Pulmonary Valve Obstruction During Cardiac Catheterization

Diagnostic applications of indicator-dilution technics in congenital heart disease

In summarizing the diagnostic value of the indicator-dilution technics in the study and investigation of congenital heart disease, perhaps a simple listing of the advantages and disadvantages of the technics will suffice.

The advantages are as follows: 1. The technics have a high degree of safety. In the more than 3000 cardiac patients in whom they have been utilized there have been no deaths and little or no morbidity. 2. The sensitivity of the technics for the detection and localization of right-to-left and left-to-right shunts is much superior to that of the conventional blood-gas methods. 3. Quantitative determinations of systemic and pulmonary blood flow and intrathoracic shunts by indicator-dilution methods can be made simultaneously over periods of less than 1 minute; when indicator dyes are used, these technics do not require manometrie analyses, accessory respiratory exchange studies, or active cooperation of the patient; and they are independent of foreign (anesthetic) gases in the blood. 4. The technics are versatile and can be extremely useful either for the detection and diagnosis of minimal, relatively simple defects or for the elucidation of the extremely complex types of congenital malformations. 5. The information obtained is of both a qualitative and a quantitative nature; that is, the nature and location of defects can be determined and, in addition, the magnitude and direction of flow through the defects in question as well as the levels of systemic and pulmonary blood flows can be estimated.

The disadvantages of the technics are as follows: 1. Rather complicated and sensitive recording equipment is essential. 2. Considerable technical skill is required of the persons carrying out the procedure in the placement of the necessary needles and catheters and in the proper selection of the multiple possible injection and sampling sites reached by these instruments in order to obtain the information needed to establish the diagnosis in question. 3. Correct interpretation of the diagnostic significance of the dilution curves obtained requires careful study and considerable experience by the person responsible for this phase of the investigation.

In other words, these technics entail relatively little discomfort and little danger for the patient, but require good equipment and, more important, considerable time, effort and skill on the part of the investigator and his assistants in order to obtain highly successful results.