Cardiac Catheterization

Cardiac catheterization is a minimally invasive procedure generally employed to diagnose and treat certain heart conditions. It involves threading a thin flexible tube through a blood vessel to the heart. Your doctor can perform diagnostic tests and some procedures on your heart with the help of the catheter.

Diagnostic cardiac catheterization is a procedure that involves insertion of a thin flexible tube (catheter) into the right or left side of the heart, usually through the groin or arm. Cardiac catheterization allows injection of radio-opaque dye for angiography, measurement of intracardiac pressures and oxygen saturations and also assists the passage of electrophysiological instruments, angioplasty and valvuloplasty balloons.

Based on the placement of the catheter, diagnostic cardiac catheterization can be categorized as:

• Left heart catheterization
• Right heart catheterization

Diagnostic uses

Diagnostic cardiac catheterization procedure allows the doctor to confirm the diagnosis and provide more accurate and detailed information. Diagnostic cardiac catheterization is used to evaluate:

• Cardiac amyloidosis
• Causes of congestive heart failure or cardiomyopathy
• Congenital heart defects
• Pulmonary hypertension
• Coronary artery disease
• Valvular heart disease

Left Heart Catheterization

Catheterization of the left side of the heart is performed via an arterial route. It is used to assess:

• Left Ventricular function
• Outflow tract obstruction
• Valve disease
• Coronary artery disease

Cardiac catheterization is also used to perform left ventricular biopsies and electrophysiological studies.

Right Heart Catheterization

Catheterization of the right side of the heart is performed through the venous route. It helps in the assessment of the following parameters:

• Measurement of cardiac output, left ventricular filling pressure and pulmonary artery wedge pressure
• Measurement of right heart oxygen saturations
• Assessment of pulmonary hypertension
• To perform an electrophysiological study

Procedure

The procedure is performed via the arterial route or the venous route depending upon the heart condition, anatomical considerations and the preference of your doctor. The common steps involved in diagnostic cardiac catheterization are as follows:

• The patient is positioned on the operating table and is sedated. The skin overlying an artery or vein is cleaned and sterilized.
• A small incision is made in the skin and a hollow plastic tube is inserted into the blood vessel (artery/vein).
• A catheter is then advanced through the tube into the appropriate heart chamber under fluoroscopic X-ray guidance. The required tests can be performed with the help of the catheters present in the heart chambers.
• After the procedure, the catheter and tube are removed.
• Firm pressure is applied to the incisional area for 5-20 minutes to prevent bleeding.

Following the procedure, the patient has to stay overnight in the hospital and is advised to rest for at least 6-24 hours.

Risks and Complications

Although diagnostic cardiac catheterization is a safe procedure, it carries some risks and complications such as:

• Cardiac tamponade
• Heart attack
• Injury to the coronary artery
• Irregular heart beat
• Stroke
• Reaction to the contrast dye
• Blood clots
• Damage to the blood vessels
• Bleeding, infection, and pain at the insertion site
• Kidney damage due to the contrast dye