Echokardiographische Katheterführung beim Rechtsherzkatheter

BACKGROUND: Pulmonary artery catheterisation plays an important role in the diagnosis of and therapy for pulmonary hypertension. Usually the pressure waveforms show the actual position of the catheter. In the case of inadequate waveforms X-ray fluoroscopy is recommended to avoid complications such as catheter malpositioning or knotting. Disadvantages of X-ray fluoroscopy are the costs of the X-ray devices and the radiation itself. METHODS: We demonstrate a special method of guiding the catheter by ultrasonic imaging that has not been published until now. This procedure combines the right heart catheterisation with the echocardiography performed through the subcostal axis. PATIENTS: 19 patients with pulmonary hypertension have been assessed/evaluated prospectively by this method. RESULTS: It was possible to trace the passage of the catheter from the upper right atrium through the right ventricle into the main stem of the pulmonary artery in all 19 patients. In 14 patients (74 %) it was even possible to show the exact position of the catheter in the right or left pulmonary artery. Malpositioning of the catheter such as knotting or intubation of the vena cava inferior were discovered very early and with ease. X-ray fluoroscopy was not necessary in any of the reported cases. CONCLUSIONS: Echocardiography is a non-invasive, easily available method for tracing the right heart catheter, that does not interfere with the catheterisation itself and matches it perfectly. Major advantages of this method in contrast to the standard X-ray fluoroscopy are the lack of radiation, the cost-effectiveness, the ubiquitous availability and the ease of use.