TO THE EDITORIn reading a recent report regarding a new technique for right heart catheterization with balloon flotation catheter via femoral vein in the patient with dilated right heart chambers by Drs. Lee and Mahrer [ 11, it reminded me that we too have had this problem particularly in patients undergoing frequent pretransplant procedures, many of whom have extremely dilated right heart chambers.When the problem first arose in our laboratory several years ago in such a patient, it was apparent that if we could stiffen the catheter, especially that segment which tends to coil in the right atrium, that we would have a more maneuverable system but still with the advantage of flow directed balloon flotation. I had some stainless steel wires which in years past came with woven Dacron catheters to maintain their shape during autoclaving. These were fine enough to fit through one of the lumens of a balloon flotation catheter, but because of the rather small size, did not work quite so well as we had planned. Thus we purchased several sizes of nickel steel wire and tried them on several models of balloon flotation catheters until we found the appropriate size wires to put lumens in a given catheter system. These have worked extremely well in the situation described where a catheter tends to either coil in the right atrium and/or the right ventricle. One can move the inner stiffening wire antegrade or retrograde in order to allow tip flexibility and to allow the balloon flotation system to function as designed. A right angle bend should be made in the proximal end of the wire prior to inserting the catheter into the patient so that this will be the marker for allowing maximal antegrade insertion of the wire since if it does exit through the distal lumen, it represents a dangerous projection at the catheter tip.After trying 0.018 pediatric Teflon coated guide wires, it was found they generally are not long enough for the balloon flotation type systems available, and they are also flexible in the distal portion which is where the rigidity is needed. This led us to another system available in most laboratories which works extremely well, albeit more expensive. A 0.018 Teflon coated guide wire as used in many of the coronary angioplasty catheters might be reversed and inserted stiff end first again to allow the extremely rigid part of this wire to stiffen the terminal portion of the balloon flotation catheter system. In an ad hoc situation where the laboratory has not yet purchased and fitted a variety of nickel steel wires, this works extremely well.Using either the nickel steel wire or the reversed angioplasty guide wire, one can very promptly traverse the right atrium and right ventricle and place the catheter tip appropriately in the distal pulmonary segments. At this point the wire is withdrawn, and fluid flow is re-established for pressure measurements.
REFERENCE1. Lee HH. Mahrer PR: A new technique for right heart catheterization with a Swan-Ganz balloon catheter via femoral vein in the patient with dilated right ...
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