provided with a distal measuring lumen and a balloon-inflating lumen, comprising the steps of inserting the catheter by way of a suitable vein until the distal end us positioned inside the thorax, subsequently inflating the balloon, inserting the catheter further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the inflated balloon in wedge position is stuck in a branch thereof and closes.off the latter, providing a proximal measuring lumen spaced closely to the distal measuring lumen, measuring the pulmonary arterial pressure (PAP) during insertion of the catheter into the pulmonary artery as long as the catheter has not yet arrived in the wedge position via both the proximal measuring lumen and the distal measuring lumen, and simultaneously recording the two relevant, virtually identical pressure curves with the measuring unit.
According to a second aspect of the invention there is provided a method or carrying out hemodynamic measurements on a patient using a flow-directed balloon catheter which is connected to a control and pressure-measuring unit and is at least provided with a distal measuring lumen, a balloon-inflating lumen and a proximal measuring lumen spaced closely r~ -13332~1 3a to the distal measuring lumen, said method comprising the steps of:
inserting the catheter by way of a suitable vein until the distal end is positioned inside the thorax;
subsequently inflating the balloon;
inserting the catheter further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the inflated balloon in wedge position is stuck in a branch thereof and closes off said branch;
measuring pulmonary arterial pressure (PAP) during insertion of the catheter into the pulmonary artery as long as the catheter has not yet arrived in the wedge position via both the proximal measuring lumen and the distal measuring lumen;
measuring, in the wedge position of the catheter with the balloon inflated, the pulmonary arterial pressure (PAP) and the pulmonary capillary wedge pressure (PCWP) via the proximal measuring lumen and via the distal measuring lumen; and simultaneously recording two relevant pressure curves with the measuring unit reflecting said measurement via the proximal measuring lumen and via the distal measuring lumen at all times so that the moment at which the catheter arrives in the wedge position can be clearly detected as said two curves diverge, whereby 6imultaneous measurement of said pressures relative to each other is independent of interfering cardiac and respiratory influences.

3b A further aspect of the invention provides a method for carrying out hemodynamic measurements on a patient using a flow-directed balloon catheter which is connected to a control and pres~ure-measuring unit and is at least provided with a distal measuring lumen, a balloon-inflating lumen and a proximal measuring lumen spaced closely to the distal measuring lumen, said method comprising the steps of:
inserting the catheter by way of a suitable vein until the distal end positioned inside the thorax;
subsequently inflating the balloon;
inserting the catheter further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the inflated balloon in wedge position is stuck in a branch thereof and closes off said branch;
measuring pulmonary arterial pressure (PAP) during insertion of the catheter into the pulmonary artery as long as the catheter has not yet arrived in the wedge position via both the proximal measuring lumen and the distal measuring lumen;
measuring, in the wedge position of the catheter with the balloon inflated, the pulmonary arterial pressure (PAP) and the pulmonary capillary wedge pressure (PCWP via the proximal measuring lumen and via the distal measuring lumen;
simultaneously recording two relevant pressure curves with the measuring unit reflecting said measurement of said pulmonary arterial and pulmonary capillary measurement of said pulmonary arterial and pulmonary capillary wedge pressures at B

.," v 3c 13~3~1 all times 80 that the moment at which the catheter arrives in the wedge position can be clearly detected as said two curves diverge, whereby simultaneous measurement of said pressures relative to each other i8 independent of interfering cardiac and respiratory influences; and incidentally inflating the balloon in the wedge position of the catheter and measuring said pulmonary arterial and pulmonary capillary wedge pressures simultaneously via the two measuring lumina in the uninflated and inflated state of the balloon so as to produce virtually identical and mutually different pressure curves on the measuring unit as a result of which the wedge position is exactly determined and a reliable measure of the pulmonary arterial and pulmonary capillary wedge pressures is guaranteed.

According to a still further aspect of the invention there is provided a method for carrying out hemodynamic measurements on a patient using a flow-directed balloon catheter which is connected to a control and pressure-measuring unit and is at least provided with a distal measuring lumen, a balloon-inflating lumen and a proximal measuring lumen spaced closely to the distal measuring lumen, said method comprising the steps of:
inserting the catheter by way of a suitable vein until,the distal end is positioned inside the thorax subsequently inflating the balloon;

~.

3d 13~3291 inserting the catheter further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the inflated balloon in wedge position i8 stuck in a branch thereof and closes off said branch;
measuring pulmonary arterial pressure (PAP) during insertion of the catheter into the pulmonary artery as long as the catheter has not yet arrived in the wedge position via both the proximal measuring lumen and the distal measuring lumen;
simultaneously recording the two relevant, virtually identical pressure curves with the measuring unit;
measuring, during the insertion of the catheter by way of the right atrium and ventricle into the pulmonary artery or during removal of the catheter therefrom the pressure on one side and on the other side of a valve selected from the group consisting of the tricuspid valve, the pulmonary valve and both tricuspid and pulmonary valves, by means of the proximal and distal measuring lumina and recording the pressure gradient over the said valve on the measuring unit by means of two pressure curves.
-------------The flow-directet balloon catheter mentioned in the outset is tesigned for carrying out the abovementionet method6 in a manner 6uch that a proximal measuring lumen i6 provided a few centimetres apart from the distal measuring lumen which make6 it possible to measure the pulmonary arterial pre6sure and the pulmonary capillary wedge pres6ure simultaneously in the wedge position of the catheter. Present catheter may also be implementet such that each measuring lumen includes a pressure tran6ducer, f.i. in chip form.
Said transducer directly converts the pres6ure, mea6ured at said lumen, into an electrical signal. Said signal is transmitted to the mea6uring unit instead tbat the pressure, otherwise present in the lumen and corresponding tube, is converted into a signal via a transducer in the messuring unit per se.
It is known in practice to provide such a flow-directed balloon catheter with a proximal lumen for mea6uring pre66ures, this being provided, however, at a di6tance of 25 to 30 cm from the di6tal tip. Thi6 proximal lumen i6 601ely intended for mea6uring the right atrial pressure or the central venous pre6sure when the distal tip of the catheter is located in the pulmonary artery.
Furthermore, particular fluids for infusion or medicines may be administered via this lumen.
The invention will be explained in detail by mean6 of an embodiment with reference to the drawings, in which:
Figure 1 6hows a simplified diagram of the systemic blood -.
: - .

circulation in humsn beings;
Figure 2 ~hows a view of a known flow-directed balloon catheter;
Figure 3 ~hows a curve exemplifying the blood pre~ure measured via the catheter from the right trium to the wedge pO8 ition;
Figure 4 (which appears on the s~me eheet as Fig. 2) shows a view of the flow-directed catheter sccording to the invention;
Figure 5 show~ curves of the pulmonsry arterial pressure and the pulmonary capillary wedge pressure measured according to the state of the art and of some other parameters;
Figure 6 shows curves of the pulmonary arterial pres~ure and the pulmonary capillary wedge pressure measured according to the invention, and of some other parameters;
Figures 7 and 8 show curves of the pres~urea mea~ured according to the invention on either side, of the tricuspid valve and the pulmonary valve, and of some other parameter~; and Figures 9 and 10 show a few other curves mes~ured according to the invention.
Figure 1 shows diagrammatically the systemic blood circulation with the heart in diastole, i.e. with the ventricle~ 7 and 9 relaxed, the pulmonary valve 10 and aortic valve 11 clo~ed and the tricuspid valve 12 and mitral valve 13 opened. In thiJ, 1 designates a catheter inserted into the pulmonary artery 3. Part of the pulmonary circulation, the systemic circulation of the body, the right atrium, the right ventricle, the left atrium, the left ventricle and the pul00nary vein are indicated diagrammatically by 4, 5, 6, 7, 8, 9 and 14, respectively. It can be seen how the flow-directed bslloon catheter 1 with the balloon 2 inflated has arrived near the wedge position in the pulmonary artery 3.
Figure 2 shows a known catheter provided with a di8tal mes~uring lumen 15, a balloon-inflating lumen 16 and a thermi~tor 17 (the function of which is explained hereinafter). During in~crtion of the catheter the tistal measuring lumen can be u~et to mea~ure the pressure consecutively in the right trium, ri8ht ventricle and thereafter ;n the pulmonary artery a8 i~ ~hown in Figure 3. Thi~
figure ~hows at the bottom specifically, viewed from the left, in X

6 1 3 3 3 2 9 l succession the right atrium pressure (RAP), right ventricular pressure (RVP), pulmonary arterial pressure (PAP) and pulmonary capillary wedge pressure (PCWP) during insertion of the catheter and the pulmonary arterial pressure (PAP) again during removal of the catheter or deflation of the balloon. This figure furthermore shows the electrocardiogram (EKG), the radial arterial pressure (ART) and respiration (RSP) of said patient.
Figure 4 shows the catheter according to the invention which is additionally provided with a proximal measuring lumen 18 a few centimetres apart from the distal measuring lumen 15. As indicated before each lumen may include a pressure (chip) transducer. This embodiment makes it possible to measure simultaneously the PA
pressure and PCW pressure and the pressures at either side of the tricuspid valve and on either side of the pulmonary valve as indicated by Figures 5 to 8.
As mentioned before, the position of the distal end of the catheter may represent a possible risk for the patient. In fact, the catheter may spontaneously move into an upward-displaced wedge position with the balloon uninflated. As a result, the blood supply to the region of the lung located behind this is shut off, and the consequence may be a pulmonary infarct. Such an unexpected displacement of the catheter tip without inflated balloon into an upward-displaced wedge position is not always noticed or it is not always directly recognisable from the PA pressure curve or the PCW
pressure curve which then occurs. However, in this situation the new catheter can contribute to an alarm being given by the control and pressure measuring unit.
Figure 5 consecutively shows the electrocardiogram (Figure 5a), the radial arterial pressure (ART) and respiration (RSP) of a patient (Figure 5b), and the pressure measured in the pulmonary artery (Figure 5c) in mm Hg. This PA pressure measured with the known catheter passes over to the PCW pressure during further insertion of the catheter with inflated balloon or when the catheter is already in the wedge position after inflation of the balloon. CVP
and TMP means central venous pressure and temperature respectively.
Figure 6 consecutively shows the electrocardiogram (Figure 6a), the radial arterial pressure (ART) and respiration (RSP) of a patient (Figure 6b), and the pressure6 measured by the distal and proximal measuring lumina of the catheter according to the invention (Figure 6c) in the pulmonary artery. During further insertion of the catheter with the balloon inflated or when the catheter i6 already in the wedge position after inflation of the balloon, the two curves will diverge because the distal measuring lumen will measure the PCW pressure and the proximal measuring lumen will measure the PA pressure.
Due to the fact that the PA and PCW pressure curves can be measured simultaneously, control of the pulmonary pressure measurement is considerably improved. When the catheter is in position, but not in the wedge (balloon not inflated), the PA
pressure curve and the PCW pressure curve converge. If this is not the case the catheter has come spontaneously in an upward-displaced wedge position or the two pressure systems are no longer exactly synchronous (artefact transducer, incorrect calibration procedure, etc.). In the case of a single pulmonary pressure curve it will not be possible to detect these deviations as quickly.
Figure 7 consecutively shows for a patient: the electrocardiogram (Figure 7a), the respiration (Figure 7b) and the simultaneously measured right atrial pressure (RAP: bottom curve) and right ventricular pressure (RVP: top curve) (Figure 7c). The two curves in Figure 7c are measured by the proximal measuring lumen and distal measuring lumen of the catheter according to the invention.
Figure 8 consecutively shows for a patient: the electrocardiogram (Figure 8a), the respiration (Figure 8b) and the simultaneously measured right ventricular pressure (RVP: bottom curve) and pulmonary pressure (PAP: top curve) (Figure 8c). The two curves in Figure 8c are measured by the proximal measuring lumen and distal measuring lumen of the catheter according to the invention.
As indicated in Figures 7 and 8, the pressure on one side and on the other side of the tricuspid valve and the pulmonary valve can be measured and recorded simultaneously via the proximal and distal measuring lumina during insertion or removal of the catheter.
This makes it possible to diagnose stenosis or valvular insufficiency.

8 1~33293L

The good quality of the pulmonary pressure measurement described above moreover results in the following.
As has been illustrated, the messurement becomes independent of interfering cardiac and respiratory influences due to the simultaneous recording of the PAP curve and the PCWP curve. The intrathoracic pressure changes and hemodynamic fluctuations are completely parallel in the two curves. As an example reference is made to Figure 9 which shows an interfering cardiac influence (Figure 9a), i.e. a ventricular extrasystole, and an interfering respiratory influence (Figure 9b), while said PAP and PCWP curves (Figure 9c) relative to each other are nevertheless satisfactorily interpretable.
This is also of great importance for calculating the pulmonary vascular resistance (PVR). When measurement of the PAP
and PCWP is not carried out in an exact and synchronous manner this may incorrectly result in a negative deflection of the PVR.
Unphysiological data may be quickly obtained especially when relying exclusively on digital reading on the monitor and when the fundamental curves are not used for quality control.
PVR is determined using the equation PVR=(PAP- LAP)/C0, wherein LAP is the left atrial pressure and C0 the cardiac output.
This cardiac output C0 is measured via the known thermodilution method, and for this the catheter is provided with a thermistor.
The left atrial pressure (LAP) can be replaced, as indicated in the introduction, approximately by the pulmonary capillary wedge pressure (PCWP).
In the context of analyzing the pulmonary vascular resistance, determined by a viscosity factor to be measured and a vascular factor not to be measured, correct measurement of PCWP and calculation of PVR is of fundamental value for specifying the medical indication. Reduction of iatrogenic complications is a further safety aspect which is not unimportant.
If the PAP curve and the PCWP curve are subtracted from each other as shown in Figure lOd, a "a(PAP-PCWP)" curve can be seen which is completely independent of the respiration (Figure lOb) and therefore independent of the intrathoracic pressure changes (Figure lOc) due to respiration, and which is representative of the cardiac output and tbe pulmonary vascular resistance (CO x PVR).
. One of the reasons why pulmonary pressures are difficult to read i8 that the distal tip of the catheter sometimes "sways"
("catheter-whip effect") and that no satisfactory PAP curve can be distinguished. When the balloon is inflated with preservation of the PAP and PCWP measurements, the distal tip of the catheter is fixed and this problem is largely solved. The possibility of PAP
measurement with inflated balloon is lost in the classical catheter.

Claims (8)

1. Method for carrying out hemodynamic measurements on a patient, using a flow-directed balloon catheter, which is connected to a control and pressure-measuring unit and is at least provided with a distal measuring lumen and a balloon-inflating lumen, comprising the steps of inserting the catheter by way of a suitable vein until the distal end is positioned inside the thorax, subsequently inflating the balloon, inserting the catheter further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the inflated balloon in wedge position is stuck in a branch thereof and closes off the latter, providing a proximal measuring lumen spaced closely to the distal measuring lumen, measuring the pulmonary arterial pressure (PAP) during insertion of the catheter into the pulmonary artery as long as the catheter has not yet arrived in the wedge position via both the proximal measuring lumen and the distal measuring lumen, and simultaneously recording the two relevant, virtually identical pressure curves with the measuring unit.
2. Method for carrying out hemodynamic measurements on a patient using a flow-directed balloon catheter which is connected to a control and pressure-measuring unit and is at least provided with a distal measuring lumen, a balloon-inflating lumen and a proximal measuring lumen spaced closely to the distal measuring lumen, said method comprising the steps of:

inserting the catheter by way of a suitable vein until the distal end is positioned inside the thorax;
subsequently inflating the balloon;
inserting the catheter further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the inflated balloon in wedge position is stuck in a branch thereof and closes off said branch;
measuring pulmonary arterial pressure (PAP) during insertion of the catheter into the pulmonary artery as long as the catheter has not yet arrived in the wedge position via both the proximal measuring lumen and the distal measuring lumen;
measuring, in the wedge position of the catheter with the balloon inflated, the pulmonary arterial pressure (PAP) and the pulmonary capillary wedge pressure (PCWP) via the proximal measuring lumen and via the distal measuring lumen; and simultaneously recording two relevant pressure curves with the measuring unit reflecting said measurement via the proximal measuring lumen and via the distal measuring lumen at all times so that the moment at which the catheter arrives in the wedge position can be clearly detected as said two curves diverge, whereby simultaneous measurement of said pressures relative to each other is independent of interfering cardiac and respiratory influences.
3. Method for carrying out hemodynamic measurements on a patient using a flow-directed balloon catheter which is connected to a control and pressure-measuring unit and is at least provided with a distal measuring lumen, a balloon-inflating lumen and a proximal measuring lumen spaced closely to the distal measuring lumen, said method comprising the steps of:
inserting the catheter by way of a suitable vein until the distal end positioned inside the thorax;
subsequently inflating the balloon;
inserting the catheter further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the inflated balloon in wedge position is stuck in a branch thereof and closes off said branch;
measuring pulmonary arterial pressure (PAP) during insertion of the catheter into the pulmonary artery as long as the catheter has not yet arrived in the wedge position via both the proximal measuring lumen and the distal measuring lumen;
measuring, in the wedge position of the catheter with the balloon inflated, the pulmonary arterial pressure (PAP) and the pulmonary capillary wedge pressure (PCWP via the proximal measuring lumen and via the distal measuring lumen;
simultaneously recording two relevant pressure curves with the measuring unit reflecting said measurement of said pulmonary arterial and pulmonary capillary measurement of said pulmonary arterial and pulmonary capillary wedge pressures at all times so that the moment at which the catheter arrives in the wedge position can be clearly detected as said two curves diverge, whereby simultaneous measurement of said pressures relative to each other is independent of interfering cardiac and respiratory influences; and incidentally inflating the balloon in the wedge position of the catheter and measuring said pulmonary arterial and pulmonary capillary wedge pressures simultaneously via the two measuring lumina in the uninflated and inflated state of the balloon so as to produce virtually identical and mutually different pressure curves on the measuring unit as a result of which the wedge position is exactly determined and a reliable measure of the pulmonary arterial and pulmonary capillary wedge pressures is guaranteed.
4. Method according to claim 3, comprising the step of simultaneously measuring the pulmonary arterial pressure (PAP) and pulmonary capillary wedge pressure (PCWP) via the proximal measuring lumen and via the distal measuring lumen in a spontaneously assumed and upward-displaced wedge position of the catheter with the uninflated balloon producing thereby mutually different pressure curves on the measuring unit, as a result of which the moment at which the catheter without inflated balloon spontaneously arrives in an upward-displaced wedge position can be clearly detected due to the two said curves diverging and an alarm can be given.
5. Method according to claim 3 further comprising the step of generating a gradient curve equal to the difference between the pulmonary arterial pressure and the pulmonary wedge capillary pressure and which is completely independent of respiration and independent of intrathoracic pressure changes due to respiration and which is representative of cardiac output and pulmonary vascular resistance, said gradient curve presenting an exact end-diastolic pressure gradient having an important predictive value to a patient's prognosis.
6. Method according to claim 3 further comprising the step of fixing the distal tip of the catheter within the pulmonary artery by inflating the balloon so as to facilitate an improved measurement of the pulmonary artery pressure measured via the proximal measuring lumen through the avoidance of catheter sway or catheter whip effect.
7. Method according to claim 2 or 3, in which the catheter has a thermistor lumen near the distal end for a thermodilution measurement in order to determine the cardiac output (CO), the pulmonary vascular resistance PVR=(PAP-LAP)/CO being determined (wherein LAP is the left atrial pressure) by LAP~PCWP, the intra-thoracic pressure changes, cardiac and respiratory fluctuations which may occur during the measurement of PAP and PCWP having no influence.
8. Method for carrying out hemodynamic measurements on a patient using a flow-directed balloon catheter which is connected to a control and pressure-measuring unit and is at least provided with a distal measuring lumen, a balloon-inflating lumen and a proximal measuring lumen spaced closely to the distal measuring lumen, said method comprising the steps of:
inserting the catheter by way of a suitable vein until,the distal end is positioned inside the thorax subsequently inflating the balloon;
inserting the catheter further by way of the right atrium and ventricle into the pulmonary artery until the distal end with the inflated balloon in wedge position is stuck in a branch thereof and closes off said branch;
measuring pulmonary arterial pressure (PAP) during insertion of the catheter into the pulmonary artery as long as the catheter has not yet arrived in the wedge position via both the proximal measuring lumen and the distal measuring lumen;
simultaneously recording the two relevant, virtually identical pressure curves with the measuring unit;
measuring, during the insertion of the catheter by way of the right atrium and ventricle into the pulmonary artery or during removal of the catheter therefrom the pressure on one side and on the other side of a valve selected from the group consisting of the tricuspid valve, the pulmonary valve and both tricuspid and pulmonary valves, by means of the proximal and distal measuring lumina and recording the pressure gradient over the said valve on the measuring unit by means of two pressure curves.
CA000570599A 1987-06-30 1988-06-28 Method for carrying out hemodynamic measurements on a patient and flow-directed balloon catheter used for this Expired - Fee Related CA1333291C (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
NL8701536 1987-06-30
NL8701536A NL8701536A (en) 1987-06-30 1987-06-30 METHOD FOR PERFORMING HAEMODYNAMIC MEASUREMENTS IN A PATIENT AND FLOW-GUIDED BALLOON CATHETER USED THEREFOR

Publications (1)

Publication Number Publication Date
CA1333291C true CA1333291C (en) 1994-11-29

Family

ID=19850229

Family Applications (1)

Application Number Title Priority Date Filing Date
CA000570599A Expired - Fee Related CA1333291C (en) 1987-06-30 1988-06-28 Method for carrying out hemodynamic measurements on a patient and flow-directed balloon catheter used for this

Country Status (10)

Country Link
US (1) US5035246A (en)
EP (1) EP0297675B1 (en)
JP (1) JPH0815483B2 (en)
AT (1) ATE120630T1 (en)
BR (1) BR8807593A (en)
CA (1) CA1333291C (en)
DE (1) DE3853495T2 (en)
ES (1) ES2072860T3 (en)
NL (1) NL8701536A (en)
WO (1) WO1989000025A1 (en)

Families Citing this family (49)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
BE1009291A6 (en) * 1995-04-14 1997-01-07 Billiet Erik Device for measuring blood flow by means of a swan-ganz catheter.
CA2382222A1 (en) * 1999-08-26 2001-03-01 Ted Vander Wiede Improvements relating to catheter positioning
US7181285B2 (en) 2000-12-26 2007-02-20 Cardiac Pacemakers, Inc. Expert system and method
US6741033B2 (en) 2001-03-20 2004-05-25 General Electric Company High transmittance alumina for ceramic metal halide lamps
US7383088B2 (en) 2001-11-07 2008-06-03 Cardiac Pacemakers, Inc. Centralized management system for programmable medical devices
GB0127209D0 (en) * 2001-11-13 2002-01-02 Medics Dev Ltd Haemodynamic monitoring
US8391989B2 (en) 2002-12-18 2013-03-05 Cardiac Pacemakers, Inc. Advanced patient management for defining, identifying and using predetermined health-related events
US20040122487A1 (en) * 2002-12-18 2004-06-24 John Hatlestad Advanced patient management with composite parameter indices
US20040122294A1 (en) 2002-12-18 2004-06-24 John Hatlestad Advanced patient management with environmental data
US8043213B2 (en) 2002-12-18 2011-10-25 Cardiac Pacemakers, Inc. Advanced patient management for triaging health-related data using color codes
US7043305B2 (en) 2002-03-06 2006-05-09 Cardiac Pacemakers, Inc. Method and apparatus for establishing context among events and optimizing implanted medical device performance
US7983759B2 (en) 2002-12-18 2011-07-19 Cardiac Pacemakers, Inc. Advanced patient management for reporting multiple health-related parameters
US7131950B1 (en) * 2002-09-23 2006-11-07 E.P. Limited System and method for noise reduction in thermodilution for cardiac measurement
US8712549B2 (en) 2002-12-11 2014-04-29 Proteus Digital Health, Inc. Method and system for monitoring and treating hemodynamic parameters
DE10260762A1 (en) 2002-12-23 2004-07-22 Pulsion Medical Systems Ag Device for determining cardiovascular parameters
US7972275B2 (en) 2002-12-30 2011-07-05 Cardiac Pacemakers, Inc. Method and apparatus for monitoring of diastolic hemodynamics
US7378955B2 (en) 2003-01-03 2008-05-27 Cardiac Pacemakers, Inc. System and method for correlating biometric trends with a related temporal event
US7136707B2 (en) 2003-01-21 2006-11-14 Cardiac Pacemakers, Inc. Recordable macros for pacemaker follow-up
US7200439B2 (en) * 2003-01-24 2007-04-03 Proteus Biomedical, Inc. Method and apparatus for enhancing cardiac pacing
JP4528766B2 (en) * 2003-01-24 2010-08-18 プロテウス バイオメディカル インコーポレイテッド System for remote hemodynamic monitoring
JP4465349B2 (en) * 2003-01-24 2010-05-19 プロテウス バイオメディカル インコーポレイテッド Method and system for measuring cardiac parameters
WO2006029090A2 (en) * 2004-09-02 2006-03-16 Proteus Biomedical, Inc. Methods and apparatus for tissue activation and monitoring
WO2006054342A1 (en) * 2004-11-18 2006-05-26 Japan Health Sciences Foundation Cardiac disease diagnostic system
CN101107024B (en) * 2004-11-18 2010-08-11 日本健康科学财团 Cardiac disease treatment system
EP1871470A4 (en) 2005-03-31 2011-06-01 Proteus Biomedical Inc Automated optimization of multi-electrode pacing for cardiac resynchronization
US7404800B2 (en) * 2005-04-13 2008-07-29 Mcintyre Kevin M Hybrid LVEDP monitor
US7922669B2 (en) 2005-06-08 2011-04-12 Cardiac Pacemakers, Inc. Ischemia detection using a heart sound sensor
US7983751B2 (en) 2005-08-12 2011-07-19 Proteus Biomedical, Inc. Measuring conduction velocity using one or more satellite devices
US7941213B2 (en) * 2006-12-28 2011-05-10 Medtronic, Inc. System and method to evaluate electrode position and spacing
EP2136706A1 (en) 2007-04-18 2009-12-30 Medtronic, Inc. Chronically-implantable active fixation medical electrical leads and related methods for non-fluoroscopic implantation
US8340751B2 (en) * 2008-04-18 2012-12-25 Medtronic, Inc. Method and apparatus for determining tracking a virtual point defined relative to a tracked member
US8494608B2 (en) * 2008-04-18 2013-07-23 Medtronic, Inc. Method and apparatus for mapping a structure
US8532734B2 (en) * 2008-04-18 2013-09-10 Regents Of The University Of Minnesota Method and apparatus for mapping a structure
US8839798B2 (en) 2008-04-18 2014-09-23 Medtronic, Inc. System and method for determining sheath location
US8457371B2 (en) * 2008-04-18 2013-06-04 Regents Of The University Of Minnesota Method and apparatus for mapping a structure
US8663120B2 (en) * 2008-04-18 2014-03-04 Regents Of The University Of Minnesota Method and apparatus for mapping a structure
US20090287266A1 (en) * 2008-05-13 2009-11-19 Mark Zdeblick High-voltage tolerant multiplex multi-electrode stimulation systems and methods for using the same
EP2355761A4 (en) 2008-12-15 2012-05-02 Assis Medical Ltd Device, system and method for sizing of tissue openings
US8175681B2 (en) 2008-12-16 2012-05-08 Medtronic Navigation Inc. Combination of electromagnetic and electropotential localization
EP2424588A4 (en) 2009-04-29 2013-05-22 Proteus Digital Health Inc Methods and apparatus for leads for implantable devices
WO2011011736A2 (en) 2009-07-23 2011-01-27 Proteus Biomedical, Inc. Solid-state thin film capacitor
US8494613B2 (en) 2009-08-31 2013-07-23 Medtronic, Inc. Combination localization system
US8494614B2 (en) 2009-08-31 2013-07-23 Regents Of The University Of Minnesota Combination localization system
AU2010297345B2 (en) * 2009-09-18 2014-06-26 St. Jude Medical Coordination Center Bvba Eavesdropping device
US9301699B2 (en) 2009-09-18 2016-04-05 St. Jude Medical Coordination Center Bvba Device for acquiring physiological variables measured in a body
US8355774B2 (en) 2009-10-30 2013-01-15 Medtronic, Inc. System and method to evaluate electrode position and spacing
US8718770B2 (en) 2010-10-21 2014-05-06 Medtronic, Inc. Capture threshold measurement for selection of pacing vector
US8355784B2 (en) 2011-05-13 2013-01-15 Medtronic, Inc. Dynamic representation of multipolar leads in a programmer interface
JP6747779B2 (en) * 2015-04-28 2020-08-26 フクダ電子株式会社 Heart catheter inspection apparatus and method of operating heart catheter inspection apparatus

Family Cites Families (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3995623A (en) * 1974-12-23 1976-12-07 American Hospital Supply Corporation Multipurpose flow-directed catheter
JPS5812020A (en) * 1981-07-15 1983-01-24 Mitsubishi Electric Corp Poroidal power supply
US4502488A (en) * 1983-01-13 1985-03-05 Allied Corporation Injection system
US4554927A (en) * 1983-08-30 1985-11-26 Thermometrics Inc. Pressure and temperature sensor
US4508103A (en) * 1983-09-06 1985-04-02 Calisi Constance M Pressure monitoring interconnect system
US4543961A (en) * 1983-11-14 1985-10-01 Cordis Corporation Data transmission system
US4621646A (en) * 1983-12-15 1986-11-11 The United States Of America As Represented By The Secretary Of The Army Blood flow measuring method
US4610256A (en) * 1984-09-25 1986-09-09 Utah Medical Products, Inc. Pressure transducer
US4637401A (en) * 1984-11-01 1987-01-20 Johnston G Gilbert Volumetric flow rate determination in conduits not directly accessible
US4601706A (en) * 1984-12-03 1986-07-22 Rene Aillon Central venous pressure catheter for preventing air embolism and method of making
US4856529A (en) * 1985-05-24 1989-08-15 Cardiometrics, Inc. Ultrasonic pulmonary artery catheter and method
US4733669A (en) * 1985-05-24 1988-03-29 Cardiometrics, Inc. Blood flow measurement catheter
US4777951A (en) * 1986-09-19 1988-10-18 Mansfield Scientific, Inc. Procedure and catheter instrument for treating patients for aortic stenosis
US4815472A (en) * 1987-06-01 1989-03-28 The Regents Of The University Of Michigan Multipoint pressure-sensing catheter system

Also Published As

Publication number Publication date
NL8701536A (en) 1989-01-16
US5035246A (en) 1991-07-30
WO1989000025A1 (en) 1989-01-12
DE3853495D1 (en) 1995-05-11
EP0297675A1 (en) 1989-01-04
JPS6486935A (en) 1989-03-31
EP0297675B1 (en) 1995-04-05
BR8807593A (en) 1990-05-29
DE3853495T2 (en) 1995-10-05
ATE120630T1 (en) 1995-04-15
JPH0815483B2 (en) 1996-02-21
ES2072860T3 (en) 1995-08-01

Similar Documents

Publication Publication Date Title
CA1333291C (en) Method for carrying out hemodynamic measurements on a patient and flow-directed balloon catheter used for this
LEVIN et al. Atrial pressure-flow dynamics in atrial septal defects (secundum type)
US6231498B1 (en) Combined catheter system for IABP and determination of thermodilution cardiac output
US5181517A (en) Method and apparatus for the measurement of atrial pressure
US3995623A (en) Multipurpose flow-directed catheter
Moskowitz et al. Altered systolic and diastolic function in children after “successful” repair of coarctation of the aorta
US5398692A (en) Combination esophageal catheter for the measurement of atrial pressure
JP4266832B2 (en) Noninvasive measurement method of left ventricular pressure
Luchsinger et al. Relationship of pulmonary artery-wedge pressure to left atrial pressure in man
Little et al. Effect of regional ischemia on the left ventricular end-systolic pressure-volume relation in chronically instrumented dogs
US7404800B2 (en) Hybrid LVEDP monitor
KR20020002493A (en) Method and apparatus for measuring cardiac flow output
Dell'Italia et al. Acute determinants of the hangout interval in the pulmonary circulation
Chuang et al. Measurement of pulmonary artery diastolic pressure from a right ventricular pressure transducer in patients with heart failure
EP0363117A1 (en) A position-monitoring flow-directed catheter and method
Aaslid et al. Accuracy of an ultrasound Doppler servo method for noninvasive determination of instantaneous and mean arterial blood pressure.
Ragosta et al. Normal waveforms, artifacts, and pitfalls
AU627425B2 (en) Method for carrying out hemodynamic measurements on a patient and flow-directed balloon catheter used for this
US6447458B1 (en) Method and system of color coding components of central venous and pulmonary artery wedge pressure waveforms
Nakano et al. Acute hemodynamic effects of nitroprusside in children with isolated mitral regurgitation
Lipman Pitfalls in interpretation of pulmonary capillary wedge pressure
RuSKIN et al. Pressure flow studies in patients having a pressor response to the Valsalva maneuver
AU665747B2 (en) Method and apparatus for the measurement of atrial pressure
Sunavala Hemodynamic Monitoring
Macdonald et al. A modified catheter system for retrograde left ventricular catheterization in aortic valve stenosis

Legal Events

Date Code Title Description
MKLA Lapsed