Orta D A, Eisen S, Yergin B M, Olsen G N
Chest. 1979 Sep;76(3):269-73. doi: 10.1378/chest.76.3.269.
Selective pulmonary angiography was performed using a flow-directed, balloon-tipped catheter in 20 consecutive intensive care unit patients requiring heart catheterizations on the right side for hemodynamic monitoring. No morbidity was encountered from this procedure. Adequate quality balloon-occlusion angiographs were obtained with a portable chest roentgenogram in 17 (85 percent) but appeared normal in only 12 (60 percent), seriously limiting the usefulness of this technique in the diagnosis of occult pulmonary embolisms. With this technique, the catheter tip was found to be in a segmental pulmonary artery anterior to the left atrium (zone I) in 30 percent of the patients. From these findings, we conclude that not infrequently the catheter tip was situated in zone I anterior to the left atriums. Slective pulmonary angiography using a flow-directed, balloon-tipped catheter proved useful in demonstrating the precise location of the catheter tip. When this is the case, the catheter tip should be relocated to a segment below the left atrium (zone III) in patients requiring positive end-expiratory pressure because the "wedge" pressure measured in zone I may not accurately reflect left atrial pressure.
对20例在重症监护病房需要经右侧进行心导管插入术以进行血流动力学监测的患者，使用带球囊的血流导向导管进行了选择性肺血管造影。该操作未出现任何并发症。17例（85%）患者通过便携式胸部X线片获得了质量足够的球囊阻塞血管造影照片，但只有12例（60%）的照片显示正常，这严重限制了该技术在隐匿性肺栓塞诊断中的应用。采用该技术时，30%的患者导管尖端位于左心房前方的肺段动脉（I区）。基于这些发现，我们得出结论，导管尖端位于左心房前方I区的情况并不少见。使用带球囊的血流导向导管进行选择性肺血管造影被证明有助于显示导管尖端的精确位置。在这种情况下，对于需要呼气末正压通气的患者，导管尖端应重新放置到左心房下方的肺段（III区），因为在I区测得的“楔压”可能无法准确反映左心房压力。
