Cardiac catheterization | indications, procedure

Cardiac catheterization:

Cardiac catheterization Definition:

  1. This involves the insertion of a catheter into the heart via the femoral or radial artery or venous system, and manipulating it within the heart and great vessels to:
  2. Inject radiopaque contrast medium to image cardiac anatomy and blood flow.
  3. Perform angioplasty (ballooning and stenting), valvuloplasty (eg transcatheter aortic valve implantation  cardiac biopsies, transcatheter septal defect closure. 
  4. Perform electrophysiology studies and radiofrequency ablations. 
  5. Sample blood to assess oxygen saturation and measure pressures. 
  6. Perform intravascular ultrasound or echocardiography. During the procedure, ECG and arterial pressures are monitored continuously. In the UK, the majority are performed as day-case procedures.
Cardiac catheterization
Cardiac catheterization

Cardiac Catheterization Indications:


• Coronary artery disease: diagnostic (assessment of coronary vessels and graft patency); therapeutic (angioplasty, stent insertion)
• Valvular disease: diagnostic (pressures indicate severity); therapeutic valvuloplasty (if the patient is too ill or declines valve surgery). 
• Congenital heart disease: diagnostic (assessment of severity of lesions by measuring pressures and saturations); therapeutic (balloon dilatation or septostomy). 
• Other: cardiomyopathy; pericardial disease; endomyocardial biopsy.

Procedure for Cardiac Catheterization:

Pre-procedure checks: 
• Brief history/examination; NB: peripheral pulses, bruits, aneurysms.  
• Consent for procedure, including possible extra procedures, eg consent for angioplasty if planning to do angiography as you may fi nd a lesion that needs stenting. Explain reason for procedure and possible complications. 
• IV access, ideally in the left hand. 

Post-procedure checks: 
• Pulse, BP, arterial puncture site (for bruising or swelling), foot pulses. 

Complications:

• Hemorrhage: apply firm pressure over puncture site. If you suspect a false aneurysm, ultrasound the swelling and consider surgical repair. Hematomas are high risk for infections. 
• Angina: may occur during or after cardiac catheterization
• Arrhythmias: usually transient. Manage along standard lines. 
• Pericardial effusion: suspect if unexplained continued chest pain. 
• Pericardial tamponade: rare, but should be suspected if the patient becomes hypotensive and anuric. Urgent pericardial drain. 

Mortality Rate:


<1 in 1000 patients, in most centers.

Intracardiac electrophysiology:


This catheter technique can determine types and origins of arrhythmias, and locate and ablate problem areas, eg aberrant pathways in WPW or arrhythmogenic foci. Arrhythmias may be induced, and the eff effectiveness of control by drugs assessed. 

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