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In 1929 Werner Forssman, a resident surgeon at Eberswalde in Germany, inserted a urologic catheter into his right atrium from a left antecubital vein cutdown he had performed on himself using a mirror. After walking downstairs to the radiology suite, the position of the catheter tip was verified by a roentgenogram. This was the beginning of cardiac catheterization: the insertion and passage of small plastic catheters into arteries, veins, the heart, and other vascular structures. Because there have been dramatic and innovative advances in both methods and materials, catheterization has become a standard medical procedure, allowing the clinician to use physiologic data to guide treatment; measure cardiovascular hemodynamics such as pressures, cardiac output, and oximetry data; acquire radiographic images of coronary arteries and cardiac chambers; and examine the aorta (Ao), pulmonary veins, and peripheral vessels for diseases, anomalies, or obstructions. In the last 3 decades, cardiac catheterization has evolved further, from a diagnostic modality to one of a treatment through numerous catheter-based interventions (eg, angioplasty, stenting, closure of atrial septal defects) (Table 19–1).

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TABLE 19–1. Diagnostic and Therapeutic Interventional Procedures That May Accompany Coronary Angiography
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Indications and Contraindications

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Cardiac catheterization is used to diagnose atherosclerotic artery disease, cardiomyopathy, myocardial infarction, and valvular or congenital heart abnormalities. The principal indications for cardiac catheterization are summarized in Table 19–2. In general, cardiac catheterization is an elective diagnostic procedure ...

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