Andersons pediatric cardiology 415

oneshouldconsiderifthecatheteriswithinthecoronarysinus.

SeptumPrimumandPatentForamenOvale
Theseptumprimumisusedtomovethecathetertowardthelimbusandtestfor
presenceorabsenceofaPFO.Oncethecatheterisonthelimbus,aclockwise
rotationwilloftenpushthecatheterthroughthePFO.Itisusefultocheckforthe
PFObecause15%to25%ofpeoplehaveapatentforamen.Thisaccessallows
directleftatrialpressuresandpulmonaryveinsaturations.Inaddition,this
accesscanallowthecatheterizationphysiciantoperformafulldiagnosticleft
heartcardiaccatheterizationthroughanexistingatrialseptalopening,thus
precludingtheneedforanarterialsheath.

TranseptalPuncture
TranseptalpunctureisusedintheabsenceofaPFOandinpatientswhoneed
directleftatrialpressuresand/orpulmonaryveinsaturationstobestdelineatethe
congenitalheartanatomyandphysiology.

TricuspidValveApparatus
TricuspidValveAtresia
Thissingleventricleanatomyoftendoesnotoftenrequirecardiaccatheterization
unlessthereareanatomicconsiderationssuchasarestrictiveatrialseptumor
concernfortherestrictivenatureofthepulmonaryoutflowanatomyfromtheLV
acrosstheVSD,orasapartofhemodynamicevaluationpriortotheFontan
operation.

TricuspidValveStenosis
Pulmonaryatresiaintactventricularseptumpatientshaveasmalltricuspidvalve
apparatusandoftenwarrantdiagnosticevaluationwithangiographyoftheRV
(seepulmonaryvalvesection).

EbsteinAnomaly

Ebsteinanomalyisararecongenitalheartfindingfirstdescribedin1866by


Ebstein,withthefirstsurgicalproceduresinthelate1950s.Diagnostic
catheterizationisattimesnecessaryforevaluationofthetricuspidvalve
position,insufficiency,andfillingpressurespriortosurgicalrepair.Moreoften,
thediagnosticcatheterizationisperformedinadultsaftersurgicalrepairofthe
tricuspidvalvetoassesshemodynamicsandvalvefunction,ifthiscannotbe
assessedbyCMRIorechocardiography.

RightVentricleandRightVentricularOutflow
Tract
Saturations
Thesesaturationscanbe3%to4%lowerthantheRA,duetoalowcoronary
sinussaturation(<30%to50%).Anincreaseofgreaterthan7%to9%is
consideredasignificantshuntandcanbeduetoalefttorightshuntingVSDor
streamingfromanatriallevelshunt.

Pressures
■Normalpressures(Fig.17.5):
■Child:15to25/0mmHg,andenddiastolicof
5to8mmHg
■Adults:15to30/0mmHg,andenddiastolic
8to12mmHg


FIG.17.5 Rightventriculartracingwithend-diastolicmeasurement
ontheupslopeoftheQRS.

■Abnormalpressures:

■Increasedsystolicpressure—Significantleftto-rightshunt,doublechamberRV,subvalvar
pulmonarystenosis,valvarpulmonary
stenosis,RVOTconduitorbioprosthetic
valvestenosis,branchpulmonaryartery
stenosis,pulmonaryhypertension,pulmonary
veinstenosis,pulmonaryvenoocclusive
disease,orfailingleftheartphysiology.
■Increaseddiastolicpressureandend-diastolic
pressure—DiminishedRVcompliance,
restrictivecardiomyopathy,constrictive
pericarditis,historyofRVOTobstructionsas
aneonate,pulmonaryinsufficiency,
significantleft-to-rightshunt,volumeload
fromaortopulmonarycollaterals,tricuspid